Comprehensive school-based health clinics: a growing movement to improve adolescent health and reduce teen-age pregnancy.
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Adolescent↗
Biomedical subjects
D Kirby
Publications and source records attributed to D Kirby.
Sexuality education: a more realistic view of its effects.
Sexuality education has been proffered as a partial solution to a variety of adolescent sexual problems. Research demonstrates that programs increase knowledge, but have little direct impact on values and attitudes, actual sexual behavior, use of birth control, and teen-age pregnancy. This article compares the effects of sexuality education programs with the results of other educational programs and discusses why sex education programs may increase knowledge, but may not effectively change behavior. Finally, good reasons to offer sexuality education are discussed.
Adolescent↗
The effects of school sex education programs: a review of the literature.
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Adolescent↗
The experts rate important features and outcomes of sex education programs.
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Child↗
Polycythemia and tetralogy of Fallot in a cat.
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Animals↗
A new barrier-free burn center.
This article describes a barrier-free burn center that is accessible to persons with disabilities and that complies with Title III of the Americans with Disabilities Act. The burn center has 3 separate components: patient rooms, patient support facilities, and staff support facilities. Thirteen rooms are used to care for 16 patients. Two of the 13 rooms are accessible to people with disabilities. These 2 rooms have wide doors that permit a wheelchair to pass through, and they have enough clear floor space for a wheelchair to make a 180 degrees turn. The rooms have a sink that is accessible from a wheelchair. The bathrooms have large, clear floor spaces that allow for the turning of a wheelchair, elevated toilets, grab bars, and showers that permit wheelchair access. Special wheelchairs that provide easier shower and commode access are available. The patient support services feature a large hydrotherapy room that contains a table-shower system that allows a person in a wheelchair to gain access to both sides of the shower table. A tub room has been constructed to provide compact patient bathing and hydromassage, and it is also accessible to people in wheelchairs. The staff support services include a locker room that has a shower accessible to people with disabilities so that staff members with mobility disorders can work in the burn center. Grade II braille writing marks all of the signs that designate the permanent rooms and spacing in the burn center and in the contiguous common use areas. The common use area has a restroom accessible to people with disabilities and a waiting room with a telephone communications system for people with mobility disorders or mobility impairment.
Architectural Accessibility↗
Absence seizure with generalized rhythmic delta activity.
In seven children, 5-11 years old, who presented with spells of staring or unresponsiveness, hyperventilation reproduced clinical spells that were accompanied on the EEG by generalized, rhythmic, delta activity. The discharges were usually of abrupt onset, extremely high amplitude, recurrent, and prolonged. One spontaneous staring spell, not provoked by hyperventilation, was also accompanied by generalized rhythmic delta activity. All patients had improvement or complete control of their spells and abolition of the EEG changes with ethosuximide or valproate. Delta activity during hyperventilation in children may not always be benign and may be associated with clinical absence seizures.
Anticonvulsants↗
Manifestations of poverty and birthrates among young teenagers in California zip code areas.
CONTEXT: Given that many communities are implementing community-wide initiatives to reduce teenage pregnancy or childbearing, it is important to understand the effects of a community's characteristics on adolescent birthrates. METHODOLOGY: Data from the 1990 census and from California birth certificates were obtained for zip codes in California. Regression analyses were conducted on data from zip code areas with at least 200 females aged 15-17 between 1991 and 1996, to predict the effects of race and ethnicity marital status, education, employment, income and poverty, and housing on birthrates among young teenagers. RESULTS: In bivariate analyses, the proportion of families living below poverty level within a zip code was highly related to the birthrate among young teenagers in that zip code (r=.80, p<.001). In multivariate analyses, which controlled for some of the correlates of family poverty level, the proportion of families living below poverty level remained by far the most important predictor of the birthrate among young teenagers (b=1.54), followed by the proportion of adults aged 25 or older who have a college education (b=-0.80). Race and ethnicity were only weakly related to birthrate. In all three racial and ethnic groups, poverty and education were significantly related to birthrate, but the effect of college education was greater among Hispanics (b=-2.98) than among either non-Hispanic whites (b=-0.53) or blacks (b=-1.12). Male employment and unemployment and female unemployment were highly related to the birthrate among young teenagers in some racial or ethnic groups, but not in others. CONCLUSIONS: Multiple manifestations of poverty, including poverty itself, low levels of education and employment, and high levels of unemployment, may have a large impact upon birthrates among young teenagers. Addressing some of these issues could substantially reduce childbearing among young adolescents.
Adolescent↗
Reducing the risk: impact of a new curriculum on sexual risk-taking.
Reducing the Risk is a new sexuality education curriculum, based on social learning theory, social inoculation theory and cognitive-behavioral theory and employing explicit norms against unprotected sexual intercourse. In a quasi-experimental evaluation, this curriculum was implemented at 13 California high schools; 758 high school students assigned to treatment and control groups were surveyed before their exposure to the curriculum, immediately afterwards, six months later, and 18 months later. Among all participants, the program significantly increased participants' knowledge and parent-child communication about abstinence and contraception. Among students who had not initiated intercourse prior to the pretest, the curriculum significantly reduced the likelihood that they would have had intercourse by 18 months later. Reducing the Risk did not significantly affect frequency of sexual intercourse or use of birth control among sexually experienced students. Among all lower risk youths and among all students who had not initiated intercourse prior to their exposure to the curriculum, the curriculum appears to have significantly reduced unprotected intercourse, either by delaying the onset of intercourse, either by delaying the onset of intercourse or by increasing the use of contraceptives. Among the students not sexually active before participation in the program, effects seem to have extended across a variety of subgroups, including both whites and Latinos and lower risk and higher risk youths, but were particularly strong among lower risk youths and females.
Adolescent↗
Six school-based clinics: their reproductive health services and impact on sexual behavior.
An evaluation of the reproductive health programs of six diverse school-based clinics measured the impact of the clinics on sexual behavior and contraceptive use. All six clinics served low-income populations; at five of them, the great majority of the students served were black. An analysis of student visits by type of care given found that these clinics were not primarily family planning facilities; rather, they provided reproductive health care as one component of a comprehensive health program. Student survey data collected in the clinic schools and nearby comparison schools (four sites) or collected both before the clinic opened and two years later (two sites) indicated that the clinics neither hastened the onset of sexual activity nor increased its frequency. The clinics had varying effects on contraceptive use. Providing contraceptives on site was not enough to significantly increase their use; in only one of the three sites that did so were students in the clinic school significantly more likely than students in the comparison school to have used birth control during last intercourse. However, condom use rose sharply at one clinic school that had a strong AIDS education program and was located in a community where AIDS was a salient issue. At another clinic school, where pregnancy prevention was a high priority and staff issued vouchers for contraceptives, the use of condoms and pills was significantly higher than in the comparison school. A third clinic school--which focused on high-risk youth, emphasized pregnancy prevention and dispensed birth control pills--recorded a significantly higher use of pills than its comparison school. Although the data suggest that the clinics probably prevented small numbers of pregnancies at some schools, none of the clinics had a statistically significant effect on school-wide pregnancy rates.
Acquired Immunodeficiency Syndrome↗
A direct mailing to teenage males about condom use: its impact on knowledge, attitudes and sexual behavior.
In August 1987, a letter, informational pamphlet and order coupon for free mail-order condoms were sent to an experimental group of teenage males 16-17 years of age. An experimental design was used to measure the impact of the mailing on teenagers' knowledge, attitudes and behavior. Approximately five weeks after the mailing, 985 members of this group and 1,033 members of the control group (who received no mailing) were interviewed by telephone. About seven months after the mailing, members of the experimental group who claimed they had ordered the free condoms were reinterviewed by phone. The results of the initial interviews revealed that about three-fourths of the teenagers in the experimental group had received the materials, and about two-thirds had read them. Moreover, males in the experimental group, particularly those who reported having received and read the pamphlet, were slightly but statistically significantly more knowledgeable about sexually transmitted diseases (STDs), pregnancy and contraceptives. On the other hand, there were no differences between males in the experimental and control groups in attitudes toward STDs or birth control, nor were there differences in actual sexual activity or in the use of birth control. However, the experimental group was significantly more likely to have ordered condoms by mail, presumably as a result of having received the free mail-order condom offer. Many of those who ordered condoms had previously had sex and had used condoms. However, a sizeable portion of those who ordered condoms did so prior to first intercourse, suggesting a possibly important early intervention.
Adolescent↗
Support for the silent sufferers.
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Aged↗
School-based programs to reduce sexual risk behaviors: a review of effectiveness.
This review was undertaken in recognition of the mounting public health and social problems associated with adolescent sexual behavior and the importance of basing school-affiliated programs designed to reduce sexual risk-taking behavior on sound research. The authors were commissioned by the Division of Adolescent and School Health within the Centers for Disease Control and Prevention, Public Health Service, to review carefully the research on these programs and to assess their impact on behavior. The authors identified 23 studies of school-based programs that were published in professional journals and measured program impact on behavior. They then summarized the results of those studies, identifying the distinguishing characteristics of effective programs, and citing important research questions to be addressed in the future. Not all sex and AIDS education programs had significant effects on adolescent sexual risk-taking behavior, but specific programs did delay the initiation of intercourse, reduce the frequency of intercourse, reduce the number of sexual partners, or increase the use of condoms or other contraceptives. These effective programs have the potential to reduce exposure to unintended pregnancy and sexually transmitted disease, including HIV infection. These programs should be replicated widely in U.S. schools. Additional research is needed to improve the effectiveness of programs and to clarify the most important characteristics of effective programs.
Acquired Immunodeficiency Syndrome↗
The effects of school-based health clinics in St. Paul on school-wide birthrates.
School-based clinics in St. Paul have provided comprehensive health services, including reproductive health care, for almost two decades. This study examines the effects of those clinics on the birthrates in their respective schools, using a newly developed methodology with numerous advantages over previous methods for estimating student birthrates. Confidentially matching the names of female students from school records with the names of mothers on birth records at the Department of Health provided birthrates for each of the St. Paul public high schools with clinics for each year between 1971 and 1986. The results show that birthrates fluctuated dramatically from one year to the next, but school-wide birthrates were not significantly lower in the years immediately following the opening of a clinic than in the years preceding it.
Abortion, Legal↗
The impact of the Postponing Sexual Involvement curriculum among youths in California.
Postponing Sexual Involvement (PSI) is a widely implemented middle school curriculum designed to delay the onset of sexual intercourse. In an evaluation of its effectiveness among seventh and eighth graders in California, 10,600 youths from schools and community-based organizations statewide were recruited and participated in randomly assigned intervention or control groups; the curriculum was implemented by either adult or youth leaders. Survey data were collected before the program was implemented, and at three months and 17 months afterward. At three months, small but statistically significant changes were found in fewer than half of the measured attitudes, behaviors and intentions related to sexual activity; at 17 months, none of these significant positive effects of the PSI program had been sustained. At neither follow-up were there significant positive changes in sexual behavior; Youths in treatment and control groups were equally likely to have become sexually active, and youths in treatment groups were not less likely than youths in control groups to report a pregnancy or a sexually transmitted infection. The evaluation suggests that PSI may be too modest in length and scope to have an impact on youths' sexual behavior.
Adolescent↗
Education Now and Babies Later (ENABL): life history of a campaign to Postpone Sexual Involvement.
Education Now and Babies Later (ENABL), a statewide adolescent pregnancy prevention initiative, was inaugurated in California in June 1992. Developed by the state's Office of Family Planning, ENABL utilized a five-session intervention curriculum, Postponing Sexual Involvement (PSI), targeted at delaying the onset of sexual activity among youths aged 12-14. Schoolwide and community-based activities, along with a statewide media and public relations campaign, reinforced the intervention's message. Data collected from nearly 9,000 surveys, 75 individual interviews and 50 focus groups indicated that youths, parents and community representatives supported the initiative and endorsed its message, although most recommended changes to the curriculum. However, because no impact on sexual behavior could be demonstrated, the campaign was abruptly terminated in February 1996, despite recommendations that the program be retained and improved.
Adolescent↗