Trustworthy guidance spanning every aspect of adolescent health care. Unlike other adolescent medicine references, the all-new AAP Textbook of Adolescent Care is an action-oriented working tool expressly built for efficient, on-target clinical problem-solving. Broad scope - Nearly 200 chapters cover physical growth and development, examination and laboratory screening, sexual development, puberty, obesity, sleep disorders, adolescent dermatology and much more. Clear management guidelines - Provides step-by-step recommendations: What to do, How to do it; When to admit, When to treat, When to refer. Evidence-based approach - Treat patients and counsel parents with high confidence. Excellent study reference - for the pediatric or internal medicine boards. Integrated companion resources - Use with complementary AAP resources: AAP Textbook of Pediatric Care, Tools for Practice, and Pediatric Care Online.

Trustworthy guidance spanning every aspect of adolescent health care. Unlike other adolescent medicine references, the all-new AAP Textbook of Adolescent Care is an action-oriented working tool expressly built for efficient, on-target clinical problem-solving. Broad scope - Nearly 200 chapters cover physical growth and development, examination and laboratory screening, sexual development, puberty, obesity, sleep disorders, adolescent dermatology and much more. Clear management guidelines - Provides step-by-step recommendations: What to do, How to do it; When to admit, When to treat, When to refer. Evidence-based approach - Treat patients and counsel parents with high confidence. Excellent study reference - for the pediatric or internal medicine boards. Integrated companion resources - Use with complementary AAP resources: AAP Textbook of Pediatric Care, Tools for Practice, and Pediatric Care Online.

Background: This study was conducted to compare the utility of methods of assessing ambivalent attitudes about childbearing that require deductive reasoning by the subject to methods that do not. The goal was to predict the intent to use a noncoital method of contraception during adolescence.Design: Participants (N = 340) in a racially and ethnically diverse population (white 20%, black 25%, Hispanic 55%) completed two scales concerning attitudes toward childbearing-a traditional Liken scale and a scale with positive, negative, and "I go back and forth" response choices. The indication of ambivalence according to these two scales was determined by two methods-averaging item responses and counting the number of midscale responses. Logistic regression was used to study the relationship between ambivalence (by each method) and contraceptive plans.Result: Regardless of the scale's format (Likert or back-and-forth) and the scoring method used (averaging or counting), ambivalent adolescents were less apt to plan on using noncoital contraceptives than were nonambivalent adolescents. However, many of the adolescents who were classified as ambivalent by the averaging method chose no midscale responses (26.3% for the Likert scale and 40.5% for the back-and-forth scale), hence they were not classified as ambivalent by the counting method. These adolescents were younger and had lower average scores than adolescents who were classified as ambivalent by both scoring methods. Moreover, adolescents who were classified as ambivalent by both scoring methods were less likely to intend to use noncoital contraceptives than were nonambivalent adolescents, but adolescents who were classified ambivalent by only the averaging method were not.Conclusions: Childbearing ambivalence predicts contraceptive plans. However, congruent with theories of cognitive development, methods of assessing childbearing ambivalence that require deductive reasoning on the part of the adolescent tend to overclassify adolescents with discordant attitudes as being ambivalent. Avenues of further study are discussed.

Purpose Identify new ways to increase the impact of pregnancy prevention interventions on the number of children born to adolescents. Methods The study participants, a racially/ethnically diverse group of 1,568, pregnant 13–18 year olds, reported why they had not used contraception at the time of conception. Their explanations were sorted into categories. The frequency with which each category was endorsed, the stability of these endorsements (Kappa statistic), and differences between adolescents who endorsed each category (stepwise logistic regression) were examined at two points in gestation. Results “Not ready to prevent pregnancy” was the most frequently endorsed category; it was often the only category endorsed. Logistical barriers and misperceptions about the need for contraception were the least frequently endorsed categories. The reasons individual patients gave for not using contraception changed (K ≤ 0.4) during gestation. Yet, adolescents who were not ready to prevent conception consistently differed from those who were; they were more apt to be Hispanic, to live in non-chaotic environments with an adult father of the child rather than their parents, and to have goals compatible with adolescent childbearing. Conclusions The most expedient way to strengthen the impact of pregnancy prevention programs on adolescent childbearing is to shift the focus of intervention from overcoming logistical barriers and misperceptions about the need for contraception, to helping young women develop goals that make adolescent childbearing a threat to what they want in life. This means intervening actively enough to ensure that goal setting translates into an internal desire to postpone childbearing beyond adolescence.

Purpose Compare the relationship between childbearing intentions, maternal behaviors, and pregnancy outcomes in a group of early/middle adolescents versus a group of late adolescents (specifically high school seniors, high school graduates, and GED certificate recipients). Methods The reasons given by a racially/ethnically diverse group of 1,568 pregnant 13–18 year olds for not using contraception were used to classify their pregnancies as intended or unintended. Proportion comparison tests and stepwise logistic regression analyses were used to study the relationship between childbearing intentions, maternal behaviors, and pregnancy outcomes. Results Regardless of age, adolescents who intended to become pregnant conceived in an objectively more hospitable and supportive childbearing milieu than those who conceived unintentionally. This is evidenced by their greater likelihood of having goals compatible with adolescent childbearing, cohabitation with the father of the child, and living in a non-chaotic environment. However, pregnancy planning was not associated with improved compliance with preventive health care recommendations during gestation nor with infant outcomes. As such, the consequences among adolescents with intended pregnancies were negative, as evidenced by a higher rate of smoking, STDs late in gestation, school dropout, and repeat conception. Conclusions Like adults, adolescents with intended pregnancies conceived in an objectively more supportive environment than their counterparts with unintended pregnancies. However, this advantage did not translate into better support, healthier maternal behavior during gestation, or improved pregnancy outcomes.

CONTEXT:Fostering conventional goals is a key component of pregnancy prevention interventions for teenagers. However, research has not shown whether having goals independently influences sexual behavior, or whether the perception that pregnancy represents an impediment to achieving goals mediates any association.METHODS:In 1999-2001, a racially mixed group of 351 sexually experienced female teenagers who were inadequate contraceptive users completed surveys about goals, the anticipated impact of childbearing on these goals, and protective behaviors and attitudes. Chi-square, regression and two-by-two table analyses assessed associations between goals and perceptions of early childbearing and pregnancy avoidance measures.RESULTS:Three-fourths of respondents had educational or vocational goals. Eight in 10 of these teenagers perceived their goals to be achievable, but fewer than half thought pregnancy would be an impediment to achieving these goals. Teenagers who had goals were more likely than others to have used a contraceptive at last intercourse (odds ratio, 1.9), but controlling for the perception of pregnancy as an impediment eliminated this association. In contrast, considering pregnancy an impediment was associated with an increased likelihood of supporting each pregnancy avoidance measure (2.1-9.6), and of intending to avoid pregnancy and to have an abortion if pregnant, regardless of whether teenagers had goals (8.3-13.8).CONCLUSIONS:Conventional goals appear to motivate teenagers to avoid getting pregnant only if they believe pregnancy will be an impediment. Thus, it may be less important to encourage young women to formulate goals than to ensure that they consider adolescent childbearing a threat to their plans.

Background: American adolescents are bigger and more likely to be overweight or obese than they were two decades ago. Adult mothers and their infants have also gotten bigger. The purpose of this study was to determine if the size of pregnant adolescents and the size and maturity of their infants has changed.

Background: Randomized controlled trials have demonstrated that the advanced provision of emergency contraceptive pills (ECPs) increases their use without deterring the use of condoms or highly effective contraceptives or incurring risky sexual behavior or the acquisition of sexually transmitted diseases. The purpose of this study was to examine the effect of two advance provision intervention strategies (ECP packets vs. prescription) on unprotected sexual intercourse, ECP use, and pregnancy rates in an adolescent maternity program.

Background: In 1998, the Centers for Disease Control and Prevention (CDC) changed their guidelines for treatment of adolescents with pelvic inflammatory disease (PID), no longer recommending hospitalization of all teenagers.Study Objectives: (1) To determine the proportion of adolescents with PID who were admitted for failed outpatient treatment after the CDC guideline change. (2) To determine if adolescents admitted for PID after the guideline change needed longer hospital stays and/or were more likely to be "very ill" [as measured by inflammation markers, e.g. fever] or to have tubo-ovarian abscess (TOA) than those admitted before the change.Design: Retrospective chart reviewSetting/Participants: All 12-21-year-old females with the diagnosis of PID admitted to an adolescent inpatient unit in an inner-city teaching hospital during a two-year period before [T1=1995-1997 (54 cases)] and after [T2 = 1998-2000 (91 cases)] the CDC guideline change.Interventions: NoneMain Outcome measures: Reason for admission (failed outpatient treatment; TOA; or admission at the time of diagnosis of PID); clinical toxicity at admission, and length of hospital stay (LOS).Results: During T2, 22% of PID admissions were for failure of outpatient therapy. However, those admitted after failure of outpatient therapy (n=20) in T2 were less likely to be "very ill" than those who were admitted at the time of PID diagnosis in either T1 or T2 (n= 123) [RR:0.30; 95% CI:0.09-0.94]. Mean LOS for females admitted to the adolescent unit with all diagnoses other than PID did not change between T1 and T2 but mean LOS for those diagnosed with PID decreased significantly from 6.3 +/- 3.7 days to 4.7 +/- 2.7 days, respectively (P = 0.002). LOS for PID was longer for younger (< 16 years; 8.20 +/- 4.5 days) than older ( >= 16 years; 5.0 +/- 2.8 days) girls (P = 0.02) and for adolescents with TOA (7.9 +/- 5.0 days) than for those without (5.3 +/- 2.9 days) (P = 0.05).Conclusion: At our medical center, after the CDC guideline change many adolescents with PID were admitted because of failure of outpatient therapy but they were not sicker than those admitted at the time of diagnosis and overall LOS for PID was shorter. These findings are reassuring because they suggest that an initial trial of outpatient therapy for PID is unlikely to harm adolescents and may lead to significant cost savings.

Objective: To determine if omission of the Center for Epidemiologic Studies Depression Scale (CES-D) items that assess the somatic symptoms of depression improves the psychometric properties of the scale and utility of the CES-D diagnosis of depression for predicting four adverse obstetrical outcomes that have been tentatively linked to maternal depression.Methods: A cohort of 1684 13-21-year-old participants in an adolescent-oriented maternity program completed the CES-D at enrollment. Chi-square analyses were used to compare the predictive capacity of depression diagnosed by the full CES-D and the 14-item non-somatic subscale of the CES-D. The reliability and construct validity of the two scales were also compared.Results: Removing the somatic component of the CES-D decreased the proportion of adolescents who met screening criteria for depression. However, it did not improve the psychometric properties of the scale. The reliability (Cronbach of,: 0.87) and Construct validity (depressed adolescents were significantly more psychologically stressed and had poorer social support) of the two scales were equivalent. Regardless of the scale used, adolescent mothers who were depressed in the second and third trimesters were at increased risk for inadequate weight gain and both small for gestational age fetuses and preterm delivery (ORs 1.6-1.8). The differences in case definition and predictive capacity were most evident when the CES-D was administered during the first trimester. However, overall effect sizes were nearly identical with the two scales.Conclusion: Removing the somatic component does not improve the psychometric properties of the CES-D or the predictive capacity of the CES-D diagnosis of depression for three sentinel obstetrical outcomes. This information should be reassuring to researchers and clinicians as most

We sought to determine which factors influence the association between menarche and conception among adolescent study participants (n = 1030), who demonstrated an earlier age of menarche than did national samples. Age at first sexual intercourse (coitarche) mediated the relationship between age at menarche and first pregnancy among White girls, whereas gynecologic age at coitarche (age at coitarche minus age at menarche) and age at menarche explained the timing of the first pregnancy among Black and Hispanic girls. Pregnancy prevention interventions to delay coitarche should also include reproductive education and contraception.

Background: Gestational weight gain recommendations are based on Institute of Medicine (IOM) body mass index (BMI)-based scheme which classifies women as under, average, and overweight. Weight gain in excess of the recommended level increases the risk of maternal obesity without benefit to the fetus. Since BMI cut-points for under, average, and overweight increase during adolescence, we hypothesized that basing weight gain recommendations for pregnant teens on the IOM scheme would overestimate their nutritional needs and put them at risk for obesity but not significantly decrease the risk of small for gestational age (SGA) delivery.

Background: Emergency contraceptive pills (ECPs) have not had the anticipated impact on teen pregnancy. This is because even young women who have ECPs on hand often fail to use them following unprotected intercourse. Few studies pair ECP use with episodes of unprotected sexual intercourse. We hypothesized that the problem of ECP under-utilization is far bigger and more pervasive than the literature suggests.

Background: The reasons teens give for not using contraception prior to one pregnancy can inform the prevention of subsequent pregnancies. They are an attractive proxy for childbearing intentions because asking about contraceptive use eliminates the potentially stigmatizing experience of characterizing a pregnancy, and by extension a child, as unwanted. The purpose of this study was to determine if these explanations are sufficiently stable to be used as the basis for prevention intervention.

Study Objective: Identify correlates of contraceptive discontinuation, which if modified, might make teenagers more, not less, effective contraceptors as they age.Setting: Teen clinic.Participants: Teenagers who used contraception at first intercourse (N = 120). Some "never" used contraception during the 4 months immediately prior to the survey ("contraceptive stoppers"; n = 38). The others (n = 82) did so "always" or "most of the time" ("consistent contraceptive users").Interventions: Questionnaire responses were used to determine univariate and multivariate associations between contraceptive use group and five categories of factors: inability to plan for sex, belief that pregnancy is unlikely to occur, belief that contraceptives are unsafe, inability to negotiate contraceptive use, and lack of desire to remain non-pregnant.Main Outcome Measure: Odds of being a contraceptive stopper.Results: In univariate analyses contraceptive stoppers scored significantly higher on scales that assessed inability to plan for sex, belief that pregnancy is unlikely, and lack of desire to remain non-pregnant. Contraceptive Stoppers were also older and more likely to have been sexually active for at least 6 months. In multivariate analyses, those who were sexually active for at least 6 months (odds ratio [OR]: 2.9, confidence interval [95%CI]: 1.1-7.1), those who believed that pregnancy was unlikely (OR: 3.8; 95% CI: 1.7-8.6), and those who lacked the desire to remain non-pregnant (OR: 2.7; 95% CI: 1.4-5.1) were more likely to stop using contraception.Conclusions: Our findings suggest that teens who use contraception at coitarche stop doing so as they mature sexually because they begin to doubt the necessity and desirability of using contraceptives. Longitudinal studies are needed to determine if such doubts are preventable and if doing so encourages teens to continue to use contraception.

PURPOSE:Assess the feasibility of offering and barriers to accepting urine-based screening for Chlamydia trachomatis (CT) among asymptomatic adolescent mothers during their children's health care visits.METHOD:Providers were automatically cued to offer CT-screening to 13 through 21 year old mothers when they opened the child's medical record. Recording the mothers' screening decisions removed the flag for 6 months. Providers were also prompted to assess the perceived importance of CT prevention, likelihood of having CT, and the worst aspect of having CT.RESULTS:Mothers usually brought their children to the clinic. Hence, providers could act on 97% of the 318 flags they saw. They responded appropriately 75% of the time. Only 96 (42%) of the 229 mothers who were asked agreed to screening. The primary reasons for declining were "monogamous" and "tested within 6 months". Almost everyone said CT was a top preventive health priority, but that they would be surprised if they were infected. Mothers who agreed to screening were less likely to have a child less than 6 months of age (26.0% vs. 57.1%; P < 0.0001). They were also more likely to rate knowledge of partner infidelity (39.4% vs. 13.6%; P = 0.03) and less likely to rate medical problems (15.2% vs. 40.9%; P = 0.01) the worst aspect of having CT. None of the 21 urine samples obtained within 6 months of delivery were positive for CT. Thereafter, 5 (9.1%) of the 55 urines were positive.CONCLUSIONS:It is feasible and useful to screen adolescent mothers for CT at their children's health care visits. The best way to increase the efficacy and strengthen the impact of urine-based CT-screening in this setting is to initiate testing after the 6th postpartum month and heighten awareness of STD-risk among adolescent mothers.

OBJECTIVE:Identify ways to increase the impact a well-known home-based intervention--the Nurse Family Partnership (NFP)--has on conception rates among teenage mothers.METHODS:Secondary analysis of data collected on 111, 13-to-19 years old, primiparas who were visited in their homes by nurses during, and for 2 years after pregnancy. Data bearing on assistance with family and career planning were culled from the nurses' records. These were graded on a 3-point scale. Higher scores reflected more active, therapeutic interventions. The primary outcome was repeat pregnancy.RESULTS:The pregnancy rate at 6, 12, and 24 months was 8.3%, 18.4%, and 28.1%. Teenagers who conceived were less likely to have used contraceptives during the previous six months than those who did not. Almost everyone received the recommended number of visits. However, discussions and active interventions related to lapses in contraceptive use were only documented during 30% of visits. Those who conceived had as many visits and discussions of this type as those who did not. Nurses rarely involved boyfriends and family. Other differences between teens that did and did not conceive support the NFP theoretical framework.CONCLUSIONS:Contrary to the stated aims of the intervention, the nurses rarely documented therapeutic interventions that could make repeated childbearing fit less harmoniously into the teenagers' lives. The best way to strengthen the impact of this program on teen pregnancy rates is to deepen the nurses' training so that they are able to intervene actively enough to bring about behavioral change in family planning.

After two decades of trying to prevent teen pregnancy, when a colleague suggested trying to simultaneously prevent sexually transmitted diseases (STD), I wondered how the prospect could seem foreign. Given their frequent co-occurrence, tendency to recur at short intervals, and common etiology and cure, Cates suggested that unplanned pregnancies and STDs were “natural bedfellows” long ago. 1 Cates W. Sexually transmitted diseases and family planning: Strange or natural bedfellows. J Reprod Med. 1984; 29: 317 PubMed Google Scholar In theory, everyone agrees. However, contracepting American women are rarely screened annually for STDs, 2 Fiscus L.C. Ford C.A. Miller W.C. Infrequency of sexually transmitted disease screening among sexually experienced US female adolescents. Perspect Sex Reprod Health. 2004; 36: 233 Crossref PubMed Scopus (28) Google Scholar and providing STD-clinic patients with contraception is still an experimental intervention. 3 Schlay J.C. Mayhugh B. Foster M. et al. Initiating contraception in sexually transmitted disease clinics: A randomized trial. Am J Obstet Gynecol. 2003; 189: 473 Abstract Full Text Full Text PDF PubMed Scopus (25) Google Scholar Thus, in practice they remain “strange bedfellows.”

OBJECTIVE:To clarify the interaction between maternal age and race in the prediction of infant size at birth.METHODS:Birth certificate data was used to study the relationship between maternal age, race/ethnicity, and the size of term, singleton infants born to 91,061 healthy, non-smoking, non-substance using, primigravidas.RESULTS:Maternal race/ethnicity (Black race: OR: 1.95, 95% CI: 1.49-2.56; Hispanic ethnicity: OR: 1.38, 95% CI: 1.19-1.61) and the interaction term, maternal age x race/ethnicity (OR: 1.06, 95% CI: 1.01-1.11) predicted small-for-gestational age (SGA) birth. The strength of the association between Black race and SGA delivery increased and the strength of the association between Hispanic ethnicity and SGA delivery decreased with age (P < 0.001 for trend). Thus, Black and Hispanic teenagers were more likely to have SGA babies than White teenagers (1.7% and 1.6%, respectively compared to 1.2%; P = 0.003). However, Black women who postponed childbearing until their mid-twenties were more likely to have SGA babies than their Hispanic and White counterparts (2.6% compared to 1.2%, and 1.0%, respectively; P < 0.0001).CONCLUSION:The findings suggest that acquired maternal characteristic(s) cause the reproductive health of Black primigravidas to deteriorate and Hispanic primigravidas to improve with age.