A comparison of Hispanic and white adolescent females' use of family planning services in California.Adolescent pregnancy adolescent pregnancy See Teenage pregnancy. is associated with negative social and economic outcomes for both the mother and the child, (1) and it is a persistent problem among Hispanics in California. Hispanic adolescents have a birthrate birth·rate or birth rate n. The ratio of total live births to total population in a specified community or area over a specified period of time, often expressed as the number of live births per 1,000 of the population per year. that is three times that of whites (83 vs. 25 births per 1,000). (2) And while the overall adolescent birthrate in the state has decreased during the past decade, the rate of decrease among Hispanics has been lower than that among whites. Because the proportion of California's adolescent population who are Hispanics is projected to be 50% by 2020, (3) it is imperative to understand the unique factors underlying this group's health0-including reproductive health-status. The main factors associated with differences between Hispanic and white adolescents' pregnancy rates include Hispanic teenagers' slightly higher rates of sexual activity and lower levels of contraceptive contraceptive /con·tra·cep·tive/ (-sep´tiv) 1. diminishing the likelihood of or preventing conception. 2. an agent that so acts. and condom 1. condom - The protective plastic bag that accompanies 3.5-inch microfloppy diskettes. Rarely, also used of (paper) disk envelopes. Unlike the write protect tab, the condom (when left on) not only impedes the practice of SEX but has also been shown to have a high failure use. (4) In addition, Hispanic adolescents lack access to health care, (5) and this may hinder hin·der 1 v. hin·dered, hin·der·ing, hin·ders v.tr. 1. To be or get in the way of. 2. To obstruct or delay the progress of. v.intr. their access to reproductive health Within the framework of WHO's definition of health[1] as a state of complete physical, mental and social well-being, and not merely the absence of disease or infirmity, reproductive health, or sexual health/hygiene information, use of prescription methods of contraception contraception: see birth control. contraception Birth control by prevention of conception or impregnation. The most common method is sterilization. The most effective temporary methods are nearly 99% effective if used consistently and correctly. and referral to family planning family planning Use of measures designed to regulate the number and spacing of children within a family, largely to curb population growth and ensure each family’s access to limited resources. services. Poverty and lack of health insurance are known to hinder Hispanics' access to and use of health care services. (6) Parental immigration immigration, entrance of a person (an alien) into a new country for the purpose of establishing permanent residence. Motives for immigration, like those for migration generally, are often economic, although religious or political factors may be very important. status may also be a factor: Hispanic children of immigrant parents are more likely than Hispanic children of U.S.-born parents to lack health insurance and access to health care services. (7) However, the relationship between parental immigration status and use of reproductive health care services among Hispanic adolescents has so far not been examined in the literature. Therefore, the goal of our study was to analyze data from Hispanic and white adolescents in order to identify Hispanics' unique characteristics associated with the use of family planning services. We also examined health policy--relevant factors that we expected to be associated with use of family planning services, including having at least one parent without legal immigration status, having health insurance and having a regular source of primary health care. By comparing Hispanic and white adolescents, we can identify potential cultural factors that may impede im·pede tr.v. im·ped·ed, im·ped·ing, im·pedes To retard or obstruct the progress of. See Synonyms at hinder1. [Latin imped adolescents' use of family planning services. We hypothesize hy·poth·e·size v. hy·poth·e·sized, hy·poth·e·siz·ing, hy·poth·e·siz·es v.tr. To assert as a hypothesis. v.intr. To form a hypothesis. that because of cultural norms within Hispanic families, which often forbid for·bid tr.v. for·bade or for·bad , for·bid·den or for·bid, for·bid·ding, for·bids 1. To command (someone) not to do something: I forbid you to go. 2. adolescents from having sexual intercourse sexual intercourse or coitus or copulation Act in which the male reproductive organ enters the female reproductive tract (see reproductive system). before marriage, Hispanic adolescents are less likely than white adolescents to use family planning services before pregnancy. In contrast, we hypothesize that Hispanic adolescents will be as likely as whites to use such services after pregnancy, because after a Hispanic teenager has been pregnant, her family may be less likely to object to the use of family planning services for the prevention of future pregnancies. METHODS Data We analyzed an·a·lyze tr.v. an·a·lyzed, an·a·lyz·ing, an·a·lyz·es 1. To examine methodically by separating into parts and studying their interrelations. 2. Chemistry To make a chemical analysis of. 3. data from the 2001 California Health Interview Survey (CHIS CHIS Chiapas (Estado de México) CHIS Channel Islands National Park (US National Park Service) ) (8)--a random-digit dial telephone survey of 55,000 households drawn from every county in California, which was conducted between November 2000 and September 2001. The sample was representative of the state's noninstitutionalized population living in households. The CHIS interviewed one adult from each household, as well as one adolescent aged 12-17, if present. (Adults were asked to identify adolescents of whom they were the parent or guardian, and one adolescent per household was randomly selected to participate.) The adolescent interviews were conducted in six languages (including English and Spanish), and lasted an average of 19 minutes; adult interviews lasted 32 minutes. The overall household response rate was 38%, which was comparable to that of other 30-minute telephone surveys conducted in California in multiple languages. A full description of the methods is available from the Web site of the Center for Health Policy Research of the University of California The University of California has a combined student body of more than 191,000 students, over 1,340,000 living alumni, and a combined systemwide and campus endowment of just over $7.3 billion (8th largest in the United States). at Los Angeles Los Angeles (lôs ăn`jələs, lŏs, ăn`jəlēz'), city (1990 pop. 3,485,398), seat of Los Angeles co., S Calif.; inc. 1850. . (9) Among the 5,801 adolescents interviewed, 60% were white and 34% were Hispanic (8% of the Hispanic adolescents were interviewed in Spanish); 49% of respondents In the context of marketing research, a representative sample drawn from a larger population of people from whom information is collected and used to develop or confirm marketing strategy. were female. Data were weighted according to according to prep. 1. As stated or indicated by; on the authority of: according to historians. 2. In keeping with: according to instructions. 3. the 2000 census, so that the sample was representative of California's noninstitutionalized adolescent population. In our study, we selected the subset A group of commands or functions that do not include all the capabilities of the original specification. Software or hardware components designed for the subset will also work with the original. of 1,629 Hispanic and white adolescent females aged 14-17, who represented 760,000 such individuals in California. (Adolescents younger than 14 were not selected because the CHIS did not ask this age-group about their sexual behavior sexual behavior A person's sexual practices–ie, whether he/she engages in heterosexual or homosexual activity. See Sex life, Sexual life. .) Parents were asked socioeconomic so·ci·o·ec·o·nom·ic adj. Of or involving both social and economic factors. socioeconomic Adjective of or involving economic and social factors Adj. 1. and demographic questions about their household, themselves and the adolescent; the adolescent was asked about his or her health status, health-related behavior and use of health care and family planning services. Variables * Socioeconomic and demographic characteristics. Parents provided the following information: whether English or Spanish was the primary language spoken at home; the family's type of health insurance; the household income (which we converted to the percentage of the federal poverty level); whether their residence was urban or rural; their citizenship or immigration status, marital status marital status, n the legal standing of a person in regard to his or her marriage state. and educational level; the adolescent's age, citizenship or immigration status, and proficiency pro·fi·cien·cy n. pl. pro·fi·cien·cies The state or quality of being proficient; competence. Noun 1. proficiency - the quality of having great facility and competence in spoken English; and whether the adolescent was attending school. * Adolescents' health. The adolescents were asked about their general health status, regular source of primary health care and history of substance use; they were also asked whether they had ever had sexual intercourse. Sexually experienced respondents were asked how much their parents knew about their sexual activity, as well as whether they had ever been pregnant, received family planning counseling or services in the past year, had sex before age 14, used a contraceptive the first and the most recent time they had sex, and ever had a sexually transmitted disease sexually transmitted disease (STD) or venereal disease, term for infections acquired mainly through sexual contact. Five diseases were traditionally known as venereal diseases: gonorrhea, syphilis, and the less common granuloma inguinale, . Statistical Analyses We determined the precision of all estimates by calculating coefficients of variation (the standard deviation In statistics, the average amount a number varies from the average number in a series of numbers. (statistics) standard deviation - (SD) A measure of the range of values in a set of numbers. divided by the mean); estimates with coefficients of variation of 30% or larger were considered unstable. We used chi-square tests chi-square test: see statistics. to conduct pairwise comparisons of proportions of adolescents categorized cat·e·go·rize tr.v. cat·e·go·rized, cat·e·go·riz·ing, cat·e·go·riz·es To put into a category or categories; classify. cat by their characteristics. We also conducted multivariate The use of multiple variables in a forecasting model. logistic regressions In statistics, logistic regression is a regression model for binomially distributed response/dependent variables. It is useful for modeling the probability of an event occurring as a function of other factors. to examine the association between selected characteristics and sexually experienced adolescents' use of family planning services in the past year. We focused on variables that had potential implications for health policy, including composite variables combining race or ethnicity ethnicity Vox populi Racial status–ie, African American, Asian, Caucasian, Hispanic with parental citizenship or immigration status, and with pregnancy history. Because CHIS has a stratified sampling Noun 1. stratified sampling - the population is divided into subpopulations (strata) and random samples are taken of each stratum proportional sampling, representative sampling sampling - (statistics) the selection of a suitable sample for study design, SUDAAN 8.0 was used for the statistical analyses. This software allowed us to account for the effect of the sampling design on the variance of the regression parameter estimates. Normalized weights were included in the regression analyses. RESULTS The samples of white and Hispanic adolescent females shared several characteristics: The majority lived in an urban area, were born in the United States United States, officially United States of America, republic (2005 est. pop. 295,734,000), 3,539,227 sq mi (9,166,598 sq km), North America. The United States is the world's third largest country in population and the fourth largest country in area. or had legal residence status, spoke English well, were currently attending school and had parents who were married (Table 1). Significantly larger proportions of white households than of Hispanic households used English as the main language, had employer-based health insurance and had an income of at least 300% of the federal poverty level. On the other hand, larger proportions of Hispanic households than of white households had no insurance or public insurance, had an income of less than 200% of the federal poverty level and were located in urban areas. Furthermore, compared with whites, Hispanics less commonly had two parents who were U.S. citizens or had a green card, had less educated parents, less commonly were U.S.-born citizens, spoke English less proficiently pro·fi·cient adj. Having or marked by an advanced degree of competence, as in an art, vocation, profession, or branch of learning. n. An expert; an adept. , rated their health status lower and less commonly had a regular source of health care. However, they had lower rates of experience with alcohol, drugs and sexual intercourse than whites. We limited our analysis of reproductive health status and use of family planning services to adolescent females who had ever had sex (Table 2). Distributions of whites by parents' level of knowledge about the adolescent's sexual activity and by history of pregnancy were similar to those of Hispanics. The rate of use of family planning counseling or services during the previous year among Hispanics was also similar to that among whites (34% and 27%, respectively). However, the proportion of adolescents who had ever been pregnant and also used family planning services in the previous year was significantly larger among Hispanics than among whites (42% vs. 9%). The first multivariate logistic regression analysis focused on the following health policy-relevant variables: age, race or ethnicity, parental citizenship or immigration status, language spoken at home, health insurance status, poverty stares, parental education and the regular source of primary health care (Table 3, page 160). None of these variables were significantly associated with adolescents' use of family planning services within the past year. The second multivariate analysis multivariate analysis, n a statistical approach used to evaluate multiple variables. multivariate analysis, n a set of techniques used when variation in several variables has to be studied simultaneously. excluded parental citizenship or immigration status but included pregnancy history. Hispanic adolescents who had ever been pregnant were significantly more likely than whites who had never been pregnant to have used family planning services in the previous year (odds ratio, 11.6), although the wide confidence interval confidence interval, n a statistical device used to determine the range within which an acceptable datum would fall. Confidence intervals are usually expressed in percentages, typically 95% or 99%. reflects the relatively small sample of Hispanic teenagers. DISCUSSION Although only one-quarter of sexually experienced white adolescent females and one-third of Hispanic counterparts had received family planning services in the past year, Hispanics who had ever been pregnant had an increased likelihood of using family planning services. Therefore, it appears that the main problem to be addressed in increasing levels of use of reproductive health care services among Hispanic adolescents in California is how to encourage this group to use such services as a preventive measure before pregnancy. Implementing information campaigns at schools or community-based organizations may be one way of doing this. Our hypotheses that parental immigration status and having a regular source of care are associated with Hispanic adolescents' use of family planning services were not supported by our findings. In addition, health insurance status and family income (in terms of federal poverty level), which typically predict access to and use of health care services, were not associated with use of family planning services in our sample. A possible explanation is that in California, the Family PACT (Planning, Access, Care and Treatment) program provides family planning services regardless of health insurance status or the ability to pay. Hispanic adolescents in our study had a somewhat lower rate of sexual experience than did whites. In contrast, other researchers have found a slightly higher rate of sexual experience among Hispanic adolescents than among whites. (10) However, these researchers included adolescents aged 15-19, whereas we focused on 14-17-year-olds. Parental knowledge of adolescents' sexual activity did not vary by race or ethnicity in our sample. This result was surprising, because a previous study on unmarried Hispanics in the United States Hispanics in the United States, or Hispanic Americans, are American citizens or residents of Hispanic ethnicity who identify themselves as having Hispanic Cultural heritage.[1] According to the 2000 Census, Hispanic Americans constitute roughly 12. found that a pervasive sexual silence existed, especially among women, and that more than half of respondents reported that their mothers had never spoken to them about sex when they were younger. (11) Still, parental attitudes toward adolescents' sexual behavior are likely to differ between whites and Hispanics: Sexual activity among unmarried young persons is considered culturally unacceptable among Hispanics and even harmful to the reputation of young females. Therefore, messages that Hispanic adolescents receive about sexuality from their parents, especially from their mothers, may focus more on abstinence abstinence: see fasting; temperance movements. than on pregnancy prevention. These messages may deter nonpregnant Hispanic adolescents from seeking family planning services, because this would imply that they are sexually active. Our survey did not measure parental attitudes toward adolescents' sexual activity, and future research needs to focus on this area, as well as on the communication between parents and adolescents about sexual matters. The sampling procedures used by CHIS are designed to obtain a representative sample of adolescents in California. Our study included all Hispanic and white adolescent females aged 14-17 in the CHIS sample. The sampling procedures used are the strength of our study. Nevertheless, there are some limitations. First, our data were cross-sectional and did not allow the temporal sequence or causality causality, in philosophy, the relationship between cause and effect. A distinction is often made between a cause that produces something new (e.g., a moth from a caterpillar) and one that produces a change in an existing substance (e.g. to be established. Second, both the cross-sectional nature of the analysis and the relatively small sample of young adolescents who had ever had sex (especially in the Hispanic sample) limited our ability to make comparisons between Hispanic and white adolescents, and to examine all factors relevant to reproductive health status, including sexual history before age 14, contraceptive use and history of sexually transmitted diseases Sexually transmitted diseases Infections that are acquired and transmitted by sexual contact. Although virtually any infection may be transmitted during intimate contact, the term sexually transmitted disease is restricted to conditions that are largely . Third, all of our data are based on self-reports and therefore are subject to reporting bias, especially considering the sensitive nature of the questions on sexual behavior and the young age of the sample. (However, a previous study indicates that adolescents can accurately report their sexual behavior. (12)) Fourth, CHIS did not survey adolescents on abortion history. Adolescents who had ever had an abortion may have underreported past pregnancies. Finally, because CHIS used telephone interviews, it may not have adequately sampled Hispanic adolescents living in an unstable environment without a telephone in their home (e.g., those who are poor or whose parents lack U.S. citizenship or legal immigration status). Further research focusing on Hispanic adolescents' reproductive health is needed--in particular, studies with large samples exploring differences in contraceptive use and examining Hispanic adolescents' attitudes toward the most effective methods of contraception, including the pill and other hormonal methods. Studies that use qualitative methods to explore Hispanic adolescents' barriers to the use of family planning services before pregnancy are especially needed. In conclusion, our findings point to a need for family planning programs to target Hispanic adolescents and to send a clear message that contraceptive services are available and should be used before a woman ever becomes pregnant.
TABLE 1. Percentage distribution of females aged 14-17,
by selected characteristics, according to race or ethnicity,
2001 California Health Interview Survey
Characteristic White Hispanic
(N=1,156) (N=473)
HOUSEHOLD
Language spoken at home
English 97.4 48.4 ***
Spanish u 51.6
Health insurance plan
None 5.1 27.3 ***
Medi-Cal or Healthy Families 8.7 28.3 ***
Employer-based 81.6 41.5 ***
Other (e.g. self-purchased) 4.7 u
% of federal poverty level
0-99 6.6 39.6 ***
100-199 11.1 32.0 ***
200-299 17.1 12.5
[greater than or equal to] 300 65.3 16.0 ***
Residence
Urban 86.9 93.5 ***
Rural 13.1 6.5
PARENT
Citizenship/immigration status
Both parents are citizens/have green card 99.2 71.6 ***
[greater than or equal to] one parent u 28.4
is a noncitizen/has no green card
Marital status
Married 74.2 75.7
Single 25.8 24.3
Education
<high school 4.2 52.4 ***
High school 21.0 22.3
[greater than or equal to] some college 74.6 25.3 ***
ADOLESCENT
Citizenship/immigration status
U.S.-born citizen 97.1 68.3 ***
Naturalized citizen u 6.4
Noncitizen with green card u 10.0
Noncitizen without green card u 15.3
Proficiency in spoken English
Good/very good 99.1 92.1 ***
None/not good u 7.9
Currently attends school
Yes 97.7 98.1
No 2.3 1.9
General health status
Good/excellent 92.2 79.2 ***
Poor/fair 7.8 20.8 ***
Has regular source of primary health care
Yes 92.5 82.3 ***
No 7.5 17.7
Substance use ([dagger])
Ever smoked cigarettes regularly 9.7 u
Ever had alcoholic drink 44.0 36.7 *
Ever tried drugs (e.g.,marijuana, cocaine) 24.3 15.7 **
Ever had sex
Yes 21.0 13.9 *
No 79.0 86.1
Total 100.0 100.0
* p<.05. ** p<.01. *** p<.001. ([dagger]) Percentages do not
total 100 because categories are not mutually exclusive.
Notes: Percentages are weighted and may not total 100 because
of rounding; Ns are unweighted. u=unavailable, because
unweighted cell size was less than five, the coefficient of
variation was 30% or larger, or data were missing.
TABLE 2. Percentage distribution of sexually experienced
females aged 14-17, by selected characteristics, according
to race or ethnicity
Characteristic White Hispanic
(N=277) (N=68)
Parents' knowledge of adolescent's sexual activity
A lot 53.4 61.6
None/a little 46.6 38.4
Ever been pregnant
Yes 8.3 18.3 ([dagger])
No 91.7 81.7
Used family planning services in past year ([double dagger])
Yes 27.0 33.5
No 73.0 66.5
Ever been pregnant and used family
planning services in past year
Yes 9.3 42.4 **
No 90.7 57.6
Total 100.0 100.0
** p<.01. ([dagger]) Because the coefficient of variation was 37%,
this estimate may not be stable. ([double dagger]) Data for fewer
than 0.5% of respondents were missing. Notes: Percentages are
weighted; Ns are unweighted. Distributions of adolescents by whether
they had first had sex before age 14, used a contraceptive at first
most recent intercourse, and ever had a sexually transmitted disease
are not reported because the unweighted cell sizes for Hispanic were
small and coefficients of variation were 30-48%.
TABLE 3. Odds ratios (and 95% confidence intervals) from
logistic regression analyses assessing the association
between selected variables and adolescents' use of family
planning services in the past year
Variable Model 1
Age
14-16 (ref) 1.0
17 1.4 (0.7-3.0)
Race/ethnicity x parental citizenship/immigration status
White, one parent is a citizen (ref) 1.0
Hispanic, one parent is a citizen/
has green card 1.1 (0.4-2.9)
Hispanic, [greater than or equal to]
one parent is a noncitizen/
has no green card 3.1 (0.4-21.8)
Race/ethnicity x pregnancy history
White, never pregnant (ref) na
White, ever pregnant na
Hispanic, never pregnant na
Hispanic, ever pregnant na
Language spoken at home
English (ref) 1.0
Spanish 1.3 (0.3-5.3)
Health insurance status
Uninsured (ref) 1.0
Insured 4.5 (0.6-34.9)
% of federal poverty level
0-99 (ref) 1.0
100-199 1.5 (0.4-6.0)
200-299 1.8 (0.4-7.2)
[greater than or equal to] 300 1.2 (0.3-4.5)
Parental education
<high school (ref) 1.0
High school 0.6 (0.2-2.2)
[greater than or equal to] some college 1.1 (0.3-3.8)
Regular source of primary health care
None (ref) 1.0
Doctor's office/health
maintenance organization 1.2 (0.4-3.8)
Clinic/health center 1.3 (0.4-4.5)
Emergency room/other 0.7 (0.0-9.0)
Variable Model 2
Age
14-16 (ref) 1.0
17 1.4 (0.2-2.9)
Race/ethnicity x parental citizenship/immigration status
White, one parent is a citizen (ref) na
Hispanic, one parent is a citizen/
has green card na
Hispanic, [greater than or equal to]
one parent is a noncitizen/
has no green card na
Race/ethnicity x pregnancy history
White, never pregnant (ref) 1.0
White, ever pregnant 1.3 (0.4-4.1)
Hispanic, never pregnant 0.9 (0.3-2.8)
Hispanic, ever pregnant 11.6 (1.8-76.3) **
Language spoken at home
English (ref) 1.0
Spanish 1.7 (0.4-6.6)
Health insurance status
Uninsured (ref) 1.0
Insured 3.1 (0.7-14.6)
% of federal poverty level
0-99 (ref) 1.0
100-199 1.6 (0.4-6.2)
200-299 1.8 (0.4-7.5)
[greater than or equal to] 300 1.3 (0.3-4.9)
Parental education
<high school (ref) 1.0
High school 1.0 (0.3-3.7)
[greater than or equal to] some college 1.6 (0.4-6.4)
Regular source of primary health care
None (ref) 1.0
Doctor's office/health
maintenance organization 1.2 (0.4-3.9)
Clinic/health center 1.3 (0.4-4.3)
Emergency room/other 0.6 (0.0-10.0)
** p<0.01. Notes: ref=reference category. na=not applicable.
Acknowledgments This research was supported by funds from the California Program on Access to Care, California Policy Research Center, University of California, through grant BNN BNN Boston Neighborhood Network BNN Boundary Network Node (IBM) BNN Back-Propagation Neural Network BNN Biological Neural Network BNN Bart's Neverending Network (public-service TV network in The Netherlands) 11K. The authors thank Jong-ho Baek for assisting in data analysis. The views and opinions expressed in this manuscript are solely those of the authors. REFERENCES (1.) Black MM et al., Behavior problems among preschool children born to adolescent mothers: effects of maternal depression and perceptions of partner relationships, Journal of Clinical Child and Adolescent Psychology Adolescent Psychology addresses the specific issues of adolescents. Adolescence Adolescence, the transitional stage of development between childhood and adulthood, represents the period of time during which a person experiences a variety of biological changes and , 2003, 31(1):16-26; East PL and Felice ME, Outcomes and parent-child relationships of former adolescent mothers and their 12-year-old children, Journal of Developmental and Behavioral Pediatrics, 1990, 11(4): 175-183; and Passino AW et al., Personal adjustment during pregnancy and adolescent parenting, Adolescence adolescence, time of life from onset of puberty to full adulthood. The exact period of adolescence, which varies from person to person, falls approximately between the ages 12 and 20 and encompasses both physiological and psychological changes. , 1993, 28(109):97-122. (2.) Department of Health and Human Services Noun 1. Department of Health and Human Services - the United States federal department that administers all federal programs dealing with health and welfare; created in 1979 Health and Human Services, HHS , 1999 Natality na·tal·i·ty n. The ratio of births to the general population; the birth rate. natality the birth rate. Data Set, 2001, Series 21, No. 12. (3.) California State Department of Finance, County Population Projections with Age, Sex and Race/Ethnic Detail, July 1, 1990-2040 in 10-year Increments, 1998, <http://www.dof.ca.gov/html/demograp/proj_age.htm>, accessed June 7, 2004. (4.) Potter FJ et al., Sample design, sampling weights, imputation IMPUTATION. The judgment by which we declare that an agent is the cause of his free action, or of the result of it, whether good or ill. Wolff, Sec. 3. , and variance estimation estimation In mathematics, use of a function or formula to derive a solution or make a prediction. Unlike approximation, it has precise connotations. In statistics, for example, it connotes the careful selection and testing of a function called an estimator. in the 1995 National Survey of Family Growth, National Center for Health Statistics National Center for Health Statistics (NCHS) is part of the Centers for Disease Control and Prevention (CDC), which is part of the United States Department of Health and Human Services. NCHS is the United States' principal health statistics agency. , Vital and Health Statistics, 1998, Series 2, No. 124; and Brener N et al., Trends in sexual risk behaviors among high school students--United States, 1991-2001, Morbidity and Mortality Weekly Report Morbidity and Mortality Weekly Report (MMWR) is a weekly epidemiological digest for the United States published by the Centers for Disease Control and Prevention. The 5 June 1981 issue of the MMWR published the cases of five men in what turned out to be the first report of AIDS. , 2002, 51(38):856-859. (5.) Klein JD et al., Access to health care for adolescents: a position paper of the Society for Adolescent Medicine adolescent medicine n. The branch of medicine concerned with the treatment of youth between 13 and 21 years of age. Also called ephebiatrics, hebiatrics. , Journal of Adolescent Health, 1992, 13(2):162-170. (6.) Ibid. (7.) Granados G et al, Health care for Latino children: impact of child and parental birthplace birth·place n. The place where someone is born or where something originates. birthplace Noun the place where someone was born or where something originated Noun 1. on insurance status and access to health services health services Managed care The benefits covered under a health contract , American Journal of Public Health The American Journal of Public Health (AJPH) is a peer reviewed monthly journal of the American Public Health Association (APHA). The Journal also regularly publishes authoritative editorials and commentaries and serves as a forum for the analysis of health policy. , 2001, 91(11):1806-1807. (8.) Center for Health Policy Research, University of California at Los Angeles, California Health Interview Survey: Survey Methodology and Sample Design, 2002, <http://www.chis.ucla.edu/methods_design.html> accessed Apr. 29, 2004. (9.) Ibid. (10.) Brener N et al., 2002, op. cit. (see reference 4). (11.) Gomez CA, Culture and sexual behavior, Focus, 1995, 10(4):5-6. (12.) Orr DP, Fortenberry JD and Blythe MJ, Validity of self-reported sexual behaviors in adolescent women using biomarker biomarker /bio·mark·er/ (bi´o-mahr?ker) 1. a biological molecule used as a marker for a substance or process of interest. 2. tumor marker. bi·o·mark·er n. 1. outcomes, Sexually Transmitted Diseases, 1997, 24(5):261-266. M. Rosa Solorio is Robert Wood Johnson Robert Wood Johnson was the name shared by members of the family that descended from the President of Johnson & Johnson:
n. A physician whose practice is not oriented in a specific medical specialty but instead covers a variety of medical problems. generalist physician faculty scholar and assistant professor, Department of Family Medicine; Hongjian Yu is senior statistician and associate director; E. Richard Brown Richard Brown can refer to:
Author contact: RSolorio@mednet.ucla.edu |
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