SUMMARYEosinophilic esophagitis is a chronic immune-mediated esophageal disorder. For its timely diagnosis, clinicians must recognize common symptoms, and understand differences in symptoms across patient groups. The aim of this study is to systematically review the epidemiology and natural history of eosinophilic esophagitis. The MEDLINE, Embase, and Cochrane databases were searched from 1974 to February 2017 for studies describing the epidemiology and natural history of eosinophilic esophagitis. Congress abstracts from 2014 to 2016 were also searched. Search results were screened against predetermined inclusion/exclusion criteria by two independent reviewers, and data extraction was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Of 1376 articles identified, 47 met the inclusion criteria: 20 on epidemiology and 27 on natural history. Incidence and prevalence of eosinophilic esophagitis varied widely across North America and Europe, and increased over time. Incidence increased 131-fold in the Netherlands (1996–2010), 20-fold in Denmark (1997–2006), and 5.1-fold in Calgary, Canada (2004–2008). The most commonly reported symptoms were emesis and abdominal pain in children, and dysphagia and food impaction in adults. Age at diagnosis was 5.9–12.0 years in children, and approximately 30 years in adults. Time between symptom onset and diagnosis was 1.2–3.5 years in children and 3.0–8.0 years in adults. Diagnostic delay was associated with an increased risk of endoscopic features of fibrostenosis. Symptoms of eosinophilic esophagitis differed significantly by age and race. In conclusion, there is an increasing incidence and prevalence of eosinophilic esophagitis. The considerable delay between symptom onset and diagnosis suggests that clinicians do not readily recognize the disease, which may have important clinical ramifications.

Youth who initiate sexual intercourse in early adolescence (age 11-14) experience multiple risks, including concurrent adjustment problems and unsafe sexual practices, The current study tested two models describing the links between childhood precursors, early adolescent risk factors, and adolescent sexual activity: a cumulative model and a meditational model, A longitudinal sample of 694 boys and girls from four geographical locations was utilized, with data collected from kindergarten through high school. Structural equation models revealed that, irrespective of gender or race, high rates of aggressive disruptive behaviors and attention problems at school entry increased risk for a constellation of problem behaviors in middle school (school maladjustment, antisocial activity, and substance use) which, in turn, promoted the early initiation of sexual activity. Implications are discussed for developmental models of early sexual activity and for prevention programming. Keywords Risky sexual activity; Externalizing behaviors; Early adolescent problemsThe initiation of sexual activity is a major milestone for many adolescents on the road to adulthood. Whereas only 13-15% of American teens report having sexual intercourse before turning 15, the rate climbs steeply after that. Forty-five percent report having sex before turning 17, and approximately 70% have had sex by the time they reach age 19 (Guttmacher Institute 2006;Leitenberg and Saltzman 2000). Early initiation of sexual intercourse (i.e., occurring during preadolescence or very early in adolescence) is associated with a variety of concurrent risk factors for both boys and girls, including school maladjustment and substance use (Kotchick et al. 2001;Martin et al, 2005). In addition, girls who initiate intercourse early are at higher risk for unintended pregnancy and sexually transmitted diseases compared with girls who delay intercourse until late adolescence Leitenberg and Saltzman 2000).These statistics point towards a clinical and societal need to explore the predictors of early sexual activity, in order to better inform preventive interventions. Although a significant body of research has documented the concurrent risky behaviors that characterize sexually active teenagers in cross-sectional samples, very few studies have examined childhood precursors of Correspondence to: Karen L. Bierman. Members of the CPPRG in alphabetical order include Karen L. Bierman (Pennsylvania State University), John D. Coie (Duke University), Kenneth A. Dodge (Duke University), Mark T. Greenberg (Pennsylvania State University), John E. Lochman (University of Alabama), Robert J. McMahon (University of Washington), and Ellen E. Pinderhughes (Tufts University). NIH Public Access NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author Manuscript early sexual activity. The present study utilized a sample of 694 boys and girls from four geographical locations, with an oversampling of youth with high rates of externalizing behavior problems at school entry. Youth were...

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