Carol A. Ford

Parent decision-making around the genetic testing of children for germline TP53 mutations

Li‐Fraumeni syndrome is a rare genetic cancer predisposition syndrome caused by germline TP53 mutations. Up to 20% of mutation carriers develop cancer during childhood. The benefits of TP53 mutation testing of children are a matter of debate and knowledge of parent decision‐making around such testing is limited. The current study examined how parents make decisions regarding TP53 testing for their children.

Annual Physical Examination Reports Vary by Gender Once Teenagers Become Sexually Active

INTRODUCTION Few sexually active male adolescents receive sexual and reproductive health (SRH) services. To understand this, we examined the association between sexual behavior status and physical examination of the adolescents over time. METHODS We conducted longitudinal cohort analysis of the National Longitudinal Study of Adolescent Health with 9,239 adolescents who completed the baseline school (1994/1995) and wave 2 (1996) follow-up surveys approximately 1.5 years later (retention rate = 71%). The logistic regression models were fitted with random effects to estimate individual odds of reporting a physical examination in the past 12 months at follow-up, compared with baseline, stratified by sexual behavior status and gender, and adjusting for sociodemographic and healthcare access factors. RESULTS In all, 34.5% of male and 38.2% of female adolescents reported experiencing vaginal intercourse by follow-up, and 22.4% of male and 24.7% of female adolescents reported first experiencing intercourse during the study period. Among sexually active adolescents, about half reported having annual physical examinations and one-fifth reported not having any physical examinations. Among female adolescents, baseline to follow-up examination reports significantly increased in the following: sex initiators (adjusted odds ratio [OR] = 2.09, 95% confidence interval [CI] = 1.66-2.64); those reporting sex at both times (OR = 2.16, CI = 1.51-3.09); and those reporting no sex either time (OR = 2.47, CI = 2.00-3.04). Among male adolescents, baseline to follow-up examination reports significantly increased in those reporting no sex either time (OR = 1.57, CI = 1.26-1.96) and showed increasing trends in sex initiators (OR = 1.27, CI = .92-1.76). DISCUSSION A majority of sexually active adolescents report annual physical examinations over time. Providers should not miss opportunities to deliver evidence-based SRH to sexually active adolescents. Future efforts are needed to increase access of all adolescents to SRH services. MESH TERMS: Health Services Accessibility, Male, Female.

Review of Foreign Body Ingestion and Esophageal Food Impaction Management in Adolescents

Foreign body ingestion is a common clinical scenario among patients of all ages. The immediate risk to the patient ranges from negligible to life threatening. Initial and follow-up management strategies depend on multiple patient and ingested object-related factors. Available literature on this topic tends to focus on the small child or adult, leaving the clinician caring for adolescents to extrapolate this information to guide decision making for individual patients. This article reviews foreign body ingestion literature with important implications to the adolescent patient and raises awareness of some highly dangerous objects such as large button batteries, high-powered magnets, long sharps, narcotic packages, and super absorbent objects. An additional focus includes the management of esophageal food impaction. We highlight the unique aspects to the care of the adolescent with intentional ingestion and co-morbid psychiatric illness. The article concludes by discussing the challenges to prevention of ingestion in the at-risk patient.

Source of Parental Reports of Child Height and Weight During Phone Interviews and Influence on Obesity Prevalence Estimates Among Children Aged 3-17 Years

Objective. We compared parental reports of childrens height and weight when the values were estimated vs parent-measured to determine how these reports influence the estimated prevalence of childhood obesity. Methods. In the 2007 and 2008 North Carolina Child Health Assessment and Monitoring Program surveys, parents reported height and weight for children aged 3–17 years When parents reported the values were not measured (by doctor, school, or home), they were asked to measure their child and were later called back. We categorized body mass index status using standard CDC definitions, and we used Chi-square tests and the Stuart-Maxwell test of marginal homogeneity to examine reporting differences. Results. About 80% (n=509) of the 638 parents who reported an unmeasured height and/or weight participated in a callback and provided updated measures. Children originally classified as obese were subsequently classified as obese (67%), overweight (13%), and healthy weight (19%) An estimated 28% of younger children (<10 years of age) vs. 6% of older children (aged ≥10 years) were reclassified on callback. Having parents who guessed the height and weight of their children and then reported updated values did not significantly change the overall population estimates of obesity. Conclusion. Our findings demonstrate that using parent-reported height and weight values may be sufficient to provide reasonable estimates of obesity prevalence Systematically asking the source of height and weight information may help improve how it is applied to research of the prevalence of childhood obesity when gold-standard measurements are not available.

Awareness Is Not Enough The Need to Increase Meningococcal Vaccine Uptake

Objective. Adolescent meningococcal vaccine uptake remains low. We examined vaccine awareness among parents of adolescents and uptake. Methods. Parents of adolescents aged 11 to 17 years (n = 1281) participated in a statewide survey. Logistic regression with weighted data provided population-based estimates. Results. In all, 65% had heard of meningococcal vaccine; parents more likely to report awareness had adolescents aged 16 to 17 years, in private school, or with health insurance. In total, 44% of aware parents reported vaccination; vaccinated teens were more likely to be black (odds ratio [OR] = 2.17), had a preventive checkup within 12 months (OR = 3.03), or resided with another child ≤18 years (OR = 1.83). Many parents of unvaccinated adolescents (38.5%) did not plan to vaccinate them within 12 months. The most common reasons for not vaccinating were providers not recommending it and believing adolescents did not need it. Conclusion. Many parents aware of meningococcal vaccine did not vaccinate their adolescents. Interventions that include increasing provider recommendation and annual visits may increase uptake.

Clinical preventive services for adolescents: position paper of the Society for Adolescent Medicine.

Over the past several years, new vaccines have become available to prevent serious illnesses and conditions in the adolescent population. Several have already been approved by the FDA for use in this age group; others are still in development. Recently, significant public attention has been focused on the availability of vaccines for several strains of HPV, to prevent both cervical cancer and genital warts. Prior to that, the vaccine for Hepatitis B was approved and recommended for the adolescent age group. Others currently available and recommended include vaccines for pertussis, meningitis, and influenza. In the future, additional vaccines are expected to become available for sexually transmitted and communicable diseases such as herpes simplex virus and HIV. Unfortunately, financial limitations and consent requirements can impede adolescents’ access to the vaccines that are recommended for their age group. However, a variety of policy options exist for overcoming the barriers and expanding access. These policy options are grounded both in international principles of human rights and in the existing framework of laws in the United States, and can be enhanced by attending to variations in age and developmental status among adolescents.

Celebrating progress in adolescent health and optimism for the future

It is important to remember why we attend annual meetings of the Society for Adolescent Health and Medicine (SAHM). I believe that the fundamental thing that brings us together year after year is our deep commitment to young people. Our professional lives are dedicated to the health and well-being of young people. This is our common ground. This is why our work is important. For my presidential address, I share with you my perspective on important changes and progress that have been made in the field of adolescent health and medicine over the past 25 years. In 1990, I was practicing as an internist and pediatrician in coastal North Carolina. I became concerned that adolescent and young adult health was being overlooked and that this was having substantial negative impact on young people and their entire life trajectories of health. I discovered the field of adolescent medicine, completed a subspecialty fellowship at the University of California San Francisco in the early 1990s, and since then have devoted my career to academic medicine. Although we all know there is a tremendous amount of work still ahead of us, I think it is important to reflect on the progress we have made in adolescent health over the past 25 years.

Effect of Financial Incentives on Glucose Monitoring Adherence and Glycemic Control Among Adolescents and Young Adults With Type 1 Diabetes: A Randomized Clinical Trial

Importance Glycemic control often deteriorates during adolescence and the transition to young adulthood for patients with type 1 diabetes. The inability to manage type 1 diabetes effectively during these years is associated with poor glycemic control and complications from diabetes in adult life. Objective To determine the effect of daily financial incentives on glucose monitoring adherence and glycemic control in adolescents and young adults with type 1 diabetes. Design, Setting, and Participants The Behavioral Economic Incentives to Improve Glycemic Control Among Adolescents and Young Adults With Type 1 Diabetes (BE IN CONTROL) study was an investigator-blinded, 6-month, 2-arm randomized clinical trial conducted between January 22 and November 2, 2016, with 3-month intervention and follow-up periods. Ninety participants (aged 14-20) with suboptimally controlled type 1 diabetes (hemoglobin A1c [HbA1c] >8.0%) were recruited from the Diabetes Center for Children at the Children’s Hospital of Philadelphia. Interventions All participants were given daily blood glucose monitoring goals of 4 or more checks per day with 1 or more level within the goal range (70-180 mg/dL) collected with a wireless glucometer. The 3-month intervention consisted of a

Acute HIV Infection in a Critically Ill 15-Year-Old Male

60 monthly incentive in a virtual account, from which

Confidentiality in Adolescent Health Care

2 was subtracted for every day of nonadherence to the monitoring goals. During a 3-month follow-up period, the intervention was discontinued. Main Outcomes and Measures The primary outcome was change in HbA1c levels at 3 months. Secondary outcomes included adherence to glucose monitoring and change in HbA1c levels at 6 months. All analyses were by intention to treat. Results Of the 181 participants screened, 90 (52 [57.8%] girls) were randomized to the intervention (n = 45) or control (n = 45) arms. The mean (SD) age was 16.3 (1.9) years. The intervention group had significantly greater adherence to glucose monitoring goals in the incentive period (50.0% vs 18.9%; adjusted difference, 27.2%; 95% CI, 9.5% to 45.0%; P = .003) but not in the follow-up period (15.3% vs 8.7%; adjusted difference, 3.9%; 95% CI, −2.0% to 9.9%; P = .20). The change in HbA1c levels from baseline did not differ significantly between groups at 3 months (adjusted difference, −0.08%; 95% CI, −0.69% to 0.54%; P = .80) or 6 months (adjusted difference, 0.03%; 95% CI, −0.55% to 0.60%; P = .93). Conclusions and Relevance Among adolescents and young adults with type 1 diabetes, daily financial incentives improved glucose monitoring adherence during the incentive period but did not significantly improve glycemic control. Trial Registration clinicaltrials.gov Identifier: NCT02568501