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PubMed2003

The feasibility, demand, and effect of integrating primary care services with HIV voluntary counseling and testing: evaluation of a 15-year experience in Haiti, 1985-2000.

BACKGROUND: HIV voluntary counseling and testing (VCT) may be an effective strategy to prevent transmission of HIV in developing countries. Hypothesizing that primary care services and HIV VCT have synergistic benefits, we examine the feasibility, the demand, and the effect of integrating on-site primary care services into VCT at a stand-alone VCT center in Port au Prince, Haiti. METHODS: Through a retrospective review of patient records, we describe the integration of primary care services at the Groupe Haitien d'Etude du Sarcome de Kaposi et des Infections Opportunistes (GHESKIO) VCT center between1985 and 2000. RESULTS: Between 1985 and 1999, services for HIV care, tuberculosis care, treatment of sexually transmitted diseases, and reproductive health were sequentially integrated into HIV VCT at GHESKIO. The number of new people seeking voluntary counseling and testing at GHESKIO increased from 142 in 1985 to 8175 in 1999, with an increasing percentage of women, adolescents, symptom-free clients, and self-referred clients. Of new adults seeking VCT in 1999, the center was able to provide AIDS care to 17%, tuberculosis treatment to 6%, sexually transmitted infection management to 18%, and family planning to 19%. HIV transmission between discordant couples was 0 infections/100 follow-up years (95% CI, 0-3.2); vertical transmission from mother to child was 11 infections/100 live births (95% CI, 4.6-21.9); These rates are significantly lower than expected rates of transmission in Haiti. CONCLUSIONS: This report demonstrates the feasibility, demand, and effective synergy of integrating on-site primary care services into HIV VCT in Haiti. VCT is a good entry point for people in need of services for communicable diseases and reproductive health, and, reciprocally, services attract more people to VCT, including populations that are at high risk for HIV infection. This program is being duplicated elsewhere in Haiti and can serve as a model for other countries.

Adolescent↗
PubMed2007

A pilot intervention to enhance psychosexual development in adolescents and young adults with cancer.

BACKGROUND: Evidence suggests that cancer diagnosed during adolescence and young adulthood may present considerable challenges to what would otherwise be a relatively smooth developmental trajectory, particularly in areas related to reproductive health. We created and pilot tested a two-session, individually-delivered, counseling intervention to enhance psychosexual development in this unique population. PROCEDURES: A total of 21 patients, aged 15 to 25 years and treated for cancer within the past 5 years, completed the counseling intervention. Patients were adaptively randomized to begin the intervention immediately, or to be placed on a 3-month waitlist, after which time, they were reassessed and began the intervention. The content of the intervention included education, dialog, and support regarding cancer and such issues as sexual development and function, body image, fertility, prevention of sexually transmitted disease and unwanted pregnancy, and romantic relationships (e.g., dating, sexual communication). A 1-month follow-up booster call followed the intervention. Questionnaires were completed at baseline, post-waitlist (for half the sample), post-treatment, and at 3-month follow-up. RESULTS: Participation in the intervention increased cancer-specific knowledge regarding sexual issues; improved body image; lessened anxiety about sexual and romantic relationships; and decreased overall level of psychological distress. Gains were maintained through the 3-month follow-up. CONCLUSIONS: Addressing issues of reproductive health in the adolescent/young adult with cancer can and should be offered as a part of comprehensive pediatric cancer care.

Adolescent↗
PubMed2001

In vitro reproductive toxicity of polychlorinated biphenyls: effects on oocyte maturation and developmental competence in cattle.

Polychlorinated biphenyls (PCBs) are one of the most persistent and widespread group of endocrine disrupting compounds in the ecosystem. High concentrations of these substances are known to be present in sewage sludge from industrial, agricultural, and domestic origin that is spread in increasing amounts on arable land and pasture as fertilizer and is found in water, representing an increasing risk for the reproductive health of farm animals. Objective of this study was to determine the impact of PCBs on maturation and developmental competence of cattle oocytes. Since PCBs are a family of 209 molecules present in the environment as a mixture, Aroclor-1254, a pool of more than 60 congeners, was used in these experiments as its composition is considered to be environmentally relevant. Cumulus-oocytes complexes were exposed during IVM to serial concentrations of Aroclor-1254 (between 1 microg/ml and 0.0001 microg/ml) and compared with control groups. Aroclor decreased the percentage of oocytes that reached metaphase II stage after 24 hr, at doses as low as 0.01 microg/ml. Groups treated with 0.001 microg/ml or above, showed an impaired fertilization rate and a dramatic increase of polyspermy. Moreover, exposure during maturation resulted in a reduced proportion of oocytes that cleaved and developed until blastocyst stage although no differences in embryo cell numbers were observed. The present study indicates that very low PCBs concentrations are sufficient to disrupt bovine oocyte maturation, its fertilization, and developmental competence. These results also provide a set of reference data for the assessment of the risk posed by these substances to animal reproductive health, though further work will be necessary to equate in vitro doses to in vivo exposures.

Animals↗
PubMed1997

Morbidity in a large cohort study of children born to mothers exposed to radiation from Chernobyl.

Reproductive health was reviewed in four oblasts of the Republic of Belarus that were either heavily exposed (Mogilev and Gomel) or lightly exposed (Brest and Vitebsk) to ionizing radiation after the meltdown of a nuclear reactor in Chernobyl. A retrospective analysis was conducted on pregnancies occurring between January 1, 1982, and December 31, 1990, and a comparison of results was made between pregnancy outcomes prior to and after the meltdown for individuals residing in heavily exposed and lightly exposed oblasts. Pregnant women who resided in heavily exposed oblasts appeared to be at risk for development of toxemia, renal insufficiency and anemia. Neonates born in heavily contaminated areas were apparently at risk for development of anemia and congenital malformations and perinatal death. In addition, a cohort of 757 neonates, 0-18 months old, with a normal physical examination, was identified for laboratory analysis of hematological, immunological, endocrinological and nutritional status. Decreased levels of copper and zinc were documented in erythrocytes from neonates from heavily contaminated oblasts, findings that may be related more to inadequate nutrition than to radiation exposure. Increased absolute "null" lymphocyte number and diminished absolute T lymphocyte number with a reduction in the "helper" (i.e., T4) subclass of T cells were evident in neonates born-in heavily exposed oblasts. Geographic differences in reproductive health and immune status are apparent in Belarus that may be related to radiation exposure. Additional studies are required to exclude confounding variables and possible selection bias.

Abnormalities, Radiation-Induced↗
PubMed2006

Reproductive disorders and pregnancy outcomes among female flight attendants.

BACKGROUND: Occupational exposures in female aircrew may cause adverse pregnancy outcomes and menstrual disturbances. We studied reproductive health among female flight attendants. METHODS: We conducted a cross-sectional health survey among an occupational cohort of current and former flight attendants using a postal questionnaire including items on pregnancy outcome, menstrual characteristics, and infertility. We investigated these factors by occupational status (in service or not). RESULTS: The questionnaire was sent to 3036 women with a response rate of 64% (74% for current and 48% for former flight attendants). Spontaneous abortion rates were similar for pregnancies of women in service and not (12.6 vs. 11.4%; p = 0.58). Induced abortion rates were lower for in-service pregnancies (7.9%) compared with pregnancies of women not in service (21.1%) (p < 0.001). Menstrual irregularities in the year preceding the survey for women under 40 yr were more frequent among current than former flight attendants (20.6% vs. 10.4%, p = 0.02). Fertility problems were reported by 20.6% of respondents. An association between infertility and irregular menstrual cycles was found: odds ratio 1.6; 95% confidence limits 1.1, 2.4. CONCLUSIONS: Active flight attendants had a lower rate of induced abortions than former flight attendants, but the spontaneous abortion rate was similar between the two groups. Active flight attendants reported more menstrual irregularities, which are a risk factor for infertility. Lack of comparison with working women in other occupations precludes a conclusion that flight attendants are at greater occupational risk of reproductive disorders. Future studies of reproductive health in flight attendants should address personal and work-related risk factors in more detail and include comparison occupational groups.

Abortion, Induced↗
PubMed2001

Impaired maturation, fertilization, and embryonic development of porcine oocytes following exposure to an environmentally relevant organochlorine mixture.

The reproductive health risks related to exposure to persistent organic pollutants in the environment remain controversial. This debate is partly because most studies have investigated only one or two chemicals at a time, whereas populations are exposed to a large spectrum of persistent chemicals in their environment. Using the pig as a toxicological model, we hypothesized that exposing immature cumulus-oocyte complexes to an organochlorine mixture during in vitro maturation (IVM) would adversely affect oocyte maturation, fertilization, and subsequent embryo development. This organochlorine mixture mimics that which contaminates the Arctic marine food chain. Cumulus-oocyte complexes were cultured in IVM medium containing increasing concentrations of the organochlorine mixture, similar to that found in women of highly exposed populations. Organochlorines reduced the quality of cumulus expansion and the viability of cumulus cells in a dose-response manner. The proportion of apoptotic cumulus cells also increased due to organochlorine exposure. Half of the oocytes were fixed after insemination, and the remainders were cultured for 8 days. Concentrations of organochlorines did not affect the rates of oocyte degeneration, sperm penetration, and development to morula. However, incidence of incompletely matured oocytes increased and polyspermy rate decreased, both in a dose-response manner with increasing organochlorine concentrations. Blastocyst formation and number of cells per blastocyst declined with organochlorine concentration. Exposing porcine cumulus-oocyte complexes to an environmentally pertinent organochlorine mixture during IVM disturbs oocyte development, supporting recent concerns that such pollutants harm reproductive health in humans and other mammalian species.

Animals↗
PubMed2003

Temporal trends in orchidopexy, Great Britain, 1992-1998.

Concern has been expressed in recent years about worsening male reproductive health, possibly mediated by increasing exposures to environmental endocrine-disrupting agents. Trends suggested large increases in cryptorchidism in Britain and the United States between the 1950s and 1980s, although published data on recent trends have been scarce. We examined numbers of orchidopexy procedures, as a marker for cryptorchidism, using routine hospital admission data for England, Wales, and Scotland for fiscal years 1992-1993 through 1998-1999. Annual trends in orchidopexy rates were analyzed by age, in-patient admission versus day case, and geographical region. Orchidopexy rates were also obtained from the General Practice Research Database (GPRD) for England to cross-validate the hospital admissions data. Orchidopexy rates for boys 0-14 years old fell by 33% (from 23.5 to 15.8 per 10,000 population) between 1992 and 1998, with the steepest decline (50%) in 5-9-year-olds. The decreasing trend for 0-14-year-olds was evident in every region in England, in Wales, and in Scotland. Rates remained stable for men 15 or more years old, at 0.7 per 10,000. There was a marked shift from in-patient to day-case procedures. Rates from the GPRD showed a similar downward trend to the hospital data. Our findings could represent either an underlying decrease in the frequency of undescended testis or a fairly dramatic improvement in the diagnosis of cryptorchidism--resulting in fewer orchidopexies performed for retractile testis--in Great Britain during the 1990s, or both. Either way, our findings do not support the postulate of a recent worsening of male reproductive health of the scale suggested by some recent commentators on the endocrine disruptor hypothesis.

Adolescent↗
PubMed2006

Determinants of condom use among youth in Madagascar.

The objective of this study was to identify the key determinants of condom use with regular and casual partners among youth in Madagascar. Data stem from a reproductive health survey conducted in October-December 2000 among a representative sample of 2440 youth aged 15-24 living in Toamasina province. Following theoretical models of behaviour change, logistic regression was used to assess the effect of AIDS awareness,personal risk perception, condom access, perceived condom effectiveness,self-efficacy and social support on condom use. Among sexually experienced youth, only about four in ten males and two in ten females have ever used condoms. Fewer than 15% of youth used a condom in last intercourse with their regular partner. Whether youth will try condoms appears to depend largely on the perceived effectiveness of condoms for family planning, access to a nearby condom source, parental support for condom use, and patterns of risky sexual behaviour. Young males' likelihood of using a condom with a regular partner increases significantly if they perceive condoms to be effective for family planning (OR=11.4; p=0.019). For females, it increases with level of self-efficacy (OR=2 1; p=0.042) and having discussed HIV prevention with someone in the last year (OR=2.8; p=0.022). Among males,condom use with casual partners is significantly higher among those who perceive themselves to be at high risk of sexually transmitted infections(OR=2.3; p=0.014), who believe condoms are effective for family planning(OR=2.8; p=0.048), who have good access to condoms (OR=2.9; p=0.002)and who perceive their parents support condom use (OR=1-7; p=0.048). In conclusion, very few youth in Toamasina are using condoms, highlighting the need to continue and expand adolescent reproductive health interventions. In this low HIV prevalence setting, it is important for these programmes to emphasize that condoms are effective for both pregnancy prevention and STI/HIV prevention.

Adolescent↗
PubMedDate not supplied

Men's knowledge of and attitude with respect to family planning in a suburban Nigerian community.

BACKGROUND: Men's Knowledge of and attitudes to family planning (FP) in suburban and rural Nigeria is still poor despite a global move to increase the involvement of men in reproductive health matters. A cross-sectional survey was conducted to determine men's knowledge of and attitude to family planning at Ganmo, a sub-urban community on the outskirts of Ilorin, Nigeria. METHOD: The study employed an interviewer administered semi-structured questionnaire to elicit information from 360 men in the households. Only males above the age of 15 years resident in the community were selected for interview A proportionate sampling procedure was employed in selecting the required numberof men from each of the 32 compounds that make up the community. RESULTS: Nearly all men (96.5%) were aware of family planning and a majority of them were aware of some common methods of family planning e.g. Oral Contraceptive Pills (OCPs) (72.5%), Injectables (69.2%), Condoms (86.6%) and Traditional methods (70.6%). Knowledge of other alternative female methods was low e.g. Norplant (17.5%), IUCD (26.3%), Diaphragm (39.8%), Vaginal cream (30.2%), Vaginal tablet (37.8%) and Vaginal sponge (16.8%), and Tubal Ligation (51.3%). Knowledge of male controlled FP methods like Withdrawal (49.6%), Rhythm or periodic abstinence (54.6%) and Vasectomy (28.6%) was also poor. The Respondents had low knowledge of common side effects of FP methods e.g. nausea (9.8%), vomiting (13.1%), abnormal menstruation (34.4%), pain (23.2%) and unwanted weight gain (17.0%); some 25.3%% of respondents had no knowledge of any side effects. The attitude of respondents to family planning was also relatively poor as only a moderate proportion of men supported the FP concept (52.7%) and the Nigerian Population Policy (54.8%) of "four children to a woman". Some 54.8% of respondents were in support of men discussing about FP with their spouses. The major reasons for non-approval of FP by men were the fear of side-effects (70.4%) and perception of FP as being against religion (52.1%). The predictors of poor FP attitude were not having formal education, practice of polygyny and to a lesser extent being a Muslim. CONCLUSION: The study concluded that, men at Ganmo have limited knowledge of, and poor attitude to FP An intensive drive at a community based adult reproductive health education was advocated among other recommendations.

Adolescent↗
PubMed2006

Female conduct disorder: health status in young adulthood.

PURPOSE: One of the risk factors for poor adult health may be adolescent antisocial behavior, especially in girls. This study was conducted to determine if negative young adult health outcomes in girls who previously had adolescent antisocial behavior could be explained by demographic factors and pre-existing health problems. METHODS: This 3-year longitudinal study recruited 93 girls, ages 15-17 years (52 with conduct disorder [CD]; 41 with no psychiatric illness [normal controls; NC]) from the community. Baseline interviews of girls and parents collected demographic, psychiatric, and medical history data. Three annual interviews collected data about medical problems, health care service utilization, and reproductive health. In addition, the final follow-up included a standardized self-report questionnaire about young adult health status. RESULTS: CD and NC groups did not differ in age, racial composition, social class, proportion of smokers, or drug and alcohol experimentation. They were qualitatively different in baseline medical histories. Controlling for age at follow-up and baseline medical problems, the CD group as young adults had worse overall health, more discomfort, higher rates of unhealthy habits, lower rates of healthy behaviors, and more pregnancies at earlier ages. There were no group differences in rates of disorders, injuries, or health care usage. CONCLUSIONS: Adolescent girls with CD as young adults have poorer overall health, more discomfort, more health risk behaviors, and earlier onset of adult reproductive behaviors, even when controlling for demographic factors and pre-existing health history. Clinical and research implications are discussed.

Adolescent↗
PubMed1994

The introduction of Cyclofem into national family planning programmes: experience from studies in Indonesia, Jamaica, Mexico, Thailand and Tunisia. Task Force on Research on Introduction and Transfer of Technologies for Fertility Regulation, Special Programme of Research, Development and Research Training in Human Reproduction, World Health Organization, Geneva, Switzerland.

Studies on the introduction of Cyclofem into family planning programmes have been undertaken in Indonesia, Jamaica, Mexico, Thailand and Tunisia. Cyclofem is a once-a-month injectable contraceptive containing 25mg medroxyprogesterone acetate and 5mg estradiol cypionate. A total of 7927 subjects were followed in close to routine service delivery conditions in primary and secondary family planning outlets. The studies confirmed the high efficacy of the method with 12-month pregnancy rates ranging from 0 to 0.7%. Major differences were seen in reasons and rates of discontinuation between countries, the overall 12-month life table discontinuation rates ranging from 33.5% in Indonesia to 71.8% in Tunisia. The reasons for discontinuation in each of the five countries are described, differences between countries contrasted, and service delivery issues which should be addressed further, raised.

Adolescent↗
PubMed1988

Health and reproductive outcomes among American Legionnaires in relation to combat and herbicide exposure in Vietnam.

History of diagnosed illnesses, medical symptoms, and reproductive outcomes and their relation to combat intensity and herbicide exposure were studied, via a mailed questionnaire, among 6810 American Legionnaires who served during the Vietnam War (42% in Southeast Asia, 58% elsewhere). Heart disease, venereal disease, and benign fatty tumors were reported significantly more often by Vietnam veterans than by controls. Combat intensity was significantly dosage-related to history of high blood pressure, ulcers, arthritis and rheumatism, genito-urinary problems, nervous system disease, major injury, hepatitis, and benign fatty tumors. Agent Orange exposure was significantly dosage-related to history of benign fatty tumors, adult acne, skin rash with blisters, and increased sensitivity of eyes to light. Rates of the latter two conditions and of change in skin color were especially elevated in men whose military occupations involved direct handling of herbicides. Five "symptom complex" scales were constructed via factor analysis to measure degrees of feeling faint, fatigue or physical depression, body aches, colds, and skin irritation. Means of all five scales were significantly higher in Vietnam veterans compared to controls, and in herbicide handlers compared to nonhandlers. Both combat and Agent Orange exposure were significant, independent predictors of each of the five scales. Neither combat nor Agent Orange exposure was associated with difficulty in conception, time to conception of first child, or to birthweight or sex ratio of offspring, but maternal smoking was strongly related to reduced birthweight. The percentage of spouses' pregnancies which resulted in miscarriages was significantly higher for Vietnam veterans than controls (7.6% vs 5.5%, P less than 0.001). Logistic regression analysis showed that Agent Orange exposure and maternal smoking were both independently and significantly associated with miscarriage rates in a dose-related manner.

Adult↗
PubMed1983

Teenagers' assessment of reproductive health-care services.

Adolescent clients of a Teen Health Clinic were surveyed to determine those aspects of the service that were considered crucial to patient acceptance and program continuance. A simple one-page questionnaire enabled the clients to express their feelings about personnel, services, environment, and educational materials used in the clinic. Eighty-five percent of the clients expressed positive reactions to the clinic, while only 25.5% offered negative statements. Most respondents indicated clinic staff as the feature they liked most about the service and mentioned routine clinical activities as the part they liked least. Of the topics on which teenage clients wanted more information, 68% indicated that they wanted factual data rather than information about feelings, emotions, or relationships.

Adolescent↗
PubMedDate not supplied

Estrogen modulation: tiered testing for human hazard evaluation. American Industrial Health Council, Reproductive and Developmental Effects Subcommittee.

Recent concerns about the potential of certain chemicals to modulate estrogen-regulated processes have led to questions as to how chemicals should be tested for such effects. Therefore, AIHC has developed a comprehensive, resource-efficient, and flexible tiered strategy for estrogen modulation (EM) testing. Levels of evaluation include Tier 0, in which exposure, along with alerts based on structure-activity, persistence, bioaccumulation, and other data, are assessed to prioritize chemicals for preliminary testing. In Tier I, short term in vitro, ex vivo, and/or in vivo assays are used to obtain a preliminary indication of EM potential. Among these, an in vivo response assay is considered the most reliable at this time. However, none of these tests are intended for risk assessment, but rather to aid in choosing chemicals for further testing and in guiding the extent of that testing. Tier II is aimed at risk assessment and involves whole animal tests that contain EM-sensitive end points (e.g., two-generation reproduction study). Tier III consists of hypothesis-driven research reserved for situations where targeted research can reduce levels of uncertainty. This tiered approach provides a framework for the strategic and effective application of EM test methods to address specific information needs on a case by case basis.

Animals↗
PubMed2002

WHO/CONRAD technical consultation on nonoxynol-9, World Health Organization, Geneva, 9-10 October 2001: summary report.

This report summarises the evidence presented to a technical consultation on the safety of N-9 and its effectiveness for protection against pregnancy, sexually transmitted infections and HIV, organized by the World Health Organization Department of Reproductive Health and Research with CONRAD in October 2001. Key conclusions from the meeting include: 1. Although Nonoxynol-9 has been shown to increase the risk of HIV infection when used frequently by women at high risk of infection, it remains a contraceptive option for women at low risk. 2. Nonoxynol-9 offers no protection against sexually transmitted infections such as gonorrhoea or chlamydia. 3. There is no evidence that condoms lubricated with nonoxynol-9 are any more effective in preventing pregnancy or infection than condoms lubricated with silicone, and such condoms should no longer be promoted. However, it is better to use a nonoxynol-9 lubricated condom than no condom at all. 4. Nonoxynol-9 should not be used rectally.

Animals↗
PubMed2004

Developing complex interventions for rigorous evaluation--a case study from rural Zimbabwe.

Much attention has been placed on the need to develop and evaluate complex interventions targeting public health issues, such as reproductive health. However, and as has been the case in the recent past, even well-designed trials will be flawed unless meticulous attention is paid to ensuring the most appropriate intervention is designed and developed. This requires a well-resourced and carefully planned feasibility study, incorporating both formative and process evaluation, with particular attention being paid to the context of the proposed intervention. In this paper, we describe the way in which a feasibility study helped redesign and shape a complex intervention targeting adolescent sexual health in rural Zimbabwe. By using a mixture of in-depth interviews, focus groups and participant observation with pupils, parents, teachers and education officers, we were able to show that the intervention as originally conceived was unlikely to be deliverable. Process evaluation findings from the feasibility study led to substantial changes to both the content and delivery of the proposed intervention, which is now subject to testing for effectiveness in a large community randomized trial.

Adolescent↗
PubMed2002

Adolescent sexuality and sexual behavior.

PURPOSE OF REVIEW: Adolescence is a time of self-discovery and physical, as well as cognitive, development. It is within this context that adolescent sexual development and sexual behavior occur. While curiosity and experimentation are normal, sexual behaviors, both coital and non-coital, place adolescents at risk for undesired consequences including sexually transmitted disease acquisition and pregnancy. Trends in adolescent sexual behavior are changing, and health care professionals must be aware of these trends to provide necessary medical care and education to this population. RECENT FINDINGS: While the sexual activity of teenagers garners much attention, attention must also be directed at non-coital activities such as masturbation, mutual masturbation and oral sex, as the riskier of these behaviors appear to be increasing. The trends in sexual activity and contraceptive use are encouraging with a decrease in the proportion of adolescents reporting sexual activity, and an increase in the proportion reporting using contraception. These trends, however, are not shared equally among racial groups with the greatest decline reported in the in lowest risk groups. Sexual minority youth continue to report a higher prevalence of high-risk behaviors, both sexual and non-sexual, as compared to their heterosexual peers. SUMMARY: These findings highlight the multiple roles health care professionals can play in caring for this unique population: firstly as health care providers, offering age appropriate, confidential health care; secondly, as reproductive health care educators providing factual, balanced, and realistic information to both teenagers and the community; and thirdly, as advocates lobbying for greater education and services for this at-risk population.

Adolescent↗
PubMed1998

Adult physical health outcomes of adolescent girls with conduct disorder, depression, and anxiety.

OBJECTIVE: To examine the young adult physical health outcomes of adolescent girls with behavior problems. METHOD: Girls with conduct disorder, girls with depression, girls with anxiety, and healthy girls (N = 459) who had been evaluated at age 15 years were followed up at age 21, when general physical health, substance dependence, and reproductive health were assessed. RESULTS: After control for potentially confounding variables including prior health, adolescent conduct disorder predicted more medical problems, poorer self-reported overall health, lower body mass index, alcohol and/or marijuana dependence, tobacco dependence, daily smoking, more lifetime sexual partners, sexually transmitted disease, and early pregnancy. Adolescent depression predicted only adult tobacco dependence and more medical problems; adolescent anxiety predicted more medical problems. CONCLUSIONS: The robust link between female adolescent conduct disorder and poor physical health in adulthood suggests that intervention with girls who have conduct disorder may be a strategy for preventing subsequent health problems.

Adolescent↗

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