Amy Suss

Attitudes and Perceptions of the HPV Vaccine in Caribbean and African-American Adolescent Girls and their Parents

OBJECTIVE To describe attitudes and perceptions toward acceptability of human papilloma virus (HPV) vaccination among inner city Caribbean (CA) and African American (AA) adolescents and their parents, and discuss correlates that may be associated with these factors. DESIGN Questionnaire survey. SETTING An adolescent medicine clinic. PARTICIPANTS A convenience sample was recruited of 175 adolescent girls aged 13 to 19 years and 74 parents attending adolescent clinic. INTERVENTION Participants completed an anonymous confidential 10-minute questionnaire. MAIN OUTCOME MEASURES Data on knowledge about HPV, cervical cancer (CC), attitudes and acceptance of the HPV vaccine. RESULTS Responses of 175 adolescent girls and 74 parents were analyzed. Overall, 48.9% of the teens were sexually active (SA) and had a 2.2-fold greater odds (OR = 2.21; 95% CI = 1.13-4.36) of being interested in HPV vaccination versus girls who were not SA. While only 55.8% of girls knew what HPV is, this knowledge was significantly associated with knowing that most CC is caused by HPV (P < 0.001) and with interest in receiving HPV vaccination (P < 0.001). Less than half (44.5%) of adolescent girls were interested in receiving the HPV vaccine and only 37.5% of parents. There were no significant influences in parental acceptance of the vaccine with regard to age, ethnicity and educational level, insurance, and living situation.The majority of parents wanted the vaccine for its role in preventing CC. CONCLUSIONS Although controversy surrounds HPV vaccine in regard to its supposed role in promoting SA, only a minority of our parents showed concern for that association. The level of acceptance of the HPV vaccine was overall lower than what has been reported among other racial/ethnic populations. Knowledge about HPV and its association with CC were significantly associated with interest in getting the HPV vaccine and both parents and teens seem to accept the HPV vaccine more for its role in CC prevention.

Risk factors for pelvic inflammatory disease in inner-city adolescents.

Objective: To determine risk factors associated with pelvic inflammatory disease (PID) among inner‐city adolescents. Study Design: A case‐control study was performed from 1994 to 1997 in an inner‐city hospital. Methods: Seventy‐one adolescent girls diagnosed with PID and 52 sexually active adolescents girls without PID participated in a confidential face‐to‐face interview using a questionnaire about risk behaviors. Established criteria were used for the diagnosis of PID. Data were analyzed using t tests, chi‐square tests, and stepwise logistic regression. Results: Persons with PID were significantly more likely to show younger age at first intercourse, older sex partners, involvement with a child protection agency, prior suicide attempt(s), consumption of alcohol before last sex, and a current Chlamydia trachomatis infection. There were no significant differences between the two groups regarding number of lifetime sex partners, condom use, rape, syphilis, prior PID, hepatitis B, hepatitis C, or HIV infection. Conclusions: Not previously noted in the literature are the association of PID with older sex partners, prior involvement in a child protection agency, and a prior suicide attempt. Confirming prior studies are the association of PID with earlier age at first sex, alcohol use, and C trachomatis infection.

Hyperandrogenism Does Not Influence Metabolic Parameters in Adolescent Girls with PCOS.

Background. Underlying insulin resistance and/or obesity has clearly been implicated in the development of metabolic syndrome in adolescents and young adults with polycystic ovarian syndrome (PCOS). It is not clear however what role hyperandrogenism has on the development of metabolic syndrome or its role on those metabolic parameters associated with metabolic syndrome. Methods. We studied 107 adolescent girls; 54 had PCOS according to NIH criteria. Data was obtained for systolic and diastolic blood pressure (SBP and DBP), body mass index (BMI), total testosterone (T), luteinizing hormone (LH), follicle-stimulating hormone (FSH), prolactin, fasting lipid profile, and glucose. The PCOS group was divided initially into subgroups according to BMI (kg/m2), then based on T (ng/dL) levels as follows: High Testosterone PCOS (HT), Intermediate Testosterone PCOS (IT), Obese and Normal Testosterone (ONT), and lean and normal T (Control, C). t-test analysis was performed in between all the groups. Results. There was no statistical difference between HT and IT, HT and ONT, or IT and ONT in SBP, DBP, fasting blood glucose, lipid panel, LH, FSH, and prolactin levels. The control group had lower SBP and BMI comparing with ONT, IT, and HT groups. There were no statistical differences found in DBP, fasting blood glucose, lipid panel, LH, FSH, or Prolactin. Conclusion. Metabolic profile in adolescent girls with PCOS is not affected by either the presence of hyperandrogenism or the degree of hyperandrogenism.

Risk factors for nonfatal suicide behaviors among inner-city adolescents.

Introduction: To determine whether a delineation of suicide attempt severity via toxic ingestion distinguishes adolescents in terms of needs for medical and psychosocial support. Methods: Cross-sectional study performed between 1995 through 1997 in which 92 adolescents, mean age 15.6 years, presented to an urban pediatric emergency department for a nonfatal suicide attempt by ingestion. As defined by the authors, these adolescents were divided into 2 groups. The higher risk or more severe attempt group (n = 54) was defined as those that either ingested a toxic amount of a drug or had a toxic blood level or were admitted to the intensive care unit secondary to abnormal vital signs. The lower risk or less severe attempt group (n = 38) included those that did not meet these criteria. A 50-item confidential questionnaire was administered in the emergency room, which included information on demographic, clinical/laboratory, psychosocial characteristics and review of all psychiatric consultation(s). Results: In accord with our definition, the higher risk or more severe attempt group was more likely than the lower risk or less severe attempt group to have elevated heart rates at intake (96.4 ± 18.4 vs. 87.0 ± 18.0, P = 0.023), and to have ingested a drug less than 3 hours prior to the arrival to the emergency room (59% vs. 29%, P < 0.037). These individuals were more likely to have been diagnosed by the consulting psychiatrist as having an adjustment disorder (77% vs. 50%, P < 0.013), and to have fewer than 2 prior suicide attempts (100% vs. 84%, P < 0.019). There were no differences between the 2 groups with regard to family history of suicide behaviors, drug/alcohol use, type of drug ingested (analgesics being the most common), sexual activity, rape, school grade, and pregnancy. Conclusions: The higher risk or more severe suicide attempt group of these urban adolescents were associated with psychologic adjustment disorder, but was not associated with other known risk factors for suicidal behaviors.

SCHOOL-BASED CORPORAL PUNISHMENT PRESENTING AS EXERCISE INDUCED RHABDOMYOLYSIS 1782

As of 1994, corporal punishment in schools is prohibited in 27 American states including New York State. Two boys, aged 11and 12 years, developed rhabdomyolysis from excessive exercise used as corporal punishment they received in a New York City public school. Both boys were ordered to perform 150 push-ups by their gymnastics teacher as a punishment for running around the gymnasium. Both developed tender and swollen deltoid and pectoralis major muscles and both required hospitalization for five days for parenteral hydration and urinary alkalinization to prevent acute renal failure. Serum levels of creatine kinase (CK), aminotransferases (AST, ALT), lactate dehydrogenase (LDH), and urine myoglobin (Ur Myoglobin) are shown below:Table After educational intervention, school officials responded with a new policy that no student perform more than six push-ups at any one time. As demonstrated here, corporal punishment in schools still endangers the health of children even in those states where it is illegal. Pediatricians can contribute to the abolishment of corporal punishment by: (1) educating him/herself that it is still legal in many American states, (2) promoting public awareness, (3) educating school officials and parents regarding alternatives, such as positive reinforcement for good behavior, (4) detecting and reporting cases of such punishment in schools and encouraging parents to utilize their rights to request that their children not be punished, and (5) educating school personnel and parents about the potential adverse effects of excessive exercise.