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Background : Food insecure children are at increased risk for medical and developmental problems. Effective screening and intervention are needed. Methods : Our purpose was to (1) evaluate the validity and stability of a single item food insecurity (FI) screen. (2) Assess whether use may lead to decreased FI. Part of a larger cluster randomized controlled trial, pediatric residents were assigned to SEEK or control groups. A single FI question (part of a larger questionnaire) was used on SEEK days. SEEK residents learned to screen, assess, and address FI. A subset of SEEK and control clinic parents was recruited for the evaluation. Parents completed the USDA Food Security Scale (“gold standard”), upon recruitment and 6-months later. Validity, positive and negative predictive values (PPV, NPV) was calculated. The proportion of screened families with initial and subsequent FI was measured. Screening effectiveness was evaluated by comparing SEEK and control screening rates and receipt of Supplemental Nutrition Assistance Program (SNAP) benefits between initial and 6-month assessments. Results : FI screen stability indicated substantial agreement (Cohen's kappa =0.69). Sensitivity and specificity was 59% and 87%, respectively. The PPV was 70%; NPV was 81%. SEEK families had a larger increase in screening rates than control families (24% vs. 4.1%, p

OBJECTIVES. To estimate the prevalence of intimate partner violence among parents at a pediatric primary care clinic and to evaluate the stability, sensitivity, specificity, positive and negative predictive values, and likelihood ratios of a very brief screen for intimate partner violence. METHODS. A total of 200 parents (mostly mothers) bringing in children less than 6 years of age for child health supervision completed the Parent Screening Questionnaire in a primary care clinic. The Parent Screening Questionnaire, a brief screen for psychosocial problems developed for the study, includes 3 questions on intimate partner violence. Mothers then completed the computerized study protocol within 2 months. This included the Parent Screening Questionnaire as well as the Revised Conflict Tactics Scale. Different combinations of the intimate partner violence questions were evaluated against the Revised Conflict Tactics Scale. RESULTS. A total of 12.0% of the mothers answered “yes” to at least one of the screening questions. On the standardized Revised Conflict Tactics Scale, responses ranged from 9% reporting a physical injury in the past year to 76% reporting psychological aggression. There was moderate stability of the screening questions. A single question, “Have you ever been in a relationship in which you were physically hurt or threatened by a partner?” in relation to the “physically injured” Revised Conflict Tactics Scale subscale was most effective. Sensitivity was 29%, specificity was 92%, positive predictive value was 41%, and negative predictive value was 88%. The positive likelihood ratio was 3.8, and the negative likelihood ratio was 0.77. CONCLUSIONS. Intimate partner violence is a prevalent problem. A very brief screen can reasonably identify some mothers who could benefit from additional evaluation and possible services. Additional research is needed to find a more sensitive screen and to examine whether identifying intimate partner violence leads to interventions that benefit mothers, families, and children.

Objective Parental alcohol and drug abuse may have significant deleterious effects on children. Although screening in the pediatric office is recommended, few screening measures have been evaluated for use in this setting. We sought to validate a 2-question screening tool for parental substance abuse. Methods A total of 216 caregivers bringing children to a primary care clinic completed a brief screening for psychosocial problems that contained 2 substance abuse questions. To assess reliability and validity of the questionnaire, recruited caregivers returned within 2 months to complete a computerized study protocol that contained the brief screening questions and the substance abuse sections of the Composite International Diagnostic Inventory (CIDI). Results Sixteen percent of caregivers acknowledged a problem with drugs or alcohol on the CIDI. A "yes" response to either screening question had a sensitivity of 29%, specificity of 95%, positive predictive value of 17%, and negative predictive value of 98% for drug abuse. Values were 13%, 96%, 33%, and 87%, respectively for predicting alcohol abuse. Conclusions Brief screening in pediatric primary care can identify many, but not all, parents who may need intervention for problems with drugs and/or alcohol. Children should benefit from such screening if it enables parents to acknowledge and receive treatment for substance abuse. Further research is needed to assess whether sensitivity of screening can be improved without sacrificing brevity.

To examine whether weight recovery among children with weight faltering varied by enrollment age and child and household risk factors.Observational, conducted in an interdisciplinary specialty practice with a skill-building mealtime behavior intervention, including coaching with video-recorded interactions. Eligibility included age 6-36 months with weight/agefifth percentile or crossing of 2 major percentiles. Children were categorized as24 months vs ≥ 24 months. Child and household risk factors were summed into risk indices (top quartile = elevated risks, vs reference). Outcome was weight/age z-score change over 6 months. Analyses were conducted with longitudinal linear mixed-effects models, including age by risk index interaction terms.Enrolled 286 children (mean age 18.8 months, SD 6.8). Significant weight/age recovery occurred regardless of risk index or age. Mean weight/age z-score change was significantly greater among younger compared with older age (0.29 vs 0.17, P = .03); top household risk quartile compared with reference (0.34 vs 0.22, P = .046); and marginally greater among top child risk quartile compared with reference (0.37 vs 0.25, P = .058). Mean weight/age z-score change was not associated with single risk factors or interactions; greatest weight gain occurred in most underweight children.Weight recovery over 6 months was statistically significant, although modest, and greater among younger children and among children with multiple child and household risk factors. Findings support differential susceptibility theory, whereby some children with multiple risk factors are differentially responsive to intervention. Future investigations should evaluate components of the mealtime behavior intervention.

Objective.—To determine how pediatric residents' perceptions of continuity clinic experiences vary by level of training, after controlling for the effect of continuity setting. Method.—Cross-sectional survey of pediatric and combined pediatric trainees in US residency programs. Results.—Survey responses were received from 1355 residents in 36 training programs. Residents' continuity experiences were in hospital-based and community settings. Numbers of patients seen increased between PGY-1 and PGY-3 years, but not in the PGY-4 and PGY-5 years. Compared to PGY-1 residents, PGY-2 and PGY-3 residents were more likely to report more encounters with established patients, but were not more likely to feel like the primary care provider. There were no significant differences by training level in terms of involvement in panel patients' laboratory results, hospitalizations, or telephone calls, although nursery involvement decreased with increasing training level. Autonomy was directly related to training level. The perception of having the appropriate amount of exposure to practice management issues was low for all respondents. Conclusions.—Residents perceived that they had greater autonomy and continuity with patients as they become more senior, yet they were not more likely to feel like the primary care provider. Lack of increased involvement in key patient care and office responsibilities across training years may reflect a need for changes in resident education. These data may be helpful in formulating recommendations to program directors with regard to determining which Accreditation Council for Graduate Medical Education competencies should be emphasized and evaluated in the continuity experience.

Objective.— To identify factors associated with resident satisfaction concerning residents' continuity experience. Design and Methods.— Continuity directors distributed questionnaires to residents at their respective institutions. Resident satisfaction was defined as satisfied or very satisfied on a Likert scale. The independent variables included 60 characteristics of the continuity experience from 7 domains: 1) patient attributes, 2) continuity and longitudinal issues, 3) responsibility as primary care provider, 4) preceptor characteristics, 5) educational opportunities, 6) exposure to practice management, and 7) interaction with other clinic and practice staff. A stepwise logistic regression model and the Generalized Estimating Equations approach were used. Results.— Thirty-six programs participated. Of 1155 residents (71%) who provided complete data, 67% (n = 775) stated satisfaction with their continuity experience. The following characteristics (adjusted odds ratio [OR] and 95% confidence interval [CI]) were found to be most significant: preceptor as good role model, OR=7.28 (CI = 4.2, 12.5); appropriate amount of teaching, OR=3.25 (CI = 2.1, 5.1); involvement during hospitalization, OR=2.61 (CI = 1.3, 5.2); exposure to practice management, OR=2.39 (CI = 1.5, 3.8); good balance of general pediatric patients, OR=2.34 (CI = 1.5, 3.6); resident as patient advocate, OR=1.74 (CI = 1.2, 2.4); and appropriate amount of nursing support, OR=1.65 (CI = 1.1, 2.6). Future career choice, type of continuity site, and level of training were not found to be statistically significant. Conclusions.— Pediatric resident satisfaction was significantly associated with 7 variables, the most important of which were the ability of the preceptor to serve as a role model and teacher. The type of continuity site was not significant. Residency programs may use these data to develop interventions to enhance resident satisfaction, which may lead to enhanced work performance and patient satisfaction.

PURPOSE: To explore whether violence victimization and witness experiences of predominantly African-American, low-income, urban adolescents were associated with distress and whether psychosocial factors contributed to symptomatology. METHODS: Data for this study were obtained from a cross-sectional survey of 349 youth between the ages of 9 and 15 years who resided in any of 10 low-income public housing communities in an East Coast city. Survey instruments assessed exposure to violence, distress symptomatology, youth psychosocial functioning, and family dynamics. Data were analyzed by computing Pearson correlation coefficients and a series of multiple linear regression models. RESULTS: Witnessing violence was related to youth reports of intrusive thoughts and feelings, difficulties with concentration, and vigilant or avoidant behavior. Violence victimization was correlated with feelings of despondency about having either a happy or long life, as well as feelings of being unloved, uncared for, and afraid. Younger youth, boys, and active problem solvers were more likely to report intrusive thoughts. Problematic family communication was related to intrusive thoughts, distraction, feeling a lack of belonging, and expressions of emotional numbing. CONCLUSIONS: The act of witnessing violence may be associated with a set of distinct symptoms. Youth who witness violence also need to be identified so they may be aided in dealing with their distress. Family communication, particularly problematic family communication, and problem solving also contribute to symptomatology. Language: en

Objective: To test the hypothesis that involvement in drug trafficking leads to illicit drug use among urban African-American adolescents. Methods: Self-reports of substance use, illicit drug use, and drug trafficking were obtained at baseline and every 6 months for 24 months from 383 African-American early adolescents. Transitions between involvement in drug trafficking and illicit drug use over time were examined. Path analysis was conducted to examine the causal relation between drug trafficking and drug use. Results: Among the 35 youth who were initially involved only in drug trafficking, 22 (67%) subsequently used illicit drugs. Of the 53 youth who were initially involved only in illicit drug use, only 19 (42%) continued using drugs at later waves ( p Conclusions: Initiation of drug trafficking by adolescents appears to lead to sustained involvement in drug-related activities, including continued drug trafficking and drug use. By contrast, initiation of drug use does not necessarily lead to continued involvement in drug-related behaviors.

To assess the prevalence and pattern of alcohol consumption and its relation to participation in other social activities and problem behaviors among adolescents residing in the People's Republic of China.Data were collected from a sample of 1,040 students in 6th, 8th, and 10th grades from five public schools in Beijing, China by using a self-administered questionnaire. Chi-square statistics and two-way ANOVA were used to assess the gender and grade difference in lifetime alcohol use of various alcoholic beverages. The age-adjusted and grade-adjusted odds ratio was used to assess the association between alcohol use and selected social activities and problem behaviors.Approximately 70% of the study sample reported prior alcohol consumption. The rate of drinking among males was significantly higher than among females (78% vs. 61%, p.00001), and the rates among both genders increased with advancing grade (54%, 72%, and 84%, respectively, p.001). Beer was the most commonly consumed alcoholic beverage. The results also suggested a progression from beer to wine and/or liquor. Drinking behavior was positively associated with participation in unstructured social activities and other problem behaviors.Alcohol use was prevalent among adolescents residing in China. The findings underscore the need for and importance of intervention efforts targeting alcohol consumption among early adolescents in China.

Longitudinal data obtained 6 months apart from 132 urban African American adolescents, 9 through 15 years of age, were analyzed to assess the stability and predictability of behaviors, intentions, and perceptions regarding drug trafficking. Drug trafficking behaviors, intentions, and perceptions were relatively stable over time. Although rates of drug trafficking were low (7%o), about two-thirds of the youth involved at baseline were still involved 6 months later Males were more likely to be involved than females. Previous involvement was the best predictor for subsequent behavior and intention. Baseline intention was not predictive of subsequent behavior but was predictive of subsequent intention. Perceptions, particularly those regarding extrinsic rewards and response costs of drug trafficking, were predictive of subsequent behavior and intention. The youth appeared to differentiate between drug selling and drug delivering. These results represent the first longitudinal description of the natural history of involvement in drug trafficking from a community-based cohort.

Acquired immunodeficiency syndrome (AIDS) continues to be a significant concern for adolescents, especially in minority populations. There is a scarcity of knowledge of the cultural context of sexual behavior in this age group and the influences that lead to early initiation of sex and unsafe sex. Few efforts targeting young adolescents have been community based, although there has been an increased awareness of the need for such research and intervention programs. Four key processes have been defined in gaining community participation in health education programs: (a) defining the community and reaching the community; (b) recognizing tensions among service, research, and community participation; (c) involving community residents; and (d) considering cultural differences in a community. These processes are used to describe the "Focus on Kids" project, a human immunodeficiency virus (HIV) risk reduction intervention that resulted in significant increases in condom use demonstrated by a randomized controlled trial.

The relation between drug trafficking (selling and delivering) and drug use among young adolescents has remained poorly characterized to date. In the current study, the associations between drug trafficking, cigarettes and/or alcohol use, and illicit drug use have been explored in three different areas—self-reported behaviors, personal feelings, and perception of friends' involvement—based on a sample of 455 African American youths 9 through 15 years of age residing in six urban public-housing developments. Results confirm findings from previous research that illicit drug use rarely occurs in the absence of cigarette/alcohol use or drug trafficking. By contrast, drug trafficking is equally likely to occur in isolation of, or along with, some drug use. The results support a potential role of drug trafficking in the genesis of illicit drug use. Prevention efforts should extend their focus beyond cigarettes, alcohol, and illicit drug use to drug trafficking.

OBJECTIVES. Adolescents are increasingly at risk for infection with human immunodeficiency virus (HIV) and other sexually transmitted diseases, especially in poor urban minority communities. To aid the design of interventions in these communities, this study investigated the role of knowledge, attitudes, perceived parental monitoring, and peer behavior in the onset and progression of sexual behavior in children at risk for exposure to HIV. METHODS. A computerized personal interview was administered to 300 African-American 9- to 15-year-old children living in six public housing developments in a large US city. RESULTS. Although children's knowledge about the hazards of sex increased with age, their sexual activity also increased (from 12% sexually experienced at 9 years of age to more than 80% experienced at 15 years of age). Parental monitoring appeared able to influence sexual activity. However, the perceived behavior of friends was associated with the rate at which sexual activity progressed with age and the degree to which condom use was maintained with age. CONCLUSIONS. The early onset and prevalence of sexual behavior and the importance of peer group influence call for early interventions that simultaneously influence the parents and peers in children's social networks.

The placement of children in need of out-of-home care with relatives (i.e., kinship care) has been an increasing trend. The study summarized in this paper represents the first comprehensive assessment of the physical and mental health and educational status of children in kinship care. The anticipated high risk status of these children was supported by study findings in all areas of assessment. These findings are discussed and recommendations are offered for policy, practice and future research.

An exploratory study examining the meaning of drug use and drug trafficking among 64 urban youths and parents attending a community health center was conducted using qualitative and quantitative data-gathering techniques. Many youths had experimented with alcohol or tobacco but not illicit drugs. Drug use and drug trafficking ("running," selling, and dealing) were pervasive in the community, but youths viewed them as two separate activities. Whereas the youths believed that drugs were dangerous and considered themselves invulnerable to using drugs, many were conflicted about involvement in drug trafficking. Parents, however, perceived a close relationship between drug dealing and drug use and strongly feared the negative consequences of both activities. Due to the economic and social attractions of the drug trade, drug running and selling may be activities that serve as precursors to drug use. Attention should be directed toward prevention of drug trafficking as well as drug use, both serious risk behaviors.

Exposures to measles in medical settings have contributed to the recent resurgence of the disease in the United States. Following a measles exposure in two pediatric medical facilities serving an inner-city population, we investigated the effectiveness of a disease notification strategy and compliance of the exposed population with recommendations for post-exposure prophylaxis, two requirements of a successful intervention program. Of 106 families with children eligible for a prophylactic vaccination by standard guidelines, 64% were notified of exposure by telephone. Compliance was assessed by a brief telephone questionnaire based upon the Health Belief Model, and verified by medical records. Forty-six families were interviewed regarding their decisions to comply with the recommendations. Most (75%) families were compliant. Compliant parents perceived measles to be severe and their children to be in excellent health. In a multiple logistic regression analysis, only the perceived severity of measles significantly contributed to the model. We conclude that: infection control outreach may need to extend beyond telephone notification for an inner-city population, and that once notified, most people will comply with recommendations. The Health Belief Model explains compliance with infection control measures and may be useful in guiding public health interventions.

OBJECTIVE: The objectives of this study were to determine whether 1) residents trained in the SEEK (A Safe Environment for Every Kid) model would report improved attitudes, knowledge, comfort, competence, and practice regarding screening for psychosocial risk factors (parental depression, parental substance abuse, intimate partner violence, stress, corporal punishment, and food insecurity); 2) intervention residents would be more likely to screen for and assess those risk factors; and 3) families seen by intervention residents would report improved satisfaction with their child’s doctor compared to families receiving standard care from control residents. METHODS: Pediatric residents in a university-based pediatrics continuity clinic were enrolled onto a randomized controlled trial of the SEEK model. The model included resident training about psychosocial risk factors, a Parent Screening Questionnaire, and a study social worker. Outcome measures included: 1) residents’ baseline, 6-month, and 18-month posttraining surveys, 2) medical record review, and 3) parents’ satisfaction regarding doctor-parent interaction. RESULTS: Ninety-five residents participated. In 4 of 6 risk areas, intervention residents scored higher on the selfassessment compared to control subjects, with sustained improvement at 18 months. Intervention residents were more likely than control subjects to screen and assess parents for targeted risk factors. Parents seen by intervention residents responded favorably regarding interactions with their doctor. CONCLUSIONS: The SEEK model helped residents become more comfortable and competent in screening for and addressing psychosocial risk factors. The benefits were sustained. Parents viewed the intervention doctors favorably. The model shows promise as a way of helping address major psychosocial problems in pediatric primary care.

CONTEXT. Effective strategies for preventing child maltreatment are needed. Few primary care–based programs have been developed, and most have not been well evaluated. OBJECTIVE. Our goal was to evaluate the efficacy of the Safe Environment for Every Kid model of pediatric primary care in reducing the occurrence of child maltreatment. METHODS. A randomized trial was conducted from June 2002 to November 2005 in a university-based resident continuity clinic in Baltimore, Maryland. The study population consisted of English-speaking parents of children (0–5 years) brought in for child health supervision. Of the 1118 participants approached, 729 agreed to participate, and 558 of them completed the study protocol. Resident continuity clinics were cluster randomized by day of the week to the model (intervention) or standard care (control) groups. Model care consisted of (1) residents who received special training, (2) the Parent Screening Questionnaire, and (3) a social worker. Risk factors for child maltreatment were identified and addressed by the resident physician and/or social worker. Standard care involved routine pediatric primary care. A subset of the clinic population was sampled for the evaluation. Child maltreatment was measured in 3 ways: (1) child protective services reports using state agency data; (2) medical chart documentation of possible abuse or neglect; and (3) parental report of harsh punishment via the Parent-Child Conflict Tactics scale. RESULTS. Model care resulted in significantly lower rates of child maltreatment in all the outcome measures: fewer child protective services reports, fewer instances of possible medical neglect documented as treatment nonadherence, fewer children with delayed immunizations, and less harsh punishment reported by parents. One-tailed testing was conducted in accordance with the study hypothesis. CONCLUSIONS. The Safe Environment for Every Kid (SEEK) model of pediatric primary care seems promising as a practical strategy for helping prevent child maltreatment. Replication and additional evaluation of the model are recommended.

OBJECTIVES. The goals were to estimate the prevalence of parental depressive symptoms among parents at a pediatric primary care clinic and to evaluate the stability, sensitivity, specificity, and positive and negative predictive values of a very brief screen for parental depression.METHODS. A total of 216 mothers (because 96% of caregivers were mothers, we use this term) bringing in children RESULTS. Twelve percent of the mothers met the Beck Depression Inventory II clinical cutoff value for at least moderate depressive symptoms. There was moderate stability of the screening questions. When a positive response to either or both of the 2 questions was considered, the sensitivity was 74%, the specificity was 80%, the positive predictive value was 36%, and the negative predictive value was 95%.CONCLUSIONS. Maternal depressive symptoms are prevalent. A very brief screen can identify reasonably those who could benefit from additional evaluation and possible treatment. This should benefit mothers, families, and children.

Lactoferrin has an array of biological activities that include growth, immune modulation, and antimicrobial effects. The aim of this randomized, placebo-controlled, double-blind study was to examine the impact of bovine lactoferrin supplementation in infants.Healthy, formula-fed infants,or =34 weeks' gestation andor =4 weeks of age, enrolled in a pediatric clinic. Infants received either formula supplemented with lactoferrin (850 mg/L) or commercial cow milk-based formula (102 mg/L) for 12 months. Growth parameters and information on gastrointestinal, respiratory, and colic illnesses were collected for the infants' first year. Antibodies to immunizations and hematologic parameters were measured at 9 and 12 months.The lactoferrin-enhanced formula was well tolerated. There were significantly fewer lower respiratory tract illnesses, primarily wheezing, in the 26 lactoferrin-fed (0.15 episodes/y) compared with the 26 regular formula-fed (0.5 episodes/y) infants (P0.05). Significantly higher hematocrit levels at 9 months (37.1% vs 35.4%; P0.05) occurred in the lactoferrin-supplemented group compared with the control formula group.Lactoferrin supplementation was associated with potentially beneficial outcomes such as significantly fewer lower respiratory tract illnesses and higher hematocrits. Larger, more focused studies in infants are warranted.

This study examined the cumulative change of unprotected sex over a period of three years among 383 African American youth ages 9 to 15 at baseline who participated in a trial of a Human Immunodeficiency Virus (HIV) risk reduction intervention. Cumulative scores of sexual intercourse and failure to use condoms were compared between intervention and control groups. The results indicate that cumulatively over the three-year period, intervention youth reported significantly lower rates of failure to use a condom. The findings indicate that face-to-face interventions may offer significant cumulative protection from unprotected sex over the long-term.

Purpose: To ascertain the proportion of youths involved in acts of violence; to examine individual, social, and environmental factors associated with perpetration; and to determine the relationship among victimization, witnessing, and perpetration of violence. Methods: A cross-sectional survey was completed by 349 volunteer males and females, aged 9–15 years, 96% of whom were African-American. The youths were recruited from recreation centers associated with 10 public-housing communities in an eastern city. Survey instruments included the Child Health and Illness Profile, Survey of Children's Exposure to Community Violence, and other standardized questionnaires. Statistical analyses included Chi-square, correlation, regression, and test for linear trends. Results: Half of the youths self-reported at least one act of violence perpetration, with similar distributions among males and females. One-third of the youths reported both personal victimization and the witnessing of violent events. Victim and witness status were moderately correlated. Individual risk behaviors and victimization made significant contributions to perpetration status. Further analysis demonstrated a linear relationship between acts of perpetration and number of victimization events. Conclusions: Participation in problem behaviors may place youths in circumstances in which they may be victim, witness, or aggressor. The chronic and high levels of community violence to which many youths are exposed are likely to contribute to an individual's participation in acts of violence.

Purpose: To examine gender and age differences among urban, low-income, African-American children and adolescents in perceived monitoring by their parents, and the association of perceived parental monitoring with family characteristics, health risk behaviors, and risk perceptions. Methods: Three cross-sectional surveys were conducted in 1992 ( n = 455), 1994 ( n = 355), and 1996 ( n = 349). Respondents aged 9–17 years were recruited from low-income urban areas including public housing communities and associated recreation centers. Both multivariate analysis of variance and correlation analysis were performed. Results: Low levels of perceived parental monitoring were associated with participation in several health risk behaviors, including sexual behavior, substance/drug use, drug trafficking, school truancy, and violent behaviors. Females perceived themselves to be more monitored than did males. In general, the perceived parental monitoring tended to decrease with advancing age of the youth. Conclusions: The strong inverse correlation between perceived parental monitoring and adolescent risk behavior suggests that parental monitoring initiatives may be an effective intervention tool. Longitudinal studies are needed to determine the long-term relationship between perceived parental monitoring and adolescent risk involvements.

Objectives: To develop and evaluate an intervention (ImPACT) seeking to increase monitoring (supervision and communication) by parents and guardians of African-American youth regarding high risk and protective behaviors; and to develop an instrument to assess parental monitoring, the Parent–Adolescent Risk Behavior Concordance Scale. Design/Intervention: This research was a randomized, controlled longitudinal study. Baseline (preintervention), and 2 and 6 months postintervention data were obtained via a talking MacIntosh computer regarding youth and parent perceptions of youth involvement in 10 risk behaviors, parental monitoring and youth–parent communication, and condom-use skills. Intervention parents and youth received the ImPACT program and a video emphasizing parental supervision and discussion, followed by a structured discussion and role-play emphasizing key points. Control parents and youth received an attention-control program on goal-setting, which also included an at-home video and discussion. Participants: A total of 237 parents and one each of their youth (ages 12–16 years) recruited from eight public housing developments located in a city in the mid-Atlantic region. Results: Similarity of youth and parental reporting on the Parent–Adolescent Risk Behavior Concordance Scale was positively correlated with protective behaviors, perceived parental monitoring, and good parent–youth communication. At baseline, parents significantly underestimated their youth's risk behaviors. However, 2 and 6 months postintervention, the ImPACT program increased similarity of reports by youth and their parents of youth involvement in risk and protective behaviors. In addition, at 6 months postintervention, intervention (compared to control) youths and parents also demonstrated higher levels of condom-use skills. Conclusion: Parental monitoring interventions such as ImPACT should be given to parents in conjunction with more traditional youth-centered risk-reduction interventions.

Background: African American adolescents living in high-poverty urban settings are at increased risk for early sexual initiation and sexually transmitted diseases. Objective: To determine whether parental stategies to monitor their children’s social behavior and to communicate with them about sexual risks help to reduce the initiation of risky sexual behavior and prevent the resulting adverse health outcomes. Methods: To assess the viability of these strategies, we surveyed a stratified cross-section of African American children aged 9 to 17 years (N = 355) living in urban public housing. Talking computers were used to increase the confidentiality and comparability of the interviews across the wide age range. Results: Children who reported high levels of parental monitoring were less likely to report initiating sex in preadolescence (aged #10 years) and reported lower rates of sexual initiation as they aged. Children who reported receiving both greater monitoring and communication concerning sexual risks were also less likely to have engaged in anal sex. Communication was also positively related to the initiation of condom use and consistent condom use. The protective correlates of these parenting strategies were independent of the type of guardian (mother vs other family member). Conclusion: Interventions with parents and other guardians to increase monitoring and communication about sexual risks seem to be promising healthpromotion strategies for adolescents in high-risk settings.

Pediatric residency training requires a broad-based learning experience consisting of exposure to multiple subspecialty areas in which knowledge and skills are in a constant state of flux. Amidst this overwhelming educational challenge to house officers lies the necessity of mastering the basics of general pediatrics. With the current emphasis of health care reform on primary care medicine, pediatric residency programs are being required to provide more ambulatory experiences for those in training.

This chapter examines the nature of cross-informant reports of behavior programs of teens in kinship care. Specifically, it looks at the behavior problem rating differences between kinship care providers and the youths who are in their care. Cross informants differ in their evaluation of externalizing problems. Caregivers of boys and boys themselves tend to report higher levels of problem behavior than caregivers of girls or girls themselves. The most significant finding is that more than a quarter of caregivers characterized the teenager in their care as having an Externalizing problem, while only nine percent of the youth reported a problem.

OBJECTIVE: To examine the association between exposure to drug trafficking (selling or delivering drugs) and exposure to other forms of community violence and risk behaviors among urban, low-income African American children and adolescents. DESIGN: Community-based, cross-sectional survey. SETTING: Ten public housing developments in a large eastern city in the United States. PARTICIPANTS: Three hundred forty-nine urban, low-income African American children and adolescents (198 boys and 151 girls), aged 9 to 15 years. MAIN OUTCOME MEASURES: Exposure to drug trafficking and other forms of community violence (as either a victim or a witness), risk behaviors/perceptions including risk-taking/delinquency, drug use, perpetration of violence or other crimes, threats to school achievement, and perceived peer involvement. ANALYSIS: Exploratory factor analysis was performed to examine whether exposure to drug trafficking is a risk factor that is distinct from other exposure to violence. Multivariate analysis of variance and chi2 tests were performed to assess the relationship between exposure to drug trafficking and other forms of community violence and risk behaviors/perceptions. RESULTS: Of 349 participants, 63 (18%) had been asked to traffic drugs and 134 (38%) had seen someone else being asked to traffic drugs. Factor analysis indicates that exposure to drug trafficking appears to be different from other forms of community violence. However, having been asked and having seen other people being asked to traffic drugs were both strongly associated with exposure to other forms of community violence. Compared with children and adolescents who had not been exposed to drug trafficking, those who were exposed to drug trafficking reported more risk-taking and delinquent behaviors, drug use, threats to achievement, and a perception of more peer involvement in these risk behaviors. CONCLUSION: Exposure to drug trafficking is a unique risk factor that is strongly associated with exposure to other forms of community violence and involvement in other risk behaviors. Language: en

To examine the evolution of risk behaviors over 2 years among a community-based cohort of low-income African American preadolescents and young adolescents enrolled in a randomized trial of an acquired immunodeficiency syndrome risk reduction intervention.Longitudinal, community-based cohort.Nine recreation centers serving 3 public housing developments.Three hundred eighty-three African American youths aged 9 through 15 years at baseline.Frequency distributions, chi 2 analyses, and regression analyses regarding 10 risk behaviors were conducted. To assess whether a specific risk behavior or its protective (nonrisk) behavioral analogue, composing a risk-nonrisk behavioral complex (eg, was sexually active and was sexually abstinent or used drugs and refrained from drugs), was stable over time, kappa values were determined for the 10 risk-nonrisk behavioral complexes.Instrument assessing risk/ behaviors administered at baseline and every 6 months aurally and visually via talking computer.The prevalence of sexual intercourse, cigarette smoking, alcohol consumption, and drug use increased notably over time. Drug use increased from a 6-month cumulative prevalence of 7% at baseline to 27% at the 24-month follow-up (P.001). Cumulatively over the 2-year study interval, 81% of youths had engaged in fighting, 58% had engaged in sexual intercourse, and from 33% to 40% had engaged in truancy, knife or bat carrying or both, alcohol consumption, drug use, and cigarette smoking. All of the risk-nonrisk behavioral complexes except weapon carrying were stable during the semiannual assessment intervals. Fighting (kappa = 0.22, P.01), sexual intercourse (kappa = 0.33, P.001), alcohol consumption (kappa = 0.21, P.001), and unprotected sexual intercourse (kappa = 0.34, P.05) were stable for 2 years. Six risk-nonrisk behavioral complexes were stable for the 2-year interval among youths aged 13 through 15 years at baseline, while only 2 risk-nonrisk behavioral complexes were stable among younger youths. The intervention seemed to affect the stability of 4 risk behaviors: truancy, drug use, unprotected sexual intercourse, and, possibly, fighting. For unprotected sexual intercourse, this intervention effect seemed to be due to stabilization of nonparticipation in risky behavior. Intervention youths were less likely to adopt a risk behavior (ie, engage in it foror = 2 risk assessment periods) than control youths, but they were not less likely to experiment with a risk behavior.There is evidence that although the prevalence of risk behaviors does change with age, most risk-nonrisk behavioral complexes seem to be relatively stable over time and stability may increase with time. Risk reduction interventions seem to decrease risk adoption, stabilize nonrisk behaviors, and possibly destabilize risk behavior.

To assess the stability and predictability of perceptions, intentions, and behaviors regarding intended sexual intercourse and condom use.One hundred and nineteen African-American youth aged 9-15 years living in urban public housing provided information at baseline and 6 months later using a theory-based and culturally- and developmentally-tailored instrument assessing perceptions, intentions, and sexual behaviors.Over the 6-month study interval, individual behaviors, intentions, and perceptions demonstrated considerable stability. Intentions regarding sexual intercourse in the next half-year were predictive of subsequent coitus among the entire cohort and among the subset who were virgins at baseline. Youth who thought it likely that they would be sexually-active in the next 6 months were at significantly elevated risk of doing so, compared to youth who were uncertain or thought coitus unlikely. However, intentions regarding future coitus among the subset of youth who were sexually-experienced at baseline were not predictive of future coital behavior.These data suggest that social cognitive behavioral models that incorporate intentions and perceptions are appropriate as the theoretical basis for interventions targeting these young adolescents.A longitudinal study conducted among low-income African-American early adolescents identified the salience of intentions and perceptions regarding sexual intercourse to subsequent behavior. The 119 boys and girls 9-15 years of age were recruited from public housing project recreation centers in Baltimore, Maryland, in 1993. Each youth completed the Youth Health Risk Behavioral Inventory; the instrument was re-administered 6 months later. At baseline, 71 respondents (60%) were virgins; 6 (9%) became sexually active during the 6-month study period. 27 (56%) of the 48 subjects who were sexually experienced at baseline engaged in intercourse during the ensuing 6 months. Overall, the predictiveness of intention to have sex in the next 6 months and actual behavior was very strong, especially among younger youth; nearly half of young people who thought it likely they would have sex did so, while only one-fifth of those who were uncertain and one-seventh of those who considered it unlikely had sex. Condom intention, on the other hand, was not predictive of subsequent use. Youth who engaged in sexual intercourse during the study period had more perceived peer support and internal rewards for sexual activity and perceived the sequelae of intercourse as less severe than their abstinent counterparts. Overall, these findings suggest that social cognitive behavioral models that incorporate intentions and perceptions should form the theoretical basis for interventions aimed at young adolescents.

• Objective. —The objectives of this study were to assess the current and chronic health problems and the adequacy of primary health care of children placed with a relative (kinship care) by a public agency. Research Design. —Population survey. Setting. —Children in kinship care in Baltimore, Md. Participants. —Four hundred seven (78%) of 524 children in kinship care in 1989. Interventions. —None. Measxurements/Main Results. —Information on the child's health status and care was obtained via a review of medical records; questionnaires sent to primary care physicians, parents, care givers, and caseworkers; and clinical assessment of the child by a nurse, pediatrician, and child psychologist. The children were found to have health problems similar to those in foster and poor children, but more problems than American children in general. Frequent diagnoses included impaired visual acuity and hearing, obesity, dental caries, and asthma; often, these problems had not been identified or treated. Gaps in the medical records precluded firm conclusions concerning the children's primary care, but suggest an inadequate system for ensuring their health care. Conclusions. —There is a need for improving the system of health care for children in kinship care. There is also a need for additional research on this high-risk group of children. ( AJDC . 1992;146:603-610)

We conducted a case-control study to examine the correlates of emergency room use in the first year of life, particularly the role of parental health beliefs, among the families of inner-city children enrolled in a hospital-based primary care program. Data were collected by structured interviews and by medical record review. Emergency room users were more likely to have single mothers and to have acute, recurrent medical conditions than were non-users. Health beliefs differed between groups by maternal report of worry about the kinds of illnesses that her child acquires. Emergency room use was predicted by: maternal marital status, maternal worry and concern that illness interferes with her child's activity, acute recurrent illnesses, hospitalization. This model may be applicable to other populations in designing intervention strategies to modify emergency room utilization.

Objectives: To evaluate the success of efforts to educate youth not only to use prescription contraceptives to avoid pregnancy, but also to use condoms to avoid sexually transmitted diseases, including infection with the human immunodeficiency virus. Methods: Longitudinal study of 383 African-American youth aged 9 to 15 years enrolled in a randomized, controlled trial of an acquired immunodeficiency syndrome (AIDS) risk reduction intervention. Data about contraceptive practices were obtained at baseline and 6, 12, and 18 months later using a culturally and developmentally appropriate risk assessment tool administered with "talking" computers (Macintosh, Apple Computer Inc, Cupertino, Calif). Results: Approximately three fourths of sexually active youth used some form of contraception in each 6-month round, with almost half of the youth using combinations of contraceptives. Among all youth at baseline and among control youth throughout the study, more than half used condoms and more than two thirds who used oral contraceptives also used condoms. Receipt of an AIDS education intervention was associated with use of more effective contraceptive practices (eg, condoms and another prescription or nonprescription method of birth control). After receiving the intervention, more than 80% of the youth who used oral contraceptives also used condoms. Contraceptive practices showed considerable stability. Knowledge about AIDS was positively associated with use of more effective contraceptive methods. Conclusions: Many youth are using condoms and prescription birth control simultaneously, and these use rates can be increased through AIDS education interventions. (Arch Pediatr Adolesc Med. 1996;150:17-24)

Objectives: To determine the characteristics of children in kinship care and their caregivers who have access to health care (a single source of health care or a single provider), and to determine the relation between indicators of access and health needs. Design: Cross-sectional. Setting: A large eastern city. Subjects: Two hundred ten children selected from households with children in kinship care in April 1989. Methods: Data were obtained from medical records, access and demographic questionnaires, and a medical and psychologic evaluation. Results: A single facility for health care was reported by 93% of the sample; two thirds of those identified one health care provider. One source of care or one provider was associated with variables such as young age at placement and medical assistance insurance. Children who did not have a single source of care were more likely to have unmet health needs (87% vs 61%, P P Conclusions: Children in kinship care had good access to health care, but the level of unmet health needs was high. Children who did not have a single source of health care were more likely to have unmet health needs, especially unmet mental health needs. These findings have implications for future health care planning for children in out-of-home care. (Arch Pediatr Adolesc Med. 1995;149:882-886)

An increasing number of children needing out-of-home care are being placed with relatives. Despite this pervasive policy, there has been scant research on children in this arrangement called kinship care. The objectives of this study were (1) to assess the behavior of children in kinship care and (2) to identify predictors of their behavior. The caregivers of 346 children in kinship care completed the Child Behavior Checklist (CBCL). Background information was obtained from caregivers and caseworkers. Forty-two percent of boys and 28% of girls had overall CBCL scores in the clinical range, compared with an expected 10% in the general population. Logistic regressions revealed several variables significantly associated with behavior problems including: reason for placement, gender, race, caregiver's perception of the child, caregiver's educational level, number of contacts between caregiver and caseworker, long-term plan, and child's age. The frequent behavior problems among these high-risk children in kinship care suggest they all deserve mental health evaluations; at a minimum, periodic screening is indicated.

• Objective. —To determine quantitative measles, mumps, and rubella serum antibody levels as a function of time since vaccination in a sample of vaccinated Baltimore children. Design. —Cross-sectional serologic survey. Setting. —Pediatric outpatient departments at the University of Maryland Medical Center, Baltimore. Participants. —One hundred seventy children, ranging in age from 1.5 through 16 years, who had measles, mumps, and rubella vaccination between ages 12 and 18 months. Results. —Serum antibody levels to measles and rubella declined with increasing time since vaccination. However, no such decline in antibody levels to mumps was observed. Children who were vaccinated between ages 12 and 14 months did not have lower antibody levels than children who were vaccinated at age 15 months or older. Conclusions. —In areas free from natural disease, antibody levels resultant from measles, mumps, and rubella vaccine are likely to decline with advancing age. Revaccination with measles, mumps, and rubella vaccine may boost falling antibody titers. ( AJDC . 1993;147:558-560)