- Email: [email protected]
Pubertal Growth, IGF1, and Windows of Susceptibility
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Oral Abstracts / J Pediatr Adolesc Gynecol 29 (2016) 159e166
dilatation (N¼17, 31%). The vast majority of respondents (87%) requested further training on PPD at either an annual clinical meeting (N¼26, 47%) or with a training video (N¼22, 40%). Conclusions: Our study highlights the varied experiences that providers have shared when working with patients requiring PPD. There is a need for further training on PPD. The results of this study will contribute to the creation of a standardized method for teaching PPD in the future. 3. Pubertal Growth, IGF1, and Windows of Susceptibility F.M. Biro, B. Huang, H. Wasserman, S. Pinney Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
Background: Younger age of menarche is a well-documented risk marker for breast cancer; pooled analyses revealed risk of pre-and post-menopausal breast cancers decreased 9% and 4%, respectively, for each year delay in age of menarche (Clavel-Chapelon 2002). Both Ahlgren (2006) and Li (2007) have noted that peak height velocity (PHV) and age of PHV may account for the relationship between menarche and breast cancer. We examined the relationship of PHV, age of PHV, length of the pubertal growth spurt, age of menarche, and IGF1 levels in a group of girls followed for over ten years. Methods: We categorized girls into race-specific early, on-time, and late (20th and 80th percentiles) timing of puberty (based on age of breast maturation, B2). PHV, age PHV, length of pubertal growth spurt (age of B2 to age that adult height is achieved) were calculated using Preece-Baines model 1. Serum samples for IGF1 were obtained at age of B2, and measured by EIA; 343 additional specimens were analyzed for IGF1 from these participants 18 months before to 12 months after B2. This study was approved by our Institutional Review Board; in addition to parental consent, participants also assented. Results: There were 191 participants followed since 6 and 7 years of age. Age of PHV was significantly different by timing of puberty (10.5 < 11.09 < 11.86 years); PHV was different between early and late maturing girls (7.18 < 6.96 < 6.60 cm/yr). The length of pubertal growth spurt was greatest in early, and least in late maturing girls (6.9 vs 4.5 yr). Later age of menarche was related significantly to lower PHV (R¼-.43) and later age PHV (R¼.21). IGF1 levels tracked strongly in a given individual across the peripubertal period with the interclass correlation coefficient (ICC) of 0.67. Higher IGF1 levels were related significantly with later age of menarche (R¼-.22) and greater PHV (R¼.19). Conclusion: This study demonstrated that early maturating girls reached their PHV at the youngest age and had the greatest PHV, as well as longest interval of growth spurt. In addition, higher levels of IGF1 at B2 were correlated with greater PHV (as well as earlier age of menarche). IGF1 is a potent mitogen, and has been associated with greater breast density as well as greater risk of breast cancer. Age of menarche is a useful epidemiologic tool in breast cancer research; the underling physiologic basis relating menarche to risk of breast cancer may be the association of menarche with PHV and IGF1 levels, and, to a more limited basis, the total number of menstrual cycles. Our analyses suggest that the underlying mechanisms of the earlier age of menarche with greater risk of breast cancer with may be through IGF1 and an expanded window of susceptibility. Funded by U01-ES-019453.
4. LARC Attitudes and Beliefs Following an Educational Video for Adolescents Alyssa R. Bennett MD, Sonja I. Ziniel PhD, David S. Bickham MA, PhD, Amy D. DiVasta MD, MMSc* Boston Children’s Hospital, Boston, MA
Background: Despite the safety and efficacy of Long-Acting Reversible Contraception (LARC), these methods are underutilized by adolescent and young adult females. This study assessed how an educational video on LARC affected young females’ attitudes and beliefs toward LARC in comparison to viewing an educational website. We hypothesized that the educational video would increase positive attitudes towards LARC more than the educational website.
Methods: We administered a 48-item computer-based pre-intervention survey to 68 sexually active females ages 13-25y regarding their attitudes and beliefs toward LARC. Participants were recruited from an urban primary care and subspecialty adolescent medicine clinic. Participants were randomized by week to either a 6-minute LARC educational video or access to 2 LARC websites for the same amount of time. Participants then completed a post-intervention survey to assess potential changes in their attitudes toward LARC. Changes in attitudes toward LARC were compared for the 2 conditions using repeated measures ANOVA. Attitudes were measured using a 10-point Likert scale response to the question, “On a scale from 0-10, how do you feel about the idea of having an [IUD/implant] for yourself?” where 0 corresponds to “I do not like the idea” and 10 corresponds to “I really like the idea”. This study was approved by the Institutional Review Board at Boston Children’s Hospital. Results: Of the 68 participants, 29 (42.6%) were randomized to the video intervention and 39 (57.4%) to the website intervention. Mean attitude ratings increased from 3.4 3.13 to 4.1 3.54 across all participants regardless of randomization (p¼0.053). Pre-intervention attitudes towards IUDs were not statistically different between the females randomized to video (2.9 2.88) and website interventions (3.8 3.30; p¼0.278). Preintervention attitudes towards the implant were also not statistically different [3.5 3.20 (video) vs 2.8 2.94 (website); p¼0.380]. Postintervention attitudes toward IUDs remained similar between the 2 educational interventions (video 4.2 3.43 vs website 4.0 3.66; p¼0.844). In contrast, attitudes toward the implant were significantly different following the educational interventions, with females who watched the video rating the implant higher than the website browsers (video 5.0 3.61 vs website 3.3 3.48; p¼0.047). When comparing the 2 types of intervention, the website did not significantly change attitudes towards IUDs (p¼0.522) or the implant (p¼0.248). However, the video improved attitudes towards both IUDs (p¼0.054) and the implant (p¼0.003). Conclusions: A brief educational video increased positive attitudes towards LARC in adolescent and young adult females. Viewing an educational video led to significantly improved attitudes towards the hormonal implant compared to browsing an educational website. Acknowledgments: Funded in part from MCH/HRSA LEAH T71MC00009 and the Division of Adolescent/Young Adult Medicine Gallagher Grant.
5. Motivating Factors for Dual Method Contraception Use Amongst Adolescents and Young Women: A Qualitative Investigation Julie Lemoine MD, Marissa Peters MPH, Maryam Guiahi MD, MSc* University of Colorado School of Medicine, Aurora, Co
Background: Dual method contraception is the use of highly effective hormonal contraceptives with condoms. We wanted to understand when adolescents and young women perceive the need for and use dual method contraception, and which factors seemed to be the strongest motivators of dual method use. Methods: We approached patients aged 13-24 who presented to our adolescent-focused Title X family planning clinic for a new birth control method. Interested participants completed individual interviews, which were audio-taped and subsequently transcribed. We collected data using a semi-structured interview guide that included specific domains related to perception of relationship trust, sexual activity, knowledge of and use of contraceptives and condoms. The investigators independently coded the transcripts using grounded theory and subsequently met to gain consensus; codes were organized into overarching themes and discrepancies were resolved. Results: Between 09/2014 - 10/2014, we approached 34 adolescents and young women, 20 agreed to participate. Our participants were on average 19 years old (range¼ 16-24, SD 3.09), predominantly Hispanic (50%), and half of them reported use of a long-acting reversible contraceptive method (LARC). Most participants described that prior education about condom use was focused on pregnancy prevention and included vague messages
Oral Abstracts / J Pediatr Adolesc Gynecol 29 (2016) 159e166
dilatation (N¼17, 31%). The vast majority of respondents (87%) requested further training on PPD at either an annual clinical meeting (N¼26, 47%) or with a training video (N¼22, 40%). Conclusions: Our study highlights the varied experiences that providers have shared when working with patients requiring PPD. There is a need for further training on PPD. The results of this study will contribute to the creation of a standardized method for teaching PPD in the future. 3. Pubertal Growth, IGF1, and Windows of Susceptibility F.M. Biro, B. Huang, H. Wasserman, S. Pinney Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
Background: Younger age of menarche is a well-documented risk marker for breast cancer; pooled analyses revealed risk of pre-and post-menopausal breast cancers decreased 9% and 4%, respectively, for each year delay in age of menarche (Clavel-Chapelon 2002). Both Ahlgren (2006) and Li (2007) have noted that peak height velocity (PHV) and age of PHV may account for the relationship between menarche and breast cancer. We examined the relationship of PHV, age of PHV, length of the pubertal growth spurt, age of menarche, and IGF1 levels in a group of girls followed for over ten years. Methods: We categorized girls into race-specific early, on-time, and late (20th and 80th percentiles) timing of puberty (based on age of breast maturation, B2). PHV, age PHV, length of pubertal growth spurt (age of B2 to age that adult height is achieved) were calculated using Preece-Baines model 1. Serum samples for IGF1 were obtained at age of B2, and measured by EIA; 343 additional specimens were analyzed for IGF1 from these participants 18 months before to 12 months after B2. This study was approved by our Institutional Review Board; in addition to parental consent, participants also assented. Results: There were 191 participants followed since 6 and 7 years of age. Age of PHV was significantly different by timing of puberty (10.5 < 11.09 < 11.86 years); PHV was different between early and late maturing girls (7.18 < 6.96 < 6.60 cm/yr). The length of pubertal growth spurt was greatest in early, and least in late maturing girls (6.9 vs 4.5 yr). Later age of menarche was related significantly to lower PHV (R¼-.43) and later age PHV (R¼.21). IGF1 levels tracked strongly in a given individual across the peripubertal period with the interclass correlation coefficient (ICC) of 0.67. Higher IGF1 levels were related significantly with later age of menarche (R¼-.22) and greater PHV (R¼.19). Conclusion: This study demonstrated that early maturating girls reached their PHV at the youngest age and had the greatest PHV, as well as longest interval of growth spurt. In addition, higher levels of IGF1 at B2 were correlated with greater PHV (as well as earlier age of menarche). IGF1 is a potent mitogen, and has been associated with greater breast density as well as greater risk of breast cancer. Age of menarche is a useful epidemiologic tool in breast cancer research; the underling physiologic basis relating menarche to risk of breast cancer may be the association of menarche with PHV and IGF1 levels, and, to a more limited basis, the total number of menstrual cycles. Our analyses suggest that the underlying mechanisms of the earlier age of menarche with greater risk of breast cancer with may be through IGF1 and an expanded window of susceptibility. Funded by U01-ES-019453.
4. LARC Attitudes and Beliefs Following an Educational Video for Adolescents Alyssa R. Bennett MD, Sonja I. Ziniel PhD, David S. Bickham MA, PhD, Amy D. DiVasta MD, MMSc* Boston Children’s Hospital, Boston, MA
Background: Despite the safety and efficacy of Long-Acting Reversible Contraception (LARC), these methods are underutilized by adolescent and young adult females. This study assessed how an educational video on LARC affected young females’ attitudes and beliefs toward LARC in comparison to viewing an educational website. We hypothesized that the educational video would increase positive attitudes towards LARC more than the educational website.
Methods: We administered a 48-item computer-based pre-intervention survey to 68 sexually active females ages 13-25y regarding their attitudes and beliefs toward LARC. Participants were recruited from an urban primary care and subspecialty adolescent medicine clinic. Participants were randomized by week to either a 6-minute LARC educational video or access to 2 LARC websites for the same amount of time. Participants then completed a post-intervention survey to assess potential changes in their attitudes toward LARC. Changes in attitudes toward LARC were compared for the 2 conditions using repeated measures ANOVA. Attitudes were measured using a 10-point Likert scale response to the question, “On a scale from 0-10, how do you feel about the idea of having an [IUD/implant] for yourself?” where 0 corresponds to “I do not like the idea” and 10 corresponds to “I really like the idea”. This study was approved by the Institutional Review Board at Boston Children’s Hospital. Results: Of the 68 participants, 29 (42.6%) were randomized to the video intervention and 39 (57.4%) to the website intervention. Mean attitude ratings increased from 3.4 3.13 to 4.1 3.54 across all participants regardless of randomization (p¼0.053). Pre-intervention attitudes towards IUDs were not statistically different between the females randomized to video (2.9 2.88) and website interventions (3.8 3.30; p¼0.278). Preintervention attitudes towards the implant were also not statistically different [3.5 3.20 (video) vs 2.8 2.94 (website); p¼0.380]. Postintervention attitudes toward IUDs remained similar between the 2 educational interventions (video 4.2 3.43 vs website 4.0 3.66; p¼0.844). In contrast, attitudes toward the implant were significantly different following the educational interventions, with females who watched the video rating the implant higher than the website browsers (video 5.0 3.61 vs website 3.3 3.48; p¼0.047). When comparing the 2 types of intervention, the website did not significantly change attitudes towards IUDs (p¼0.522) or the implant (p¼0.248). However, the video improved attitudes towards both IUDs (p¼0.054) and the implant (p¼0.003). Conclusions: A brief educational video increased positive attitudes towards LARC in adolescent and young adult females. Viewing an educational video led to significantly improved attitudes towards the hormonal implant compared to browsing an educational website. Acknowledgments: Funded in part from MCH/HRSA LEAH T71MC00009 and the Division of Adolescent/Young Adult Medicine Gallagher Grant.
5. Motivating Factors for Dual Method Contraception Use Amongst Adolescents and Young Women: A Qualitative Investigation Julie Lemoine MD, Marissa Peters MPH, Maryam Guiahi MD, MSc* University of Colorado School of Medicine, Aurora, Co
Background: Dual method contraception is the use of highly effective hormonal contraceptives with condoms. We wanted to understand when adolescents and young women perceive the need for and use dual method contraception, and which factors seemed to be the strongest motivators of dual method use. Methods: We approached patients aged 13-24 who presented to our adolescent-focused Title X family planning clinic for a new birth control method. Interested participants completed individual interviews, which were audio-taped and subsequently transcribed. We collected data using a semi-structured interview guide that included specific domains related to perception of relationship trust, sexual activity, knowledge of and use of contraceptives and condoms. The investigators independently coded the transcripts using grounded theory and subsequently met to gain consensus; codes were organized into overarching themes and discrepancies were resolved. Results: Between 09/2014 - 10/2014, we approached 34 adolescents and young women, 20 agreed to participate. Our participants were on average 19 years old (range¼ 16-24, SD 3.09), predominantly Hispanic (50%), and half of them reported use of a long-acting reversible contraceptive method (LARC). Most participants described that prior education about condom use was focused on pregnancy prevention and included vague messages