0
We're unable to sign you in at this time. Please try again in a few minutes.
Retry
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
Retry
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Article |

Infrequent Parental Monitoring Predicts Sexually Transmitted Infections Among Low-Income African American Female Adolescents FREE

Richard A. Crosby, PhD; Ralph J. DiClemente, PhD; Gina M. Wingood, ScD, MPH; Delia L. Lang, MPH, PhD; Kathy Harrington, MPH, MAEd
[+] Author Affiliations

From the Department of Behavioral Sciences and Health Education, Rollins School of Public Health (Drs Crosby, DiClemente, Wingood, and Lang), Department of Pediatrics, Division of Infectious Diseases, Epidemiology and Immunology, and Department of Medicine, Division of Infectious Diseases, School of Medicine (Dr DiClemente), Emory University, Atlanta, Ga; the Emory/Atlanta Center for AIDS Research (Drs Crosby, DiClemente, and Wingood); and the Department of Pediatrics, School of Medicine, University of Alabama at Birmingham (Ms Harrington).


Arch Pediatr Adolesc Med. 2003;157(2):169-173. doi:10.1001/archpedi.157.2.169.
Text Size: A A A
Published online

Objective  To prospectively determine (using an 18-month follow-up period) the association between African American female adolescents' perceptions of parental monitoring and their acquisition of biologically confirmed infection with Chlamydia trachomatis, Neisseria gonorrhoeae, and Trichomonas vaginalis.

Design  A prospective cohort study of 217 African American female adolescents enrolled in the control arm of a randomized trial of a human immunodeficiency virus prevention intervention program.

Setting and Participants  A volunteer sample of adolescents (aged 14-18 years) recruited from low-income neighborhoods characterized by high rates of unemployment, substance abuse, violence, and sexually transmitted diseases.

Main Outcome Measures  Adolescents provided 2 self-collected vaginal swab specimens. One was tested for C trachomatis and N gonorrhoeae DNA with ligase chain reaction. The other was used to inoculate culture medium for T vaginalis. Identical assay procedures were repeated at the 6-month, 12-month, and 18-month follow-up intervals.

Results  Adjusted odds ratios indicated that adolescents who perceived infrequent parental monitoring at baseline were 1.8 (95% confidence interval, 1.01-3.21) and 2.4 (95% confidence interval, 1.22-4.87) times more likely to acquire chlamydia or trichomoniasis, respectively, compared with their counterparts who perceived greater levels of monitoring. Similarly, adolescents who perceived infrequent parental monitoring were 2.1 (95% confidence interval, 1.16-3.74) times more likely to test positive for a sexually transmitted infection during the course of the 18-month follow-up period.

Conclusions  Adolescents' perceptions of their parental-monitoring levels predicted subsequent acquisition of biologically confirmed chlamydia and trichomoniasis infections. These findings suggest that expanded efforts leading toward effective clinic- and community-based sexually transmitted infection intervention programs involving parents may be warranted.

SEXUALLY TRANSMITTED infections (STIs) are a significant and immediate health risk to adolescents.1 In the United States, African American female adolescents are disproportionately likely to acquire STIs including human immunodeficiency virus.2,3 Evidence suggests that family-level interventions are a promising approach to reducing STI incidence among African American female adolescents.47 Parental monitoring is one aspect of family-level intervention that may be a particularly important focal point for these efforts.812

Cross-sectional and prospective studies provide evidence suggesting that female adolescents who perceive infrequent parental monitoring may be more likely to engage in sexual risk behaviors.8,9,11 Unfortunately, the outcome measures for these studies were self-reported, and past evidence suggests that adolescents' self-reported sexual risk behaviors may lack validity.13 Previously, we reported significant cross-sectional associations between African American female adolescents' perceptions of parental monitoring and the prevalence of biologically confirmed chlamydial, gonococcal, and trichomonad infections.10 The purpose of our study was to prospectively test (using an 18-month follow-up period) the association between African American female adolescents' perceptions of parental monitoring and their acquisition of biologically confirmed infection with Chlamydia trachomatis, Neisseria gonorrhoeae, and Trichomonas vaginalis.

STUDY DESIGN AND SAMPLE

A prospective cohort study design was used. The study participants were female adolescents enrolled in a randomized trial of a human immunodeficiency virus prevention program. Only those randomized to receive an attention control intervention were included in the analysis. The attention control curriculum provided the adolescents with information related to health but unrelated to sexual risk behaviors. Baseline data and 6-month, 12-month, and 18-month follow-up data collected from adolescents randomized to the control condition were used for this study.

From December 1996 through April 1999, sexually active African American female adolescents (aged 14-18 years) were recruited from low-income neighborhoods in Birmingham, Ala, that were characterized by high rates of unemployment, substance abuse, violence, teen pregnancy, and sexually transmitted diseases. The study achieved an 85.7% baseline participation rate. Retention rates for the control group were 90% (6 months), 89% (12 months), and 85% (18 months). More detailed descriptions of the study have been published elsewhere.10,14 All study protocols were approved by the university institutional review board.

At the conclusion of the 18-month follow-up period, data for 230 adolescents were available for analysis. Of these, 217 (94%) provided usable specimens at each assessment interval. Our analyses were based on these 217 female adolescents.

DATA COLLECTION

Data collection was conducted at the University of Alabama Family Medicine Clinic in Birmingham. A self-administered questionnaire was developed for adolescents with a fifth-grade reading level. The questionnaire was administered in a group setting with monitors providing assistance to those with limited literacy and helping to assure confidentiality of the responses. The adolescents were assured that their names could not be linked to the codes used to identify documents containing their responses. Subsequently, participants were instructed in the correct procedure for self-collecting a vaginal swab specimen. They were asked to provide 2 self-collected vaginal swab specimens for sexually transmitted disease testing.

MEASURES
Assessment of Parental Monitoring

Although a uniform definition of parental monitoring has not been applied in the research literature, most studies measure 2 important aspects of parental monitoring: (1) adolescents' perceptions of their parents' knowledge of where they go, and (2) adolescents' perceptions about parents' knowledge of whom they are with when the adolescent is not at home or at school. Given that perceptions are powerful determinants of behavior, adolescents' perceptions of parental monitoring rather than assessments from parents have been used to assess this construct.812

At baseline, participants completed a 2-item measure assessing parental monitoring. These items were strongly correlated (Pearson r = 0.70; P = .01), yet the correlations were not strong enough to suggest that the items were redundant. One item asked the adolescents how often parents (or parental figures) knew where they were when they were not at home or at school. The other assessed how often their parents knew whom they were with when not at home or at school. Responses were provided on a 5-point scale: 1, "never or almost never," 2, "rarely," 3, "sometimes," 4, "usually," and 5, "almost always." Adolescents who responded "almost always" or "usually" to both items were classified as perceiving frequent parental monitoring; the remainder were classified as perceiving infrequent parental monitoring.

Laboratory Measures

Participants provided 2 vaginal swab specimens. The first was placed in a transport tube (Abbott LCx Probe System; Abbott Laboratories, Abbott Park, Ill) and tested for C trachomatis and N gonorrhoeae DNA with ligase chain reaction.15,16 The second was used to inoculate culture medium for T vaginalis (InPouch TV test; BioMed Diagnostics Inc, Santa Clara, Calif).17 Identical assay procedures were repeated at each 6-month follow-up interval. Adolescents who tested positive for an STI were notified by telephone or in person (with written documentation) and requested to return for an oral single-dose treatment.

Assessment of Covariates Related to the Outcome

Identification of covariates is an important method of controlling for their potentially confounding effects. Therefore, several variables were tested as potential covariates between adolescents' perceived level of parental monitoring and acquisition of STIs during the 18-month follow-up period. Potential key covariates were age, whether participants tested positive for any of the STIs assessed at baseline, and frequency of adolescents' communication with parents about sex-related issues. The latter measure was assessed using a scale that asked participants how frequently they discussed each of 5 topics with their parents: sex, how to use condoms, how to prevent infection with an STI, how to prevent infection with the virus that causes acquired immunodeficiency syndrome, and how to prevent pregnancy. The scale achieved adequate inter-item reliability (α = .88). Only 1 of the covariates that we tested (Table 1) met the statistical criteria for a covariate (ie, a significant association using a screening level of P≤.10 with parental monitoring and at least 1 of the outcome measures).

Table Graphic Jump LocationTable 1. Bivariate Associations Between Potential Covariates, Parental Monitoring, and Incidence of 3 STIs*
DATA ANALYSIS

Bivariate associations between baseline levels of parental monitoring and STI acquisition were assessed using contingency table analysis. Relative risk ratios compared STI incidence rates between adolescents who reported relatively infrequent parental monitoring and those who reported more frequent monitoring. To control for the identified covariate, hierarchical logistic regression was used to calculate an adjusted odds ratio that controlled for the prevalence of biologically confirmed STIs at baseline. Significance was defined by 95% confidence intervals and an obtained P value of less than .05.

DESCRIPTIVE FINDINGS

At enrollment, the age of the adolescents was mean ± SD, 16.0 ± 1.2 years. At baseline, 36.5% of participants were classified as perceiving infrequent parental monitoring. More than half (53.5%) of the adolescents tested positive at least once for 1 of the 3 assessed STIs. Thirty-three adolescents (15.2%) tested positive for gonorrhea during at least 1 of the 3 assessment periods. In addition, 84 participants (38.7%) tested positive for chlamydia and 48 (22.1%) tested positive for trichomoniasis during at least 1 of the 3 assessment periods.

BIVARIATE ASSOCIATIONS

Table 2 presents relative risk ratios, 95% confidence intervals, and their respective P values. In contrast to those who perceived frequent monitoring, adolescents perceiving infrequent monitoring were significantly more likely to test positive for at least 1 STI during the 18-month follow-up period. As indicated, the strongest association observed was for trichomoniasis. More than one third (35.7%) of the adolescents who perceived infrequent parental monitoring tested positive for trichomoniasis at least once during the 18-month follow-up period, as compared with 17.7% among those perceiving more frequent monitoring. The association between parental monitoring and incidence of chlamydia was also significant. Nearly half (47.4%) of the adolescents who perceived infrequent parental monitoring tested positive for chlamydia at least once during the 18-month follow-up period, as compared with 33.6% among those perceiving more frequent monitoring. Significant bivariate associations between parental monitoring and incidence of gonorrhea or acquisition of multiple STIs were not observed.

Table Graphic Jump LocationTable 2. Bivariate and Multivariate Associations Between Infrequent Parental Monitoring and STI Incidence Among African American Female Adolescents
ADJUSTED ASSOCIATIONS

Table 2 also presents odds ratios adjusted for the effects of STI prevalence at baseline. Adjusted odds ratios indicate that adolescents who perceived infrequent parental monitoring at baseline were 1.8 and 2.4 times more likely to acquire chlamydia or trichomoniasis, respectively, compared with their counterparts who perceived greater levels of monitoring. Similarly, adolescents who perceived infrequent parental monitoring were more than twice as likely to test positive for an STI during the course of the 18-month follow-up period.

To the best of our knowledge, this is the first prospective report showing that female adolescents' perceptions of infrequent parental monitoring predict subsequent biologically confirmed acquisition of STIs. This evidence adds to the emerging empirical literature supporting family-level programs designed to reduce adolescents' STI risk.712 Our findings are strengthened by the fact that all participants began the prospective period free of infection (ie, those testing positive at baseline were effectively treated).

Physicians are in a unique position to facilitate parental involvement in the lives of their adolescent patients. Our findings suggest that one potentially beneficial talking point between physicians and parents may be the importance of frequent parental monitoring. Beyond the reduced risk of acquiring STIs, more frequent parental monitoring may lead to adolescents' less frequent engagement in antisocial activities,811 decreased odds of substance use,10,1820 and decreased risk of pregnancy.21 Thus, physicians' efforts to promote parental monitoring may be beneficial on multiple levels.

Recent evidence from a randomized controlled trial suggests that programs designed to promote parental monitoring can be effective.12 Research has increasingly focused on parental involvement as a strategy for promoting health-protective behaviors among adolescents.22,23 Parental monitoring may be viewed as one component of "authoritative parenting," which can be defined as a combination of parenting behaviors (eg, setting and enforcing clear standards, encouraging autonomy and communication with parents, and being involved and supportive in adolescents' activities).23 Although brief, clinic-based interventions designed to promote parental monitoring have not been described by published report, our findings suggest that such research is warranted with respect to reducing the incidence of STI infection among African American female adolescents. Key issues that could be addressed by future research include the effects of increased parental monitoring both on adolescents' perceptions of monitoring and on other parental behaviors (eg, frequency of communication).

Of note, it was interesting that adolescent's age was not significantly associated with the measure of parental monitoring. This lack of association suggests that perceptions of monitoring change very little throughout the course of the teen years (ages 14-19 years). In addition, age was not significantly associated with STI incidence during the 18-month follow-up period. Also noteworthy is the lack of association between the incidence of gonorrhea and parental monitoring. Differences in the epidemiological patterns of gonorrhea as opposed to chlamydia and trichomoniasis may explain this observed lack of association.

Our findings are limited by the validity of the self-reported measure of parental monitoring. Furthermore, our study assessed parental monitoring only at enrollment; thus, changes in perceived monitoring during the 18-month follow-up period were not assessed. The findings are also limited by the use of a convenience sample of economically disadvantaged African American adolescents. Our results may not apply to other African American female adolescents, to those from other racial or ethnic groups, or to different socioeconomic strata. Clearly, further research is needed with diverse adolescent populations.

Adolescents' perceptions of their parental-monitoring levels predicted subsequent acquisition of biologically confirmed chlamydia and trichomoniasis infections. Our findings suggest that expanded efforts leading toward effective clinic- and community-based STI intervention programs involving parents may be warranted.

Corresponding author and reprints: Richard A. Crosby, PhD, Rollins School of Public Health, Department of Behavioral Sciences and Health Education, 1518 Clifton Rd NE, Fifth Floor, Atlanta, GA 30322 (e-mail: rcrosby@sph.emory.edu).

Accepted for publication September 19, 2002.

This study was supported by grant 1R01 MH54412 from the Center for Mental Health Research on AIDS, National Institute of Mental Health, Rockville, Md (Dr DiClemente).

We thank Susan L. Davies, PhD (School of Public Health), Edward Hook III, MD (School of Medicine, Division of Infectious Diseases), and M. Kim Oh, MD (School of Medicine, Department of Pediatrics), University of Alabama at Birmingham (UAB), for their assistance and input. We also thank Jane R. Schwebke, MD (UAB School of Medicine, Division of Infectious Diseases), for provision of cultures for Trichomonas vaginalis, and Kim Smith, MT(ASCP), for assistance and oversight of testing for Neisseria gonorrhoeae and Chlamydia trachomatis.

What This Study Adds

Previous evidence collected in cross-sectional studies suggests that parental monitoring may be an important protective factor against STI acquisition among female adolescents. Although a couple of studies have examined this question prospectively, the outcome measures were self-reported sexual risk behavior rather than biologically confirmed end points.

This study combined a prospective design with biologically confirmed outcome measures to provide a more rigorous test of the hypothesis that parental monitoring can be protective against STI infection among female adolescents. Our findings add further support to the hypothesis that parental monitoring serves a protective function. Expanded efforts leading toward effective clinic- and community-based STI intervention programs involving parents may be warranted.

Eng  TRedButler  WTed The Hidden Epidemic: Confronting Sexually Transmitted Diseases.  Washington, DC National Academy Press1997;
Centers for Disease Control and Prevention, Sexually Transmitted Disease Surveillance, 2000.  Atlanta, Ga US Dept of Health and Human Services2001;
Office of National AIDS Policy, Youth and HIV/AIDS: An American Agenda.  Washington, DC Office of National AIDS Policy1996;
DiIorio  CResnicow  KDenzmore  PPequegnat  W, Szapocznik J, edsed  et al.  Keepin' it REAL: a mother-adolescent HIV prevention program. Working With Families in the Era of HIV/AIDS Thousand Oaks, Calif Sage Publications Inc2000;113- 132
Jemmott  LSOutlaw  FHJemmott  JBPequegnat  W, Szapocznik J, eds.ed  et al.  Strengthening the bond: the mother-son health promotion project. Working With Families in the Era of HIV/AIDS Thousand Oaks, Calif Sage Publications Inc2000;133- 154
DiClemente  RJWingood  GM Expanding the scope of HIV prevention for adolescents: beyond individual-level interventions. J Adolesc Health. 2000;26377- 378
Link to Article
Crosby  RAMiller  KSWingood  GM, DiClemente RJ, eds.ed The pivotal role of the family on adolescent females' sexual health. Women's Sexual and Reproductive Health: Social, Psychological, and Public Health Perspectives. New York, NY Plenum/Kluwer Press2002;113- 128
Li  XFeigelman  SStanton  B Perceived parental monitoring and health risk behaviors among urban low-income African-American children and adolescents. J Adolesc Health. 2000;2743- 48
Link to Article
Li  XStanton  BFeigelman  S Impact of perceived parental monitoring on adolescent risk behavior over 4 years. J Adolesc Health. 2000;2749- 56
Link to Article
DiClemente  RJWingood  GMCrosby  RA  et al.  Parental monitoring and its association with a spectrum of adolescent health risk behaviors. Pediatrics. 2001;1071363- 1368
Link to Article
Romer  DStanton  BGalbraith  J  et al.  Parental influence on adolescent sexual behavior in high-poverty settings. Arch Pediatr Adolesc Med. 1999;1531055- 1062
Link to Article
Stanton  BFLi  XGalbraith  J  et al.  Parental underestimates of adolescent risk behavior: a randomized, controlled trial of a parental monitoring intervention. J Adolesc Health. 2000;2618- 26
Link to Article
Zenilman  JMWeisman  CSRompalo  AM  et al.  Condom use to prevent STDs: the validity of self-reported condom use. Sex Transm Dis. 1995;2215- 20
Link to Article
Crosby  RADiClemente  RJWingood  GM  et al.  Correlates of unprotected vaginal sex among African American female teens: the importance of relationship dynamics. Arch Pediatr Adolesc Med. 2000;154893- 899
Link to Article
Hook III  EWChing  SFStephens  JHardy  KFSmith  KRLee  HH Diagnosis of Neisseria gonorrhoeae infections in women by using the ligase chain reaction on patient-obtained vaginal swabs. J Clin Microbiol. 1997;352129- 2132
Hook III  EWSmith  KMullen  C  et al.  Diagnosis of genitourinary chlamydia trachomatis infections in women by using the ligase chain reaction on patient-obtained vaginal swabs. J Clin Microbiol. 1997;352133- 2135
Schwebke  JRMorgan  SCPinson  GB Validity of self-obtained vaginal specimens for diagnosis of trichomoniasis. J Clin Microbiol. 1997;351618- 1619
Benda  BBDiBlasio  FA An integration of theory: adolescent sexual contacts. J Youth Adolesc. 1994;23403- 420
Link to Article
Baker  JGRosenthal  SLLeonhardt  D  et al.  Relationship between perceived parental monitoring and young adolescent girls' sexual and substance use behaviors. J Pediatr Adolesc Gynecol. 1999;1217- 22
Link to Article
Mulhall  PFStone  DStone  B Home alone: is it a risk factor for middle school youth and drug use? J Drug Educ. 1996;2639- 48
Link to Article
Crosby  RADiClemente  RJWingood  GM  et al.  Low parental monitoring predicts subsequent pregnancy among African-American adolescent females. J Pediatr Adolesc Gynecol. 2002;1543- 46
Link to Article
Pequegnat  WedSzapocznik  Jed Working With Families in the Era of HIV/AIDS.  Thousand Oaks, Calif Sage Publications Inc2000;
Simons-Morton  BHartos  JDiClemente  RJ, Crosby RA, Kegler MC, eds.ed Application of the authoritative parenting model to adolescent health behavior. Emerging Theories in Health Promotion Practice and Research. San Francisco, Calif Jossey-Bass2002;100- 125

Figures

Tables

Table Graphic Jump LocationTable 1. Bivariate Associations Between Potential Covariates, Parental Monitoring, and Incidence of 3 STIs*
Table Graphic Jump LocationTable 2. Bivariate and Multivariate Associations Between Infrequent Parental Monitoring and STI Incidence Among African American Female Adolescents

References

Eng  TRedButler  WTed The Hidden Epidemic: Confronting Sexually Transmitted Diseases.  Washington, DC National Academy Press1997;
Centers for Disease Control and Prevention, Sexually Transmitted Disease Surveillance, 2000.  Atlanta, Ga US Dept of Health and Human Services2001;
Office of National AIDS Policy, Youth and HIV/AIDS: An American Agenda.  Washington, DC Office of National AIDS Policy1996;
DiIorio  CResnicow  KDenzmore  PPequegnat  W, Szapocznik J, edsed  et al.  Keepin' it REAL: a mother-adolescent HIV prevention program. Working With Families in the Era of HIV/AIDS Thousand Oaks, Calif Sage Publications Inc2000;113- 132
Jemmott  LSOutlaw  FHJemmott  JBPequegnat  W, Szapocznik J, eds.ed  et al.  Strengthening the bond: the mother-son health promotion project. Working With Families in the Era of HIV/AIDS Thousand Oaks, Calif Sage Publications Inc2000;133- 154
DiClemente  RJWingood  GM Expanding the scope of HIV prevention for adolescents: beyond individual-level interventions. J Adolesc Health. 2000;26377- 378
Link to Article
Crosby  RAMiller  KSWingood  GM, DiClemente RJ, eds.ed The pivotal role of the family on adolescent females' sexual health. Women's Sexual and Reproductive Health: Social, Psychological, and Public Health Perspectives. New York, NY Plenum/Kluwer Press2002;113- 128
Li  XFeigelman  SStanton  B Perceived parental monitoring and health risk behaviors among urban low-income African-American children and adolescents. J Adolesc Health. 2000;2743- 48
Link to Article
Li  XStanton  BFeigelman  S Impact of perceived parental monitoring on adolescent risk behavior over 4 years. J Adolesc Health. 2000;2749- 56
Link to Article
DiClemente  RJWingood  GMCrosby  RA  et al.  Parental monitoring and its association with a spectrum of adolescent health risk behaviors. Pediatrics. 2001;1071363- 1368
Link to Article
Romer  DStanton  BGalbraith  J  et al.  Parental influence on adolescent sexual behavior in high-poverty settings. Arch Pediatr Adolesc Med. 1999;1531055- 1062
Link to Article
Stanton  BFLi  XGalbraith  J  et al.  Parental underestimates of adolescent risk behavior: a randomized, controlled trial of a parental monitoring intervention. J Adolesc Health. 2000;2618- 26
Link to Article
Zenilman  JMWeisman  CSRompalo  AM  et al.  Condom use to prevent STDs: the validity of self-reported condom use. Sex Transm Dis. 1995;2215- 20
Link to Article
Crosby  RADiClemente  RJWingood  GM  et al.  Correlates of unprotected vaginal sex among African American female teens: the importance of relationship dynamics. Arch Pediatr Adolesc Med. 2000;154893- 899
Link to Article
Hook III  EWChing  SFStephens  JHardy  KFSmith  KRLee  HH Diagnosis of Neisseria gonorrhoeae infections in women by using the ligase chain reaction on patient-obtained vaginal swabs. J Clin Microbiol. 1997;352129- 2132
Hook III  EWSmith  KMullen  C  et al.  Diagnosis of genitourinary chlamydia trachomatis infections in women by using the ligase chain reaction on patient-obtained vaginal swabs. J Clin Microbiol. 1997;352133- 2135
Schwebke  JRMorgan  SCPinson  GB Validity of self-obtained vaginal specimens for diagnosis of trichomoniasis. J Clin Microbiol. 1997;351618- 1619
Benda  BBDiBlasio  FA An integration of theory: adolescent sexual contacts. J Youth Adolesc. 1994;23403- 420
Link to Article
Baker  JGRosenthal  SLLeonhardt  D  et al.  Relationship between perceived parental monitoring and young adolescent girls' sexual and substance use behaviors. J Pediatr Adolesc Gynecol. 1999;1217- 22
Link to Article
Mulhall  PFStone  DStone  B Home alone: is it a risk factor for middle school youth and drug use? J Drug Educ. 1996;2639- 48
Link to Article
Crosby  RADiClemente  RJWingood  GM  et al.  Low parental monitoring predicts subsequent pregnancy among African-American adolescent females. J Pediatr Adolesc Gynecol. 2002;1543- 46
Link to Article
Pequegnat  WedSzapocznik  Jed Working With Families in the Era of HIV/AIDS.  Thousand Oaks, Calif Sage Publications Inc2000;
Simons-Morton  BHartos  JDiClemente  RJ, Crosby RA, Kegler MC, eds.ed Application of the authoritative parenting model to adolescent health behavior. Emerging Theories in Health Promotion Practice and Research. San Francisco, Calif Jossey-Bass2002;100- 125

Correspondence

CME
Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.
Submit a Comment

Multimedia

Some tools below are only available to our subscribers or users with an online account.

Web of Science® Times Cited: 35

Related Content

Customize your page view by dragging & repositioning the boxes below.

Articles Related By Topic
Related Collections
PubMed Articles