Sharon Marshall

Recovery of bone mineral density in adolescents following the use of depot medroxyprogesterone acetate contraceptive injections

BACKGROUND Depot medroxyprogesterone acetate (DMPA) is a highly effective progestin-only contraceptive that is widely used by adolescents. We investigated bone mineral density (BMD) changes in female adolescents during and following use of this method. STUDY DESIGN A multicenter, prospective, non-randomized observational study in 98 healthy female adolescents aged 12-18 years who initiated DMPA intramuscular injections for contraception and provided BMD data for up to 240 weeks while receiving DMPA and for up to 300 weeks after DMPA cessation. BMD at the lumbar spine (LS), total hip (TH) and femoral neck (FN) was assessed by dual-energy X-ray absorptiometry. A mixed model analysis of variance was used to examine BMD changes. RESULTS At the time of their final DMPA injection, participants had mean BMD declines from baseline of 2.7% (LS), 4.1% (TH) and 3.9% (FN) (p<.001 at all three sites). Within 60 weeks of discontinuation of DMPA, mean LS BMD had returned to baseline levels, and 240 weeks after DMPA discontinuation, the mean LS BMD was 4.7% above baseline. Mean TH and FN BMD values recovered to baseline values more slowly: 240 weeks and 180 weeks, respectively, after the last DMPA injection. CONCLUSIONS BMD loss in female adolescents receiving DMPA for contraception is substantially or fully reversible in most girls following discontinuation of DMPA, with faster recovery at the LS than at the hip.

Effects through 24 months of an HIV/AIDS prevention intervention program based on protection motivation theory among preadolescents in the Bahamas.

OBJECTIVES. The purpose of this work was to report the intervention effects of Focus on Youth in the Caribbean (youth HIV intervention), an HIV prevention intervention based on protection motivation theory, through 24 months of follow-up on sexual risk and protection knowledge, perceptions, intentions, and behavior among Bahamian sixth-grade youth. METHODS. We randomly assigned 1360 sixth-grade youth (and their parents) attending 15 government elementary schools in the Bahamas to 1 of 3 conditions: (1) youth HIV intervention plus a parental monitoring/communication/HIV education intervention; (2) youth HIV intervention plus a parental goal-setting intervention; or (3) an environmental protection intervention plus the parental goal-setting intervention. Baseline and 4 follow-up surveys at 6-month intervals were conducted. Intervention effects were assessed using the mixed model for continuous outcome variables and the generalized linear mixed model for dichotomous outcome variables. RESULTS. Through 24 months of follow-up, youth HIV intervention, in combination with the parent interventions, significantly increased youths’ HIV/AIDS knowledge, perceptions of their ability to use condoms, perception of the effectiveness of condoms and abstinence, and condom use intention and significantly lowered perceived costs to remaining abstinent. There was a trend for higher condom use among youth in the Focus on Youth in the Caribbean groups at each follow-up interval. CONCLUSIONS. Focus on Youth in the Caribbean, in combination with 1 of 2 parent interventions administered to preadolescents and their parents in the Bahamas, resulted in and sustained protective changes on HIV/AIDS knowledge, sexual perceptions, and condom use intention. Although rates of sexual experience remained low, the consistent trend at all of the follow-up periods for higher condom use among youth who received youth intervention reached marginal significance at 24 months. Additional follow-up is necessary to determine whether the apparent protective effect is statistically significant as more youth initiate sex and whether it endures over time.

A new mixed micellar preparation for oral vitamin K prophylaxis: randomised controlled comparison with an intramuscular formulation in breast fed infants

OBJECTIVE To compare a new oral preparation of vitamin K1 (Konakion MM) containing lecithin and glycocholic acid with a standard intramuscular (IM) preparation during the first 8 weeks of life in exclusively breast fed infants. METHODS Infants were randomised at birth to the IM group (1 mg vitamin K) or the oral group (2 mg given at birth and repeated at 7 and 30 days of life). Prothrombin time (INR), plasma vitamin K1, and PIVKA II (undercarboxylated prothrombin) were monitored at 14, 30, and 56 days of age. RESULTS Seventy nine infants were randomised to the oral group and 77 to the IM group. Sixty seven infants in each group completed eight weeks of the study. Prothrombin times did not differ between the two groups. Mean (SD) plasma vitamin K1values (in ng/ml) decreased in both groups over time, but were higher in the oral group at 14 and 56 days: 2.0 (1.6) v 1.3 (1.1) at 14 days; 0.5 (0.3) v 0.5 (0.7) at 30 days; and 0.5 (0.8) v 0.2 (0.2) at 56 days of life. PIVKA II was raised (⩾ 0.1 AU/ml) in cord blood in 47% of the infants. By 14 days, only one infant in each group had a raised PIVKA II value and both of these initially had high concentrations of PIVKA II in cord blood. At 30 days, there were no raised PIVKA II values. At 56 days, there were no raised PIVKA II values in the oral group, although three infants in the IM group had raised values. CONCLUSIONS Plasma vitamin K concentrations were at least equal or significantly higher in babies given oral vitamin K supplements compared with IM treated babies at the time points measured. Through the first 8 weeks of life, multiple doses of the new oral preparation maintain haemostasis and vitamin K status in breast fed infants at least equal to that of the intramuscular preparation.

A Pilot Study of Motivational Interviewing Targeting Weight-Related Behaviors in Overweight or Obese African American Adolescents

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.

Effects on condom use of an HIV prevention programme 36 months postintervention: a cluster randomized controlled trial among Bahamian youth

Data are lacking on long-term effects of HIV behavioural intervention programmes. In this study, we report intervention effects 36 months postintervention on condom use and relevant outcome variables from the theory-based programme ‘Focus on Youth in the Caribbean’ (FOYC). Participants (1360 sixth-grade youth) were randomized by school into: (1) FOYC, plus one of two brief parent interventions or (2) the control condition ‘Wondrous Wetlands’, plus a brief parent intervention. Mixed effect analysis demonstrated significant programme effects, including enhanced HIV/AIDS knowledge (effect size D = 0.44, 95% confidence interval [CI]: 0.43, 0.46), increased self-efficacy of (D = 0.42, 95% CI: 0.30, 0.54), skills for (D = 0.62, 95% CI: 0.56, 0.64) and intention to use a condom (D = 0.20, 95% CI: 0.03, 0.37). Youth who received FOYC plus the parental monitoring intervention had higher condom use rates (odds ratio = 1.49, 95% CI: 0.97, 2.28). Feedback effects from key variables were also detected, supporting the sustained effect.

Perceived Anxiety of Pediatric Patients to Magnetic Resonance

Magnetic resonance imaging (MRI), a nonionizing radiologic technique without known adverse physical effects, is utilized frequently in children and adolescents. The MRI technique requires prolonged immobility in a narrow, confined space, and concern has been raised regarding possible patient anxiety and noncompliance. Several reports suggest that up to 10% of adults undergoing MRI may experience anxiety and/or claustrophobia. 1 However, to our knowledge, no studies of the subjective MRI experiences of children and adolescents have been published. We report here the general characteristics of 491 consecutive Pediatric patients who were evaluated with MRI at our institution, including the experience of anxiety in 85 older children and adolescents.

Effect of a Grade 6 HIV Risk Reduction Intervention Four Years Later Among Students Who Were and Were Not Enrolled in the Study Trial

PURPOSE To assess the long-term impact of HIV-prevention interventions delivered to youth before sexual initiation and the effects of interventions delivered in nonstudy settings. METHODS A five-group comparison of HIV knowledge, and condom-use skills, self-efficacy, intentions, and practice among 1,997 grade 10 students attending one of the eight government high schools in Nassau, The Bahamas. Group 1 received an HIV-prevention intervention, Focus on Youth in the Caribbean (FOYC), in grade 6 as part of a randomized trial; group 2 received FOYC as part of the regular school curriculum but outside of the trial; group 3 received the control condition as part of the trial; group 4 received the control condition as part of the school curriculum but outside of the trial; and individuals in group 5 (naive controls) were not enrolled in a school receiving FOYC or the control conditon and did not participate in the trial. RESULTS FOYC youth compared with the control youth and naive controls had higher HIV knowledge, condom-use skills, and self-efficacy 4 years later. By subgroups, group 1 demonstrated higher HIV/AIDS knowledge than all groups except group 2, higher condom skills than all groups, and higher condom self-efficacy than Naive Controls. Youth in group 2 demonstrated higher HIV knowledge than youth in groups 3-5. Behavioral effects were not found. CONCLUSIONS FOYC delivered to grade 6 students continued to have protective effects 4 years later. Positive effects are present among youth who received FOYC as part of the school curriculum but were not enrolled in the trial.

The effects of multisystemic therapy on family support for weight loss among obese African-American adolescents: Findings from a randomized controlled trial

Objective: To determine whether multisystemic therapy, an intensive, home- and community-based intervention, could increase family support for healthy eating and exercise in obese African-American adolescents. Relationships between changes in family support, weight status, and body fat composition at the end of the trial were also evaluated. Method: A pilot randomized clinical trial was conducted with 49 obese adolescents (body mass index ≥ 95th %ile). Participants were randomized to receive multisystemic therapy or Shapedown, a group weight loss intervention. Participants received treatment for 6 months. Data were collected at baseline and 7-month posttest (i.e., treatment termination). Changes in family support for healthy eating and exercise were assessed by self-report questionnaire. Bivariate analyses were used to assess the relationship between change in family support during the trial and youth body mass index, percent overweight, and body fat composition at follow-up. Results: Participation in multisystemic therapy was associated with significantly greater improvements in family encouragement for healthy eating and family participation in exercise and greater decreases in discouraging behavior from family members than Shapedown participation. Increases in family participation in exercise were significantly related to lower youth body mass index, percent overweight, and body fat composition at follow-up. Conclusions: Intensive, home- and community-based treatment increased family support for health behavior changes among obese minority adolescents, and these changes were directly related to weight status. Such health improvements are important for the well-being of a subset of youth who are at high risk for future health complications.

Recruitment Strategies and the Retention of Obese Urban Racial/Ethnic Minority Adolescents in Clinical Trials: The FIT Families Project, Michigan, 2010-2014

Introduction The successful recruitment and retention of participants is integral to the translation of research findings. We examined the recruitment and retention rates of racial/ethnic minority adolescents at a center involved in the National Institutes of Health Obesity Research for Behavioral Intervention Trials (ORBIT) initiative by the 3 recruitment strategies used: clinic, informatics, and community. Methods During the 9-month study, 186 family dyads, each composed of an obese African American adolescent and a caregiver, enrolled in a 6-month weight-loss intervention, a sequential multiple assignment randomized trial. We compared recruitment and retention rates by recruitment strategy and examined whether recruitment strategy was related to dyad baseline characteristics. Results Of the 186 enrolled families, 110 (59.1%) were recruited through clinics, 53 (28.5%) through informatics, and 23 (12.4%) through community. Of those recruited through community, 40.4% enrolled in the study, compared with 32.7% through clinics and 8.2% through informatics. Active refusal rate was 3%. Of the 1,036 families identified for the study, 402 passively refused to participate: 290 (45.1%) identified through informatics, 17 (29.8%) through community, and 95 (28.3%) through clinics. Recruitment strategy was not related to the age of the adolescent, adolescent comorbidities, body mass index of the adolescent or caregiver, income or education of the caregiver, or retention rates at 3 months, 7 months, or 9 months. Study retention rate was 87.8%. Conclusion Using multiple recruitment strategies is beneficial when working with racial/ethnic minority adolescents, and each strategy can yield good retention. Research affiliated with health care systems would benefit from the continued specification, refinement, and dissemination of these strategies.

Factors Associated with Weight Resilience in Obesogenic Environments in Female African-American Adolescents

This study used a descriptive, cross-sectional analysis to examine a social ecological model of obesity among African-American female adolescents residing in obesogenic environments. The goal was to identify factors that promote weight resilience, defined as maintaining a healthy body weight despite living in an environment that encourages inactivity and undermines healthy weight behaviors. During 2005 to 2008, weight-resilient (n=32) and obese (n=35) African-American female adolescents (12 to 17 years) living in Detroit, MI, and their caregivers completed measures of individual, family, and extrafamilial weight-resilience factors. Variables related to weight resilience in bivariate analyses were subjected to multivariate analysis using logistic regression to test the hypothesis that these factors independently predicted adolescent membership into the weight-resilient or obese group. As hypothesized, the odds of an adolescent being weight resilient were predicted by lower caregiver body mass index (calculated as kg/m(2)) (odds ratio [OR]=0.790; 95% confidence interval [CI]: 0.642 to 0.973), lower caregiver distress (OR=0.796; 95% CI: 0.635 to 0.998), higher caregiver monitoring and supervision of exercise (OR=5.746; 95% CI: 1.435 to 23.004), more frequent full-service grocery store shopping (OR=5.147; 95% CI: 1.137 to 23.298), and more peer support for eating (OR=0.656; 95% CI: 0.445 to 0.969). Contrary to prediction, lower eating self-efficacy (OR=0.597; 95% CI: 0.369 to 0.965) also predicted weight resilience. The model correctly classified 92.5% of all cases. Findings suggest that increasing psychosocial weight-resilience factors across multiple systems might be an important intervention strategy for obese African-American female adolescents residing in obesogenic environments.