Journal of Adolescent Health RSS feed: Current Issue. The Journal of Adolescent Health is a multidisciplinary scientific Journal, which seeks to publish new research findings in the field of Adolescent Medicine and Health ranging from the basic biological and behavioral sciences to public health and policy. We seek original manuscripts, review articles, letters to the editor, commentaries, and case reports from our colleagues in Anthropology, Dentistry and Oral Health, Education, Health Services Research, International Health, Law, Medicine, Mental Health, Nursing, Nutrition, Psychology, Public Health and Policy, Social Work, Sociology, Youth Development, and other disciplines that work with or are committed to improving the lives of adolescents and young adults. The Journal is the official publication of the Society for Adolescent Health and Medicine (SAHM) , a multidisciplinary organization committed to improving the health and well-being of adolescents. One of the Society's primary goals is the development, synthesis, and dissemination of scientific and scholarly knowledge unique to the health needs of adolescents. To meet this goal, the Society established the Journal of Adolescent Health in 1980. According to the 2010 Journal Citation Reports®, published by Thomson Reuters, Journal of Adolescent Health has a 2009 Impact Factor of 3.325, and is ranked in the following categories: 6th of 94 journals in Pediatrics (Science edition) 17th of 122 journals in Public, Environmental and Occupational Health (Science edition) 10th of 59 journals in Developmental Psychology (Social Science edition) 4th of 95 journals in Public, Environmental and Occupational Health (Social Science edition) http://www.jahonline.org/?rss=yesElsevier Inc.en © 2012 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved. Journal of Adolescent Health1054-139X502February 2012 © 2012 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved. healthpermissions@elsevier.comhttp://www.jahonline.org/article/PIIS1054139X11006264/abstract?rss=yes See Related Article p. 132Cardiometabolic Risk Factors in American Children: What Can Be Learned From Current Trends?Zeina M. Nabhan, Tamara S. Hannon10.1016/j.jadohealth.2011.11.006Journal of Adolescent Health 50, 2 (2012)2012-02-01Journal of Adolescent Health2012-02-01502S1054-139X(11)X0013-7Editorial107109http://www.jahonline.org/article/PIIS1054139X11003545/abstract?rss=yesAbstract: Purpose: Global data on human papillomavirus (HPV) serological and deoxyribonucleic acid (DNA) prevalence are essential to optimize HPV prophylactic vaccination strategies. Methods: We conducted a global review of age-specific HPV antibody and studies with both antibody and DNA prevalence for HPV-16, −18, −6, and −11. Results: One hundred seventeen studies were included; participants' ages ranged from several hours to >90 years. HPV-16 seroprevalence was generally higher in Africa, Central and South America, and North America, more prevalent among women than among men, and peaked around ages 25–40 years. HPV-18 seroprevalence was generally lower than HPV-16 with a later age peak. Data were limited for HPV-6 and −11, both of which peaked at ages similar to HPV-18. Among 9–26-year-old females, HPV-16 seroprevalence ranged from 0%–31% in North America, 21%–30% in Africa, 0%–23% in Asia/Australia, 0%–33% in Europe, and 13%–43% in Central and South America. HPV-16/-18 DNA prevalence peaked 10–15 years before corresponding HPV-16/-18 antibody prevalence. Conclusions: Females within the HPV vaccine-eligible age-group (9–26 years) had a range of dual HPV-16 DNA and serology negativity from 81%–87%, whereas 90%–98% were HPV-16 DNA negative. Serology and DNA data are lacking worldwide for females younger than age 15 years, the prime target group for vaccination. Age-Specific Human Papillomavirus Antibody and Deoxyribonucleic Acid Prevalence: A Global ReviewSarah M. Tiggelaar, Margaret J. Lin, Raphael P. Viscidi, Jia Ji, Jennifer S. Smith10.1016/j.jadohealth.2011.10.010Journal of Adolescent Health 50, 2 (2012)2012-02-01Journal of Adolescent Health2012-02-01502S1054-139X(11)X0013-7Review Article110131http://www.jahonline.org/article/PIIS1054139X11001492/abstract?rss=yesAbstract: Aim: To characterize trends and clustering of cardiometabolic risk factors in 12–17-year-old non-Hispanic white, non-Hispanic black (NHB), Mexican-American (MA), and multiracial American (MRA) adolescents. Methods: Data from the 1999–2000 to 2007–2008 U.S. National Health and Nutrition Examination Surveys were used for this investigation. Clustering of cardiometabolic risk factors was determined using cardiometabolic risk factor clustering score (cMetS) computed by aggregating z scores of mean arterial blood pressure, triglycerides, fasting blood glucose, waist circumference, and high-density lipoprotein cholesterol. Results: There were significant increases in waist circumference and high-density lipoprotein cholesterol, and decreases in low density lipoprotein cholesterol, triglycerides, and mean arterial blood pressure in the 10-year period between 1999–2000 and 2007–2008. There were gender and racial/ethnic differences in cMetS, with NHB having a more favorable cMetS for each studied time point. Overall, cMetS decreased by 93% in the 10-year period between 1999–2000 and 2007–2008. cMetS decreased by 98% and 77.3% for male and female adolescents, respectively, in the period between 1999–2000 and 2007–2008. With the exception of Mexican-American and multiracial American female adolescents, all racial/ethnic groups had improved cMetS values on comparing mean cMetS values of 1999–2000 with mean values of 2007–2008. Compared with other racial/ethnic groups, NHB male and female adolescents had the most improved cMetS. Conclusion: Because clustering of cardiometabolic risk factors is predictive of adult health status, early lifestyle intervention in adolescence may help slow down the progress and delay or prevent the onset of cardiovascular diseases in adulthood. Trends and Clustering of Cardiometabolic Risk Factors in American Adolescents From 1999 to 2008Ike S. Okosun, J. Paul Seale, John M. Boltri, Monique Davis-Smith10.1016/j.jadohealth.2011.04.016Journal of Adolescent Health 50, 2 (2012)2011-06-15Journal of Adolescent Health2011-06-15502S1054-139X(11)X0013-7Original Articles132139http://www.jahonline.org/article/PIIS1054139X11001959/abstract?rss=yesAbstract: Purpose: Adolescence is associated with the onset of depressive symptoms as well as significant increases in health-risk behaviors. Potential explanations for the direction of effects in the association between depressive symptoms and health-risk behaviors include the self-medication/acting out hypothesis (i.e., early depressive symptoms predict increases in risk behaviors over time) and the failure hypothesis (i.e., early participation in health-risk behaviors predicts increases in depressive symptoms over time). The purpose of the present longitudinal study was to assess these competing hypotheses across the high school years, and to examine whether the direction of effects (and therefore the self-medication/acting out and failure hypotheses) may differ depending on the type of risk behavior under consideration. Methods: The sample consisted of 4,412 adolescents (49% female) who were followed up from grade nine to 12. Adolescents reported on their depressive symptoms and six health-risk behaviors (frequency of alcohol use, amount of alcohol consumed per drinking episode, cigarette smoking, marijuana use, hard drug use, and delinquency). Analyses were conducted with dual trajectory growth curve modeling. Results: Adolescents who had higher depressive symptoms in grade nine reported faster increases than their peers in smoking, marijuana, and hard drug use across the high school years, supporting the self-medication hypothesis. The failure hypothesis was not supported. Conclusion: The results are important because they suggest that by targeting depressive symptoms during early adolescence, treatment programs may prevent increases in the frequency of these risk behaviors later in adolescence. Does the Direction of Effects in the Association Between Depressive Symptoms and Health-Risk Behaviors Differ by Behavior? A Longitudinal Study Across the High School YearsSetareh Hooshmand, Teena Willoughby, Marie Good10.1016/j.jadohealth.2011.05.016Journal of Adolescent Health 50, 2 (2012)2011-08-29Journal of Adolescent Health2011-08-29502S1054-139X(11)X0013-7Original Articles140147http://www.jahonline.org/article/PIIS1054139X1100190X/abstract?rss=yesAbstract: Purpose: The aim of the present work was to examine the correlated eight-syndrome model of the Youth Self-Report (YSR) proposed by Ivanova et al , using a confirmatory factor analysis for ordinal data. Likewise, we explored the measurement invariance of the YSR across gender and age using multigroup comparisons, and checked whether there were differences in the latent means. Methods: The sample was made up of 4,868 nonclinical adolescents (47.6% males), with a mean age of 14.6 years (SD = 1.6). Results: The correlated eight-syndrome model proposed by Ivanova et al showed a reasonable fit to the data, both for the total sample and by participants' gender and age. Moreover, the factor-equivalence analysis showed that the hypothesized dimensional model was invariant across gender and age. Statistically significant differences were found when comparing latent means between the groups. Conclusions: These results coincide with those found in the literature and are in support of the replicability, generalizability, and consistency of the eight-syndrome model of the YSR, as well as its measurement invariance across gender and age. Future studies should explore the measurement invariance of this model through multigroup comparisons across cultures. Dimensional Structure and Measurement Invariance of the Youth Self-Report Across Gender and AgeEduardo Fonseca-Pedrero, Susana Sierra-Baigrie, Serafín Lemos-Giráldez, Mercedes Paino, José Muñiz10.1016/j.jadohealth.2011.05.011Journal of Adolescent Health 50, 2 (2012)2011-07-04Journal of Adolescent Health2011-07-04502S1054-139X(11)X0013-7Original Articles148153http://www.jahonline.org/article/PIIS1054139X11001923/abstract?rss=yesAbstract: Purpose: The current study examined gender and racial/ethnic (Hispanics, non-Hispanic Caucasians, non-Hispanic African Americans, and non-Hispanic Asians) differences in developmental trajectories of alcohol use, heavy drinking, smoking, and marijuana use from early adolescence to young adulthood using a nationally representative sample. Methods: Participants from the National Longitudinal Study of Adolescent Health (N = 20,160) reported rates of alcohol use, heavy drinking, smoking, and marijuana use between the ages of 12 and 34 years. Data analyses were completed using longitudinal multilevel modeling analyses. Results: Levels of substance use increased from early adolescence to mid-20s, and then declined thereafter. Females showed higher levels of substance use in early adolescence, although males exhibited greater changes overtime and higher levels of use in mid-adolescence and early adulthood. Overall, Hispanic youth had higher initial rates of substance use, whereas Caucasian adolescents showed higher rates of change and had the highest levels of substance use from mid-adolescence through the early 30s. Racial/ethnic differences largely disappeared after age 30, except that African Americans showed higher final levels of smoking and marijuana use than the other racial/ethnic groups. Results provide evidence for both similarities and differences in general patterns of development and in gender and racial/ethnic differences across different forms of substance use. Conclusions: Findings from the current study suggest that the critical periods for intervention and prevention of substance use may differ across gender and race/ethnicity, and that future research needs to identify common and unique mechanisms underlying developmental patterns of different forms of substance use. Developmental Trajectories of Substance Use From Early Adolescence to Young Adulthood: Gender and Racial/Ethnic DifferencesPan Chen, Kristen C. Jacobson10.1016/j.jadohealth.2011.05.013Journal of Adolescent Health 50, 2 (2012)2011-07-11Journal of Adolescent Health2011-07-11502S1054-139X(11)X0013-7Original Articles154163http://www.jahonline.org/article/PIIS1054139X11001972/abstract?rss=yesAbstract: Purpose: The mortality-lowering benefits of living in a union are well-known in the adult population, but the association between living arrangements and mortality among the young remains unclear. This study examines the association between current living arrangements and external causes of death in early adulthood, adjusting for factors such as parental socioeconomic position, current main activity, household income, and level of own education. Methods: The study is based on annually updated longitudinal register data that include a representative 11% sample of the whole Finnish population with an over-sample of 80% of all deaths. We used mortality rates and Cox proportional hazards models to study deaths in young adults aged between 17 and 29 years of age, from 1995 to 2004. Results: Compared with living in parental home with married parents, those living alone in late teens and early 20s had clearly higher risk of external mortality among both sexes. Young adults living in cohabiting- or one-parent families carried likewise a higher risk of death. Living with a partner was associated with lower mortality in early 20s, but especially in late 20s. The observed mortality differentials by living arrangements remained notable for the most part, even after adjustment for socioeconomic factors. Conclusions: Strong excess mortalities among those living alone, single parents, children of single and cohabiting parents, the nonemployed, the less educated, and the less earning highlight the importance of late adolescence and early adulthood as a critical period for emerging health inequalities. Living Arrangements and External Causes of Deaths in Early AdulthoodHanna M. Remes, Pekka T. Martikainen10.1016/j.jadohealth.2011.05.018Journal of Adolescent Health 50, 2 (2012)2011-08-16Journal of Adolescent Health2011-08-16502S1054-139X(11)X0013-7Original Articles164171http://www.jahonline.org/article/PIIS1054139X1100293X/abstract?rss=yesAbstract: Purpose: This article presents findings from the largest experimental evaluation to date of school-based mandatory-random student drug testing (MRSDT). The study tested the effectiveness of MRSDT in reducing substance use among high school students. Methods: Cluster randomized trial included 36 high schools and more than 4,700 9th through 12th grade students. After baseline data collection in spring 2007, about half the schools were randomly assigned to a treatment group that was permitted to implement MRSDT immediately, and the remaining half were assigned to a control group that delayed MRSDT until after follow-up data collection was completed 1 year later, in spring 2008. Data from self-administered student questionnaires were used to compare rates of substance use in treatment and control schools at follow-up. Results: Students subject to MRSDT by their districts reported less substances use in past 30 days compared with students in schools without MRSDT. The program had no detectable spillover effects on the substance use of students not subject to testing. We found no evidence of unintentional negative effects on students' future intentions to use substances, the proportion of students who participated in activities subject to drug testing, or on students' attitudes toward school and perceived consequences of substance use. Conclusions: MRSDT shows promise in reducing illicit substance use among high school students. The impacts of this study were measured for a 1-year period and may not represent longer term effects. The Effectiveness of Mandatory-Random Student Drug Testing: A Cluster Randomized TrialSusanne James-Burdumy, Brian Goesling, John Deke, Eric Einspruch10.1016/j.jadohealth.2011.08.012Journal of Adolescent Health 50, 2 (2012)2011-10-03Journal of Adolescent Health2011-10-03502S1054-139X(11)X0013-7Original Articles172178http://www.jahonline.org/article/PIIS1054139X11003387/abstract?rss=yesAbstract: Purpose: The purpose of this research was to explore the trends in youth reports of unwanted online sexual solicitation, harassment, and exposure to pornography over time. Methods: The study was based on three separate cross-sectional national telephone surveys of approximately 1,500 youth Internet users, aged 10 through 17 years. Data were collected in 2000, 2005, and 2010. Results and Conclusion: Nine percent of youth reported an unwanted sexual solicitation in 2010. This continued the decline in unwanted sexual solicitations that occurred between 2000 (19%) and 2005 (13%), resulting in a total 50% decrease between 2000 and 2010. Twenty-three percent of youth reported an unwanted exposure to pornography, a decline from 34% in 2005, following an increase between 2000 and 2005 (25% to 34%). However, marking the only trend to show an increase over the past 5 years, 11% of youth reported an online harassment experience, which was an increase from 9% in 2005, and 6% in 2000. Some differences in these trends were noted for subgroups of youth across age, gender, and race. The trends in unwanted experiences online over the past decade identified by three Youth Internet Safety Surveys may contradict impressions that the general population, professionals, and the media have about what is happening. Trends provide evidence for some optimism that protective adaptations to the online environment have been successful; however, online harassment appears to be increasing for youth, particularly girls, and may require additional mobilization. Trends in Youth Internet Victimization: Findings From Three Youth Internet Safety Surveys 2000–2010Lisa M. Jones, Kimberly J. Mitchell, David Finkelhor10.1016/j.jadohealth.2011.09.015Journal of Adolescent Health 50, 2 (2012)2011-12-15Journal of Adolescent Health2011-12-15502S1054-139X(11)X0013-7Original Articles179186http://www.jahonline.org/article/PIIS1054139X1100615X/abstract?rss=yesAbstract: Purpose: Long-term immunogenicity and safety of the human papillomavirus (HPV)-16/18 AS04-adjuvanted vaccine when administered to adolescent girls was evaluated. Methods: This open-label, follow-up study (NCT00316706) was conducted in 31 centers in Taiwan, Germany, Honduras, Panama, and Colombia. In the initial study (NCT00196924), 1,035 girls aged 10–14 years received the HPV-16/18 AS04-adjuvanted vaccine at 0, 1, and 6 months. Here, geometric mean titers (GMTs) of antibodies against HPV-16, HPV-18, and monophosphoryl lipid A (MPL), a component of the AS04 Adjuvant System, were reported up to month 48. Results: In the according-to-protocol immunogenicity cohort (N = 563), GMTs at month 48 in initially seronegative participants were 2,374.9 (95% confidence interval: 2,205.7–2,557.0) EL.U/mL for anti-HPV-16 and 864.8 (796.9–938.4) EL.U/mL for anti-HPV-18, that is, six- and threefold higher than the plateau level in a reference study demonstrating vaccine efficacy in young women (age, 15–25 years). All participants remained seropositive for anti-HPV-16 and anti-HPV-18 at month 48. Most participants (81.8%) were seropositive for anti-MPL antibodies before vaccination. Anti-MPL antibody titers in initially seropositive participants increased initially, and then declined. Most initially seronegative participants for anti-MPL seroconverted; 69.6% remained seropositive at month 48, with anti-MPL antibody titers similar to the natural background level. The vaccine was generally well tolerated. No serious adverse events were considered related to vaccination. Conclusions: In adolescent girls, the HPV-16/18 AS04-adjuvanted vaccine produces anti-HPV-16 and anti-HPV-18 antibody titers that are maintained for up to 4 years at higher levels than those in young women in whom vaccine efficacy against cervical lesions was demonstrated. Four-Year Follow-up of the Immunogenicity and Safety of the HPV-16/18 AS04-Adjuvanted Vaccine When Administered to Adolescent Girls Aged 10–14 YearsTino F. Schwarz, Li-Min Huang, Doris Maribel Rivera Medina, Alejandra Valencia, Tzou-Yien Lin, Ulrich Behre, Grégory Catteau, Florence Thomas, Dominique Descamps10.1016/j.jadohealth.2011.11.004Journal of Adolescent Health 50, 2 (2012)2012-02-01Journal of Adolescent Health2012-02-01502S1054-139X(11)X0013-7Original Articles187194http://www.jahonline.org/article/PIIS1054139X11001479/abstract?rss=yesAbstract: Purpose: To examine the short-term effects on the sexual health of adolescent boys in age discordant relationships. Methods: Weighted logistic regression analyses were conducted using data from waves 1 and 2 of the National Survey of Adolescent Health to determine the health effects of entry into an age discordant relationship on adolescent boys. Results: Results indicate that boys involved in an age discordant relationship, in comparison with boys in a similar age relationship, had higher odds of having had sexual intercourse (OR = 2.92), having got a partner pregnant (OR = 1.89), having been diagnosed with STD (OR = 4.41), and having lost one's virginity (OR = 3.39). Analyses on the sexually active subset reveal no significant relationship between involvement in an age discordant relationship and birth control use broadly, or condom use specifically, at their most recent sexual intercourse. Conclusion: In general, entering into an age discordant relationship as a younger partner is associated with some adverse sexual health effects for adolescent boys. Thus, some outcomes that were demonstrated in previous research to be problematic for adolescent girls dating significantly older males are similarly problematic for adolescent boys dating older females. Short-Term Sexual Health Effects of Relationships with Significantly Older Females on Adolescent BoysJeni Loftus, Brian C. Kelly10.1016/j.jadohealth.2011.04.014Journal of Adolescent Health 50, 2 (2012)2011-06-15Journal of Adolescent Health2011-06-15502S1054-139X(11)X0013-7Adolescent Health Briefs195197http://www.jahonline.org/article/PIIS1054139X11001509/abstract?rss=yesAbstract: Purpose: This study describes the vaccine-related knowledge and attitudes of adolescents aged 11–18 years and parents of adolescents aged 11–18 years. Methods: We analyzed the 2007 HealthStyles and YouthStyles surveys related to vaccine knowledge and attitudes of parents (n = 1,208) and adolescents (n = 1,087). Results: In all, 21% of parents and 11% of adolescents correctly identified the three vaccines recommended at the time of the survey for adolescents. Regarding the hypothetical scenario that minor adolescents should be allowed to consent to vaccination without parental knowledge, 70% of parents and 72% of adolescents disagreed. The majority of parents and adolescents recognized the importance of vaccines in protecting an adolescent's health yet a substantial minority of both groups also reported concerns about vaccine safety. Conclusions: Many parents and adolescents surveyed were not aware of all vaccine recommendations for adolescents and did not support adolescents receiving vaccinations independent of parental knowledge and/or consent. Limited Awareness of Vaccines Recommended for Adolescents and Other Results from Two National Consumer Health Surveys in the United StatesAllison Kennedy, Shannon Stokley, C. Robinette Curtis, Deborah Gust10.1016/j.jadohealth.2011.04.017Journal of Adolescent Health 50, 2 (2012)2011-06-15Journal of Adolescent Health2011-06-15502S1054-139X(11)X0013-7Adolescent Health Briefs198200http://www.jahonline.org/article/PIIS1054139X11001510/abstract?rss=yesAbstract: Purpose: To pilot motivational interviewing (MI) targeting weight-related behaviors in African American adolescents with body mass index ≥85th percentile. Methods: A total of 44 adolescents were randomly assigned to MI or nutrition counseling with baseline and 3-month assessment. Results: MI group reported improved eating behaviors and activity motivation. Conclusion: Brief clinic-based MI interventions merit further study in this population. A Pilot Study of Motivational Interviewing Targeting Weight-Related Behaviors in Overweight or Obese African American AdolescentsKaren MacDonell, Kathryn Brogan, Sylvie Naar-King, Deborah Ellis, Sharon Marshall10.1016/j.jadohealth.2011.04.018Journal of Adolescent Health 50, 2 (2012)2011-06-15Journal of Adolescent Health2011-06-15502S1054-139X(11)X0013-7Adolescent Health Briefs201203http://www.jahonline.org/article/PIIS1054139X11001753/abstract?rss=yesAbstract: Purpose: To assess awareness and knowledge of human papillomavirus (HPV) in the adult Swedish population. Methods: A cross-sectional study among young adults aged 18–30 years and the parents of children aged 12–15 years was conducted in 2007 to collect information on awareness and knowledge of HPV. Correlates of HPV knowledge were investigated. Results: Awareness of cervical cancer and condyloma were high but awareness of HPV was low. Many participants were uncertain or did not know about the causal relation between HPV and condyloma, and cancers other than cervical cancer. Among parents, gender, age, country of origin, and education were the most important correlates of HPV knowledge. Among young adults, these factors were gender, income, and education. Conclusions: HPV education campaigns should particularly target young men and those with low education. Educational messages should clarify the risk of HPV, and the causal relationship between HPV and condyloma, and other cancers. Awareness and Knowledge of Human Papillomavirus in the Swedish Adult PopulationLisen Arnheim Dahlström, Karin Sundström, Cecilia Young, Cecilia Lundholm, Pär Sparén, Trung Nam Tran10.1016/j.jadohealth.2011.05.009Journal of Adolescent Health 50, 2 (2012)2011-06-27Journal of Adolescent Health2011-06-27502S1054-139X(11)X0013-7Adolescent Health Briefs204206http://www.jahonline.org/article/PIIS1054139X11003338/abstract?rss=yesPettifor et al. recently compared sexual behavior self-reports and HIV prevalence in nationally representative samples of young people in South Africa (SA) and the United States . They concluded that “young people in the US report riskier sexual behaviors than young people in SA, despite the much higher prevalence of HIV infection in SA. Factors above and beyond sexual behavior likely play a key role in ongoing transmission of HIV in South African youth, and thus should be urgently uncovered to develop maximally effective prevention strategies” (p. 237). We agree.Sexual Behavior, HIV and South African YouthJohn J. Potterat, Devon D. Brewer, David Gisselquist, Stuart Brody10.1016/j.jadohealth.2011.09.010Journal of Adolescent Health 50, 2 (2012)2012-02-01Journal of Adolescent Health2012-02-01502S1054-139X(11)X0013-7Letters to the Editor207208http://www.jahonline.org/article/PIIS1054139X11003399/abstract?rss=yesPettifor et al's recent study concludes that “the remarkable prevalence of HIV in young people in South Africa cannot be ascribed to exceptional risk taking behavior” . This and the accompanying editorial argue that behavioral change campaigns have “failed,” and that more emphasis needs to be placed on biological interventions.A Tale Of Two Epidemics Within TWO CountriesChris Kenyon, Andrew Boulle, Robert Colebunders, Sipho Dlamini, Saul Johnson10.1016/j.jadohealth.2011.09.016Journal of Adolescent Health 50, 2 (2012)2012-02-01Journal of Adolescent Health2012-02-01502S1054-139X(11)X0013-7Letters to the Editor208209http://www.jahonline.org/article/PIIS1054139X11006501/abstract?rss=yesIn their letter, Potterat et al raise the question of whether the high prevalence of HIV observed among young people in South Africa is the result of parenteral HIV exposure. Although we found that young people in South Africa did not report more sexual risk behaviors than their U.S. peers, current evidence suggests that the vast majority of infections in sub-Saharan Africa, including South Africa, are the result of sexual transmission . Several studies have documented that unclean needles contribute only a small proportion of new HIV infections in sub-Saharan Africa . Although measuring all exposures is important when trying to determine the etiology of infection, in a setting such as South Africa, the dominant modifiable risk factor for HIV is sexual behavior. Measuring sexual behavior well is important to understanding transmission and for developing interventions. We do not believe that the combination of high HIV prevalence and the lack of high-risk behavior among South African youth means that they are being significantly exposed through routes other than sexual intercourse. Rather, we hypothesize that a combination of sexual mixing in a high-prevalence setting, structural factors that put young people at increased risk of exposure and unique biological factors, such as the predominance of clade C HIV , is driving the epidemic in sub-Saharan Africa over and above individual sexual behaviors.The Authors replyAudrey E. Pettifor, William C. Miller, Myron Cohen, Catherine MacPhail, Helen Rees10.1016/j.jadohealth.2011.11.017Journal of Adolescent Health 50, 2 (2012)2012-02-01Journal of Adolescent Health2012-02-01502S1054-139X(11)X0013-7Letters to the Editor209210http://www.jahonline.org/article/PIIS1054139X11006537/abstract?rss=yesAlthough rates of meningococcal disease have remained low in the United States since 2000, the severity of the disease, rapidity with which it strikes, and significant sequelae remain compelling reasons to employ all means possible to prevent it. Meningococcal disease has a bimodal peak distribution in the United States with its highest incidence rates in infants and adolescents aged 16 years and older. The 2005 recommendations from the Advisory Committee on Immunization Practices (ACIP) of the Centers for Disease Control and Prevention were intended to protect youth entering adolescence including individuals 16–21 years of age, the ages at which meningococcal disease rates peak for children and young adults. Administration of the quadrivalent (serogroups A, C, Y, and W-135) meningococcal conjugate vaccine (MCV4) was recommended at preventive care visits for persons aged 11–12 years. Although duration of protection of the vaccine was unknown, it was assumed that the conjugate vaccine would confer protection lasting through the young adult years.Meningococcal Vaccine: A Position Statement of the Society for Adolescent Health and MedicineLisa S. Ipp, Cora C. Breuner, Amy B. Middleman, SAHM Committee on Adolescent Vaccination10.1016/j.jadohealth.2011.11.020Journal of Adolescent Health 50, 2 (2012)2012-02-01Journal of Adolescent Health2012-02-01502S1054-139X(11)X0013-7Position Statement211212http://www.jahonline.org/article/PIIS1054139X11006793/abstract?rss=yesEditorial Board10.1016/S1054-139X(11)00679-3Journal of Adolescent Health 50, 2 (2012)2012-02-01Journal of Adolescent Health2012-02-01502S1054-139X(11)X0013-7FrontmatterA1A1http://www.jahonline.org/article/PIIS1054139X11006811/abstract?rss=yesTable of Contents10.1016/S1054-139X(11)00681-1Journal of Adolescent Health 50, 2 (2012)2012-02-01Journal of Adolescent Health2012-02-01502S1054-139X(11)X0013-7FrontmatterA3A4