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Objectives: To evaluate the impact of a positive herpes simplex virus type 2 (HSV-2) serological test on psychosocial functioning among people with no known history of genital herpes., Methods: Individuals (age 14-30 years) without a history of genital herpes were recruited from an urban university setting and sexually transmitted diseases (STD), primary care, and adolescent clinics. Participants completed a questionnaire addressing psychological functioning, psychosocial adjustment, and perceived quality of sex and were offered free HSV-2 antibody testing. 33 HSV-2 positive people and 60 HSV-2 negative people demographically matched from the same source of recruitment were re-evaluated at a 3 month follow up visit. HSV-2 positive participants also completed a genital herpes quality of life (GHQOL) measure., Results: Of the 33 who were HSV-2 seropositive, four did not recall their diagnosis. In comparing those who were HSV-2 positive with those who were negative, repeated measures analysis of variance indicated there were no significant differences over time on any of the measures. None the less, many HSV-2 positive individuals indicated that the diagnosis had a notable impact on their quality of life. Also, among the HSV-2 positive people, lower GHQOL at the 3 month follow up was predicted by higher interpersonal sensitivity (r = -0.44, p<0.05), lower social support (r = 0.40, p<0.05), and quality of sex (r = 0.62, p<0.01) at baseline., Conclusions: A diagnosis of asymptomatic HSV-2 infection does not appear to cause significant lasting psychological difficulties. Those for whom the diagnosis had the greatest impact were interpersonally vulnerable before the diagnosis. These results suggest that assessment of interpersonal distress may be important to include as part of pretest and post-test counselling.

We examined alcohol use concordance (respondent and partner alcohol use) and relationship quality as predictors of condom non-use among adolescent women. Both variables were significant independent predictors of condom non-use. These results suggest that both the individual's and her partner's behaviors should be taken into consideration in research and clinical practice.

Over the past 150 years, innovations in immunization practices have dramatically improved the health of children, and parents are increasingly asked to consider and accept new childhood vaccines. We present a conceptual model to frame a review of research on the role of parental attitudes and beliefs in decision making about child and adolescent immunization and describe the historical context of vaccine-related decision-making research. This review focuses on theory-based Social-environmental and parent-specific personal factors as potential influences on vaccine decision making. Relevant Social-environmental issues discussed include media coverage of vaccines, perceived social norms, and the persuasive influence of peer groups. Health care provider recommendations are presented as an exemplar of factors related to the family's interface with the health care system. Personal factors addressed include parental health beliefs, attitudes, and knowledge related to vaccine preventable diseases and immunization, as well as cognitive heuristics that are employed in the decision-making process (e.g., omission bias, protected values, framing of information). Last, promising directions for research and suggestions for clinical practice are presented.

The success of future human papillomavirus (HPV) vaccination programs will depend on individuals' willingness to accept vaccination, parents' willingness to have their preadolescent and early adolescent children vaccinated, and health care providers' willingness to recommend HPV vaccination. The purpose of this article is to provide a qualitative review of the relevant literature, including research on knowledge and attitudes about HPV infection and its clinical sequelae, the acceptability of HPV vaccination to individuals and parents, and health care providers' attitudes about recommending HPV vaccination. Additionally, strategies are suggested by which providers of adolescent health care can discuss and recommend HPV vaccines with parents and their children. The research published to date suggests that there is a good deal of misunderstanding about HPV infection, cervical cancer screening, and the sequelae of HPV infection. However, the majority of research studies to date indicate that young women, parents, and health care providers are interested in vaccines that prevent HPV and other sexually transmitted infections (STIs). Of particular note are the consistent findings that providers are less comfortable vaccinating younger versus older adolescents and that endorsement of vaccination by a professional organization is of great importance. Furthermore, research suggests that most parents are interested in having their preadolescent and adolescent children vaccinated against HPV. Parents value the information and recommendations provided by their children's health care providers. To the extent that providers are concerned about potential negative reactions of parents to a recommendation of HPV vaccination, these findings should provide reassurance. At the same time, health care providers will need to be prepared to provide patients and parents with information about HPV and HPV immunization and to respond productively to the rare parent who expresses opposition to HPV vaccine or any other vaccine.

Study Objective: Human papillomavirus (HPV) vaccines will soon be available for clinical use, and the effectiveness of vaccine delivery programs will depend largely upon whether providers recommend the vaccine. The objectives of this study were to examine family physicians' attitudes about HPV immunization and to identify predictors of intention to recommend immunization., Design: Cross-sectional survey instrument assessing provider and practice characteristics, knowledge about HPV, attitudes about HPV vaccination, and intention to administer two hypothetical HPV vaccines., Participants: Surveys were mailed to a national random sample of 1,000 American Academy of Family Physicians (AAFP) members., Main Outcome Measure: Intention to administer two hypothetical HPV vaccines (a cervical cancer/genital wart vaccine and a cervical cancer vaccine) to boys and girls of different ages., Results: One hundred fifty-five surveys (15.5%) were returned and 145 were used in the final sample. Participants reported higher intention to recommend both hypothetical HPV vaccines to girls vs. boys (P < 0.0001) and to older vs. younger adolescents (P < 0.0001). They were more likely to recommend a cervical cancer/genital wart vaccine than a cervical cancer vaccine to boys and girls (P < 0.001). Variables independently associated with intention (P < 0.05) included: female gender of provider, knowledge about HPV, belief that organizations such as the AAFP would endorse vaccination, and fewer perceived barriers to vaccination., Conclusions: Female gender, knowledge about HPV, and attitudes about vaccination were independently associated with family physicians' intention to recommend HPV vaccines. Vaccination initiatives directed toward family physicians should focus on modifiable predictors of intention to vaccinate, such as HPV knowledge and attitudes about vaccination.

Purpose: To identify attitudes and behavioral factors associated with parental intent to vaccinate their adolescent children against sexually transmitted infections (STI) and adolescent intent to accept vaccination for the prevention of STI., Methods: In this cross-sectional study, 320 parents and their adolescent children (aged 12-17 years) were recruited from urban adolescent health clinics and private practice pediatric offices to complete audio, computer-assisted self-interviews (A-CASI). Parents and their adolescents were asked about acceptability of gonorrhea, genital herpes, and human immumodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS) vaccines. These three items were summed to create an STI vaccine acceptability scale, the primary outcome variable. Potential predictors measured included health beliefs, sociodemographic factors, and health and sexual behaviors., Results: A substantial majority of parents and their adolescent children rated the three STI vaccines as very acceptable. Parental health beliefs and parental history of STI diagnosis were significant independent predictors of intent to vaccinate adolescent children against STI. Parental intent to vaccinate and having a friend who had engaged in sexual intercourse were significant independent predictors of adolescents' intent to accept STI vaccination., Conclusions: The majority of these parents and their adolescent children found STI vaccination very acceptable, suggesting that there will be great interest in these vaccines once they become available. Interventions designed to address parental health beliefs may prove successful at maintaining or increasing interest in STI vaccines. Adolescents are likely to look to their parents for guidance around acceptance of these vaccines, but personal experiences also may play a role.

Objectives: To evaluate parental attitudes about adolescent vaccination as a function of vaccine characteristics, including whether the vaccine prevented a sexually transmitted infection (STI), and to explore possible sociodemographic predictors of acceptability of STI vaccines., Design: Participants were 278 parents who accompanied their children (69.1% female, aged 12-17 years) to appointments at medical clinics. By using computer-based questionnaires, parents rated 9 hypothetical vaccine scenarios, each of which was defined along 4 dimensions: mode of transmission (STI or non-STI), severity of infection (curable, chronic, or fatal), vaccine efficacy (50%, 70%, or 90%), and availability of behavioral methods for prevention (available or not available). Willingness by parents to vaccinate their adolescents under each vaccine scenario was assessed on a scale that ranged from 0 to 100. Conjoint analysis was used to determine the relative contribution of each dimension to the ratings., Results: The mean vaccine scenario rating was 81.3. Sexually transmitted infection vaccines (mean, 81.3) were not rated differently than non-STI vaccines (mean, 80.0). Conjoint analysis indicated that severity of infection and vaccine efficacy had the strongest influence on ratings, followed by availability of behavioral prevention. Mode of transmission had a negligible effect on ratings. Child age (P = .08) and sex (P = .77), parent age (P = .32) and education (P = .34), insurance status (P = .08), and data collection site (P = .48) were not significantly associated with STI vaccine acceptability., Conclusions: Parents were accepting of the idea of vaccinating their adolescent children against STIs. The most salient issues were severity of infection and vaccine efficacy, not sexual transmissibility. Parents also favored vaccines for infections that had no method of behavioral prevention available.

Purpose: To examine gay youth experiences within the context of normal adolescent development., Methods: Thematic analyses of interviews with 13 self-identified gay male youth, aged 16-22 years, each reporting minimal sexual identity distress, were completed. Interviews focused on: (a) descriptions of developmental changes perceived to occur for all adolescents, (b) descriptions of the participants' developmental experience, and (c) participants' direct comparisons of their perceptions of gay and nongay developmental experience. Data were analyzed by two investigators who, after initial review of the interview transcripts, developed a unified coding template to permit systematic analysis of the transcripts for recurrent themes., Results: (a) Few (2 of 13) participants reported overall developmental experience markedly different from nongay peers. (b) Peer interaction was seen as the domain most different from that of nongay peers. (c) Open gay self-identification altered, generally positively, all peer interaction. (d) Increased peer interaction enhanced maturity in other domains. (e) Family dynamics were not substantively altered by open gay self-identification. (f) Middle and high school were identified as relatively hostile environments in which to openly identify as gay, affecting the timing and the extent of self-disclosure. (g) Developmental progress showed asynchrony across developmental domains., Conclusion: General developmental dysfunction is not inevitable for gay adolescents, nor is identifiable personal or family pathology directly related to sexual identity.

Background: The demographic, historical, and behavioral factors that predict a positive herpes simplex virus type 2 (HSV-2) antibody test in persons without a history of genital herpes have not been well-defined., Methods: Individuals (age 14-30 years) without a history of genital herpes completed a questionnaire and were offered free HSV-2 antibody testing. Factors from the questionnaire were correlated with the HSV-2 antibody result., Results: Univariate analysis showed that female gender was significantly associated with positive test results. In gender-specific, multiple logistic regression models, a positive HSV-2 antibody test among men was associated with older age, non-white race, and a history of sexually transmitted disease (STD). Gender-specific symptom scores from the questionnaire were not predictive in either gender, but the gender-common symptom score was marginally predictive of a positive HSV-2 antibody test in women. Among women, older age, non-white race, and STD history predicted a positive test., Conclusions: Among young persons with no history of genital herpes who agreed to HSV-2 antibody testing, increasing age, non-white race, and a history of an STD were predictors of a positive test. A history of frequent pain, itching, burning, and rashes in the anogenital region was marginally associated with positive HSV-2 tests in women. These results might help guide selective use of HSV-2 antibody screening.

Background: The rates and determinants of acceptance of herpes simplex virus type 2 (HSV-2) testing have not been adequately studied., Objectives: The objective of this study was to identify factors associated with acceptance of HSV-2 antibody testing in individuals with no history of genital herpes., Study: We conducted a cross-sectional survey study followed by the offer of free HSV-2 serologic testing at an urban sexually transmitted disease (STD) clinic, 2 general adult medical clinics, an urban university campus, and an urban adolescent medicine clinic. A total of 1199 individuals aged 14 to 30 years completed the survey and were offered testing., Results: A total of 68.4% accepted HSV-2 testing. Factors independently associated with acceptance were female sex, older age, having an STD history, having 1 or more sexual partners in the last 6 months, perceived vulnerability to HSV-2 infection, and perceived benefits of HSV-2 testing. Fear of needles predicted rejection of testing, as did attending a general medical clinic versus an STD clinic and nonwhite race., Conclusion: There is a substantial interest in HSV-2 antibody testing across a variety of settings. Those at greatest behavioral and historic risk for HSV-2 infection, women, and persons whose health beliefs are consistent with testing are more likely to accept serologic testing when it is offered.

Objective: The objective of this study was to evaluate factors associated with return for results of type-specific herpes simplex virus (HSV) screening., Methods: Participants receiving type-specific HSV testing were asked to return for results 2 weeks after testing. Predictors of return included demographics, herpes-related knowledge and attitudes, and past sexual behaviors., Results: A total of 820 sexually active subjects (age, 14-30 years; 41% male) received HSV screening and 578 (70%) returned for results. Higher probability of return for HSV testing results was significantly associated with older age (odds ratio [OR], 1.06), female gender (OR, 1.57), enrollment at sites other than the county sexually transmitted disease clinic (OR, 1.70-4.71), and heightened level of perceived HSV vulnerability (OR, 1.07). Lower probability of return was associated with having more than 1 recent sex partner (OR, 0.46)., Conclusions: Lower rates of return of high-risk patients suggest the need to focus resources on receipt of test results.

Background: Human papilloma virus (HPV) is the causative agent of cervical neoplasia and genital warts. A vaccine has recently been developed that may prevent infection with HPV. Vaccination for HPV may become a routine part of office gynecology. We surveyed members of the American College of Obstetricians and Gynecologists (ACOG) to determine their attitudes to HPV vaccination., Methods: A survey was sent to Fellows of ACOG to evaluate gynecologists' attitudes. Vaccine acceptability was analyzed using 13 scenarios with the following dimensions and respective attributes: age of patient (13, 17 and 22 years); efficacy of vaccine (50% or 80%); ACOG recommendation (yes or no); and disease targeted (cervical cancer, warts or both). Each scenario was rated by means of an 11-point response format (0 to 100). Responses were evaluated using conjoint analysis., Results: Of 1200 surveys that were sent out, 181 were returned and included in our analysis. ACOG recommendation was considered the most important variable in vaccine distribution (importance score = 32.2), followed by efficacy (24.5), age (22.4) and, lastly, disease targeted (20.9). Of these variables, higher efficacy was favored; preference was given to age 17 years, with a strong disinclination to vaccinate at age 13 years; and protection against cervical cancer, or genital warts, or both, was significantly favored over a vaccine against genital warts alone. Demographic characteristics of the gynecologists (i.e., age of physician, gender, practice setting and community size) did not play an important role in the decision to recommend vaccination., Conclusion: Professional society recommendation is important for acceptability of a potential HPV vaccine. Gynecologists are willing to include this vaccine in their office practice.

The consistency of childhood sexual abuse (CSA) reporting was explored in this study. Two-hundred seventeen adolescents and young adults (ages 14-24) enrolled in urban health care clinics completed self-report questionnaires assessing CSA and other problem behaviors at enrollment and at 7 months. Results indicated that the stability of CSA self-report at two time points was poor (58% consistent nonreporters of CSA, 20% consistent reporters, 22% inconsistent reporters). Consistent and inconsistent reporters were differentiated on risk measures. Adolescents who endorsed more items from the CSA scale were five times more likely to be consistent reporters. In sum, adolescent CSA reporting was quite inconsistent over time. Using multi-item scales and assessing CSA at two time points enhances accuracy of reporting.

Objective: To examine the role of self-esteem in predicting coitus initiation in a population of early adolescents., Methods: Questionnaires assessing coital status, self-esteem, and pubertal maturation were collected from 188 participants who had not engaged in coitus by enrollment. Data were collected longitudinally while the participants were in the seventh and ninth grade. Ages ranged from 12 to 14 (mean: 12.50; standard deviation: 0.57) at Time 1 and from 14 to 16 (mean: 14.30; standard deviation: 0.49) at Time 2., Results: Boys with higher self-esteem ratings at Time 1 were more likely to initiate intercourse by Time 2. Girls with higher self-esteem at Time 1 were more likely to remain virgins than girls with lower self-esteem. Pubertal status was unrelated to initiation of coitus in this sample., Conclusions: Self-esteem, regardless of pubertal status, predicted coitus transition differentially in boys and girls. Results from this longitudinal study seem to fit within traditional problem behavior theory.

Background: Sexually transmitted disease (STD) clinic patients are at risk for hepatitis B virus infection, but have been relatively neglected in terms of hepatitis B virus (HBV) immunization. Acceptance of HBV vaccine among patients attending an STD clinic was examined., Goal: To evaluate potential predictors of HBV vaccine acceptance., Study Design: In this study, 99 patients attending an STD clinic completed a brief questionnaire that addressed knowledge of STD and vaccines as well as sexual behavior. After the questionnaire, each patient was offered HBV vaccine, then interviewed to assess reasons for acceptance or refusal., Results: Among the patients in this study, 23% accepted the vaccine and 11% reported prior vaccination. Acceptors were younger, had less education, and used condoms less frequently than those who refused vaccination. The reasons given for acceptance or rejection typically involved health beliefs related to infection or vaccination., Conclusion: The findings indicate an unacceptably low rate of HBV vaccine acceptance in a group at high risk for infection. However, some of the reasons for refusal may be modifiable through brief, targeted interventions.

The acceptance of a future HIV vaccine may be influenced, in part, by the characteristics of the vaccine itself. This study evaluated the relationship of vaccine characteristics to acceptability of hypothetical HIV immunization. Subjects were 549 undergraduates (18-56 years of age); 70.3% were female, and 80.4% were non-Hispanic white. Subjects completed a self-administered questionnaire assessing a series of 12 hypothetical vaccines that varied along the dimensions of efficacy (80 or 50%), cost (free or $300) and social saturation or percentage of the population already vaccinated (10, 50 or 90%). The vaccines were each rated on an 11-point scale ranging from zero ('I will never get this vaccine') to 100 ('I will definitely get this vaccine'), in increments of ten. All three dimensions were significantly associated with probability of vaccine acceptance, particularly vaccine efficacy and cost. The highest rated vaccine (free, 80% efficacious, 90% saturation level) received a mean acceptability score of 83.4, whereas the lowest rated vaccine ($300, 50% efficacious, 10% saturation level) received a mean score of 32.8. The mean acceptability rating across all 12 vaccines was 55.14. These findings indicate the potential importance of considering the influence of vaccine characteristics in future HIV immunization programmes.

The development of a vaccine to prevent human immunodeficiency virus (HIV) infection is a highly desirable goal. However, there may be a number of psychosocial barriers to HIV vaccine acceptance. The purpose of this study was to evaluate the relationship of health beliefs and health lifestyles to acceptability of hypothetical HIV immunization. The subjects were 549 college students who completed self-administered questionnaires that addressed health beliefs, health behaviours, and acceptability of hypothetical HIV vaccines. Results showed that all 6 variables of health beliefs, based in part on the Health Belief Model, independently predicted HIV vaccine acceptability. For the overall sample, 5 health behaviours were significantly correlated with HIV vaccination: diet, smoking, drug use, alcohol use, and prior sexual experience. The results suggest that universal HIV acceptance cannot be assumed, and that certain health beliefs and behaviours are likely to influence decisions regarding HIV immunization.

The high prevalence of genital warts, human papillomavirus (HPV), and the virus's cancer-causing potential warrant that women be well informed about these conditions and measures to prevent them. The purpose of this descriptive study was to examine women's knowledge and beliefs about genital warts, HPV, cervical cancer, and Pap tests. We interviewed 40 women recruited from health clinics in Chicago (20 adults) and Indianapolis (20 adolescents) about these issues. Audiotapes of the interviews were transcribed and analyzed. Among both the adults and adolescents there was a good deal of misunderstanding about symptoms associated with genital warts, about the purpose of Pap smears, and about the association of genital HPV with abnormal Pap smears and cervical cancer. The gaps in women's understanding about this potentially deadly infection suggest the need for more comprehensive education about preventing genital HPV, the infection's possible sequelae, and the significance of Pap screening for cancer detection and prevention.

The psychometric properties of the Multidimensional Scale of Perceived Social Support (MSPSS) were investigated in 222 urban, largely African-American adolescents (68%). High internal consistency was demonstrated, and factor analysis confirmed the three subscale structures of the MSPSS: family, friends, and significant other. Correlations with a family caring scale supported the discriminant validity of the Family subscale. These results confirm the reliability, validity, and utility of the MSPSS with an urban, largely African-American adolescent sample. Implications of the findings are discussed.

HIV immunization programmes will only be effective if sufficient numbers of persons accept the vaccine. Our aims were to evaluate HIV vaccine acceptability among adolescents and to examine how vaccine characteristics influence acceptability. We recruited 661 adolescents from community health clinics in Indianapolis, Indiana, USA to complete either written or computerized questionnaires, both of which assessed HIV vaccine acceptability as a function of efficacy, cost, type of vaccine, mode of delivery, and parental permission for immunization (required or not required). For both the written and computer methods, efficacy had the strongest effect on acceptability, followed by type of vaccine and cost. Low efficacy, high cost, and live-attenuated vaccines were associated with lower acceptability. These findings suggest that as efforts to develop HIV vaccines continue, it will be important, in parallel, to anticipate potential obstacles to vaccine acceptance, including the belief that a less efficacious HIV vaccine is unacceptable.

The purpose of this study was to examine the attitudes about hypothetical human papillomavirus (HPV) vaccines in two groups of women in clinical settings. Twenty adolescent women attending an urban community adolescent health clinic and 20 adult women attending a city health department sexually transmitted disease (STD) clinic were recruited to participate in individual interviews. Adolescents were 14-18 years of age (mean 15.6), 75% nonHispanic white, and 75% sexually experienced. Adults were 20-50 years of age (mean 33.6), 95% African American, and all were sexually experienced. As part of the interview, participants ranked nine hypothetical HPV vaccines in order of acceptability. Each vaccine was uniquely defined as a function of cost ($150, $50, or free), efficacy (50% or 90%), disease targeted (genital warts, cervical cancer, or both), and physician recommendation (not mentioned by a physician or specifically recommended). Rankings by adolescents and adults were highly concordant (Spearman rho = 0.9). Efficacy, physician's recommendation, and cost influenced rankings most strongly. Ranking decisions were often based on complex decision making, in which all characteristics were considered simultaneously. These findings suggest that certain features of an HPV vaccine might significantly affect vaccine acceptability. Vaccine efficacy, physician endorsement, and cost were particularly salient issues.

Adolescents rated hypothetical human immunodeficiency virus vaccines described as 90% and 50% efficacious and discussed how immunization might influence behavior of their peers. The low-efficacy vaccine was largely unacceptable and most believed immunization with the high-efficacy vaccine would cause increased risk behaviors. Immunization programs will need to address vaccine acceptability issues and behavioral responses to immunization.

Objective: To describe the types and sources of social support received by adolescents obtaining care at a large urban sexually transmitted diseases (STD) clinic., Method: A total of 140 females and 82 males (ages 13-20 mean, 17.6 years) indicated whether they had received any of 11 types of social support, and, if so, from whom. Types of support included: companionship to clinic, advice on symptom interpretation, advice to seek clinical care, advice on potential sources of care, help making appointments, prior provision of medications, supportive talking, help talking to sex partner, provision of money, provision of transportation, and help getting STD protection., Results: Eighty percent received at least one type of social support of whom 77% of subjects reported at least two types of support. The most frequently received support was information about symptom interpretation and appropriate clinic use (47% for each); 41% were accompanied to their clinic visit, and 37% received emotional support. A total of 15% of men but only 4% of women (p < .05 by Chi-square) received medication (usually antibiotics) but women were more likely to receive financial help (5% vs. 0% for women and men, respectively; p < .05). Although women obtained support earlier in the care-seeking process than men, there were no other significant gender differences in types of received support. Friends and sex partners were the most frequently cited sources of companionship and transportation, but parents provided transportation, information, medicine, and money for 15-20% of subjects receiving these types of support., Conclusion: Most adolescents receive a social support as part of seeking care for STD-related problems.

Purpose: To investigate the comparability of health behavior data obtained from adolescents via notebook computer versus those obtained via written questionnaire., Methods: We interviewed adolescent patients (ages 13-20 years) receiving services at community adolescent health clinics. Participants anonymously completed either a computer-assisted self-interview (CASI) or a self-administered questionnaire (SAQ), both assessing health-protective behaviors, substance use (i.e., tobacco, alcohol, marijuana) and sexual behaviors. From a pool of 671 adolescent participants (348 completing CASI, 323 completing SAQ), we matched 194 SAQ participants with 194 CASI participants on the basis of gender and race. We could not match individually on the basis of age, but were able to match each gender-race subgroup by mean age., Results: Across the majority of health behaviors (i.e., all health-protective behaviors, tobacco use, sexual behaviors), mode of administration made no significant difference in the reporting of information by adolescents. However, girls reported a greater frequency of alcohol use and marijuana use on CASI than on SAQ, whereas boys reported a lower frequency of alcohol use and marijuana use on CASI than on SAQ., Conclusions: The findings of this study suggest that there may be gender-related differences between modes of anonymous collection of specific adolescent health behaviors such as alcohol and marijuana use. Future studies should incorporate direct questions regarding adolescents' attitude and comfort levels toward completing different modes of data collection.

Objective: To develop a multidimensional classification of sexual partnerships., Methods: Eighty-two female subjects (ages 15-20 years; 77% African American) used coital logs to record dates of 1265 coital events, partner initials, and condom use. Logs were collected at 1-, 3-, 9-, 15-, and 21-month return visits. Three adolescent health professionals independently classified partnership patterns of each subject; classification schemes were revised until complete consensus for each subject was obtained., Results: Complete agreement in partnership classification was reached after 3 rounds. The consensus partnership classification had three dimensions: number (1, > or = 2 partners), pattern (1 partner, serially exclusive, concurrent), and duration (any partnership < or = 21 days, all partnerships >21 days). A total of 34 of 82 (34%) of subjects had > or = 2 partners; 11 of 34 (32%) had concurrent partnerships. Twenty of 82 (24%) had only partnerships lasting >21 days. Condom use was less common for subjects in only longer-term (>21 days) partnerships, but did not significantly vary by number or pattern., Conclusion: Multiple dimensions of adolescent sexual partnerships may be identified. Detailed research and clinical assessments along these dimensions may improve understanding of protective behaviors such as condom use.

Studies of condom use must rely upon self-report data which may not be reliable and valid. This investigation examined how 192 undergraduates (17-48 years) interpret response categories (never, rarely, sometimes, most of the time, always) used in some surveys to assess frequency of condom use. Subjects completed a questionnaire that described a scenario of a couple who had engaged in sexual intercourse 20 times during the past 3 months. As part of the survey, there were 21 statements in which the stated number of times condoms were used varied from 0 to 20 (e.g., condoms were used 18 out of the 20 episodes of sexual intercourse). For each statement, subjects were instructed to circle the category they believed best matched the frequency with which condoms had been used: 31% indicated that using condoms 1 out of 20 times was an example of never using condoms; similarly, 23% indicated that using condoms 2 times out of the 20 encounters was an example of never using condoms, 40% indicated that condom use for 19 out of 20 encounters was always using condoms, whereas 23% applied the always label to condom use for 18 out of 20 encounters. These results generally support the validity of this type of condom use measurement, but suggest that caution is needed in interpretation. Implications of these findings are discussed with respect to health messages and research methodology.

Objective: To assess the psychosocial functioning of adults who were evaluated as children for short stature and were not treated with human growth hormone., Design: Inception cohort study., Setting: Hospital-based pediatric endocrinology clinic., Participants: From 1975 to 1980, medical record review indicated that 181 of the children referred to our clinic for concerns about short stature were non-growth hormone deficient. In 1992 and 1993, we were able to recruit 35 of these patients for a follow-up study. Eligible subjects were at least 18 years of age at the time of follow-up., Main Outcome Measures: Standardized self-report questionnaires assessed various domains of psychosocial adjustment. Also, a brief test of intellectual functioning was administered and subjects underwent a semistructured in-person interview to evaluate pragmatic functioning and experiences associated with short stature., Results: Few significant differences between the study sample and standardization samples were found on measures of psychosocial and intellectual functioning. Within-group childhood height during the first evaluation appointment was not significantly associated with most adult measures of psychosocial adjustment. Shorter adult stature was significantly associated with lower educational achievement, lower self-esteem, and greater emotional distress., Conclusions: The absence of significant psychosocial distress or impairment in these subjects brings into question one basis for hormonal treatment for non-growth hormone deficient short stature; that short stature in childhood is likely to lead to psychological dysfunction in adulthood. The results, however, also suggest that shorter stature in adulthood may constitute a psychosocial stressor, increasing vulnerability across several domains.

Tested for defensive attributional bias in mothers' causal explanations for infant (2-12.5 months) growth deficiency. Mothers of healthy babies (controls; n = 82), growth deficient babies without medical problems (n = 27) and growth deficient babies with mild medical problems (n = 22) rated their levels of agreement with 23 causes of growth problems which were designed to vary in the degree of personal threat to parenting self-esteem. Ratings were completed for the mother's (Own) baby and for a nonspecific (Other) baby. Findings partially support a theory of defensive attributional bias, with higher agreement when causes referred to Other (vs. Own) baby, and lower agreement with family-related than with medical/nutritional causes. Factors that may have influenced material experience of threat and implications of the findings for clinical practice are discussed.

Purpose: The objective of this research is to describe aspects of the organization of adolescent sexual behavior in order to understand factors associated with risk for sexually transmitted diseases (STD)., Methods: Subjects were 82 females (ages 16-19 years; 77% African-American) participating in a larger STD study. Subjects completed diaries for each coital event, recording date of event, partner initial, condom use, and use of drugs or alcohol before intercourse. Partner change was defined as any event for which the sex partner initials differed from those listed for the most recent previous coital event., Results: The 82 subjects recorded 1265 coital events; the average span of the records was 10 weeks. Intercourse was least likely on Sundays (154 of 1265; 12.2%) and most common on Friday and Saturday (221 of 1265 for each day; 17.5%). The proportion of coital events associated with drugs or alcohol increased from Sunday to Saturday, although the proportion of coital events in which a condom was used did not vary significantly. Intercourse was most common in spring and summer, and least frequent in winter., Conclusions: These data indicate substantial temporal organization of adolescent sexual behaviors that may be related to risk of sexually transmitted diseases. Some STD-preventive interventions may be most effective when targeted to higher risk times.

Purpose: The purpose of this study was to evaluate the relationship of health beliefs to intention to accept human immunodeficiency virus (HIV) vaccination., Methods: Respondents were 81 female and 44 male college students who completed self-administered questionnaires. Questionnaires included items assessing intention to get vaccinated for HIV and the following health beliefs: perceived susceptibility to HIV infection, severity of AIDS, benefits of HIV immunization, pragmatic obstacles to vaccination, conditional nonmembership in a risk group, fear of the vaccine, and fear of needles., Results: Nearly 30% of the subjects were uncertain about or opposed to getting immunized for HIV. Susceptibility, severity, pragmatic obstacles, conditional nonmembership in a risk group, and fear of the vaccine were significantly correlated with intent to get vaccinated. Fear of needles, gender, and race were not associated with intent to get an HIV vaccine. Multiple regression analysis identified susceptibility, benefits, pragmatic obstacles, nonmembership in risk group, and fear of the vaccine as significant independent predictors of intent to vaccinate., Conclusions: These preliminary survey findings demonstrate that intention to accept HIV immunization is not universal and that health beliefs may influence HIV vaccine acceptance. They suggest that it may be important to consider the effects of psychological factors in future research on HIV vaccine acceptance and in the ultimate implementation of HIV immunization programs.

Since synthetic growth hormone became available in the mid-1980s, there has been debate about its use for non-growth-hormone-deficient short children. Justification for this use of growth hormone often is based on a presumed association of short stature with significant psychosocial maladjustment. However, systematic evaluation of psychosocial functioning in short children has been limited, and our understanding of this area is scant. In this study, we have used a combination of interview and self-report measures to examine self-esteem, personality characteristics, affective functioning, coping style, and stature-related stresses in 41 children (5 to 16 years) referred to a pediatric endocrinology service because of short stature. Parent-report and child measures of self-esteem and psychological functioning indicated no evidence of maladjustment in comparison with norms. Furthermore, within the subject sample, the degree of short stature was not related to poor psychological functioning. We found limited evidence linking increased age with increased distress, suggesting that short stature may pose greater difficulties for children as they enter adolescence. Taken as a whole, however, the results do not support the contention that short stature is generally associated with psychosocial maladjustment in children referred for evaluation of their short stature.

Intellectual abilities of 300 children with serious emotional disorders, referred to either psychiatric day- or inpatient-hospital treatment, were compared. Comparisons also were made to WISC-R standardization data. The findings indicated that children referred to inpatient settings were similar in intellectual competency to children in day treatment. Also, children with serious emotional disorders did not appear to differ strongly in clinically meaningful ways from the WISC-R standardization sample, a finding that replicates results of other investigators. Three distinct, clinically useful profiles emerged from a cluster analysis of the total group that may be practical in planning educational and therapeutic interventions in treatment settings for seriously disturbed children. The profiles underscored the wide range of intellectual abilities represented among these children.

This study investigated how 99 children who were examined for suspected sexual abuse (SSA) perceived their own medical evaluation experiences. Each child was interviewed about the degree of pain and fear associated with the experience, the kindness of the doctor, general fear of doctor visits, and degree of fear associated with a hypothetical second examination. The majority of children did not perceive their SSA examination to be strongly negative. However children did report greater fear associated with the SSA evaluation compared to an ordinary doctor visit. Using multiple regression, general fear of doctor visits and fear and pain associated with the SSA examination contributed to the prediction of intensity of fear about a hypothetical second SSA evaluation. Perceived kindness of the doctor, patient sex and age, and physician sex and age did not contribute to the regression equation. The relatively low reported rate of intense distress associated with medical evaluation of SSA suggests that fear and pain can be minimized and effectively managed for many children. The results of the regression analysis suggest that previous negative medical experiences may play an important role in determining how a child interprets the experience of an SSA medical evaluation.

Compares teachers' ratings of the school behaviors of children entering an outpatient clinic, a day psychiatric program, and an inpatient psychiatric hospital. Many of the ratings did not discriminate among the three groups. Children starting outpatient versus day treatment were rated as higher in aggression, anxiety, and hostile withdrawal, and children beginning outpatient and day treatment versus inpatient treatment, were reported as more skilled socially.

The intellectual performances of children with a variety of psychiatric disorders were examined and compared with the findings from a similar study by Hodges and Plow (1990). Mean IQ scores were in the average range for both study samples, and no significant differences were found in WISC-R summary scores. Nevertheless, the Hodges and Plow findings were only partially corroborated. They observed, for instance, a relative deficit in verbal abilities for conduct-disordered children and lower IQ scores for children with anxiety disorders vs. children with all other disorders. Our replication study found no significant differences among the disorder groups for any of the scores examined. Possible explanations for the divergence in findings are discussed.

Objective: To compare parents' ratings of home behaviors of three groups of children: those entering an outpatient clinic, a day hospital, and an inpatient hospital. It was hypothesized that the home behaviors of children starting day and inpatient hospital treatment would be rated as significantly more deviant than those of children beginning outpatient treatment, and there would be no significant differences in behavior ratings of children beginning day and inpatient hospital treatment., Method: A standardized behavior checklist was completed by the primary parent at the time treatment was begun. Scores on four factor scales were obtained, and a multivariate analysis of covariance was carried out., Results: The hypotheses were partially supported. Children beginning day and inpatient hospitalization were seen as more disordered, anxious, and aggressive than were those starting outpatient treatment; children starting day treatment were reported as more learning disabled than were those in both outpatient and inpatient settings; and children entering the inpatient setting were perceived as more aggressive than were those in day treatment., Conclusion: Aggressive behavior and learning disability appear to be determinants of choice of treatment setting. The progression from least to most restrictive placement was demonstrated for aggressive behavior only.

We compared AIDS-related attitudes of junior and senior high school students from 1988 to 1991 and across grade level to examine how effectively schools are addressing AIDS. Attitudes measured included knowledge and social anxiety about AIDS, as well as perceptions of vulnerability to HIV infection. Junior high school students (grades 7-9) were sampled three times, from 1989 to 1991. High school students (grades 10-12) were sampled four times, from 1988 to 1991. The 1991 junior high school sample had lower AIDS knowledge scores than the 1989 sample. Conversely, the 1991 high school sample had more accurate knowledge than earlier groups. With respect to grade level, 9th graders had more accurate knowledge than 7th and 8th graders, but knowledge did not increase from 10th through 12th grade. Anxiety about interacting with a person with AIDS and perceptions of vulnerability to HIV infection were unrelated to either sampling time or grade level. It is concluded that it will be important to redouble efforts to educate adolescents about AIDS and that particular attention needs to be paid to young adolescents.

A common approach to evaluating the reliability of AIDS knowledge scales has relied on the demonstration of internal consistency through the use of Kuder-Richardson formula 20 (KR-20) or coefficient alpha. In this study, the argument was made that, in a knowledge-based scale with diverse content (exemplified by AIDS knowledge scales), internal consistency does not make sense conceptually and underestimates the scale's true reliability. It was therefore hypothesized that a split-half approach, in which items in each half were matched for content, would provide superior estimates of reliability when compared to either KR-20 or an odd-even split-half approach. Reliability analyses performed on a knowledge scale developed by the author supported this hypothesis.

The impact of the acquired immunodeficiency syndrome (AIDS) epidemic on a group of adolescents was investigated by surveying 197 sexually active, predominantly African-American, urban high school students. Reported sexual behavior changes were evaluated in relation to AIDS-related knowledge and attitudes. Over 50% of the students decreased their frequency of sexual activity, increased their condom use, and/or decreased their number of partners. These students had significantly higher scores on a measure of worry about vulnerability to human immunodeficiency virus (HIV) infection than those whose behavior had not changed. AIDS knowledge, AIDS beliefs, and AIDS-related anxiety interacted with gender to affect sexual behavior change. Male students reporting decreased frequency of sexual activity, for example, had more accurate beliefs about AIDS than males reporting no decrease. Among female students, however, those reporting decreased frequency had less accurate beliefs than those reporting no decrease. These results highlight the importance of considering gender and specific sexual behaviors when designing AIDS education interventions.

68 students who reported knowing a person with AIDS were matched with 68 students who did not know anyone with AIDS. Those who knew a person with AIDS showed less anxiety about interacting with someone with AIDS.

This study examined the psychometric properties of the Multidimensional Scale of Perceived Social Support (MSPSS; Zimet, Dahlem, Zimet, & Farley, 1988) with a diverse group of 154 students at an urban college. The following areas were investigated: internal reliability, factorial validity, social desirability bias, and the moderating effect of social support between stressful life events and depression (i.e., the buffering hypothesis). The MSPSS had good internal reliability, and the factor analysis confirmed the subscale structure of the measure: family, friends, and significant other. There was no indication that social desirability bias influenced subjects' responses. Finally, social support was related to depression only for those subjects who were experiencing high levels of life stress, which lends support for the buffering hypothesis.

Tested 25 adolescents who reported knowing a person with AIDS or HIV (PWA) and were matched by gender, race, grade, school type, and academic achievement with 25 adolescents who reported not knowing a PWA. The groups were compared with respect to their knowledge, beliefs, and social anxiety about AIDS and with respect to their worries about personal vulnerability to HIV infection. Social anxiety was significantly lower in those reporting knowing someone with AIDS than in the matching group. No significant differences between the two groups were found for knowledge, beliefs, or vulnerability worries. The implications of these findings for research on AIDS interventions with adolescents are discussed.

The initial study describing the development of the Multidimensional Scale of Perceived Social Support (MSPSS) indicated that it was a psychometrically sound instrument (Zimet, Dahlem, Zimet, & Farley, 1988). The current study attempted to extend the initial findings by demonstrating the internal reliability, factorial validity, and subscale validity of the MSPSS using three different subject groups: (a) 265 pregnant women, (b) 74 adolescents living in Europe with their families, and (c) 55 pediatric residents. The MSPSS was found to have good internal reliability across subject groups. In addition, strong factorial validity was demonstrated, confirming the three-subscale structure of the MSPSS: Family, Friends, and Significant Other. Finally, strong support was also found for the validity of the Family and Significant Other subscales.

To determine high school athletes' attitudes toward and use of ergogenic aids, we surveyed 295 students presenting for preparticipation examinations. In general, young athletes believed that steroids and amphetamines were not efficacious in enhancing sports performance and that their use was potentially harmful. Subjects reported minimal use of steroids (1%) and amphetamines (2%), and only a minority would consider their use. As a group, however, male athletes were more likely to believe that steroids were effective (32% vs 13%) and to consider the future use of these agents (14% vs 0) compared with female athletes. The majority of high school athletes believed that supplemental protein or vitamins could improve performance and that their use caused little or no health risk. These data suggest that young athletes may require information regarding the limited benefits and potential risks associated with the use of ergogenic aids.

This paper first reviews studies which have investigated the efficacy of using locus of control orientation to predict performance in various modes of biofeedback. However, contradictory evidence and methodological problems make it impossible to draw any conclusions regarding the connection between internality-externality and biofeedback performance. Second, various attempts to modify externality through biofeedback treatment are reviewed. Although EMG feedback can apparently be used to shift locus of control in an internal direction, there are some major issues that need to be resolved. Of primary importance is the fact that the rationale for modifying externality is based on an unproven assumption that externality has a role in the causation of various undesirable behaviors. Also, as no follow-up testing has been done, there is no evidence that the EMG biofeedback causes relatively permanent, stable locus of control changes. If the shifts are only temporary, then its use as a modifier of externality is questionable.