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Objectives Herpes simplex virus type 2 (HSV-2) biomarkers are often used in adolescent sub-Saharan HIV prevention studies, but evaluations of test performance and disclosure outcomes are rare in the published literature. Therefore, we investigated the proportion of ELISA-positive and indeterminate samples confirmed by western blot (WB), the psychosocial response to disclosure and whether reports of sexual behaviour and HSV-2 symptoms are consistent with WB confirmatory results among adolescent orphans in Kenya. Methods In 2011, 837 Kenyan orphan youth in grades 7 and 8 enrolled in an HIV prevention clinical trial with HSV-2 biomarker outcomes. We used a modified algorithm for the Kalon HSV-2 ELISA to improve specificity; positive and indeterminate results were WB tested. We developed culturally sensitive protocols for disclosing positive results, and documented psychosocial responses, reports of sexual contact and HSV-2 symptoms. Results 28 adolescents (3.3%) were identified as HSV-2 seropositive, six as indeterminate. Of these, 22 positive and all indeterminates were WB tested; 20 and 5, respectively, were confirmed positive. Most youth reported moderate brief stress after disclosure; 22% reported longer and more severe distress. Boys were more likely to be in the latter category. Self-reported virginity was highly inconsistent with WB-confirmed positives. Conclusions The higher than manufacturer9s cut-off for Kalon ELISA modestly reduced the rate of false-positive test results, but also increased false negatives. Investigators should consider the risk:benefit ratio in deciding whether or not to disclose HSV-2 results to adolescent participants under specific field conditions. Trial registration number NCT01501864.

Background: Although exposure to peer and family violence are documented risk factors for adolescent dating violence, less is known about the relationship between violent crime exposure and dating violence victimization. Methods: Participants in the National Longitudinal Study of Adolescent Health (n=4,794) aged 13-17 years self-reported witnessing violent crime (someone being shot or stabbed) in the 12 months prior to Wave I interview (1994-95), physical partner violence victimization within the 18 months prior to Wave II interview (1995-96), and physical and sexual partner violence victimization within the 18 months prior to Wave III interview (2001). Results: Twelve percent of respondents reported dating violence victimization at Wave II. Witnessing violent crime was positively associated with victimization in crude (OR=2.11, 95% CI 1.56-2.86) and adjusted (AOR=1.53, 95% CI 1.09-2.15) analyses. Of the adolescent partner violence victims (n=549), 32% reported continued victimization into early adulthood; after adjusting for gender, age, urbanicity, and childhood maltreatment history, witnessing violent crime in adolescence was negatively associated with having non-violent relationships in early adulthood (AOR=0.40, 95% CI 0.19-0.84). In cross-sectional and longitudinal analyses, associations between violent crime exposure and victimization did not vary by age, gender, or race/ethnicity. Conclusion: Adolescents exposed to violent crime experience an increased risk of partner violence victimization in adolescence and continuing victimization into adulthood. Targeting dating violence prevention and intervention programs to geographic areas with high levels of violent crime may be an efficient strategy to reach higher risk adolescents. Reducing community violent crime may also have spillover effects on partner violence.

To investigate the presence and patterns of modification effects of the sex of the child, social support, and childcare on the relation between maternal depressive symptoms and child behaviour problems at two developmental stages.Analyses are based on prospective longitudinal data from the study of early child care.A total of 1216 families were drawn from 10 locations across the USA. Mothers were age 18 or older at the time of the study child's birth and had completed outcome measures for at least one follow up time point (24 months, 36 months).Child internalising and externalising behaviour problems assessed at the child's age of 24 months and 36 months, as reported by the mother.Results from generalised estimating equation analyses showed that the association between child externalising behaviour problems and maternal depressive symptoms varied according to the social support received by the mother (p0.05). Overall, social support mitigated the relation, but protective effects diminished at increasing levels of depressive symptoms. Associations between child internalising behaviour problems and maternal depressive symptoms varied according to whether or not the child received care from caregivers other than the mother (p0.05).Health providers who are working with mothers with depressive symptoms may want to examine social support that is available to mothers, especially if mothers are not severely depressed. Furthermore, recommendations to begin, continue, or perhaps increase provision of childcare from other caregivers can provide respite for mothers and opportunities for children to engage in protective interactions with others.

Background Early parent–child communication about sex is associated with healthier behaviour during adolescence. Understanding parents9 cues to initiating these conversations may provide new opportunities for public health intervention. Human papillomavirus (HPV) vaccine is recommended for all 11–12-year-old girls and is highly acceptable to parents. We sought to characterise mothers9 communication with their daughters about HPV vaccine and the potential for HPV vaccine discussions to provide an opportunity for discussions about sex. Methods During December 2009, we conducted an online survey with a nationally representative sample (n=900) of US mothers of adolescent females aged 11–14 years (response rate=66%). We compared the proportion of all mothers using HPV vaccine discussions as a cue to talking about sex vs other potential cues using McNemar9s χ 2 . We also assessed whether communication about HPV vaccine was independently associated with communication about sex using multivariate logistic regression. Estimates are weighted. Results Sixty-five per cent of mothers reported talking with their daughters about HPV vaccine, of whom 41% said that doing so led to a conversation about sex. Thus, 27% of all mothers talked about sex as a result of HPV vaccine conversations, similar to the proportion talking about sex as a result of some more widely recognised cues, such as their daughter starting menses (21%) or talking about alcohol or drugs (29%), but less than some others, such as their daughters showing an interest in boys (36%; p Conclusions HPV vaccine discussions provide an acceptable opportunity for mothers to talk with their daughters about sex at an age when such communication is most influential. It may be possible to capitalise on HPV vaccine discussions to promote parent–child communication about sex and provide messages about sexual health and STI prevention to early adolescents.