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33: Impact of Maternal Communication about Skin, Cervical and Lung Cancer Prevention on Adolescent Prevention Behaviors
Abstracts / 42 (2008) S15–S49
(top quartile of scale score) included: insurance coverage (OR 2.6, CI 1.2-5.6), history of STI (OR 1.7, CI 1.0-3.0), fewer perceived barriers to vaccination (OR 3.0, CI 1.9-4.5), higher perceived severity of HPV (OR 1.6, CI 1.2-2.2), and current smoking (OR 2.2, CI 1.2-3.9). Conclusions: Although HPV prevalence was high in this sample of young women, most were negative for vaccine-type HPV and thus could potentially benefit from HPV vaccination. However, intention and self-efficacy – key predictors of vaccination – and actual vaccination rates were relatively low. Interventions to increase HPV vaccination in this population should promote positive intentions and self-efficacy by: 1) ensuring that vaccine costs are covered, and 2) addressing modifiable beliefs such as perceptions of risk and perceived barriers to vaccination. Sources of Support: Charlotte R. Schmidlapp Award (Kahn, PI) and K23 AI50923 (Kahn, PI).
SESSION I: ADOLESCENTS AND THEIR FAMILIES 33. IMPACT OF MATERNAL COMMUNICATION ABOUT SKIN, CERVICAL AND LUNG CANCER PREVENTION ON ADOLESCENT PREVENTION BEHAVIORS Jessica A. Kahn, MD, MPH, Bin Huang, PhD, Lili Ding, MS, A. Lindsay Frazier, MD, MSc. Cincinnati Children’s Hospital Medical Center, Cincinnati Ohio; and Dana Farber Cancer Institute and Children’s Hospital, Boston, Massachusetts Purpose: To determine whether maternal communication about prevention of skin, cervical, and lung cancer is associated with adolescent cancer prevention behaviors in a national study sample. Methods: The study sample consisted of U.S. adolescents (N⫽10,409) participating in a longitudinal study. The independent variables, measured on the 2001 survey, were adolescent report of maternal communication about sunscreen use, Pap screening, and quitting smoking. Outcome variables, measured in 2001 and 2003, included adolescent self-report of sunscreen use during the past summer, previous Pap screening (among girls), and quitting smoking in the past year (among smokers). We conducted multivariable logistic regression modeling to identify those factors associated independently with the three adolescent cancer prevention behaviors in 2001 and 2003, controlling in each model for variables (e.g., age, gender, sexual experience, attitudes, peer behaviors) associated in univariate analyses with each of the three outcomes. Results: Participants ranged in age from 14-21 years, and 60% were girls. The adjusted odds ratios of adolescent behaviors in 2001 and 2003, given different frequencies of maternal communication in 2001 (once, occasionally, sometimes or often, vs. never), are shown below.
Odd ratios (95% confidence intervals) for adolescent cancer prevention behaviors
2001 Sunscreen use Pap screening Quit smoking 2003 Sunscreen use Pap screening Quit smoking
Communicated Once
Occasionally
Sometimes
Often
1.2 (0.8-1.9) 4.0 (3.1-5.2) 0.53 (0.35-0.81)
2.0 (1.4-2.8) 7.4 (5.5-9.9) 0.56 (0.38-0.82)
3.0 (2.1-4.1) 11.1 (7.9-15.4) 0.37 (0.24-0.57)
8.3 (6.1-11.5) 14.2 (9.8-20.6) 0.48 (0.35-0.67)
1.03 (0.67-1.59) 1.71 (0.81-3.59) 0.88 (0.48-1.64)
2.05 (1.48-2.84) 1.31 (0.62-2.76) 1.09 (0.62-1.92)
2.83 (2.05-3.91) 2.62 (0.90-7.63) 1.06 (0.58-1.94)
5.62 (4.11-7.68) 4.48 (1.05-19.15) 0.86 (0.49-1.50)
S29
Conclusions: Frequent maternal communication was positively associated with adolescent sunscreen use and Pap screening at baseline and two years later, suggesting that maternal communication may promote specific adolescent cancer prevention behaviors. However, maternal communication about quitting smoking was inversely associated with adolescent smoking cessation at baseline: a possible explanation is that the longer an adolescent continues to smoke without quitting, the more frequently parents will advocate quitting. Sources of Support: American Cancer Society # RSGPB-04-00901-CPPB (Frazier, PI).
34. A MULTI-DISCIPLINARY, FAMILY-BASED APPROACH TO PEDIATRIC AND ADOLESCENT OBESITY AND EATING DISORDERS Denise Edwards, MD, Curtis Takagishi, PhD, Michelle Albers, PhD, Perry Kaly, PhD, Diane Straub, MD, MPH. University of South Florida, Tampa, Florida Purpose: The spectrum of eating disorders from anorexia to obesity involves complex social, behavioral, and medical issues. Research and recent expert recommendations reflect that familybased, multi-disciplinary programs focused on behavior modification are the most effective for management. An ideal outpatient treatment center for the spectrum of eating disorders, including obesity, would use a family based approach incorporating all of the disciplines in one physical location; we describe such a center here. Methods: The Healthy Weight Clinic is a multi-disciplinary clinic providing centralized coordinated care for patients with the entire spectrum of eating disorders. Patients are referred by community pediatricians or are self-referred to one of the primary physicians for initial evaluation, and are subsequently scheduled at the multi-disciplinary clinic according to acuity and appointment availability. Patients are initially and continually assessed by physicians for co-morbidities and medical stability, including laboratory studies and need for inpatient hospitalization/tertiary care center referral. Psychologists develop an individualized treatment plan initially focused upon identifying and overcoming barriers preventing improvement in their medical and nutritional status; subsequently cognitivebehavioral therapy, behavior modification, and family therapy are used to maintain patient motivation and continue compliance with the treatment plan devised by the team to manage their weight and address their eating disorder. The nutritionist helps patients stabilize their medical status through cessation of negative food behaviors and optimization of nutrient intake; further goals include restoration of menses in females and attainment of a self-managed, natural relationship with food. Social work and physical therapy are available as needed, the latter being especially helpful for morbidly obese, sedentary, and medically complex/disabled patients, to optimize physical activity appropriately. The entire team collaboratively develops and revises the individualized plan for the patient and family, with communication at biweekly rounds and by phone or e-mail as needed. Ongoing communication with referring doctors is provided. Results: A total of 25 patients were seen by the multiple specialists in the Healthy Weight Clinic between March and August of 2007. The demographics were age range: 8-21 years (avg. 15); gender:
(top quartile of scale score) included: insurance coverage (OR 2.6, CI 1.2-5.6), history of STI (OR 1.7, CI 1.0-3.0), fewer perceived barriers to vaccination (OR 3.0, CI 1.9-4.5), higher perceived severity of HPV (OR 1.6, CI 1.2-2.2), and current smoking (OR 2.2, CI 1.2-3.9). Conclusions: Although HPV prevalence was high in this sample of young women, most were negative for vaccine-type HPV and thus could potentially benefit from HPV vaccination. However, intention and self-efficacy – key predictors of vaccination – and actual vaccination rates were relatively low. Interventions to increase HPV vaccination in this population should promote positive intentions and self-efficacy by: 1) ensuring that vaccine costs are covered, and 2) addressing modifiable beliefs such as perceptions of risk and perceived barriers to vaccination. Sources of Support: Charlotte R. Schmidlapp Award (Kahn, PI) and K23 AI50923 (Kahn, PI).
SESSION I: ADOLESCENTS AND THEIR FAMILIES 33. IMPACT OF MATERNAL COMMUNICATION ABOUT SKIN, CERVICAL AND LUNG CANCER PREVENTION ON ADOLESCENT PREVENTION BEHAVIORS Jessica A. Kahn, MD, MPH, Bin Huang, PhD, Lili Ding, MS, A. Lindsay Frazier, MD, MSc. Cincinnati Children’s Hospital Medical Center, Cincinnati Ohio; and Dana Farber Cancer Institute and Children’s Hospital, Boston, Massachusetts Purpose: To determine whether maternal communication about prevention of skin, cervical, and lung cancer is associated with adolescent cancer prevention behaviors in a national study sample. Methods: The study sample consisted of U.S. adolescents (N⫽10,409) participating in a longitudinal study. The independent variables, measured on the 2001 survey, were adolescent report of maternal communication about sunscreen use, Pap screening, and quitting smoking. Outcome variables, measured in 2001 and 2003, included adolescent self-report of sunscreen use during the past summer, previous Pap screening (among girls), and quitting smoking in the past year (among smokers). We conducted multivariable logistic regression modeling to identify those factors associated independently with the three adolescent cancer prevention behaviors in 2001 and 2003, controlling in each model for variables (e.g., age, gender, sexual experience, attitudes, peer behaviors) associated in univariate analyses with each of the three outcomes. Results: Participants ranged in age from 14-21 years, and 60% were girls. The adjusted odds ratios of adolescent behaviors in 2001 and 2003, given different frequencies of maternal communication in 2001 (once, occasionally, sometimes or often, vs. never), are shown below.
Odd ratios (95% confidence intervals) for adolescent cancer prevention behaviors
2001 Sunscreen use Pap screening Quit smoking 2003 Sunscreen use Pap screening Quit smoking
Communicated Once
Occasionally
Sometimes
Often
1.2 (0.8-1.9) 4.0 (3.1-5.2) 0.53 (0.35-0.81)
2.0 (1.4-2.8) 7.4 (5.5-9.9) 0.56 (0.38-0.82)
3.0 (2.1-4.1) 11.1 (7.9-15.4) 0.37 (0.24-0.57)
8.3 (6.1-11.5) 14.2 (9.8-20.6) 0.48 (0.35-0.67)
1.03 (0.67-1.59) 1.71 (0.81-3.59) 0.88 (0.48-1.64)
2.05 (1.48-2.84) 1.31 (0.62-2.76) 1.09 (0.62-1.92)
2.83 (2.05-3.91) 2.62 (0.90-7.63) 1.06 (0.58-1.94)
5.62 (4.11-7.68) 4.48 (1.05-19.15) 0.86 (0.49-1.50)
S29
Conclusions: Frequent maternal communication was positively associated with adolescent sunscreen use and Pap screening at baseline and two years later, suggesting that maternal communication may promote specific adolescent cancer prevention behaviors. However, maternal communication about quitting smoking was inversely associated with adolescent smoking cessation at baseline: a possible explanation is that the longer an adolescent continues to smoke without quitting, the more frequently parents will advocate quitting. Sources of Support: American Cancer Society # RSGPB-04-00901-CPPB (Frazier, PI).
34. A MULTI-DISCIPLINARY, FAMILY-BASED APPROACH TO PEDIATRIC AND ADOLESCENT OBESITY AND EATING DISORDERS Denise Edwards, MD, Curtis Takagishi, PhD, Michelle Albers, PhD, Perry Kaly, PhD, Diane Straub, MD, MPH. University of South Florida, Tampa, Florida Purpose: The spectrum of eating disorders from anorexia to obesity involves complex social, behavioral, and medical issues. Research and recent expert recommendations reflect that familybased, multi-disciplinary programs focused on behavior modification are the most effective for management. An ideal outpatient treatment center for the spectrum of eating disorders, including obesity, would use a family based approach incorporating all of the disciplines in one physical location; we describe such a center here. Methods: The Healthy Weight Clinic is a multi-disciplinary clinic providing centralized coordinated care for patients with the entire spectrum of eating disorders. Patients are referred by community pediatricians or are self-referred to one of the primary physicians for initial evaluation, and are subsequently scheduled at the multi-disciplinary clinic according to acuity and appointment availability. Patients are initially and continually assessed by physicians for co-morbidities and medical stability, including laboratory studies and need for inpatient hospitalization/tertiary care center referral. Psychologists develop an individualized treatment plan initially focused upon identifying and overcoming barriers preventing improvement in their medical and nutritional status; subsequently cognitivebehavioral therapy, behavior modification, and family therapy are used to maintain patient motivation and continue compliance with the treatment plan devised by the team to manage their weight and address their eating disorder. The nutritionist helps patients stabilize their medical status through cessation of negative food behaviors and optimization of nutrient intake; further goals include restoration of menses in females and attainment of a self-managed, natural relationship with food. Social work and physical therapy are available as needed, the latter being especially helpful for morbidly obese, sedentary, and medically complex/disabled patients, to optimize physical activity appropriately. The entire team collaboratively develops and revises the individualized plan for the patient and family, with communication at biweekly rounds and by phone or e-mail as needed. Ongoing communication with referring doctors is provided. Results: A total of 25 patients were seen by the multiple specialists in the Healthy Weight Clinic between March and August of 2007. The demographics were age range: 8-21 years (avg. 15); gender: