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Background: The American Academy of Pediatrics recommends that adolescents with chronic health conditions begin to assume responsibility for their own care by age 14. The goal of this qualitative one‐time interview study is to learn how 14‐ to 16‐year‐old adolescents with chronic health conditions begin to develop self‐management skills and the role that caregivers play in the learning process. Methods: Twenty adolescents ages 14–16 with chronic renal (n = 5), gastrointestinal (n = 5), hematologic (n = 5), or rheumatologic (n = 5) diseases, and 20 caregivers (dyads), completed individual semi‐structured interviews discussing the adolescents' current degree of self‐management. Six coders analyzed transcripts using thematic framework analysis. Results: Three primary themes emerged: continuum, motivations, and tools. Both adolescents and caregivers described progress along a self‐management continuum with varying levels of responsibility for the adolescents, ranging from passive to responsible. Caregivers' behaviors similarly varied from directive management to supported self‐management. Motivations for self‐management skills were described in relation to one's health, self, and others. Families utilized a variety of tools to facilitate movement toward supported self‐management with the adolescent. Conclusions: The development of adolescent self‐management of their chronic condition is a complex, shifting continuum between caregiver and adolescent. This continuum may be impacted by adolescent motivation and tools/problem solving available to the family. Pediatric healthcare providers can support self‐management by assessing and attending to each patient's motivations; building a road map individualized to each patient's skills; and offering time in outpatient clinic to practice self‐management strategies. [ABSTRACT FROM AUTHOR]

Objective: To describe the development of Project Passport, a perinatal intervention designed to reduce negative outcomes among pregnant teens. Methods: A logic model guided the planning, development and evaluation plan for the intervention. It included the selection of health goals, behaviors to be targeted, determinants of the selected behaviors, and activities to impact each selected determinant. Results: The process resulted in the formulation of an intervention that incorporates CenteringPregnancy, a group model of prenatal care, Positive Youth Development components, and male involvement. The evaluation examines the effectiveness of the intervention in enhancing health, educational and psychosocial outcomes among pregnant adolescents. Conclusions: The present program was designed to address an important gap in evidence-based interventions targeting pregnant adolescents and their partners. [This project was funded by the Department of Health and Human Services, Office of Adolescent Pregnancy Programs (OAPP).]

To examine individual, interpersonal, family, and community correlates associated with moderate-to-severe depressive symptoms among pregnant adolescents. A total of 249 primarily African American and Hispanic pregnant adolescents ages 15-18 years were recruited into either an intervention group utilizing Centering Pregnancy prenatal care and case management, or to a comparison group receiving case management only. Moderate-to-severe depressive symptoms were defined as a score [greater than or equal to]16 on the Center for Epidemiologic Studies Depression Scale (CES-D). Intervention and comparison groups did not significantly differ on demographic characteristics or depression scores at baseline. A total of 115 (46.1 %) participants met criteria for moderate-to-severe depressive symptoms at entry into the program. Pregnant adolescents who were moderately-to-severely depressed were more likely to be African American, to have reported limited contact with the father of the baby, and to have experienced prior verbal, physical or sexual abuse. Depressed adolescents also experienced high levels of family criticism, low levels of general support, and exposure to community violence. A significant number of pregnant adolescents were affected by depression and other challenges that could affect their health. Comprehensive interventions addressing these challenges and incorporating partners and families are needed., Author(s): Ruth S. Buzi[sup.1] , Peggy B. Smith[sup.1] , Claudia A. Kozinetz[sup.2] , Melissa Fleschler Peskin[sup.3] , Constance M. Wiemann[sup.4] Author Affiliations: (1) Population Program, Baylor College of Medicine, One [...]

The professional process portfolio (PPP) was adopted by the Maternal Child and Health Bureau (MCHB) as an 'innovation' in best practice for all Leadership in Education and Adolescent Health (LEAH) Training Programs; however it had not been formally evaluated. Thus the objective was to evaluate the utility of the PPP for graduates of the LEAH training program in terms of (1) how alumni have used, adapted, and applied it since completing fellowship, (2) what fellows learned or gained through completing it, and (3) how it can be improved for continued use in training programs. Graduates from six disciplines were asked via telephone or email to participate in a survey regarding their experience with the PPP. Descriptive statistics were generated for demographic characteristics and closed-choice questions. Responses to open-ended questions were analyzed by a team of faculty using framework analysis. Sixty-one graduates completed surveys. The majority (85 %) found the PPP useful and utilized it post-graduation for multiple purposes in professional development: interviewing, training, and referencing previous work. Graduates recommended that the PPP be improved by making it electronic, discipline-specific, and providing earlier and more frequent instruction from faculty on expectations of creating it. Four themes emerged from the qualitative data analysis: accomplishment, experiential learning, skills and accountability, and a best practice of learning. The PPP was an effective personal learning tool for the majority of graduates and enhanced graduates' experiences. We highlight the ways that the PPP may facilitate the development of learning experiences associated with MCH leadership competence. Keywords Process portfolio * Leadership * Best practice * Innovative tool * Interdisciplinary, Introduction The professional process portfolio (PPP) is a standard methodology in many fields, e.g., art, architecture, writing, to demonstrate a professional's accomplishments during training. Medical education, however, is much harder [...]

Objectives. We used Bronfenbrenner's ecological systems theory to identify factors that predicted never or sometimes using condoms in a multiethnic cohort of adolescent mothers. Methods. We interviewed adolescent mothers within 48 hours of delivery and surveyed them 6 and 12 months after delivery (n=636). We used multinomial logistic regression to identify individual-, dyad-, family-, and peer and community level factors associated with never or sometimes using versus always using condoms during intercourse at 12 months postpartum. Results. Pregnancy status, partner refusal to use condoms, intimate partner violence, and race/ethnicity predicted both never and sometimes using condoms. Condom use 6 months earlier and church attendance also predicted never using condoms, whereas maternal monitoring was an additional predictor for some times using condoms. Conclusions. Overlapping yet distinct risk profiles predicted never or some tinges using versus always using condoms. Factors from multiple levels of influence affected the condom use behaviors of adolescent mothers indicating that multilevel interventions are needed to promote safer sexual practices among these young women. (Am J Public Health. 2009;99:S417-S424. DOI: 10.2105/AJPH.2007.131870)

Objective. To determine the usefulness of measurements of the vaginal opening and amount of hymenal tissue present inferiorly and laterally in the diagnosis of vaginal penetration. Methods. The transhymenal diameters and the amount of tissue present between the hymenal edge and vestibule inferiorly at 6 o'clock and laterally at 3 o'clock and 9 o'clock were measured from photographs of 189 prepubertal children with a validated history of digital or penile penetration and 197 children who denied previous sexual abuse. Statistical analyses were conducted to compare the mean values and hymenal symmetry between groups as well as to determine the sensitivity and specificity of various cutoff points. Results. Comparison of the mean diameters demonstrated that children with a penetration history had a significantly larger transverse opening than nonabused children when examined in the knee-chest position (5.6 vs 4.6 mm). However, there was extensive overlap in measurements between the 2 groups. No significant differences were noted between groups in the size of the vertical diameter, the amount of tissue present inferiorly or laterally, or the symmetry of the hymen in either position. Children with previous penetration were more likely than nonabused children to have a horizontal opening measuring >6.5 mm in the knee-chest position, but the sensitivity and specificity of this test were low (29% and 86%, respectively). Higher values had better specificity but very low sensitivity. Less than 1.0 mm of hymenal tissue was detected at 6 o'clock only in those with a history of penetration (100% specificity), but the sensitivity was low (1%-2%). Conclusion. Most hymenal measurements lack adequate sensitivity or specificity to be used to confirm previous penetration. Less than 1.0 mm of hymenal tissue at 6 o'clock was detected only in victims of abuse, but the usefulness of this test is limited by the rarity of this finding. Pediatrics 2002;109:228-235; sexual abuse, sexual assault, hymen, genitalia, measurements, anatomy., ABBREVIATIONS. CPH, Child Protective Health; UTMB, University of Texas Medical Branch. The examination of the external genitalia is a critical component in the evaluation of the sexually abused child. After [...]

Lack of knowledge and erroneous beliefs about Norplant may keep inner-city adolescents from using Norplant. A group of 323 low-income girls aged 11 to 18 attending a family planning and maternity care clinic responded to a survey about Norplant. Nearly two-thirds said they would be willing to consider Norplant. However 60% were not sure they could afford it, although it is free, 60% erroneously believed that it was not available to girls under 18, and 38% were not sure Norplant was approved for use. Three-quarters of the group had reservations about side effects, and over half had safety concerns. Erroneous beliefs abounded. For example, the majority were not sure whether implants might get lost in the body, pregnancy could occur on Norplant, or fertility might be permanently impaired. Education and counseling might help sexually active adolescents make a more realistic appraisal of Norplant., Objectives. To identify characteristics of patients 18 years of age and younger who would and would not consider using levonorgestrel implants (Norplant) for contraception and to isolate potential barriers to its use. Study Design. Survey of 323 adolescents attending family planning or obstetrics clinics between April 29 and October 27, 1992. For purposes of analyses, patients were stratified by their willingness to consider using Norplant. Statements about Norplant that differentiated between groups were considered significant barriers. Additional analyses were conducted for the, sample, stratified by pregnancy status, race and ethnicity, parity, and Norplant class attendance. Results. Sixty-four percent of participants stated that they would be willing to consider using Norplant. These adolescents were significantly older, were more likely to already have given birth or have had abortions, planned to delay (additional) childbearing for 5 or more years, aspired to receive college educations, and reported lower annual household incomes than did adolescents unwilling to consider using the device. Identified barriers to Norplant use included misinformation, perceived advantages, physical aversions, perceived efficacy, fertility concerns, social influences, and concerns about safety and side effects. Conclusions. Misperceptions and concerns about safety and side effects will prevent many adolescents from using Norplant. Recent negative publicity surrounding its use will intensify this problem. Health care providers must work to remove these barriers so that sexually active adolescents can make informed decisions about contraceptives. Pediatrics 1996;97:185-191, Norplant, contraception, adolescents, knowledge, attitudes., ABBREVIATION. STD, sexually transmitted disease. Failure to seek and use contraceptives correctly accounts for approximately 80% of the more than 1 million pregnancies to girls and women younger than 20 [...]