PubMed Health⌕ Search

Biomedical subjects

S G Millstein

Publications and source records attributed to S G Millstein.

At least 37 records · Page 2Linked to original sources
PubMed1996

Delivery of STD/HIV preventive services to adolescents by primary care physicians.

PURPOSE: To document the rates of STD/HIV preventive services delivered to adolescents by primary care physicians in California, and to identify variation owing to physician and practice-related factors. METHODS: A stratified random sample of California internists, family physicians, obstetricians-gynecologists, and pediatricians was drawn from the AMA Masterfile and surveyed by mail about their practices with regard to STD/HIV prevention for 15-18-year-old adolescent patients. Sixty percent of eligible physicians responded; the final sample was 1217 physicians. RESULTS: Results showed that 40% of physicians reported screening all of their adolescent patients for sexual activity and 31% reported educating all of their adolescent patients about STD/HIV transmission. For their sexually active adolescent patients, 36% of physicians always provided STD/HIV education, 17% always screened for number of previous sexual partners; 12% always screened for sexual orientation; and 10% always screened for frequency of casual sex. Four percent of the physicians reported that they always provided condoms for their sexually active adolescent patients; 81% never provided condoms. Higher levels of preventive services delivery were associated with female physician gender, specialization in obstetrics-gynecology, and more recent date of medical school graduation. Physicians practicing in health maintenance organizations reported providing significantly higher rates of preventive services to sexually active adolescents than did physicians in private practice. CONCLUSIONS: Primary care physicians provide STD/HIV preventive services to adolescents at rates far below those recommended by current guidelines. Areas where additional research would be informative are highlighted.

Adolescent↗
PubMed1996

Anticipatory guidance regarding sex: views of virginal female adolescents.

PURPOSE: To explore virginal female adolescents' perceptions of potential discussions with physicians regarding sexuality. METHODS: Twenty-seven virginal female adolescents from an urban high school completed a semistructured interview that explored perceptions of: (1) physicians as resources for discussions about sexuality; (2) content of potential sexuality discussions with physicians; and (3) risks and benefits of sexuality discussions with physicians. The relative emphasis of responses across the sample are described by mean proportional scores (MPS). RESULTS: Health care professionals were spontaneously identified by 33% of participants as potential resources for discussions about sexuality issues. Participants' perceptions of the potential content of sexuality discussions with physicians emphasized prevention of pregnancy and sexually transmitted infections (STIs) (MPS = .37), and physician counseling (MPS = .22). These topics included alternatives to sex and sex refusal skills. The perceived benefits of such discussions were gaining information or assistance regarding pregnancy and STI prevention (MPS = .32), talking with an expert (MPS = .19), and having a supportive relationship with a caring adult (MPS = .16). Lack of confidentiality was perceived as the major risk of adolescent-physician sexuality discussions (MPS = .29). CONCLUSION: Virginal female adolescents perceive a range of topics regarding sexuality as appropriate for discussions with physicians. This should be considered when providing anticipatory guidance counseling to virginal patients regarding sex. Concerns about confidentiality need to be addressed.

Adolescent↗
PubMed1996

Utility of the theories of reasoned action and planned behavior for predicting physician behavior: a prospective analysis.

The utility of the theory of reasoned action (TRA) and the theory of planned behavior (TPB) for prospectively predicting physicians' delivery of preventive services was compared. Primary care physicians (N = 765) completed 2 mail surveys at periods 6 months apart. The addition of perceived behavioral control to the TRA model significantly increased the variance accounted for in behavioral intention and subsequent behavior (p < .001). TPB constructs were related to physicians' intentions to educate adolescents about sexually transmitted disease transmission (R = .52, p < .001) and to their subsequent delivery of this service (R = .63, p < .001). Perceived behavioral control had direct effects on behavior and interacted with social norms and behavioral intentions. Applications of models such as the TRA or TPB have focused primarily on predicting the behavioral intentions and behaviors of patients. Results suggest that these models have relevance for studying the behavior of health care providers as well.

Adolescent↗
PubMed1995

Sexually-transmitted disease in female adolescents: effects of psychosocial factors and high risk behaviors.

BACKGROUND: Although previous studies have reported behavioral correlates of sexually-transmitted diseases (STDs) and psychosocial correlates of risky behavior, research has not examined the linkages between psychosocial attributes, behavioral patterns, and actual STD acquisition within the same adolescent sample. We examined the effects of five psychosocial factors on risky sexual behavior and substance use, and their direct and indirect effects on STD acquisition. METHODS: A multiethnic sample of 571 sexually-active female adolescents (ages 13-19 years) was recruited from family planning clinics. Subjects completed questionnaires prior to their gynecologic examination and STD testing. RESULTS: A multiethnic sample of 571 sexually-active female adolescents (ages 13-19 years) was recruited from family planning clinics. Subjects completed questionnaires prior to their gynecologic examination and STD testing. RESULTS: Female adolescents who were heavy substance users, who felt little control over their sexual behavior, and had a greater number of friends who engaged in risky sexual behavior were themselves more likely to engage in risky sexual behavior. Risky sexual behavior was associated with positive STD status. Subjects who used psychoactive substances during sex reported higher numbers of sexual partners and were more likely to have an STD. CONCLUSIONS: This research has identified possible causal paths by which psychosocial factors may influence specific behaviors that are predictive of STDs in adolescent females.

Adolescent↗
PubMed1994

Female adolescents at high, moderate, and low risk of exposure to HIV: differences in knowledge, beliefs, and behavior.

PURPOSE: To examine differences in the beliefs and behaviors of female adolescents at varying degrees of probable risk for HIV transmission. METHODS: A clinically-based, ethnically diverse sample of 696 sexually active female adolescents was recruited from urban and suburban general adolescent, family planning, and public health clinics. Subjects were categorized into four risk status groups on the basis of their history of IV drug use, sexually transmitted disease (STD), and probable risk of contact with an infected individual (living in a high-risk geographic location, sexual promiscuity, sex with male homo/bisexuals). RESULTS: Females in the highest risk group showed high rates of substance use, anal intercourse, and intentions to have future risky sexual partners. A second high-risk group reported high rates of STDs, inconsistent condom use, and less AIDS knowledge. CONCLUSION: Different subsets of higher risk adolescents may require different intervention strategies.

Adolescent↗
PubMed1994

Initiation of substance use in early adolescence: the roles of pubertal timing and emotional distress.

Two hypotheses regarding the effects of pubertal timing on substance use were tested in a prospective study of 221 young adolescents. A maturational-deviance hypothesis predicted that early-maturing girls and late-maturing boys would experience heightened emotional distress, which in turn would influence initiation and use of substances. Alternatively, an early-maturation hypothesis predicted that early-maturing girls would engage in more substance use than all other groups, independent of emotional distress. Early-maturing adolescents reported more substance use within 1 year. Adolescents experiencing elevated levels of negative affect also reported greater substance use within the next year. However, pubertal timing was not related to emotional distress. Results support the early-maturation hypothesis for girls and suggest its extension to boys.

Adolescent↗
PubMed1993

Risks of human immunodeficiency virus infection among adolescents attending three diverse clinics.

This study was performed to identify specific high-risk behaviors, such as unprotected oral, anal, and vaginal intercourse and substance abuse, associated with human immunodeficiency virus infection among adolescents attending three diverse clinics located in a localized geographic area: a university-based clinic, a Planned Parenthood clinic, and an inner-city public health clinic (PHC). Six hundred seventy-one female and 207 male adolescents attending one of the three clinics completed a structured questionnaire. Similarities among patients at the clinic sites included high rates of anal intercourse (21%), unprotected vaginal sex (95%), oral sex (73%), and poor communication skills (42%). Some differences appeared as well, including higher rates of homosexual experiences, no birth control use, and having multiple partners among adolescents attending the PHC (p < 0.001). In contrast, adolescents attending either the university-based clinic or the Planned Parenthood Clinic had higher rates of substance abuse around sexual activity than those who attended the PHC (p < 0.001). We conclude that adolescents attending general medical clinics in the San Francisco Bay area engage in high-risk behaviors that place them at risk for transmission of human immunodeficiency virus even though many have had previous education about acquired immunodeficiency syndrome and sexually transmitted disease. Specific risk factors include unprotected receptive anal intercourse, unprotected vaginal intercourse with new and unknown partners, experience in homosexual behavior, high rates of oral sex, multiple partners, poor communication skills, and frequent use of illicit substances in conjunction with sex. The differences found among sites indicate the need for health care providers and prevention programs to provide emphasis on practices specific to the adolescents in their service area.

Acquired Immunodeficiency Syndrome↗
PubMed1993

Autonomy, relatedness, and the initiation of health risk behaviors in early adolescence.

This study examined the relationships among sociodemographic characteristics, family processes, and the initiation of health risk behaviors in early adolescence. Subjects were 189 6th and 7th graders from a public middle school. A path-analytic model was used to analyze data. Results showed that students who received autonomy support from parents were less likely to initiate sexual intercourse. Students who were emotionally detached from their parents were more likely to fight and use substances. Those who were emotionally detached tended to come from families with low levels of cohesion and acceptance. Sociodemographic variables, such as family structure, gender, and ethnicity, had both direct and indirect effects on health risk behaviors, but the indirect effects were quite small.

Adolescent↗
PubMed1993

Appointment-keeping behavior in adolescents: factors associated with follow-up appointment-keeping.

STUDY OBJECTIVES: To identify the sociodemographic and Health Belief Model predictors of follow-up appointment-keeping behavior. DESIGN: Prospective observational study. SETTINGS: General adolescent medical clinic. PATIENTS AND MEASUREMENTS: Sequential sample of 166 adolescents (aged 12 to 20 years, mean = 15.9 years) enrolled in the clinic. The population was 75% female; the racial-ethnic distribution of the sample was 37.9% black, 29.8% white, 11.2% Asian, 14.3% Hispanic, and 6.8% "other" background. Subjects' social class was primarily lower-middle (60.5%) and middle class (28.6%). A subsample was randomly assigned to be interviewed about their beliefs concerning their follow-up appointment and the constructs of the Health Belief Model. RESULTS: Forty-eight percent of the total sample failed to keep their follow-up appointment. There was a significant positive correlation between social class and appointment keeping (F = 5.07; df = 5,110; P = .026). Neither race-ethnicity nor who made the appointment were found to be associated with follow-up appointment-keeping. The only construct of the Health Belief Model found to be significantly associated with appointment keeping was the number of potential negative outcomes resulting from noncompliance perceived by the subject (F = 6.85; df = 1.74; P = .011). CONCLUSIONS: Clinicians must work with adolescents to improve their understanding of the potential negative outcomes associated with noncompliance to improve appointment-keeping behavior.

Adolescent↗
PubMed1992

Health-risk behaviors and health concerns among young adolescents.

This study examined the health concerns and behaviors of 563 adolescents (aged 11 through 14) from a variety of social, racial, and ethnic backgrounds. Behaviors associated with adolescent morbidity and mortality were examined, including sexual behavior, substance use, and injury-related behaviors. Although young adolescents are often viewed as unlikely participants in these risk behaviors, the results of this study suggest that greater attention should be paid to this younger group and their health-risk behaviors. A majority of the sample had tried alcohol and tobacco, and almost a third had used marijuana. Twenty-one percent were sexually active. Prevalence rates varied by social class, race-ethnicity, gender, and age. More than 75% of the sample had visited a physician during the prior year, suggesting an important role physicians may serve as sources of information and positive role models for these young adolescents. The results suggest that we stop viewing young adolescents as naive children and begin to view them as observers of and participants in a changing social environment that has important implications for their current and future health status. Without a realistic appraisal of the young adolescent, we can expect to have little overall effect on the status of adolescent health in the United States.

Adolescent↗
PubMed1989

Urinary leukocyte esterase screening test for asymptomatic chlamydial and gonococcal infections in males.

We evaluated the ability of the urinary leukocyte esterase test to predict culture-verified chlamydial and gonococcal urethritis among asymptomatic adolescent males. Nine hundred forty-eight sexually active males provided first-catch urine samples for esterase screening, and 76 (8%) tested positive (greater than or equal to 1+). Among 435 boys who agreed to undergo urethral culture, the esterase was positive in 66 (15%), Chlamydia trachomatis was isolated from 39 (9%), and Neisseria gonorrhoeae was isolated from 14 (3%). The sensitivity, specificity, and positive and negative predictive values for the esterase test were 72%, 93%, and 58% and 96%, respectively. Using the esterase test to screen asymptomatic males for urethritis, we identified 38 culture-verified infections that otherwise would have remained undetected. The urinary leukocyte esterase test is a noninvasive and cost-effective screening method to detect urethritis among asymptomatic adolescent males.

Adolescent↗
PubMed1989

Adolescent health. Challenges for behavioral scientists.

Clearly, the role of behavioral scientists in adolescent health is not limited to service delivery. They also have a role to play via their contributions to basic knowledge of adolescent health and development, their involvement with the design and evaluation of health systems, their efforts to design and evaluate interventions to reduce adolescent morbidity and mortality, and their contributions to adolescent health policy. The once popular view of adolescence as a period of inevitable storm and stress has been replaced by one that emphasizes the potential of this developmental stage for constructive adaptation and maturation. Behavioral scientists have an important role to play in assuring that the potential of this life stage is reached for future generations of youth.

Adolescent↗
PubMed1988

A comparison of two measures of egocentrism.

This study examined the relationship between two prominent measures of egocentrism, Enright's Adolescent Egocentrism Scale (AES) and Elkind's Imaginary Audience Scale (IAS), in a sample of 458 adolescents, between 10 and 15 years old. Both correlational and factor analyses indicated that the two measures assess distinctly different phenomena. As predicted, IAS scores were correlated with self-reported levels of shyness, nervousness, and social skills. These results provide partial evidence for the validity of the IAS as a measure of self-consciousness, though not necessarily egocentrism per se. The validity of the AES was not examined.

Adolescent↗