Maternal and Child Health Library
This and past issues of the MCH Alert are available at http://www.mchlibrary.info/alert/archives.html.
November 9, 2007
1. Fact Sheet on Substance Use Among Adolescents and
Young Adults Updated
2. Workshop Summary Addresses Adolescent Health Care
3. Report Focuses on Barriers to High School Graduation
that Uniquely Affect Girls and Strategies for Improvement
4. Authors Assess Obstetricians-Gynecologists' Practices
Relevant to HIV Screening
5. Article Evaluates Factors Associated with Vaginal
Intercourse Without Barrier Contraception
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1. FACT SHEET ON SUBSTANCE USE AMONG ADOLESCENTS AND YOUNG ADULTS
UPDATED
The 2007 Fact Sheet on Substance Use: Adolescents and Young Adults
contains the most recent available data on substance use, including the
use of alcohol, cigarettes, and illicit drugs, among adolescents and
young adults (ages 12-25). The updated fact sheet, produced by the
National Adolescent Health Information Center (NAHIC) with support from
the Maternal and Child Health Bureau, highlights key findings and
presents trends in color-coded figures and text. Topics include
dependence on and abuse of alcohol or illicit drugs and substance use
initiation by type and major depressive episode. Data is reported by
age, gender, and race and ethnicity. Information on trends and data
sources are included. The fact sheet is available at http://nahic.ucsf.edu/download.php?f=/downloads/SubstanceUse2007.pdf.
A list of other NAHIC-produced briefs and fact sheets is available at http://nahic.ucsf.edu/index.php/data/article/briefs_fact_sheets.
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2. WORKSHOP SUMMARY ADDRESSES ADOLESCENT HEALTH CARE
Challenges in Adolescent Health Care: Workshop Report summarizes the
presentations and discussions that took place at two public workshops
to study adolescent health care services in the United States and
highlight critical health care needs, promising service models, and
components of care that may strengthen and improve health care
services, settings, and systems for adolescents and contribute to
healthy adolescent development. The report, published by the National
Academy of Sciences, provides an integrated overview of the information
and ideas that were presented and discussed at workshops convened by
the Committee on Adolescent Health Care Services and Models of Care for
Treatment, Prevention, and Healthy Development, National Research
Council and Institute of Medicine, in November 2006 and January 2007.
Topics include an overview of adolescent health issues, needs of the
most vulnerable adolescents, making the system work, and issues to
address. The agendas and participant lists are also provided. The
report is available at http://orsted.nap.edu/cart/deliver.cgi?record_id=12031 (PDF) or
to read full text online, http://www.nap.edu/catalog.php?record_id=12031.
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3. REPORT FOCUSES ON BARRIERS TO HIGH SCHOOL GRADUATION THAT UNIQUELY
AFFECT GIRLS AND STRATEGIES FOR IMPROVEMENT
When Girls Don't Graduate We All Fail: A Call to Improve High School
Graduation Rates for Girls provides information on female students who
do not complete high school. The report, produced by the National
Women's Law Center, addresses the following topics: (1) current dropout
rates for girls in the United States; (2) the economic and health
consequences of dropping out for girls and their families; (3) the
factors that put students at risk for dropping out, with a focus on
factors that may particularly affect girls, such as pregnancy and
family responsibilities; and (4) recommendations for the future. Data
on dropout rates, employment rates, and earnings are included. The
report is available at http://nwlc.org/pdf/DropoutReport.pdf.
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4. AUTHORS ASSESS OBSTETRICIANS-GYNECOLOGISTS' PRACTICES RELEVENT TO
HIV SCREENING
"The results of this study suggest that many
obstetricians-gynecologists do not know their own states' laws and
regulations pertaining to HIV [human immunodeficiency virus] testing
for pregnant women and point to the need for future research to examine
obstetricians-gynecologists' knowledge about both national . . . and
federal . . . testing recommendations and the often contradictory state
requirements under which they must practice," write the authors of an
article published in the November 2007 issue of Obstetrics and
Gynecology. In the United States, over one-fourth of newly diagnosed
HIV cases are women. A major concern of these women is mother-to-child
HIV transmission. In an effort to reduce perinatal HIV transmission,
the American College of Obstetricians and Gynecologists (ACOG), the
American Academy of Pediatrics, the Centers for Disease Control and
Prevention, and the Institute of Medicine have recommended that all
pregnant women be screened for HIV as part of routine prenatal care.
The purpose of the study described in this article is to investigate
the current knowledge and screening practices of
obstetrician-gynecologists relevant to HIV.
Researchers sent survey questionnaires to 1,032 ACOG Fellows and Junior
Fellows in practice between June and July 2006. Questionnaires included
questions about physician characteristics, testing practices, and
knowledge about HIV screening.
The authors found that
- A total of 582 surveys (56.4%) were returned.
- Almost all the obstetricians-gynecologists (97%) reported that
they recommended HIV testing to all their pregnant patients.
- Obstetricians-gynecologists reported that patients gave several
reasons for declining HIV testing, with patient perception of self as
low risk being the most commonly selected (79.0%).
- Just under one-third (30.1%) of respondents said that their state
has regulations that require recommending HIV testing during pregnancy,
and 37.0% (95% CI 28.62-37.18%) said their state does not have such
regulations.
- Almost one in three (32.9%) of respondents said that they did not
know if their state requires HIV testing during pregnancy.
- Testing approaches (opt-in vs. opt-out) reported by
obstetricians-gynecologists were not necessarily consistent with state
regulations; 57% of obstetricians-gynecologists reported using the
approach required in the state, and 43% reported using an approach not
consistent with the state's regulations. In states with no specific
requirement, the physician-reported testing approach was divided nearly
equally between opt-in and opt-out approaches.
The authors conclude that "further studies should focus on the reasons
that many obstetricians-gynecologists are not compliant with their
states' requirements and why some may know the requirements but are not
following them."
Gray AD, Carslon R, Morgan MA, et al. 2007. Obstetrician-gynecologists'
knowledge and practice regarding human immunodeficiency virus
screening. Obstetrics and Gynecology 110(5):1019-1026. Abstract
available at http://www.greenjournal.org/cgi/content/abstract/110/5/1019.
Readers: More information is available from the following MCH Library
resources:
- AIDS/HIV in Pregnancy (bibliography) at
http://www.mchlibrary.info/action.lasso?-database=Biblio&-layout=Web&-response=/databases/BibLists/bib_aidspreg.html&-MaxRecords=all&-DoScript=auto_search_aidspreg&-search
- Prenatal Care (bibliography) at
http://www.mchlibrary.info/action.lasso?-database=Biblio&-layout=Web&-response=/databases/BibLists/bib_prenatal.html&-MaxRecords=all&-DoScript=auto_search_prenatal&-search
- AIDS/HIV (organizations resource list) at
http://www.mchlibrary.info/action.lasso?-database=Organizations&-layout=Web&-response=/databases/OrgLists/orgs_aids.html&-MaxRecords=all&-DoScript=auto_search_aids&-search
- Prenatal Care (organizations resource list) at
http://www.mchlibrary.info/action.lasso?-database=Organizations&-layout=Web&-response=/databases/OrgLists/orgs_prenat.html&-MaxRecords=all&-DoScript=auto_search_prenat&-search
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5. ARTICLE EVALUATES FACTORS ASSOCIATED WITH VAGINAL INTERCOURSE
WITHOUT BARRIER CONTRACEPTION
"Future interventions should focus on STD [sexually transmitted
disease] prevention in women who are [less than] 25 years old, because
this group is at highest risk for sexually transmitted infections and
adverse reproductive outcomes," state the authors of an article
published in the November 2007 issues of the American Journal of
Obstetrics and Gynecology. Unintended pregnancy, STDs, and the adverse
health consequences of STDs are widespread public health problems in
the United States and worldwide. Barrier contraceptive methods
(specifically, male condoms), when used consistently and correctly, are
effective in the prevention of numerous STDs. However, U.S. data
indicate that individuals who have heterosexual intercourse use condoms
consistently only 19% of the time. Few studies have evaluated
patient-specific characteristics associated with vaginal intercourse
without barrier method use in women who are at risk for STDS and
unplanned pregnancy. The present article sought to address this issue.
Data for the study were derived from baseline data-collection efforts
of Project PROTECT, a randomized trial funded by the National Institute
of Child Health and Human Development that evaluated the extent to
which a computer-based individualized intervention could improve dual
contraceptive method use. The primary outcome was number of episodes of
vaginal intercourse without barrier method use (i.e., number of coital
episodes minus number of times condoms were used) in the past month.
Study participants included 469 females ages 13-35 who were competent
to give informed consent.
The authors found that
- Sixty-five percent of participants had two or more episodes of
vaginal intercourse without barrier method use in the past 30 days, 11%
had one episode, and 24% had no episodes.
- After adjustments were made for confounders, the number of coital
episodes and the male partner's unwillingness to use condoms were
associated with increased odds of having two or more episodes of
vaginal intercourse without barrier method use in the past 30 days.
- Among women under age 20, lower self-efficacy was associated with
having two or more episodes of vaginal intercourse without barrier
method use in the past 30 days, but the effects diminished among women
ages 20 and above.
The authors conclude that "given the potentially large group of women
whose partners may not be willing to use a male condom, additional
prospective studies are needed to assess the role of microbicides and
female-controlled barriers that could empower women to protect
themselves against sexually transmitted infections."
Peipert JF, Lapane KL, Allsworth JE, et al. 2007. Women at risk for
sexually transmitted diseases: Correlates of intercourse without
barrier contraception. American Journal of Obstetrics and Gynecology
197(5):474.e1-474e8. Abstract available at http://www.ajog.org/current#.
Readers: More information is available from the following MCH Library
resources:
- Adolescent Pregnancy Prevention (knowledge path) at
http://www.mchlibrary.info/KnowledgePaths/kp_adolpreg.html
- Preconception and Pregnancy (knowledge path) at
http://www.mchlibrary.info/KnowledgePaths/kp_pregnancy.html
- Adolescent Pregnancy Prevention (bibliography) at
http://www.mchlibrary.info/action.lasso?-database=Biblio&-layout=Web&-response=/databases/BibLists/bib_adolpregprev.html&-MaxRecords=all&-DoScript=auto_search_adolpregprev&-search
- Sexuality Education (bibliography) at
http://www.mchlibrary.info/action.lasso?-database=Biblio&-layout=Web&-response=/databases/BibLists/bib_sexeduc.html&-MaxRecords=all&-DoScript=auto_search_sexeduc&-search
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MCH Alert © 1998-2007 by National Center for Education in Maternal
and
Child Health and Georgetown University. MCH Alert is produced by
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