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Study Objectives: (1) To assess menstrual function in freshman cadets at a structured, rigorous military college utilizing a weekly e-mail questionnaire, (2) to compare these results to longer-term recall results from written questionnaires completed at the start and end of the same year, and (3) to determine if a relationship exists between personality attributes and menstrual regularity in this setting., Design, Setting, Participants: A questionnaire developed by the investigators about menstrual function was distributed weekly via e-mail and completed satisfactorily by 116 female freshman at the United States Military Academy (USMA), class of 1995. These data were compared to questionnaires completed by this same cohort at the start and end of the year, as well as to personality questionnaires distributed to some of these cadets as part of a larger study. Pearson's chi-square and analysis of variance were performed to determine statistical significance., Results: Weekly e-mail data revealed that only 1.7% of cadets had regular menstrual periods throughout the whole year. The remaining 98.3% were irregular: 10.3% mildly, 35.3% moderately, 30.2% severely, and 22.4% extremely irregular. Only 0.8% of subjects did not menstruate at all during the year. In comparison, on long-term recall data, 90% reported some change in menstrual function, with 48% specifically reporting menstrual irregularity. Those with the greatest irregularity prior to USMA and those who expected greater irregularity at USMA reported the greatest irregularity during the year. Irregularity was associated with coping and with commitment to health on personality questionnaires., Conclusions: On data collected via weekly e-mail, almost all freshman females at USMA experienced menstrual irregularity. This data, utilizing short-term recall, yielded different, more dramatic results than the data utilizing long-term recall. A link between menstrual irregularity and both coping and commitment suggests that menstrual irregularity may be adaptive in this environment.

Cadet basic training (CBT) at the U.S. Military Academy at West Point is an initial cadet experience designed to transition freshmen (new cadets) into the military. Challenge is an inherent component of CBT, and some challenging activities may be stressful. However, the nature and the impact of stress on health status have not been systematically investigated. An ethnographic technique, participant observation, was used to identify stressors and coping strategies among cadets aged 18 to 21 years participating in CBT. A company of 183 cadets, consisting of 123 new cadets and 60 supervising upperclass cadets from the U.S. Military Academy, was followed throughout the 6-week CBT in the summer of 1993. The investigator observed daily activities and participated in select field training experiences. Daily field observations were taped, and field notes were generated chronicling the experience. After CBT, 10 of the 60 upperclass cadets participated in a 20-minute structured interview. Field and interview notes were systematically reviewed to identify and categorize stressors and coping techniques. Stressors included anticipatory stress, time management pressures, sleep deprivation, performance evaluations, conflicts between teamwork and competitive grading, and inexperience in the leadership role. Coping techniques identified included perceiving social support, humor, and rationalization. Three new hypotheses were generated from the observations.

Context: There is a strong need to determine what effect, if any, menstruation has on the performance of duty as a Cadet at the United States Military Academy (USMA) at West Point, and to determine what impact, if any, the USMA environment has on the menstrual cycle., Study Objectives: To study menstrual function and premenstrual symptoms in a structured, rigorous military environment; determine the perceived impact of menstrual and premenstrual symptoms on academic, physical, and military activities; and evaluate the difficulties inherent to menstruation in a military setting., Design, Setting, and Participants: A survey about high school menstrual and premenstrual function, and the Premenstrual Assessment Form (PAF), were completed by all 158 freshman female Cadets in July 1991. In May 1992, 83 participants completed a survey assessing menstrual and premenstrual symptoms, including interference with activities during the year., Main Outcome Measures: Menstrual regularity, premenstrual symptoms, interference with activities., Results: Participants reported menstrual patterns and premenstrual symptoms in high school similar to other females their age. Most (62%) predicted a change in menstruation at the USMA, half were worried that physical symptoms would interfere with activities, one-fourth were worried that premenstrual symptoms would interfere with activities, and one-fourth were worried that obtaining and changing menstrual materials would interfere with activities. Almost all respondents (91%) reported changes in menstruation during the year, most commonly less regular, less frequent, shorter, lighter, and less crampy periods. Menstrual and premenstrual symptoms interfered with physical activities (66.2%, 61.4% respectively) more so than academic (50.6%, 45.7% respectively) or military activities (39.8%, 47.0% respectively). Female Cadets described significant difficulties with changing (62.6%), obtaining (51.8%), and disposing of (38.5%) menstrual materials., Conclusions: The data demonstrate major changes in menstrual function in over 90% of female Cadets; a significant perceived impact of menstrual and premenstrual symptoms on academic, physical, and military activities; and difficulties in obtaining, changing, and disposing of menstrual materials in a military setting. These findings have implications for females in the military, as well as for young women generally.

Background: As school-based health centers (SBHCs) continue to grow, it remains important to study use of the centers. The extent to which mental health problems exist in the students with access to the centers, whether those students are using the available services, if they are satisfied with the services, and the reasons for nonuse by those students who do not enroll are all meaningful questions., Methods: The above issues were studied in an urban high school with a 2-year-old SBHC by administering questions during physical education classes on health center use and mental health concerns. The 630 respondents were 45% male, 55% female, 61% black, 29% Hispanic, 54% in grades 9 or 10, 46% in grades 11 or 12., Results: Sixty percent of the students were registered in the SBHC; 40% were not registered. Seventy-five percent of registered students reported average use (< or =3 visits); females were more likely than males (P=.017) to be frequent (>3 visits) users of SBHC services. Mental health problems among all participants included depression in 31%, use of alcohol 1 time or more per month in 21%, use of alcohol daily in 5%, suicidal ideation in 16%, history of a suicide attempt in 10%, knowing someone who had been murdered in 50%, and being in at least 1 fight at school in 26%. Frequent users, average users, and nonusers did not differ by age, grade, race, or any of the measured mental health problems. Among the 472 students who completed the survey section on SBHC perceptions, 305 described health center use: 92% were satisfied with health center services, 79% were comfortable being seen in the SBHC, 74% believed visits were kept confidential, 61% told their parents about each visit, and 51% considered the SBHC their regular health care source. The health center was used for mental health services by 34% and sexuality-related care by 15%. The 167 students who described reasons for not using the SBHC most frequently reported that they already had a physician (60%), did not need it (50%), prefer continuing previous health care (45%), did not get around to it (30%), parents were opposed (20%), were not comfortable (19%), did not know about the service (19%), and did not want problems known (19%)., Conclusions: We conclude that, in this urban high school, (1) average users, frequent users, and nonusers did not differ in the mental health problems measured in this study; (2) those who used the SBHC indicated strong satisfaction with the care received; and (3) those who did not use the SBHC chose to stay away for a variety of reasons, most commonly the availability of other care or the perception of lack of need.

Purpose: The study's objective was to determine the prevalence of abnormalities in weight, eating attitudes, and eating behaviors among an urban teenage population., Methods: Measures of weight, height, and blood pressure were obtained from 1,001 students attending regularly scheduled physical education classes in a New York City high school the population of which was 66% black and 23% Hispanic. The mean age was 16 years old; 55% were female and 45% were male. Approximately three quarters of the students completed the Eating Attitudes Test (EAT-26), Rosenberg Self-Esteem Scale, Spielberger Trait Anxiety Inventory, and a questionnaire on eating behaviors., Results: By percent ideal body weight (%IBW), 25% of students were obese (>20% above IBW), 18% were overweight, and 5% were underweight. Abnormal EAT scores (>21), were found in 6% of males and 15% of females. Students reported that they had engaged in the following nutritional behaviors at least three times in the past week: eating candy (59%), skipping breakfast (58%), skipping lunch (42%), eating fast foods (28%), and skipping dinner (14%). Self-esteem was high in 60%, medium in 21%, and low in 19%. Mean self-esteem was significantly higher (P < .0001) than established norms. Self-esteem and anxiety were inversely correlated (r = .40, P < .001), and low self-esteem and high anxiety were both associated with high EAT scores (r = .29, P < .001). Self-esteem and anxiety of obese students did not differ from those who were of normal weight., Conclusions: Among this population of urban high school students there were: (a) a large number of overweight adolescents; (b) a significant subgroup with eating attitudes suggestive of an eating disorder; and (c) high levels of self-esteem and normal levels of anxiety, which were independent of weight status.

Knowledge of AIDS, attitudes toward AIDS and condoms, and behavioral changes because of AIDS were studied in 771 students, Grades 9-12 (mean age, 16 years) who completed anonymous questionnaires in gym classes of a New York City high school. Students demonstrated good knowledge of AIDS, with some misconceptions, and significant concerns about AIDS, with some behavioral changes, but most continued to engage in high-risk behaviors. These data indicate that efforts aimed at HIV/AIDS prevention in adolescents must translate knowledge and concerns into behavioral change.

Purpose: To study positive and negative correlates of sports participation in inner-city youth., Methods: We distributed anonymous questionnaires to 838 students in gym classes of an urban New York City High School. Forty five percent of students were male and 55% female, with mean age 16.0 years; 64% in grades 9-10, and 36% in grades 11-12; 63% black, 27% Hispanic, and 10% other; and 30% A/B students, 38% C students, and 32% D/F students., Results: All students reported some involvement in sports: 37% in 1-2 sports, 29% in 3-4 sports 24% in > or = 5 sports; 20% played on local teams, and 12% on junior or senior varsity. Approximately one-third each reported no weekday sports participation (30%), 1-2 hours per day (34%), or > or = 3 hours (36%); and 34% reported no participation on weekends, 26% reported 1-2 hours per day, and 40% > or = 3 hours. Basketball, volleyball, baseball, and weight lifting were the most common sports. Enjoyment, recreation, and competition were the most commonly reported reasons for participation. While 86% of subjects considered school "extremely" or "very" important, 35% considered sports "extremely" or "very" important. However, many believed they would "definitely" or "probably" receive an athletic scholarship (52% males, 20% females). Males reported more (p < .05) weekday, weekend, and team participation, and greater expectations (p <.001) of a future in sports. Sports involvement was not statistically associated with academic performance or scores on either the Rosenberg Self-Esteem Scale or Depression Self Rating Scale. Steroid use, at least once, was reported by 11% of males and 4% of females. Thirteen percent of students (21% males, 6% females) tried to gain weight for sports and 20% of both males and females tried to lose. Sports injuries within the past year were reported by 15% of students, and approximately three-quarters could correctly answer each of five questions about basic first aid., Conclusions: The data indicate that most of these urban youth had athletic involvement, many had unrealistic expectations for their futures, and some utilized unhealthy behaviors in an attempt to enhance performance. Among these students, no association was found between sports involvement and academic performance, self-esteem, or depression.

Purpose: We sought to determine the extent of exposure to violence and its relationship to other mental health risks among an urban teenage population., Methods: Students attending regularly scheduled physical education classes completed a Violence Survey, a Suicidal Ideation Survey, the Depression Self-Rating Scale (DSRS), and the Adolescent Alcohol Involvement Scale. Of the 630 students who completed the anonymous assessment 45% were male, 55% female, 61% black, 30% Hispanic; 54% grades 9-10, and 46% grades 11-12., Results: Half of the students reported knowing someone who had been murdered, 61% indicated they had witnessed a robbery, 59% had witnessed a beating, 37% had witnessed a shooting, and 31% had witnessed a stabbing. Mental health problems reported by these students included: depression (DSRS score > 13) in 31%, suicidal ideation in 16%, suicide attempts in 10%, drinking > 1 x per month in 21%, and drinking daily in 5%. Univariate analysis revealed that students who witnessed a shooting or stabbing were more likely (p < .05) to be both male and black. Multivariate analysis revealed that students reporting knowing someone who was murdered were twice as likely to report suicidal ideation and four times as likely to report suicide attempts. Witnessing a stabbing was associated with twice the likelihood of reporting suicide ideation and three times the likelihood of reporting suicide attempts. Witnessing a shooting was associated with twice the likelihood of alcohol use. Witnessing a beating or robbery had no significant relationship to measured variables., Conclusions: Among this population of urban teenagers there are many who have witnessed violence and a subgroup who have witnessed shootings and stabbings and are at increased risk for mental health problems. A comprehensive medical and psychosocial history should include a violence assessment for all urban teens.