- Email: [email protected]
Lower-Burden Sampling Strategies for Measuring Salivary Cortisol in Adolescents
Abstracts / 44 (2009) S14–S47
with one academic institution to determine HPV and tetanus vaccination rates. After rates were determined, a 48-item anonymous questionnaire was administered to providers at each site to better understand the barriers to HPV vaccination. Results: A total of 620 charts were reviewed; the mean age of the patient was 14.6. We found an overall 67% HPV vaccination rate in females compared to a 93% tetanus vaccination rate (p ¼ 0.0016). Fifty-five percent of 11-12-year-old females and 77% of 18-21-year-old females were vaccinated against HPV. These vaccination rates were consistent across all five sites, with each practice having a vaccination rate for tetanus > 90%, while the HPV vaccination rate varied between 51-71% (p ¼ 0.35). Twenty-nine percent of 11-12-year-olds were not offered the vaccine, compared with 18% of 18-21-year-olds. A total of 27/29 (93%) of providers completed the provider questionnaire. Provider reported barriers included: parental reluctance to discuss issues of sexuality and sexually transmitted infections (STIs) (48%); parental reluctance to have their child immunized against an STI (44%); parental concern about vaccine safety (44%); and parental concern that vaccination could increase risky behaviors in their children (22%). Only 4% of providers reported a reluctance to talk with adolescents about issues relating to STIs. Conclusions: The HPV vaccination rate is less than that of tetanus in an urban academic setting. Commonly reported barriers were related to parental concerns, particularly regarding sex and STIs. Fortunately, providers’ personal reluctance to discuss these issues was not a commonly reported barrier. This data differs from pre-licensure data which showed that parents were in favor of vaccinating against an STI. There are also a significant number of young patients not being offered the vaccine. Providers should address these parental concerns and consider provider prompts in order to improve the HPV vaccination rate, particularly among our young adolescents. Sources of Support: None.
37. LOWER-BURDEN SAMPLING STRATEGIES FOR MEASURING SALIVARY CORTISOL IN ADOLESCENTS Kathryn D. Swartwout, FNP-BC, PhD, APN. Rush University, Chicago, IL Purpose: The purpose of this study was to investigate the usefulness of lower burden strategies for modeling the diurnal pattern of salivary cortisol levels in adolescents Cortisol is a physiologic indicator of stress and measuring cortisol in saliva is used in an increasing number of research studies. This study sought to find the least number of saliva samples (and the timing of those samples) that could be used to predict the typical diurnal pattern of cortisol on a typical day. Methods: The setting was a large midwest public high school. Nineteen high school student volunteers recruited from eight sophomore health classes (approximately 180 students were given the opportunity to participate). Power analysis indicated that the small sample of 19 participants who provided a total number of 143 saliva samples was adequate for meaningful statistical analysis. Measures: Saliva samples for cortisol measurement were collected at six time points during a typical day. For establishing day to day stability, two samples were collected on a second day. The diurnal pattern for each individual was plotted. Mathematical models were used to investigate whether the diurnal patterns, established using the six time points, could be predicted using a lesser number of samples.
S29
Results: Area-under-the curve (AUC) analyses calculated using all six time points was the best predictor of the diurnal pattern. Significant relationships were found between (1) the awakening cortisol levels and (2) the change-scores (awakening measure minus the bedtime measure) and the diurnal patterns of cortisol secretion in teens. Conclusions: The results support the use of lower burden sampling strategies in adolescents. The awakening cortisol level (one sample) or a change score (calculated from two samples) can be used to predict the diurnal pattern determined by six samples. Source of Support: None.
38. PERCEIVED BARRIERS TO COMPLETION OF TUBERCULOSIS (TB) SCREENING Brooke Rosman, MD1, Dana Best, MD, MPH2, and Lawrence J. D’Angelo, MD, MPH1. 1Division of Adolescent & Young Adult Medicine; 2The Division of General and Community Pediatrics, Children’s National Medical Center and the Department of Pediatrics, George Washington University, Washington, DC Purpose: TB continues to be a major infectious disease threat in the US. While routine testing for TB exposure is no longer recommended, testing remains prudent in high-risk individuals and communities. Because testing for TB is a 2-stage process, we sought to describe perceived barriers to completion of TB skin testing (TST) used to screen adolescents in an urban academic primary care practice. Methods: This was an anonymous, cross-sectional survey of a convenience sample of adolescent patients receiving TST during routine physical exams. Surveys were distributed in pairs; one pair was assigned to each patient so that, if available, one guardian could also complete the survey. Questions focused on perceptions of reasons people do not complete the TST process. Knowledge of the presence of a nurse at the patient’s current school was asked. Univariate analyses were performed and response frequencies measured. Results: A total of 280 patient-guardian pairs of surveys were distributed. The mean age of patient respondents was 15 years (range, 12-21 years). The patient sample was 87% African-American, 49% male, and 90% students; similar to the racial/ethnic makeup of the population served by the practice. One hundred fifty-two (54%) of patients completed the survey; 43% of surveys distributed to guardians were completed. ‘‘Forgetfulness’’ was the reason most frequently identified by adolescents for not returning to the clinic or going to a school nurse to complete the TST (35%; n ¼ 53/152), followed by ‘‘don’t know’’ (28%), ‘‘busy’’ (26%), and ‘‘transportation’’ (14%). Guardians most often identified being ‘‘busy’’ (43%; n ¼ 51/120), followed by ‘‘forgetfulness’’ (37%), and ‘‘transportation’’ (28%). A total of 84% of patients who were students stated their school had a nurse. Conclusions: Forgetfulness is the barrier most frequently identified by adolescents for not completing TST, and the barrier second most frequently identified by parents. Parents cited ‘‘being busy’’ as the most likely reason not to return. Transportation challenges were also cited as barriers. Interestingly, students were able to identify the fact that they had a school nurse at their school. Potential solutions may include stronger partnerships with school nurses, and the use of reminder systems to promote return for TST reading. Improved availability and use of a newly developed, CDC recommended, single-visit blood test (QuantiFERON-TB Gold In-Tube), may increase the completion rate of TB testing among adolescents. Sources of Support: None.
with one academic institution to determine HPV and tetanus vaccination rates. After rates were determined, a 48-item anonymous questionnaire was administered to providers at each site to better understand the barriers to HPV vaccination. Results: A total of 620 charts were reviewed; the mean age of the patient was 14.6. We found an overall 67% HPV vaccination rate in females compared to a 93% tetanus vaccination rate (p ¼ 0.0016). Fifty-five percent of 11-12-year-old females and 77% of 18-21-year-old females were vaccinated against HPV. These vaccination rates were consistent across all five sites, with each practice having a vaccination rate for tetanus > 90%, while the HPV vaccination rate varied between 51-71% (p ¼ 0.35). Twenty-nine percent of 11-12-year-olds were not offered the vaccine, compared with 18% of 18-21-year-olds. A total of 27/29 (93%) of providers completed the provider questionnaire. Provider reported barriers included: parental reluctance to discuss issues of sexuality and sexually transmitted infections (STIs) (48%); parental reluctance to have their child immunized against an STI (44%); parental concern about vaccine safety (44%); and parental concern that vaccination could increase risky behaviors in their children (22%). Only 4% of providers reported a reluctance to talk with adolescents about issues relating to STIs. Conclusions: The HPV vaccination rate is less than that of tetanus in an urban academic setting. Commonly reported barriers were related to parental concerns, particularly regarding sex and STIs. Fortunately, providers’ personal reluctance to discuss these issues was not a commonly reported barrier. This data differs from pre-licensure data which showed that parents were in favor of vaccinating against an STI. There are also a significant number of young patients not being offered the vaccine. Providers should address these parental concerns and consider provider prompts in order to improve the HPV vaccination rate, particularly among our young adolescents. Sources of Support: None.
37. LOWER-BURDEN SAMPLING STRATEGIES FOR MEASURING SALIVARY CORTISOL IN ADOLESCENTS Kathryn D. Swartwout, FNP-BC, PhD, APN. Rush University, Chicago, IL Purpose: The purpose of this study was to investigate the usefulness of lower burden strategies for modeling the diurnal pattern of salivary cortisol levels in adolescents Cortisol is a physiologic indicator of stress and measuring cortisol in saliva is used in an increasing number of research studies. This study sought to find the least number of saliva samples (and the timing of those samples) that could be used to predict the typical diurnal pattern of cortisol on a typical day. Methods: The setting was a large midwest public high school. Nineteen high school student volunteers recruited from eight sophomore health classes (approximately 180 students were given the opportunity to participate). Power analysis indicated that the small sample of 19 participants who provided a total number of 143 saliva samples was adequate for meaningful statistical analysis. Measures: Saliva samples for cortisol measurement were collected at six time points during a typical day. For establishing day to day stability, two samples were collected on a second day. The diurnal pattern for each individual was plotted. Mathematical models were used to investigate whether the diurnal patterns, established using the six time points, could be predicted using a lesser number of samples.
S29
Results: Area-under-the curve (AUC) analyses calculated using all six time points was the best predictor of the diurnal pattern. Significant relationships were found between (1) the awakening cortisol levels and (2) the change-scores (awakening measure minus the bedtime measure) and the diurnal patterns of cortisol secretion in teens. Conclusions: The results support the use of lower burden sampling strategies in adolescents. The awakening cortisol level (one sample) or a change score (calculated from two samples) can be used to predict the diurnal pattern determined by six samples. Source of Support: None.
38. PERCEIVED BARRIERS TO COMPLETION OF TUBERCULOSIS (TB) SCREENING Brooke Rosman, MD1, Dana Best, MD, MPH2, and Lawrence J. D’Angelo, MD, MPH1. 1Division of Adolescent & Young Adult Medicine; 2The Division of General and Community Pediatrics, Children’s National Medical Center and the Department of Pediatrics, George Washington University, Washington, DC Purpose: TB continues to be a major infectious disease threat in the US. While routine testing for TB exposure is no longer recommended, testing remains prudent in high-risk individuals and communities. Because testing for TB is a 2-stage process, we sought to describe perceived barriers to completion of TB skin testing (TST) used to screen adolescents in an urban academic primary care practice. Methods: This was an anonymous, cross-sectional survey of a convenience sample of adolescent patients receiving TST during routine physical exams. Surveys were distributed in pairs; one pair was assigned to each patient so that, if available, one guardian could also complete the survey. Questions focused on perceptions of reasons people do not complete the TST process. Knowledge of the presence of a nurse at the patient’s current school was asked. Univariate analyses were performed and response frequencies measured. Results: A total of 280 patient-guardian pairs of surveys were distributed. The mean age of patient respondents was 15 years (range, 12-21 years). The patient sample was 87% African-American, 49% male, and 90% students; similar to the racial/ethnic makeup of the population served by the practice. One hundred fifty-two (54%) of patients completed the survey; 43% of surveys distributed to guardians were completed. ‘‘Forgetfulness’’ was the reason most frequently identified by adolescents for not returning to the clinic or going to a school nurse to complete the TST (35%; n ¼ 53/152), followed by ‘‘don’t know’’ (28%), ‘‘busy’’ (26%), and ‘‘transportation’’ (14%). Guardians most often identified being ‘‘busy’’ (43%; n ¼ 51/120), followed by ‘‘forgetfulness’’ (37%), and ‘‘transportation’’ (28%). A total of 84% of patients who were students stated their school had a nurse. Conclusions: Forgetfulness is the barrier most frequently identified by adolescents for not completing TST, and the barrier second most frequently identified by parents. Parents cited ‘‘being busy’’ as the most likely reason not to return. Transportation challenges were also cited as barriers. Interestingly, students were able to identify the fact that they had a school nurse at their school. Potential solutions may include stronger partnerships with school nurses, and the use of reminder systems to promote return for TST reading. Improved availability and use of a newly developed, CDC recommended, single-visit blood test (QuantiFERON-TB Gold In-Tube), may increase the completion rate of TB testing among adolescents. Sources of Support: None.