The odds of substance use for LGB youth were, on average, 190% higher than for heterosexual youth and substantially higher within some subpopulations of LGB youth (340% higher for bisexual youth, 400% higher for females). Causal mechanisms, protective factors and alternative explanations for this effect, as well as long-term substance use outcomes in LGB youth, remain largely unknown.

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Smoking media literacy can be measured with excellent reliability and concurrent criterion validity. Given the independent association between SML and smoking, media literacy may be a promising tool for future tobacco control interventions.

Background: Although three quarters of reproductive-age women see a health provider annually, less than half receive recommended contraceptive counseling services. We sought to explore providers' perspectives on the challenges to contraceptive counseling in primary care clinics to develop strategies to improve counseling services. Methods: A qualitative, focus group (n ¼ 8) study was conducted in November and December 2007; 48 of 90 providers practicing in four primary care clinics at the University of Pittsburgh Medical Center participated. Providers included physicians, nurses, and pharmacists working in these clinics' multidisciplinary teams. Discussions explored perceived barriers to the provision of counseling services. All groups were audiorecorded, transcribed, and entered into Atlas.Ti, a qualitative data management software. The data were analyzed using a grounded theory approach to content analysis. Results: Perceived patient, provider, and health system barriers to contraceptive counseling were identified. Perceived patient barriers included infrequent sexual activity, familiarity with a limited number of methods, desire for pregnancy despite medical contraindications, and religious beliefs. Provider barriers included lack of knowledge, training, and comfort; assumptions about patient pregnancy risk; negative beliefs about contraceptive methods; reliance on patients to initiate discussions; and limited communication between primary care providers (PCPs) and subspecialists. Health system barriers included limited time and competing medical priorities. Conclusions: PCPs vary widely in their knowledge, perceived competence, and comfort in providing contraceptive counseling. General efforts to improve integration of contraceptive counseling into primary care services in addition to electronic reminders and efficient delivery of contraceptive information are needed.

PURPOSE One-quarter of adolescent mothers bear another child within 2 years, compounding their risk of poorer medical, educational, economic, and parenting outcomes. Most efforts to prevent rapid subsequent birth to teenagers have been unsuccessful but have seldom addressed motivational processes. METHODSWe conducted a randomized trial to determine the effectiveness of a computer-assisted motivational intervention (CAMI) in preventing rapid subsequent birth to adolescent mothers. Pregnant teenagers (N = 235), aged 18 years and older who were at more than 24 weeks' gestation, were recruited from urban prenatal clinics serving low-income, predominantly African American communities. After completing baseline assessments, they were randomly assigned to 3 groups: (1) those in CAMI plus enhanced home visit (n = 80) received a multicomponent home-based intervention (CAMI+); (2) those in CAMI-only (n = 87) received a single component home-based intervention; (3) and those in usualcare control (n = 68) received standard usual care. Teens in both intervention groups received CAMI sessions at quarterly intervals until 2 years' postpartum. Those in the CAMI+ group also received monthly home visits with parenting education and support. CAMI algorithms, based on the transtheoretical model, assessed sexual relationships and contraception-use intentions and behaviors, and readiness to engage in pregnancy prevention. Trained interventionists used CAMI risk summaries to guide motivational interviewing. Repeat birth by 24 months' postpartum was measured with birth certifi cates.RESULTS Intent-to-treat analysis indicated that the CAMI+ group compared with the usual-care control group exhibited a trend toward lower birth rates (13.8% vs 25.0%; P = .08), whereas the CAMI-only group did not (17.2% vs 25.0%; P = .32). Controlling for baseline group differences, the hazard ratio (HR) for repeat birth was signifi cantly lower for the CAMI+ group than it was with the usual-care group (HR = 0.45; 95% CI, 0.21-0.98). We developed complier average causal effects models to produce unbiased estimates of intervention effects accounting for variable participation. Completing 2 or more CAMI sessions signifi cantly reduced the risk of repeat birth in both groups: CAMI+ (HR = 0.40; 95% CI, 0.16-0.98) and CAMI-only (HR = 0.19; 95% CI, 0.05-0.69). CONCLUSIONSReceipt of 2 or more CAMI sessions, either alone or within a multicomponent home-based intervention, reduced the risk of rapid subsequent birth to adolescent mothers. Ann Fam Med 2009;7:436-445. doi:10.1370/afm.1014. INTRODUCTIONA lmost one-quarter of adolescent mothers give birth to another child within 24 months of having a baby, 1,2 despite national objectives to increase birth spacing 3 and evidence that additional childbearing during adolescence may compound the risk of poorer medical, educational, economic, and developmental outcomes. 2,4,5 437 CO MPU T ER-A S SIS T ED MOT IVAT IONA L INT ERVENT IONwhite adolescent mothers, African Americans and Latinas are more likely to experienc...

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Purpose-To determine whether media literacy concerning tobacco use is independently associated with two clinically relevant outcome measures in adolescents: current smoking and susceptibility to smoking.Methods-We asked high school students aged 14-18 years to complete a survey that included a validated 18-item smoking media literacy (SML) scale, items assessing current smoking and susceptibility to future smoking, and covariates shown to be related to smoking. We used logistic regression to assess independent associations between the two outcome measures and SML.Results-Of the 1211 students who completed the survey, 19% reported current smoking. Controlling for all potential confounders of smoking, we found that an increase of one point (out of 10) in SML was independently associated with an odds ratio for smoking of .84 (95% confidence interval [CI] .71-.99). Compared with students below the median score on the SML scale, students above the median had an odds ratio for smoking of .57 (95% CI .37-.87). Of the students who were nonsmokers, 40% were classified as susceptible to future smoking. Controlling for all potential confounders of smoking, we found that an increase of one point (out of 10) was independently associated with and an odds ratio for smoking susceptibility of .68 (95% CI .58-. 79). Compared with students below the median SML, students above the median SML had an odds ratio for smoking susceptibility of .49 (95% CI .35-.68).Conclusions-In this sample of high school students, higher SML is independently associated with reduced current smoking and reduced susceptibility to future smoking. © 2006 Society for Adolescent Medicine. All rights reserved. [25][26][27], making media literacy attractive as an intervention. However, these studies focused on the outcomes such as student satisfaction, knowledge, and attitudes, and did not demonstrate that antismoking media literacy is associated with improvements in clinically relevant outcomes related to smoking. We therefore used a reliable, validated scale measuring the construct of smoking media literacy (SML) in youth [24] to determine the degree to which clinically relevant smoking-related outcomes are associated with SML scores in a large group of high school students. We hypothesized that higher media literacy scores would be associated with a decreased likelihood of current smoking and that, among current nonsmokers, those with higher media literacy would have a lower susceptibility to future smoking. Keywords Methods Participants and settingThe study population for our cross-sectional survey consisted of students attending a suburban public high school outside of Pittsburgh, Pennsylvania with a total enrollment of 1690. The community served by this high school is primarily Caucasian and middle-income. Male and female students were eligible to participate if they were 14-18 years old and were available to take the survey on the regular school day in January 2005 when it was administered. On this date, 79 students were absent and 86 were unav...