Yen Chi L Le

Early Weight Gain Predicting Later Weight Gain Among Depot Medroxyprogesterone Acetate Users

OBJECTIVE: To examine if early weight gain in depot medroxyprogesterone acetate (DMPA) users predicts continued excessive weight gain and to identify risk factors of early weight gain in DMPA users. METHODS: Depot medroxyprogesterone acetate users (N=240) were assessed before initiating contraception and every 3 months for 36 months. Early weight gain was defined as more than 5% baseline weight gain within 6 months of DMPA use. Mean weight gain at 6-month intervals was estimated based on early weight gain status (at or below 5% gain compared with above 5% gain). Multiple logistic and mixed-model regression analyses were used. RESULTS: About one-fourth of DMPA users had early weight gain. The mean weight gain of the at or below 5% group and above 5% group was 0.63 kg and 8.04 kg, 1.48 kg and 10.86 kg, and 2.49 kg and 11.08 kg after 12, 24, and 36 months (P<.001 at all observations), respectively. Early weight gainers also had a much steeper slope of weight gain over time than the regular weight gainers (0.35 kg/month compared with 0.08 kg/month, P<.001). Risk factors for early weight gain were body mass index less than 30 (odds ratio [OR] 4.00, 95% confidence interval [CI] 1.513–10.455), parity (OR 2.23, 95% CI:1.040–4.761), and self-reported increased appetite after 6 months of DMPA use (OR 3.06, 95% CI 1.505–6.214). CONCLUSION: Most DMPA users who gain excessive weight experience more than a 5% weight increase within 6 months. These data help physicians predict who is at risk of excessive gain and counsel them appropriately. LEVEL OF EVIDENCE: II

Forced sexual intercourse, suicidality, and binge drinking among adolescent girls

Although sexual assault victimization has been shown to predict suicidality, little is known about the mechanisms linking these two factors. Using cross-sectional data (N=6364) from the 2007 Youth Risk Behavior Survey, binge drinking significantly mediated the relationship between forced sexual intercourse and suicide for Hispanic (n=1915) and Caucasian (n=2928) adolescent females, but not for African American adolescent females (n=1521). Results suggest the need for closer monitoring of adolescent victims of sexual assault who also abuse alcohol to intervene in early suicide behaviors. Treatment and intervention programs should also be culturally sensitive to account for differences in reaction to sexual trauma among race/ethnicity. Implications for suicide prevention and alcohol intervention strategies as well as suggestions to clinical providers are discussed.

Knowledge, attitudes, and beliefs about human papillomavirus (HPV) vaccination among Puerto Rican mothers and daughters, 2010: a qualitative study.

Introduction The incidence of human papillomavirus (HPV) infection and cervical cancer can be reduced by increasing vaccination for HPV. Yet vaccination uptake and completion of the 3-dose series remain low among Puerto Rican females. This study explored psychosocial factors associated with HPV vaccination uptake decisions among Puerto Rican mothers and daughters. Methods We conducted 7 focus groups with young women aged 16 to 24 (n = 21) and their mothers (n = 9) to assess knowledge, attitudes, and beliefs related to cervical cancer, HPV, and HPV vaccination. We analyzed the focus group transcripts and identified themes by using a constant comparison method of qualitative data analysis and interpretation, guided by a grounded theory approach. Results The analysis identified several emergent themes related to vaccine uptake: 1) low knowledge about cervical cancer, HPV, and the HPV vaccine; 2) inconsistent beliefs about susceptibility to HPV infection and cervical cancer; 3) vaccine effectiveness; 4) vaccine safety and side effects; 5) concerns that the vaccine promotes sexual disinhibition; and 6) availability of insurance coverage and overall cost of the vaccine. Conclusion Our study found that adolescent girls and young women in Puerto Rico have low levels of knowledge about HPV and cervical cancer, low perceived susceptibility to HPV, and concerns about the safety and efficacy of the vaccine, and these factors may influence uptake and completion of HPV vaccination. Interventions are needed for both mothers and daughters that address these psychosocial factors and increase access to vaccination.

Perceived Weight Gain as a Correlate of Physical Activity and Energy Intake Among White, Black, and Hispanic Reproductive-Aged Women

OBJECTIVE To estimate the effects of perception of weight gain on womens physical activity and eating behaviors over time. METHODS A total of 608 women self-reported their experience regarding perceived weight gain and physical activity at baseline and every 6 months thereafter for 36 months. Data about dietary habits were obtained every 12 months. Longitudinal relationships of perceived weight gain with physical activity and total energy intake were assessed using mixed model regression analysis after adjusting for age, race/ethnicity, obesity, and lifestyle variables. Effect of body esteem scores on physical activity and energy intake was also examined. RESULTS At baseline, of 608 reproductive-aged women, 129 (21.2%) reported perceived weight gain, whereas 479 (78.8%) did not. Perceived weight gain was not associated with changes in physical activity over the period of 36 months (-8.04 min/week, 95% confidence interval [CI] -20.80-4.72 min/week, p = 0.22). A separate mixed model based on annual follow-up data over 36 months showed that those who perceived weight gain were more likely to have higher energy intake over time (112 Kcal/day higher, 95% CI 23-200 Kcal/day, p = 0.01). Body esteem was not associated with changes in physical activity over time (-0.13 min, 95% CI -0.44-0.18 min, p = 0.41) or energy intake over time (< 1 Kcal/day, 95% CI -2-2 Kcal/day, p = 0.82). CONCLUSIONS Neither perceived weight gain nor body esteem was associated with increased physical activity or decreased total energy intake. Rather, increased energy intake was observed among women who perceived weight gain. Future research should look at additional potential cues to action for behavior changes related to physical activity or energy intake.

Treatment decisions for localized prostate cancer: A concept mapping approach

Few decision aids emphasize active surveillance (AS) for localized prostate cancer. Concept mapping was used to produce a conceptual framework incorporating AS and treatment.

Is "Active Surveillance" an Acceptable Alternative?: A Qualitative Study of Couples' Decision Making about Early-Stage, Localized Prostate Cancer

The objective of our study was to describe decision making by men and their partners regarding active surveillance (AS) or treatment for early-stage, localized prostate cancer. Fifteen couples were recruited from a cancer center multispecialty clinic, which gave full information about all options, including AS. Data were collected via individual, semi-structured telephone interviews. Most patients were white, non-Hispanic, had private insurance, had completed at least some college, and were aged 49–72 years. Ten chose AS. All partners were female, and couples reported strong marital satisfaction and cohesion. All couples described similar sequences of a highly emotional initial reaction and desire to be rid of the cancer, information seeking, and decision making. The choice of AS was built on a nuanced evaluation of the man’s condition in which the couple differentiated prostate cancer from other cancers and early stage from later stages, wanted to avoid/delay side effects, and trusted the AS protocol to identify negative changes in time for successful treatment. Treated couples continued to want immediate treatment to remove the cancer. We concluded that having a partner’s support for AS may help a man feel more comfortable with choosing and adhering to AS. Using decision aids that address both a man’s and his partner’s concerns regarding AS may increase its acceptability. Our research shows that some patients want to and do involve their partners in the decision-making process. Ethical issues are related to the tension between desire for partner involvement and the importance of the patient as autonomous decision-maker. The extended period of decision making, particularly for AS, is also an ethical issue that requires additional support for patients and couples in the making of fully informed choices that includes AS.