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This Month in Archives of Pediatrics and Adolescent Medicine
March 07, 2011

This Month in Archives of Pediatrics & Adolescent Medicine

Author Affiliations

Copyright 2011 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Restrictions Apply to Government Use.2011

Arch Pediatr Adolesc Med. 2011;165(3):194. doi:10.1001/archpediatrics.2011.8
Relationship Between Adolescent Oral and Vaginal Sex

The most common form of sexual behavior among adolescents is oral sex. It has been suggested that there is a temporal order in the relationship between oral sex and vaginal sex, but the data are inconclusive. This prospective study of students from 2 California high schools found that among adolescents who initiated either oral or vaginal sex during the study, most initiated oral sex before or within the same 6-month period of their first report of vaginal sex. Adolescents who initiated oral sex at the end of ninth grade represented the group with the highest risk of vaginal sex initiation during high school. These adolescents had a 25% chance of initiating vaginal sex at the end of ninth grade and a 50% chance by the end of 11th grade. Adolescents at lowest risk of initiating vaginal sex were adolescents who never engaged in oral sex. Most interventions aimed toward reducing sexual risk need to expand traditional messages about abstinence or safer sex methods, which typically ignore the role oral sex plays in adolescent sexual behavior.

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The Window of Opportunity for Treatment Withdrawal

Physicians sometimes refer to a “window of opportunity” for withdrawing life-sustaining treatment in patients with acute severe brain injury. There is a period of critical illness and physiological instability when treatment withdrawal is likely to be followed by death but prognosis is uncertain. If decisions are delayed, greater prognostic certainty can be achieved, but with the risk that the patient is no longer dependent on life support and survives with very severe disability. Wilkinson uses the example of newborn infants with hypoxic-ischemic encephalopathy to discuss the potential arguments in favor of and against taking the window of opportunity into account. He concludes that while dealing with uncertainty can make decisions very difficult, where the outcome is sufficiently severe and there is enough certainty about prognosis, it is both ethical and appropriate for parents and physicians to take advantage of the window to withdraw life-sustaining treatment.

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Variation in Pregnancy Outcomes Following Prenatal Home Visitation

The Nurse-Family Partnership, a program of prenatal, infancy, and toddler home visitation by nurses for low-income mothers bearing their first children, is designed to improve the outcomes of pregnancy, children's health and development, and parents' economic self-sufficiency. This study examined the effect of statewide dissemination of the program on subsequent pregnancies of first-time mothers. There was no effect of the program on second pregnancies in the first few years of the program. Subsequently, the program significantly reduced the risk of second pregnancies among mothers aged 18 years or younger, and the effect was twice as strong among young mothers in rural locations compared with urban locations. The finding of potentiated benefit in rural locations would seem to justify implementation in such locations in addition to urban areas, greatly expanding the reach of the program.

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Kaplan-Meier curves describing time to second pregnancy among Nurse-Family Partnership clients compared with locally matched controls, sorted by age category of the mother during the 2004 to 2005 period.

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Individual and Family Motivational Interventions for Alcohol-Positive Adolescents

The Family Check-Up is an assessment and feedback intervention, consistent with a motivational approach, designed to enhance parental recognition of child/adolescent risk behaviors and increase motivation for reducing these problem behaviors and associated risk factors. In this randomized clinical trial of adolescents who were treated in an emergency department after an alcohol-related event, both an individual motivational interview and an individual plus family intervention resulted in a statistically and clinically significant decrease in alcohol use, quantity of use per drinking occasion, and high-volume drinking at each follow-up point compared with baseline. The largest effects were at 3-month follow-up, with a gradual increase by 6 months and then a sharper increase between 6 and 12 months. There was a small but significant additional effect at 3 months with the combined intervention.

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Percentage of the sample that reported any high-volume drinking (≥5 drinks) in the previous 3 months by condition. FCU indicates Family Check-Up; IMI, individual motivational interview.

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