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Biomedical subjects

C E Irwin

Publications and source records attributed to C E Irwin.

At least 37 records · Page 2Linked to original sources
PubMed1996

Primary care management of adolescent sexual behavior.

Adolescents continue to engage in sexual behaviors that place them at risk for sexually transmitted diseases, including HIV, and pregnancy. Recent advances in the prevention and management of sexually transmitted diseases and pregnancy may eventually lead to fewer negative consequences associated with adolescent sexual behavior. This paper discusses scientific and technologic advances in the management of adolescent sexual behavior such as the use of DNA amplification tests to detect genital chlamydial infection and the new female-controlled contraceptives.

Adolescent↗
PubMed1995

Life events, cardiovascular reactivity, and risk behavior in adolescent boys.

BACKGROUND: Risk behavior contributes to injuries, one of the most important sources of morbidity and mortality in adolescents. Although research has shown that environmental stress makes adolescents more likely to engage in risk behavior and to sustain injuries, the magnitude of these associations has been small. Little is known about the role of individual differences in psychobiologic reactivity to stress in moderating the impact of stressful events. In this study, we examined associations among environmental stressors, cardiovascular reactivity to stress, and the level of risk behavior in adolescent boys. METHODS: Twenty-four 14- to 16-year-old boys underwent a laboratory protocol designed to measure responses to psychologically and physically stressful tasks. Changes in heart rate and mean arterial blood pressure were measured serially at standard points in the protocol, and levels of positive and negative life events and recent risk behavior were measured using self-report questionnaires. RESULTS: Neither life events nor cardiovascular reactivity were independently associated with risk behavior. Positive life events and mean arterial blood pressure reactivity significantly interacted, however, in predicting risk behavior (R2 increment = .25). Boys with high reactivity who reported numerous positive life events engaged in markedly less risk behavior than their peers. CONCLUSION: We conclude that adolescents with exaggerated cardiovascular responses to laboratory stressors are associated with less risk behavior in a setting of positive life circumstances. This result suggests that reactivity may exert protective, rather than harmful, influences in some environments.

Adolescent↗
PubMed1994

Initiation of substance use in early adolescence: the roles of pubertal timing and emotional distress.

Two hypotheses regarding the effects of pubertal timing on substance use were tested in a prospective study of 221 young adolescents. A maturational-deviance hypothesis predicted that early-maturing girls and late-maturing boys would experience heightened emotional distress, which in turn would influence initiation and use of substances. Alternatively, an early-maturation hypothesis predicted that early-maturing girls would engage in more substance use than all other groups, independent of emotional distress. Early-maturing adolescents reported more substance use within 1 year. Adolescents experiencing elevated levels of negative affect also reported greater substance use within the next year. However, pubertal timing was not related to emotional distress. Results support the early-maturation hypothesis for girls and suggest its extension to boys.

Adolescent↗
PubMed1993

Risks of human immunodeficiency virus infection among adolescents attending three diverse clinics.

This study was performed to identify specific high-risk behaviors, such as unprotected oral, anal, and vaginal intercourse and substance abuse, associated with human immunodeficiency virus infection among adolescents attending three diverse clinics located in a localized geographic area: a university-based clinic, a Planned Parenthood clinic, and an inner-city public health clinic (PHC). Six hundred seventy-one female and 207 male adolescents attending one of the three clinics completed a structured questionnaire. Similarities among patients at the clinic sites included high rates of anal intercourse (21%), unprotected vaginal sex (95%), oral sex (73%), and poor communication skills (42%). Some differences appeared as well, including higher rates of homosexual experiences, no birth control use, and having multiple partners among adolescents attending the PHC (p < 0.001). In contrast, adolescents attending either the university-based clinic or the Planned Parenthood Clinic had higher rates of substance abuse around sexual activity than those who attended the PHC (p < 0.001). We conclude that adolescents attending general medical clinics in the San Francisco Bay area engage in high-risk behaviors that place them at risk for transmission of human immunodeficiency virus even though many have had previous education about acquired immunodeficiency syndrome and sexually transmitted disease. Specific risk factors include unprotected receptive anal intercourse, unprotected vaginal intercourse with new and unknown partners, experience in homosexual behavior, high rates of oral sex, multiple partners, poor communication skills, and frequent use of illicit substances in conjunction with sex. The differences found among sites indicate the need for health care providers and prevention programs to provide emphasis on practices specific to the adolescents in their service area.

Acquired Immunodeficiency Syndrome↗
PubMed1993

Autonomy, relatedness, and the initiation of health risk behaviors in early adolescence.

This study examined the relationships among sociodemographic characteristics, family processes, and the initiation of health risk behaviors in early adolescence. Subjects were 189 6th and 7th graders from a public middle school. A path-analytic model was used to analyze data. Results showed that students who received autonomy support from parents were less likely to initiate sexual intercourse. Students who were emotionally detached from their parents were more likely to fight and use substances. Those who were emotionally detached tended to come from families with low levels of cohesion and acceptance. Sociodemographic variables, such as family structure, gender, and ethnicity, had both direct and indirect effects on health risk behaviors, but the indirect effects were quite small.

Adolescent↗
PubMed1993

Appointment-keeping behavior in adolescents: factors associated with follow-up appointment-keeping.

STUDY OBJECTIVES: To identify the sociodemographic and Health Belief Model predictors of follow-up appointment-keeping behavior. DESIGN: Prospective observational study. SETTINGS: General adolescent medical clinic. PATIENTS AND MEASUREMENTS: Sequential sample of 166 adolescents (aged 12 to 20 years, mean = 15.9 years) enrolled in the clinic. The population was 75% female; the racial-ethnic distribution of the sample was 37.9% black, 29.8% white, 11.2% Asian, 14.3% Hispanic, and 6.8% "other" background. Subjects' social class was primarily lower-middle (60.5%) and middle class (28.6%). A subsample was randomly assigned to be interviewed about their beliefs concerning their follow-up appointment and the constructs of the Health Belief Model. RESULTS: Forty-eight percent of the total sample failed to keep their follow-up appointment. There was a significant positive correlation between social class and appointment keeping (F = 5.07; df = 5,110; P = .026). Neither race-ethnicity nor who made the appointment were found to be associated with follow-up appointment-keeping. The only construct of the Health Belief Model found to be significantly associated with appointment keeping was the number of potential negative outcomes resulting from noncompliance perceived by the subject (F = 6.85; df = 1.74; P = .011). CONCLUSIONS: Clinicians must work with adolescents to improve their understanding of the potential negative outcomes associated with noncompliance to improve appointment-keeping behavior.

Adolescent↗
PubMed1992

Validity of self-report of pubertal maturation in early adolescents.

Self-report measures of sexual maturation continue to be used to classify pubertal development even though their reliability remains in question. This study examined the accuracy of self-report measures by early adolescents in two settings. Standardized figured drawings depicting Tanner's sexual maturation scale (SMS) were shown to early adolescents at school (S1) and again in a clinical sitting (S2), and subjects were asked to rate their own pubertal development. Physical examination by a physician at S2 was used to corroborate sexual maturation. Participating in the study were 46 males, age 11-14 years (mean, 12.4, SD, 1.9), and 37 females, age 11-14 years (mean, 12.7, SD, 0.7). Concordance rate between physical examination and self-report of pubic hair development (males) at S1 was 58% (kappa = 0.35, p less than 0.0001) and 78% (kappa = .66, p less than 0.0001) at S2. Concordance rate of self-report of genital development at S1 and S2 was 27% (kappa = -0.06, p less than 0.49) and 44% (kappa = 0.18, p less than 0.04), respectively. Self-report of breast development demonstrated a concordance rate of 59% (kappa = 0.43, p less than 0.0001) at S1 and 72% (kappa = 0.59, p less than 0.0001) at S2. Concordance rate for self-report of pubic hair development in females was 58% at S1 (kappa = 0.42, p less than 0.0001) and 75% at S2 (kappa = 0.64, p less than 0.0001). There was a tendency for subjects to overestimate their development at early stages of maturation and underestimate development at later stages.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1992

Early adolescent knowledge and attitudes about circumcision: methods and implications for research.

The psychosocial effects of circumcision status on the adolescent male are unclear. This study explored methods for assessing attitudes toward circumcision of early adolescents and differences in satisfaction between circumcised and uncircumcised males that would warrant further investigation. Seventy-three boys, aged 11 through 14 years completed the Petersen Body Image Scale and a questionnaire concerning their own circumcision status, satisfaction with that status, and perceptions about the status of other family members and peers. To assess knowledge, subjects identified diagrams depicting differing circumcision states during a personal interview. Physical examination confirmed reported circumcision status. Of the study group, 19% (n = 14) were uncircumcised. Use of visual aids to report circumcision status was more accurate (92%) than self-report (68%). Circumcised boys scored higher on satisfaction items than did uncircumcised boys, (t(15.65) = -3.96, p less than 0.001). No differences in general body image were found between groups. Further research that examines psychosocial outcomes of circumcision status is necessary.

Adolescent↗
PubMed1992

Do adolescents understand what physicians say about sexuality and health?

The high rates of adolescent sexual activity, often with adverse medical and social outcomes among minority females, prompted us to survey 160 girls between the ages of 13 and 18 concerning their knowledge of reproductive health terms, anatomy, and body functions. All were patients in a clinic in an inner-city hospital. We hypothesized that adolescents who were older, sexually active, and/or had received formal sex education would be better informed. We used a two-part, self-administered questionnaire. The first part focused on definitions of nine common medical and reproductive health terms; the second focused on definitions of unlabeled anatomic drawings of male and female genitourinary systems. The subjects' responses revealed their lack of information as well as a great deal of misinformation. No statistical differences in knowledge were found related to age, sexual activity status, or formal sex education. Many patients knew only nontechnical and slang terms and did not understand medical terms used by physicians in the clinic. Clinicians should not assume similar patients (minority and poor) know or understand their terminology and should use simple and, if necessary, explicit vocabulary.

Academic Medical Centers↗
PubMed1992

Health consequences of behaviors: injury as a model.

Injury is the third leading cause of death in the United States and the leading cause for children, adolescents, and young adults. Injury results from multiple factors and so may its prevention. The first and simplest approach toward preventing injuries has been to innovatively and aggressively apply a traditional public health model. Strategically, the goal has been to remove harmful agents of injury and to make the environment safer. Tactics such as public information, product regulation, legislative action, and the like have been credited with reductions in mortality and morbidity. To expand our understanding and our prevention strategies across multiple injuries, other scientific knowledge bases and intervention models from fields such as psychology and child development are being used to study childhood injury. These approaches show that in addition to environmental determinants, psychosocial factors involving both the care giver and the child are related to injury. The research programs described here illustrate the advantage of investigating psychosocial factors at both molar and molecular levels. General characteristics of mothers and children related to injury help define families at risk, as well as suggesting vehicles for intervention. Behavioral factors influencing risk perception highlight the etiology of increased risk in adolescence. Injury episodes, even slight, as well as "near injuries" and dangerous and risky behavior can be quantified and analyzed by retrospective ("postmortem") approaches yielding data on commonly occurring consequences (and the lack thereof) for minor injury. Finally, approaches that simulate dangerous situations can identify interaction patterns that result in childhood injury. Based on such research, we are coming to view injuries as the result of patterns of behaviors that develop and persist over time, and as such these patterns can be detected and, one hopes, altered before a serious medical event occurs. The role of the pediatrician after injury occurs is clear. With regard to prevention of injuries, pediatricians' roles are being defined by those individuals who have begun to investigate causes, educate families, and advocate for regulation and prevention. However, like the causes and methods for prevention, the disciplines involved in the study and prevention of injury are multiple. Such a multidisciplinary approach that considers multiple factors, theories, models, and interventions to prevent injury may be the approach that is as simple as possible.

Adolescent↗
PubMed1992

Health-risk behaviors and health concerns among young adolescents.

This study examined the health concerns and behaviors of 563 adolescents (aged 11 through 14) from a variety of social, racial, and ethnic backgrounds. Behaviors associated with adolescent morbidity and mortality were examined, including sexual behavior, substance use, and injury-related behaviors. Although young adolescents are often viewed as unlikely participants in these risk behaviors, the results of this study suggest that greater attention should be paid to this younger group and their health-risk behaviors. A majority of the sample had tried alcohol and tobacco, and almost a third had used marijuana. Twenty-one percent were sexually active. Prevalence rates varied by social class, race-ethnicity, gender, and age. More than 75% of the sample had visited a physician during the prior year, suggesting an important role physicians may serve as sources of information and positive role models for these young adolescents. The results suggest that we stop viewing young adolescents as naive children and begin to view them as observers of and participants in a changing social environment that has important implications for their current and future health status. Without a realistic appraisal of the young adolescent, we can expect to have little overall effect on the status of adolescent health in the United States.

Adolescent↗
PubMed1990

Adolescent contraceptive behavior: an assessment of decision processes.

The utility of a rational model of contraceptive use in adolescents was evaluated in a cohort of 325 sexually active adolescents aged 14 to 19 years. Adolescents were interviewed regarding their beliefs about the consequences of using each of four methods of contraception, evaluation of those consequences, perception of the wishes of others regarding use of each method, motivation to comply with those wishes, general attitude toward using the method, view of general social expectations regarding their use of the method, and their intention to use the method during the next year. They were reinterviewed 1 year later to determine actual use. The results support the utility of this model for understanding adolescent behavior. Significant associations were found between intentions to use contraceptive methods and their actual use. Intentions were significantly related to adolescents' attitudes toward using the methods and their perception of social expectations regarding use. General attitudes were significantly related to a summary score reflecting the adolescents' beliefs about specific consequences of use weighted by their evaluations of them. General social perceptions were significantly related to a summary score of perceived desires of specific individuals multiplied by the adolescent's desire to comply with those desires. These findings indicate that physicians can be more effective in clinical practice by querying adolescents about their beliefs and intentions and about their perceptions of significant individuals in their lives.

Adolescent↗
PubMed1990

The utility of multiple strategies for understanding complex behaviors.

Nickerson's critique of our brief report on changes in knowledge, attitudes and use of condoms among adolescents over a year's time mistakenly interprets the paper as examining an attitude/behavior discrepancy. A number of her criticisms follow from this mistaken interpretation. We agree with some of her general points but identify several errors in her analysis and note areas of disagreement about strategies for studying complex behaviors.

Adolescent↗
PubMed1989

Differences in biologic maturation, sexual behavior, and sexually transmitted disease between adolescents with and without cervical intraepithelial neoplasia.

Because several cofactors may influence the development of cervical intraepithelial neoplasia (CIN) in young women, we compared differences in behaviors (sexual activity, contraception, and cigarette use), sexually transmitted disease (STD) infection rates (Chlamydia trachomatis, Neisseria gonorrhoeae, Trichomonas vaginalis, and herpes simplex virus), and cervical maturation (age of menarche and percentage of cervical ectopy) in groups of sexually active female adolescents with and without CIN. Those with CIN were compared with three non-CIN groups: (1) teenagers who were referred to a teen colposcopy clinic but had no evidence of CIN (high-risk group), (2) teenagers seen at a gynecology clinic without STD symptoms (asymptomatic group), and (3) teenagers seen at the gynecology clinic with STD symptoms (symptomatic group). The percentage of cervical ectopy was measured by colpophotography. Subjects with CIN had more lifetime sexual partners than the asymptomatic group (p less than 0.001) and were more likely to smoke cigarettes than either gynecology clinic group (p less than 0.01). No differences in behaviors existed between the CIN and high-risk groups. The mean age of menarche in those with CIN was 1 year older than all three non-CIN groups (p less than 0.05), and those with CIN had a greater area of ectopy than those without CIN (p less than 0.02). Those with CIN were more likely to have a past or present history of C. trachomatis infection than the two gynecology clinic groups; no difference was found between the CIN and high-risk groups. We conclude that cofactors such as smoking, sexual promiscuity, and C. trachomatis infection may influence cervical vulnerability. However, cervical biologic immaturity is an important risk factor for development of CIN in adolescent girls.

Adolescent↗