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PubMed1986

Cigarette smoking and invasive cervical cancer.

A case-control study of 480 patients with invasive cervical cancer and 797 population controls, conducted in five geographic areas in the United States, included an evaluation of the relationship of several cigarette smoking variables to cervical cancer risk. Although smoking was correlated with both age at first intercourse and number of sexual partners, a significant smoking-related risk persisted for squamous cell carcinoma after adjustment for these factors (relative risk, 1.5). The risk of squamous cell cancers increased significantly with intensity and duration of smoking. Twofold excess risks were seen for those smoking 40 or more cigarettes per day and those smoking for 40 or more years. In addition, users of nonfilter cigarettes were at particularly high risk. Increased risks, however, were observed only among recent and continuous smokers. In contrast to squamous cell cancer, no relationship was observed between smoking and risk of adenocarcinoma or adenosquamous carcinoma (n = 63). These results suggest a causal relationship between cigarette smoking and invasive squamous cell cervical cancer, perhaps through a late-stage or promotional event, although the mechanisms of action require further elucidation.

Adenocarcinoma↗
PubMed1986

[Sterility and Chlamydia infection. Risk factors].

The authors distributed a questionnaire to 89 patients who consulted them for sterility for reply by themselves. The blame for chlamydia trachomatis infection as a cause of sterility was worked out as a level of IgG above 1/8. The risk factors for being infected with chlamydia trachomatis is above all the number of sexual partners; the odds ratio of 2,68 being significant for those who had more than one partner. The age of marriage and the age at first intercourse do not count. The prevention of the consequences of infection depends on education about the risks and screening for infection when the partner is changed.

Age Factors↗
PubMedDate not supplied

Screening for sexually transmitted diseases by family planning providers: is it adequate and appropriate?

Of more than 3,000 women interviewed in the 1982 National Survey of Family Growth (NSFG) who had made at least one family planning visit in the 12 months preceding the interview, 50 percent report that they were tested for a sexually transmitted infection. Black women are far more likely to have been screened than are white women (67 percent compared with 47 percent); moreover, a racial differential is seen in every subgroup examined. There is also a large difference in the proportion screened according to the woman's source of family planning care: Those who attended a clinic are much more likely to have been screened than are women who saw a private doctor (62 percent and 43 percent, respectively). As with the race differential, this relationship persists after other variables are controlled for. In addition, women who live in the South are more likely to have been screened than are residents of other regions (58 percent compared with 46 percent). Differences by metropolitan and non-metropolitan area of residence are small and are not statistically significant. Differences by marital status and age at first intercourse appeared statistically significant in preliminary analyses, but when controls for other factors were introduced, these differences became nonsignificant. Since many characteristics that are believed to be important risk markers for sexually transmitted infections are also predictors of whether a woman will be screened for such infections, current screening practices appear, in general, to target the appropriate groups.

Adolescent↗
PubMed1985

The epidemiology of cervical neoplasia.

Controversial topics in the epidemiology of cervical neoplasia are reviewed, in the light of data from studies conducted in Italy and indications from the literature. The downward trends registered over the last three decades in mortality from cervical cancer seem to be levelling off in the younger age groups (below age 45). This may be partly due to changes in sexual habits in younger women, but is certainly attributable to deficiencies in cervical screening. Pap smear, in fact, strongly reduces the risk of cervical neoplasia, the protection (as suggested by data from a case control study), being long lasting (over five years and perhaps around 10-15 years) for invasive cancers. The results of the same case-control study indicate that, although women with pre-invasive and invasive conditions seem to share several unspecific indicators of sexual habits (i.e., total number of partners and age at first intercourse), they appear to differ with regard to clinical history of specific venereal disease. In fact, genital warts, herpes genitalis and trichomoniasis were more frequent in cases of intraepithelial neoplasia, but not of invasive cancer. The implications of these findings, and of other controversial points in the epidemiology of cervical neoplasia, such as oral contraceptives, cigarette smoking and diet, are discussed with regard to indications from other disciplines (chiefly molecular hybridization and stochastic models of carcinogenesis).

Adult↗
PubMed1985

Communication and contraceptive practices in adolescent couples.

This study presents a descriptive analysis of the content, frequency, and timing of couple communication regarding birth control among stable, sexually active adolescent couples, and the effect of communication on actual contraceptive practices. The sample consisted of 83 couples in which the female partner was 15-18 years old. All couples had been sexually active at least two months prior to the interview. The majority of couples had discussed birth control on at least one occasion, but discussions prior to first intercourse were atypical. Couples with good communication patterns were more likely to practice effective contraception. One-fourth of the respondents felt that contraception had not been adequately discussed, and these individuals were found to be most at risk to an unintended pregnancy.

Adolescent↗
PubMed1985

Cancer of the cervix. Some aspects of epidemiology, screening, risk factors and survival.

Early statistics on the occurrence of cancer of the cervix are unreliable. What is certain is that between 1950 and 1965 incidence rates (IRs) and mortality rates (MRs) fell considerably in most Western populations. Recently, however, rates in the 15-35-year age group of some populations have risen two- to threefold. In some developing populations, especially in South America and Africa, rates are very high--up to eight times those in most Western populations. Risk factors include early age at first intercourse, low socio-economic state, having multiple partners, smoking, being widowed or divorced, and having a husband who has had multiple partners. The modus operandi of carcinogenesis is not known. Screening, using the Papanicolaou test, has markedly reduced the IRs and MRs, particularly in certain Scandinavian populations. In Western populations 40-60% of patients attain 5-year survival. Understandably, in individual patients the crucial regulating factor is the stage of disease when diagnosed. Among those at stage I, 70-90% survive for 5 years or more, whereas only 0-25% of patients diagnosed at stage IV do. In Soweto, Johannesburg, length of survival in a series of black patients whose staging pattern did not markedly differ from that in Western series was less than half that in the latter. Undoubtedly, as repeatedly urged, appropriate selective screening and health education could effectively reduce the toll of mortality, especially in high-risk developing populations.

Adolescent↗
PubMedDate not supplied

Cigarette smoking and dysplasia and carcinoma in situ of the uterine cervix.

We conducted a case-control study of cigarette smoking and dysplasia and carcinoma in situ of the uterine cervix. Cases were black women 17 to 55 years of age who were attending a dysplasia clinic and had biopsy-confirmed cervical pathologic conditions. Controls were women who were attending the family planning clinic at the same hospital and who had at least two normal Papanicolaou smears. Results were adjusted for age, number of sexual partners, age at first intercourse, socioeconomic status, and oral contraceptive use. Cigarette smoking was significantly associated with carcinoma in situ, severe dysplasia, and mild-moderate dysplasia (relative risks, 3.6, 3.3, and 2.4, respectively). Cumulative exposure to cigarette smoking (as measured by pack-years smoked) was strongly related to the risk of these conditions; women with 12 or more pack-years of exposure had relative risks of 12.7, 10.2, and 4.3, respectively, for the three conditions. There was some evidence that the risk was greatest in women who began smoking in their early teenage years. A reduction in the risk of cervical cancer appears to be another inducement for young women not to smoke.

Adolescent↗
PubMed1983

Cervical Chlamydia trachomatis and mycoplasmal infections in pregnancy. Epidemiology and outcomes.

In a prospective study of chlamydial and mycoplasmal infections in pregnancy, Chlamydia trachomatis occurred in 8.0%, Mycoplasma hominis in 23.5%, and Ureaplasma urealyticum in 72.3% of 1,365 enrollees. By multivariate analysis, C trachomatis was correlated with lower socioeconomic status, age 23 years or younger, and 12 years or less of schooling. Ureaplasma urealyticum was correlated with age 23 years or younger and lower socioeconomic status. Mycoplasma hominis was correlated with more than one recent sexual partner, first intercourse at age 17 years or younger, and higher socioeconomic status. These cervical infections did not predict low birth weight, abortion, stillbirth, prematurity, or premature rupture of membranes. Only M hominis predicted endometritis/fever after vaginal delivery (relative risk, 7.3). IgM-seropositive C trachomatis-infected women had more low-birth-weight infants and more premature rupture of membranes than either IgM-negative C trachomatis-infected women or C trachomatis culture-negative women. Thus, only certain subgroups of infected women may experience adverse pregnancy outcomes.

Adult↗
PubMed1980

Cancer risk factors: an analysis of Utah Mormons and non-Mormons.

In a comparison of Mormons and non-Mormons in Utah, more Mormon men and women married spouses of the same faith, were religiously active, were of Northern Europe ancestry, lived in rural areas, had fewer exposures to occupational hazards, were less likely to smoke cigarettes or drink coffee, tea, and alcohol, used fats in cooking, and were more often married that was the cohort of other religions. No differences existed in occupation, but Mormon men had completed more years of schooling. Mormon women were less likely to be college graduates, had fewer sexual partners, had more pregnancies, were older at first pregnancy, were less likely to use birth control pills, had fewer miscarriages and hysterectomies, examined their breasts more often, and had more breast X-rays. For women, there was only a small difference by religion for age at first intercourse and no difference for age at which they began using birth control pills. Religious activity was examined for Mormons, and in most instances inactive Mormons were more like the non-Mormon population in respect to the variables measured.

Adult↗
PubMed1980

Cancer mortality in a human isolate.

Cancer mortality (1965--77) among 12,652 members of an inbred human religious isolate, the Hutterites, was compared with expectations based on mortality rates for the U.S. white population in 1970. Overall, Hutterites had significantly fewer deaths from cancer than expected (P < 0.01), due primarily to fewer lung cancers among males. Smoking is prohibited for this religious group. The most frequent types of cancers were leukemia and cancers of the digestive system, the prostate gland, and the female breast. Preliminary results suggest an association between recessive alleles and childhood leukemia. More stomach and rectal cancers were observed than expected, but differences were generally not significant. Familial aggregates of cancers of the stomach and breast are being investigated. The low frequency of cervical cancer is consistent with current evidence for an association of cervical cancer with early age at first intercourse and promiscuity, neither of which is characteristic of this population.

Canada↗
PubMed1994

Neighborhood context and the transition to sexual activity among young black women.

Previous studies report that neighborhood characteristics influence pregnancy and childbearing risk among African-American adolescent women. These studies, however, leave unidentified the effects of many neighborhood properties on the proximate determinants of nonmarital fertility. In this study I examine the effects of neighborhood characteristics on the risk of nonmarital first intercourse and on contraceptive use among black female adolescents. The results suggest that neighborhood socioeconomic status, female employment and marital dissolution rates, and peers' departure from mainstream lifecourse trajectories influence young black women's sexual and contraceptive behavior. The effects of female employment and socioeconomic status are greater for teens in urban neighborhoods than for teens living elsewhere.

Adolescent↗
PubMed1994

Human papillomavirus infection and its relationship to recent and distant sexual partners.

OBJECTIVE: To determine the relation between the detection of genital human papillomavirus (HPV) DNA and the number of new sexual partners in the last year, 1-5 years, and 5-10 years. METHODS: In a cross-sectional study, 298 women collected tampon specimens and completed self-answer questionnaires on the known risk factors for HPV infection, including the number of sexual partners during the last 1, 5, and 10 years. The tampons were analyzed for the presence of HPV DNA by polymerase chain reaction using L1 consensus primers. RESULTS: Ninety-two (30.9%) tampons were positive for HPV DNA. In univariate analysis, the presence of HPV DNA was associated with a younger age, single marital status, a previously abnormal or currently abnormal Papanicolaou smear, and one or more new sexual partners in the last year, 1-5 years, and 5-10 years. The presence of HPV DNA was not associated with education level, past pregnancy, current or past oral contraceptive use, or the age at first intercourse. In multivariate analysis, only the number of sexual partners during the last year and 1-5 years, and a previously abnormal Papanicolaou smear were associated with HPV. CONCLUSION: The presence of HPV DNA is best predicted by the number of new sexual partners in the last 5 years. Transiently detectable HPV DNA is one possible explanation for this observation.

Adolescent↗
PubMed1994

[Prevention of conception in adolescence].

The adolescent girl needs affection and understanding for all of her problems. She often does not find a satisfying measure of both in her familiar surroundings. Very often sex instruction is faulty, although the AIDS campaigns have led to remarkable improvements (condoms). Instructions for sexual behaviour should take place at home or at school, but not in the street. Nevertheless, the first intercourse occurs mostly unprotected. Teenage pregnancies present not only physical but also psychological problems. Termination of pregnancy means an especially difficult decision for the adolescent girl, often causes crisis and occasionally leads to negative consequences for later fertility. The choice of appropriate contraceptive methods for girls under 16 years of age may also have legal problems. Condoms and barrier methods are possible alternatives to the much safer hormonal contraception with the combination, sequence or minipill. Under certain circumstances, a progestin injection every three months or the 'morning-after pill' as postcoital contraception or, in the case of an abortion or of pregnancy termination, even an intrauterine device can be an alternative for adolescent girls under those exceptional circumstances.

Abortion, Induced↗
PubMed1994

Sexual behaviors and condom use: a study of suburban male adolescents.

Sexual behaviors and condom use were surveyed in a sample of 1,312 male adolescents (ages 12-19 years) in Laval, the second largest city in the province of Quebec. The data were obtained via a self-administered questionnaire to which 98.8% responded. The study showed that male adolescents became sexually active, on average, at 13.9 years, an age younger than previously reported. Further, 60% of the adolescent males used a condom at their first intercourse, a figure which doubled that previously reported; its use, however, decreased to one-third when utilization at each intercourse was examined. Overall, condom use was greatest in 14-year-olds and decreased in older adolescents, being replaced by the pill. The study further revealed that 12-13-year-olds were less likely to use condoms and more likely to use ineffective methods than were 14-year-olds. Although condoms seem to be gaining a following among male adolescents, their use is transitory and is being replaced by the pill and other methods with low protective value against sexually transmitted disease (STD) and AIDS. These results underline the necessity to reorient our educational and promotional activities in STD prevention to the realities of this group.

Adolescent↗
PubMed1994

Sexual behavior and condom use among urban, low-income, African-American and Hispanic youth.

Low income, urban, African-American, and Hispanic youth have been identified as a group for which there is concern about the spread of HIV. Using data from a household probability sample of 1,435 minority youth aged 15 to 24 in Detroit, this paper evaluates levels of sexual activity, condom use, and reasons for condom use and non-use. Comparisons with national samples of minority youth indicated that Detroit low-income youth have similar patterns of sexual behavior to national samples, although males and African-American females began their sexual experiences earlier and were less likely to have used condoms or other protection from pregnancy or sexually transmitted diseases (STDs) at first intercourse. Recent levels of condom use also left many Detroit youth unprotected from STDs. Less than half used a condom at least intercourse in the last year with nonmarital partners that they "knew well." In addition, condom use with partners that they "did not know well" was very low for Hispanic youth: Among those who had at least one casual partner in the last year, only 30% to 33% had ever used a condom with that partner. Analysis of reasons for use indicate that both pregnancy prevention and disease prevention were important motivations for condom use. However, many youth did not use condoms for reasons such as unavailability of condoms or unplanned sex.

Acquired Immunodeficiency Syndrome↗
PubMed1993

[Risky sex and contraception in students in France, Quebec and Spain].

In the context of a transational study, 404 sexual active 17-21 years-old students living in Lyon (France), Montreal (Quebec) and Salamanque and Madrid (Spain) have answered a questionnaire dealing with their contraceptive patterns, their perceptions of AIDS and their risky sexual behaviors. Results show that each group uses a different contraceptive strategy. In France and in Quebec those who had their first intercourse before 17 years of age used oral contraceptive rather than the condom. As for AIDS girls from Quebec had a higher index of risky sexual behaviors (CASH) than French, but the opposite was true among boys, while both girls and boys from Spain adopted safer sexual behaviors. Multiple regression analysis shows that the CASH rests on different predictors according to each national context.

Acquired Immunodeficiency Syndrome↗
PubMed1994

Timing of the postpartum Papanicolaou smear.

OBJECTIVE: To study the relation between the timing of the postpartum examination and the postpartum Papanicolaou smear. METHODS: One hundred eighty-four women in labor at Arlington Community Hospital were randomized to receive their postpartum Papanicolaou smear at 4, 6, or 8 weeks after delivery. Samples from the exocervix and endocervix were obtained and submitted to the pathology department, which was unaware of the study. RESULTS: Twenty-three women were lost to follow-up. Among 161 women who had a postpartum examination, 48 (30%) had it at 4 weeks, 61 (38%) at 6 weeks, and 52 (32%) at 8 weeks. The groups were similar with respect to age, ethnicity, gravidity, parity, marital status, number of sexual partners, age at first intercourse, history of cervical infections, previous history of abnormal Papanicolaou smears, and cervical surgery. Among the 139 women who had a normal prenatal smear, 26 (59%) had an abnormal smear at 4 weeks (24 [92%] had inflammation, one [4%] had inflammation with nuclear atypia, and one [4%] had cervical intraepithelial neoplasia [CIN] III), 17 (32%) were abnormal at 6 weeks (15 [88%] had inflammation, one [6%] had inflammation with nuclear atypia, and one [6%] had CIN III), and 12 (28%) were abnormal at 8 weeks (11 [92%] had inflammation and one [8%] had inflammation with nuclear atypia). There were no differences in the distribution of abnormal Papanicolaou smears at the repeat smear done 3 months after the postpartum examination. CONCLUSION: The incidence of abnormal Papanicolaou smears increased as the postpartum interval decreased from 8 to 4 weeks.

Adult↗
PubMedDate not supplied

Pelvic inflammatory disease: diagnosis and management.

BACKGROUND: Acute pelvic inflammatory disease (PID) is a major gynecologic health problem in the United States, afflicting more than 1 million women each year and generating annual direct and indirect costs estimated at $4.2 billion. Family physicians can play an important role in the prevention, as well as diagnosis and treatment, of PID. METHODS: A MEDLINE search for articles published from 1985 to the present was made using the key words "pelvic inflammatory disease," "endometritis," "salpingitis," "tubo-ovarian abscess," "adnexitis," "pelvic abscess," "parametritis," and "oophoritis." The bibliographies of these articles and the author's personal files were also sources of information. RESULTS AND CONCLUSIONS: A number of risk factors have been linked to PID, including young age, age at first intercourse, multiple sex partners, the presence of bacterial vaginosis, vaginal douching, the use of an intrauterine contraceptive device, and a history of a sexually transmitted disease. The diagnosis of PID represents a major clinical challenge that requires a careful history and physical examination coupled with selective and knowledgeable use of the diagnostic tests and procedures currently available. Broad-spectrum antibiotics, which represent the cornerstone of therapy, must adequately cover the polymicrobial spectrum of pathogens implicated in this infection, which includes Neisseria gonorrhoeae, Chlamydia trachomatis, and specific cervicovaginal anaerobic and aerobic bacteria. The numerous sequelae associated with PID, which include infertility, ectopic pregnancy, and chronic pelvic pain syndromes, underscore the need for effective measures for preventing pelvic inflammatory disease.

Acute Disease↗