Predicting Adolescent Electronic Cigarette Use: Differences by Never, Ever, and Current Users.

OBJECTIVE: Rising rates of adolescent electronic cigarette (ECIG) use is concerning because it can lead to adverse health outcomes and increased risk behavior. There are known predictors of ever versus never ECIG use, but less are known about risk factors for ever versus current use of ECIGs. Problem behavior theory (PBT) was used to evaluate possible risk factors for different ECIG use status. METHODS: Participants were 573 high school students who completed questionnaires measuring ECIG use, as well as constructs within the Social Environment, Perceived Environment, Personality, and Behavior domains of PBT. Multinomial logistic regression was used to evaluate how predictor variables differentiated between participants who reported (a) never use, (b) ever ECIG use, or (c) current ECIG use. RESULTS: Adolescents were more likely to endorse ever ECIG use than never use if they reported peer ECIG use, perceived more benefits and fewer costs (e.g., health) of ECIG use, higher extraversion, alcohol and cigarette use (never vs. ever vs. past 30 days), or attended a school with a higher percentage of socioeconomically disadvantaged students. Adolescents were more likely to report current ECIG use than ever ECIG use if they perceived fewer costs of ECIG use or used cannabis in their lifetime (yes/no). CONCLUSIONS: PBT variables differentiated between ever ECIG use and never ECIG use. However, these variables did not differentiate between ever and current ECIG use. Identifying unique risk factors for current versus ever ECIG use is important to understanding persistent ECIG use and subsequent targeted prevention and intervention programs.

Associations Between Peer Use, Costs and Benefits, Self-Efficacy, and Adolescent E-cigarette Use.

OBJECTIVE: Prior research identified peer use as a salient risk factor of adolescent electronic cigarette (e-cigarette) use, but has not expanded on the mechanisms of this association. METHODS: Participants were 562 adolescents recruited from rural and suburban public high schools and an adolescent medicine clinic in the mid-Atlantic United States. Participants completed a packet of questionnaires that assessed demographics, substance use, expectations about the consequences of e-cigarette use, and perceptions of their own self-efficacy to resist using e-cigarettes. We estimated a series of mediation models using the MODEL INDIRECT command in MPLUS statistical software. In all models, significance of indirect effects from peer e-cigarette use to self-reported e-cigarette use were tested via two variables: (a) expected costs, (b) benefits of e-cigarette use, and (c) the perceived self-efficacy of the individual to refrain from e-cigarette use. RESULTS: Adolescents with more peers using e-cigarettes were more likely to have ever used an e-cigarette and perceived greater benefits and fewer costs, which was associated with a reduced self-efficacy to refrain from e-cigarette smoking (Model 1). Those with more peers using e-cigarettes were more likely to be currently using e-cigarettes themselves because they perceived greater benefits and fewer costs, which was associated with a reduced self-efficacy to refrain from e-cigarette smoking (Model 2). CONCLUSION: Peer use, self-efficacy to resist use, and expectations of cost and benefits of e-cigarette use should be considered as possible targets when devising tailored interventions and policies to prevent or reduce negative health consequences of long-term e-cigarette use.

Educational intervention improves fruit and vegetable intake in young adults with metabolic syndrome components.

The FRUVEDomics study investigates the effect of a diet intervention focused on increasing fruit and vegetable intake on the gut microbiome and cardiovascular health of young adults with/at risk for metabolic syndrome (MetS). It was hypothesized that the recommended diet would result in metabolic and gut microbiome changes. The 9-week dietary intervention adhered to the US Department of Agriculture Dietary Guidelines for Americans and focused on increasing fruit and vegetable intake to equal half of the diet. Seventeen eligible young adults with/or at high risk of MetS consented and completed preintervention and postintervention measurements, including anthropometric, body composition, cardiovascular, complete blood lipid panel, and collection of stool sample for microbial analysis. Participants attended weekly consultations to assess food logs, food receipts, and adherence to the diet. Following intention-to-treat guidelines, all 17 individuals were included in the dietary, clinical, and anthropometric analysis. Fruit and vegetable intake increased from 1.6 to 3.4 cups of fruits and vegetables (P < .001) daily. Total fiber (P = .02) and insoluble fiber (P < .0001) also increased. Clinical laboratory changes included an increase in sodium (P = .0006) and low-density lipoprotein cholesterol (P = .04). In the fecal microbiome, Erysipelotrichaceae (phylum Firmicutes) decreased (log2 fold change: -1.78, P = .01) and Caulobacteraceae (phylum Proteobacteria) increased (log2 fold change = 1.07, P = .01). Implementing a free-living 9-week diet, with intensive education and accountability, gave young adults at high risk for/or diagnosed with MetS the knowledge, skills, and feedback to improve diet. To yield greater impact, a longer diet intervention may be needed in this population.

Clomiphene Citrate Effectively Increases Testosterone in Obese, Young, Hypogonadal Men.

BACKGROUND: Obesity has been associated with low testosterone (T) in adult males and in pubertal boys. Therapy for hypogonadism with exogenous T may lead to testicular atrophy and later infertility. Only a few studies have demonstrated that the Selective Estrogen Receptor Modulator (SERM) clomiphene citrate (CC), an estrogen receptor antagonist, increases T in obese hypogonadal men while preventing testicular atrophy. No studies to date using CC have been done in younger obese post-pubertal hypogonadal males. OBJECTIVE: To determine whether CC therapy is effective in increasing serum T levels in hypogonadal post-pubertal obese males 18-21 years. MATERIALS AND METHODS: A retrospective chart analysis of records in obese men aged 18-21 years was done. Patients with early morning T level <350 ng/dl were given 25 mg CC on alternate days. Out of 18 patients found to have low T, 11 were analyzed. Baseline serum T, LH, FSH, weight and BMI were compared at baseline and after 3 months of CC treatment. RESULTS: Baseline T level was 233 ± 66 ng/dl and increased to 581 ± 161 ng/dl (p<0.0001) after 3 months of CC treatment. Baseline LH levels increased from 3.3 ± 1.6 mIU/mL to 5.7 ± 1.7 mIU/mL (p=0.027). Similarly, baseline FSH levels increased from 2.8 ± 1.5 mIU/mL to 6.2 ± 3 mIU/mL after CC treatment (p=0.026). There was no correlation between baseline or post treatment weight or BMI and the T level, LH, or FSH level. CONCLUSION: This is the first study reporting on CC therapy in obese, hypogonadal post-pubertal men 18-21 years. The SERM CC increased T in obese post-pubertal hypogonadal men, similar to efficacy of CC in adult hypogonadal men over the age 21 years. Larger randomized controlled studies to study the safety and potential use of CC to improve T in young obese HG men are needed.

The management of menstrual suppression and uterine bleeding: a survey of current practices in the Pediatric Blood and Marrow Transplant Consortium.

BACKGROUND: Current guidelines recommend the use of combined hormonal contraceptive pills for menstrual suppression in pediatric blood and marrow transplant (BMT) recipients but recent research reveals that provider practice varies. This study was designed to describe the current practice for managing menstrual issues, that is, menstrual suppression and uterine bleeding, in pediatric BMT patients and to better understand health care providers' practices in the use of gonadotropin-releasing hormone agonists (GnRHa). PROCEDURE: A cross sectional survey consisting of 53 questions was distributed via email to principal investigators in the Pediatric Blood and Marrow Transplant Consortium (PBMTC). Responses were collected using www.surveymonkey.com. RESULTS: Menstrual suppression and uterine bleeding in pediatric BMT patients are primarily managed by pediatric oncologists (97%). The most frequently reported hormonal method used for induction of therapeutic amenorrhea was GnRHa (41%). The top three reasons for choosing a method were greater likelihood of amenorrhea, concerns about side effects, and possible gonadal protection. Continuous combined hormonal contraceptive pills were the most commonly used method for the management of clinically significant uterine bleeding regardless of primary method used for menstrual suppression. CONCLUSION: Despite the 2002 PBMTC guidelines, wide variation in menstrual suppression management practices still exists. Our data show that use of GnRHa is more common than previously reported. Additional research is needed to develop evidence-based practice guidelines in pediatric BMT patients.

The efficacy of motivational interviewing versus brief advice for adolescent smoking behavior change.

OBJECTIVE: In this study we sought to evaluate the efficacy of motivational interviewing (MI) compared with structured brief advice (SBA) for adolescent smoking behavior change. METHODS: Participants (N=355) were randomly assigned to 5 sessions of either MI or SBA. The primary outcomes were attempts to reduce and to quit smoking, smoking reduction, and cotinine-validated 7-day point-prevalence smoking abstinence at the end of treatment (week 12) and the 24-week follow-up. RESULTS: White adolescents were ∼80% less likely to attempt to cut back (odds ratio [OR]: 0.21; confidence interval [CI]: 0.08-0.53) and >80% less likely to attempt to quit smoking compared with black adolescents (OR: 0.17 [CI: 0.06-0.46]). Adolescents who were at least planning to cut back or quit smoking at baseline were almost 3 times more likely to attempt to cut back (OR: 2.87 [CI: 1.26-6.52]) and to attempt to quit smoking (OR: 3.13 [CI: 1.19-8.26]). Adolescents who received MI were ∼60% less likely than adolescents who received SBA to try to quit smoking (OR: 0.41 [CI: 0.17-0.97]). However, adolescents who received MI showed a greater reduction in cigarettes smoked per day than adolescents who received SBA (5.3 vs 3.3 fewer cigarettes per day). There were no statistically significant differences between MI and SBA in smoking abstinence (5.7% vs 5.6%, respectively). CONCLUSIONS: The effects of MI on adolescent smoking behavior change are modest, and MI may best fit within a multicomponent smoking cessation treatment approach in which behavior change skills can support and promote smoking behavior change decisions.

Adolescents' experiences using the contraceptive patch versus pills.

STUDY OBJECTIVE: To compare use of the weekly transdermal contraceptive patch (patch) with daily combined hormonal contraceptive pills (pills) in adolescents. DESIGN: Prospective longitudinal study of adolescents' self-selected (non-randomized) use of the patch or pills. SETTING: Urban, university hospital-affiliated, adolescent outpatient clinic. PARTICIPANTS: 13-22-year-old female adolescents seeking hormonal contraception, 40 who chose the patch and 40 who chose pills. INTERVENTIONS: Data were collected via self-report on paper questionnaires at three-cycle intervals for a total of up to nine cycles. MAIN OUTCOME MEASURES: Method continuation, perfect use, method satisfaction, quality of life, and side effects, including menstrual changes and perceived mood changes. RESULTS: After nine cycles, 38% of patch users and 60% of pill users were still using the method they had chosen at enrollment. There were no significant differences between the groups in self-reported perfect use. No differences were found in quality of life or side effects. Both patch and pill users noted menses became lighter and more predictable and reported decreased depression prior to their menses; only the pill group reported improvement in premenstrual anger. Method satisfaction was similar in both groups except patch users were more likely to report that their contraceptive method improved normal daily activities. CONCLUSIONS: Despite apparent advantages of the patch over the pill, adolescents using both methods continue to face challenges achieving perfect and sustained contraceptive use.

Adolescent smoking cessation: promising strategies and evidence-based recommendations.

Most adult smokers began smoking as teenagers, and an estimated 6.4 million young people will eventually suffer premature mortality and/or diminished quality of life as a result of smoking-related diseases. Most teens who smoke want to stop but fail within a month of trying to quit independently. Reaching teens with effective treatments for smoking cessation is essential to their current and future health. This article highlights evidence-based interventions and provides practice recommendations to address adolescent smoking. These include behavioral approaches and initial research regarding pharmacotherapy as well as strategies for individual patient encounters, practice management, and public advocacy.

Bariatric surgery in adolescents: mechanics, metabolism, and medical care.

Obesity is a serious, lifelong, worldwide health problem. Once obese, few people are able to lose their excess weight. Bariatric surgery is an intervention that has produced substantial and sustained weight loss in adults. It is offered increasingly as an option for extremely obese adolescents. Selection criteria have been proposed by several expert consensus panels. Outcomes and metabolic consequences of bariatric surgery on glucose-insulin interactions, diabetes, sleep architecture, the gastrointestinal tract, asthma, cardiovascular dysfunction, renal parameters, polycystic ovarian syndrome, bone health, nutrition, gynecologic concerns, and mental health are reviewed here.

Body art: attitudes and practices regarding body piercing among urban undergraduates.

OBJECTIVE: To describe the knowledge, attitudes, and practices of young adults toward body piercing. METHODS: An anonymous 30-item survey was given to 103 undergraduate students at the campus health service of a large urban university. The questionnaire collected data on students' perceptions regarding the social acceptability of body piercing, their experiences with and attitudes toward this form of body art, and their knowledge of associated health risks. RESULTS: One hundred (97%) out of the 103 surveys distributed had sufficient data for analysis. Fifty-six percent of participants (age range, 17 to 25 years) reported having a body piercing at one time. Participants with a piercing were more likely to have a tattoo (OR, 4.13; 95% CI, 1.10-15.56; P=.04). The majority of participants (65 [78%]) reported "liking" body piercing on others, though a smaller percentage (45 [52%]) reported "liking" it on themselves (z=3.58, P<.001). Participants estimated the chance of potential health risks as a result of body piercing as follows: bleeding (60%), infection (56%), keloid scarring (43%), bruising (41%), allergic reaction (38%), cyst or tetanus (each 24%), hepatitis B (20%), and human immunodeficiency virus (16%). Nonpierced participants assessed the probability of adverse events as a result of body piercing at 43%, whereas their pierced counterparts estimated the risk at 30% (F(1,83)14.06, P<.001). Forty-three percent of all participants reported knowing someone (ie, other than themselves) who experienced a health problem as a result of body piercing, though few (10 of 52 [19%]) pierced participants reported similar personal experiences. CONCLUSIONS: Young adults believe that body piercing is highly acceptable among the general public. Furthermore, though they believe such body art is acceptable on others, they feel it is less acceptable on themselves. Study participants displayed a high level of awareness regarding the potential health risks of body art, and, in fact, overestimate those risks. Implications for patient education are addressed.

Home screening for sexually transmitted diseases in high-risk young women: randomised controlled trial.

OBJECTIVE: Home screening tests could eliminate several barriers to testing sexually transmitted diseases (STDs). AIM: To determine whether offering repeated home screening tests would increase the rate of testing for chlamydia and gonorrhoea in a high-risk sample of young women. METHODS: In this randomised controlled trial, 403 young women (mean age 18.9 years, 70% black) with a recent STD or with STD-related risk factors were enrolled. Participants were recruited from clinics and high-prevalence neighbourhoods and then randomly assigned to receive either a home testing kit or an invitation to attend a medical clinic for testing at 6, 12 and 18 months after enrollment. Over 80% of women were followed for 2 years. The trial is registered with ClinicalTrials.gov, number NCT 00177437. RESULTS: Of 197 women in the intervention group, 140 (71%) returned at least one home test and 25 of 249 (10%) home tests were positive. Women who received home screening tests completed significantly more STD tests overall (1.94 vs 1.41 tests per woman-year, p<0.001) and more STD tests in the absence of symptoms (1.18 vs 0.75 tests per woman-year, p<0.001). More women in the intervention group completed at least one test when asymptomatic (162 (82.2%) vs 117 (61.3%), p<0.001). The intervention was most effective among women recruited outside medical clinics. There was no significant difference in the overall rate of STDs detected. CONCLUSIONS: Home screening significantly increased the utilisation of chlamydia and gonorrhoea testing in this sample of high-risk young women, and thus represents a feasible strategy to facilitate STD testing in young women.

Developmental and reproductive health issues in adolescent solid organ transplant recipients.

The improved survival of pediatric recipients of solid organ transplants has prompted increased attention to quality of life issues. In adolescents these include attainment of normal growth and development, and involvement in romantic and sexual relationships. This review focuses on the reproductive health care needs of adolescent solid organ transplant recipients, including issues related to puberty, menstruation, and fertility. Contraceptive options, and the implications of their use by transplant recipients, are described. With close clinical follow up, most currently available hormonal contraceptive methods can be considered, and the impact of drug interactions with immunosuppressants can be minimized by eliminating hormone-free intervals. Monitoring for sexually transmitted infections, including oncogenic Human Papilloma Virus and its sequelae, is especially important for transplant recipients. Comprehensive reproductive health care visits are recommended for all sexually active adolescent solid organ transplant recipients.

Risk factors for cervicitis among women with bacterial vaginosis.

BACKGROUND: Cervicitis commonly occurs in women with bacterial vaginosis (BV), often without concomitant chlamydial or gonococcal infection. The risk factors for cervicitis have not been described. METHODS: We characterized the risk factors for cervicitis, which is defined as endocervical mucopurulent discharge or easily induced bleeding, among women with BV who were 14-45 years of age. Associations between cervicitis and the characteristics of the subjects, including the presence of specific vaginal bacteria and chlamydial or gonococcal infection detected by strand displacement assay, were analyzed. RESULTS: Of 424 women with BV, 63 (15%) had cervicitis. Of these 63 women, only 8 (13%) had chlamydia or gonorrhea. The risk factors for cervicitis, adjusted for variables, included older age (P<.001, for trend),

Gynecologic health care for the adolescent solid organ transplant recipient.

The improved survival of pediatric recipients of solid organ transplants has prompted increased attention to quality of life issues. These include attainment of normal growth, involvement in romantic relationships, and the desire to control fertility. As an increasing number of adolescent transplant recipients are involved in normal social and sexual relationships, they require careful attention to their gynecologic and reproductive health care needs. Anticipating the onset of sexual activity before it occurs may help to prevent a mistimed pregnancy by providing or prescribing condoms and emergency contraception in advance. In addition, many transplant recipients can safely use the currently available methods of hormonal contraception provided there is careful attention to organ function, other medical problems, and concurrently prescribed medications. In adolescent patients, issues such as pubertal development and menstruation, contraception, and routine gynecologic health care are typically addressed by the patient's primary care provider. However, the complexity of the adolescent transplant recipient's medical care necessitates close collaboration among all health care providers caring for the patient. This review is intended to help the transplant team better understand the gynecologic health care needs and treatment options of their adolescent patients.