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Self-reported physical activity and bone mineral density in urban adolescent girls
J Pediatr Adolesc Gynecol (2004) 17:221–229
NASPAG 18th Annual Clinical Meeting, Issues and Answers in Pediatric and Adolescent Gynecology, May 20–22, 2004, San Diego, California Oral Abstracts
Self-Reported Physical Activity and Bone Mineral Density in Urban Adolescent Girls Margaret Stager, MD, Raymond Harvey, BS, Sarah Sylvia, MS, Michelle Secic, MS, and Barbara Cromer, MD. Metro Health Center and Care Western Reserve University School of Medicine, Clevland, OH
Background: Previous research on bone mineral density in adolescents has focused on leisure time activities such as sports. This observational study aimed to examine the prevalence of activities of daily living, as well as the impact of leisure time activities on bone mineral density in urban adolescent girls. Methods: Patients were recruited from 3 hospitalbased adolescent medicine clinics to participate in a longitudinal study of hormonal contraception and bone mineral density. Patients completed a 23-item physical activity questionnaire at baseline, recording time spent in various activities in the previous 7 days. In addition to leisure time activities such as baseball/softball, basketball and biking activities of daily life were also considered including general play, chores, and dancing. Activities were characterized and scored by metabolic intensity (METPA score) and mechanical strain on bone (MECHPA score). The METPA score for each activity is the product of the metabolic intensity of the activity and the time spent in the activity. The 쑖 2004 North American Society for Pediatric and Adolescent Gynecology Published by Elsevier Inc.
MECHPA score estimates the mechanical strain on bone from ground reaction forces (Kemper et al). Bone mineral density was measured at the femoral neck by dual energy x-ray absorptiometry with the Hologic Model QDR 4500 densiometer. Analysis of variance techniques were used to assess the relationship between femoral neck bone mineral density and the logged values of METPA and MECHPA adjusting for weight, age and race. The logged scores were divided into quartiles with the lowest quartile as the reference group. Results: Four hundred fifty five females (ages 12– 18 years) completed the survey. The mean age was 15.5 ± 1.6 years, with a racial distribution of 62% black and 38% non-black. The mean body mass index for the group was 25.0 ± 5.9. The activities with the highest reported frequency were: indoor chores (93%), general play with friends (90%), walking to/from school (88%), slow running/jogging (67%), and dancing (67%). The log of the overall METPA score was a significant predictor of bone mineral density (i.e. higher METPA score predicted a higher bone mineral density, p ⫽ 0.03). In contrast, the overall log of the MECHPA score did not predict bone mineral density. However, a MECHPA score in the highest quartile was associated with a higher bone mineral density (p ⬍ 0.05) when compared to the other MECHPA quartiles. Conclusions: In this population of urban adolescent girls, activities of daily living such as chores and dancing were reported with a higher frequency than sports activities. Results indicated a positive association between the time spent in metabolically intense activities and bone mineral density. There also appears to be a 1083-3188/04/$22.00
222
NASPAG 18th Annual Clinical Meeting
threshold effect for the relationship between activities with the highest mechanical strain and bone mineral density. Last, as seen in this urban adolescent population, future research on activities and bone mineral density need to assess the activities salient to the population.
Tampon-Related Toxic Shock Syndrome (TSS) Continues to Peak Among Adolescent Girls: A Nationwide Hospital Study Roselie A. Bright, ScD, and Judith U. Cope, MD, MPH Center for Devices and Radiological Health, Food and Drug Administration, Rockville, MD
Background: Despite the removal of certain brands of tampons from the market, tampon-related TSS may still lead to lengthy hospitalization and morbidity for adolescent girls. Importantly TSS may be confused with other acute illnesses. Because of increasing reports to the FDA and no active surveillance plan in place we further investigated national rates of TSS hospitalizations among adolescent girls. Methods: Data from the Healthcare Cost and Utilization Project (HCUP), collected by the US Agency for Healthcare Research and Quality, were used for these analyses. The HCUP Nationwide Inpatient Sample (NIS), years 1996–2001, was obtained for ages 10–19, 20–39, and 40–59. Tampon-related TSS was computed as the age-specific rate in females minus the agespecific rate in males. Weighted national estimates for each sex-specific age group were calculated by month of the year and by year. The HCUP Kids’ Inpatient Database (KID), 1997, was divided into ages 0–4, 5–9, 10–14, and 15–18 years. Numbers of TSS cases were compared by sex-specific age group. Results: The highest national annual number of tampon-related TSS hospitalizations was for 10–19 year olds, averaging 197 during the years 1996–2001. By contrast, the national average annual number of TSS hospitalization for boys age 10–19 was 76, of tamponrelated TSS hospitalizations for 20–39 year old women was 278, and of tampon-related TSS hospitalizations for 40–59 year old women was 94. TSS death rates were lowest for teens. Teen girls demonstrated a unique pattern of elevated rates during the school months. The KID data showed that TSS peaked for girls age 15–18. Below age 10 similar numbers of TSS occurred for boys and girls. The greatest numbers of TSS cases were among older adolescent females with nearly half of all female TSS cases occurring between 15 to 18 years of age.
Conclusion: These data highlight the need for health care providers to consider tampon-related TSS in the differential diagnosis of acute flu-like illness among teenage girls. Although our data suggest rates of tampon-related TSS are low, they indicate this problem has not gone away. While hospital discharge data does not establish a tampon link with TSS among adolescent females, it highlights the need for more active surveillance and an update of our understanding of this disease. Increased awareness of TSS and related conditions should be further defined for subpopulations of adolescent girls who may be at higher risk.
Objective Knowledge, Perceived Knowledge, and Condom Use Among Adolescent Males Ellen M. Rock, MD, Marjorie Ireland, Ph.D, Michael D. Resnick, Ph.D, and Clea A. McNeely, Dr.PH Division of General Pediatrics and Adolescent Health, University of Minnesota, Minneapolis, MN
Background: The role of knowledge as a protective antecedent to sexual behavior is questionable, perhaps because studies have focused only on objective knowledge. We examined the functions that both objective and perceived knowledge about condoms play in male adolescents’ condom use at first intercourse. Methods: A secondary analysis of Waves 1 and 2 of the National Longitudinal Study of Adolescent Health was undertaken. The sample included 404 adolescent males who were virgins at Wave 1 but reported being sexually experienced at Wave 2. The relationship between objective and perceived knowledge was determined using Pearson correlations. Bivariate and multivariate relationships between the knowledge variables and report of condom use at first intercourse were then examined using Student’s t-tests and multivariate logistic regression. Participants were dichotomized into high or low levels of objective and perceived knowledge; four categories were created to examine the role of discordance between knowledge domains in predicting condom use, using serial chisquare tests and multivariate logistic regression. Results: The correlation between the objective and knowledge variables was moderate (r ⫽ 0.43). Multivariate analysis revealed that higher objective knowledge and lower perceived knowledge significantly predicted condom use at first intercourse (OR ⫽ 1.48, p ⬍ 0.001, OR ⫽ 0.6, p ⫽ 0.01 respectively). Bivariate testing among the 4 groups revealed that those with
NASPAG 18th Annual Clinical Meeting, Issues and Answers in Pediatric and Adolescent Gynecology, May 20–22, 2004, San Diego, California Oral Abstracts
Self-Reported Physical Activity and Bone Mineral Density in Urban Adolescent Girls Margaret Stager, MD, Raymond Harvey, BS, Sarah Sylvia, MS, Michelle Secic, MS, and Barbara Cromer, MD. Metro Health Center and Care Western Reserve University School of Medicine, Clevland, OH
Background: Previous research on bone mineral density in adolescents has focused on leisure time activities such as sports. This observational study aimed to examine the prevalence of activities of daily living, as well as the impact of leisure time activities on bone mineral density in urban adolescent girls. Methods: Patients were recruited from 3 hospitalbased adolescent medicine clinics to participate in a longitudinal study of hormonal contraception and bone mineral density. Patients completed a 23-item physical activity questionnaire at baseline, recording time spent in various activities in the previous 7 days. In addition to leisure time activities such as baseball/softball, basketball and biking activities of daily life were also considered including general play, chores, and dancing. Activities were characterized and scored by metabolic intensity (METPA score) and mechanical strain on bone (MECHPA score). The METPA score for each activity is the product of the metabolic intensity of the activity and the time spent in the activity. The 쑖 2004 North American Society for Pediatric and Adolescent Gynecology Published by Elsevier Inc.
MECHPA score estimates the mechanical strain on bone from ground reaction forces (Kemper et al). Bone mineral density was measured at the femoral neck by dual energy x-ray absorptiometry with the Hologic Model QDR 4500 densiometer. Analysis of variance techniques were used to assess the relationship between femoral neck bone mineral density and the logged values of METPA and MECHPA adjusting for weight, age and race. The logged scores were divided into quartiles with the lowest quartile as the reference group. Results: Four hundred fifty five females (ages 12– 18 years) completed the survey. The mean age was 15.5 ± 1.6 years, with a racial distribution of 62% black and 38% non-black. The mean body mass index for the group was 25.0 ± 5.9. The activities with the highest reported frequency were: indoor chores (93%), general play with friends (90%), walking to/from school (88%), slow running/jogging (67%), and dancing (67%). The log of the overall METPA score was a significant predictor of bone mineral density (i.e. higher METPA score predicted a higher bone mineral density, p ⫽ 0.03). In contrast, the overall log of the MECHPA score did not predict bone mineral density. However, a MECHPA score in the highest quartile was associated with a higher bone mineral density (p ⬍ 0.05) when compared to the other MECHPA quartiles. Conclusions: In this population of urban adolescent girls, activities of daily living such as chores and dancing were reported with a higher frequency than sports activities. Results indicated a positive association between the time spent in metabolically intense activities and bone mineral density. There also appears to be a 1083-3188/04/$22.00
222
NASPAG 18th Annual Clinical Meeting
threshold effect for the relationship between activities with the highest mechanical strain and bone mineral density. Last, as seen in this urban adolescent population, future research on activities and bone mineral density need to assess the activities salient to the population.
Tampon-Related Toxic Shock Syndrome (TSS) Continues to Peak Among Adolescent Girls: A Nationwide Hospital Study Roselie A. Bright, ScD, and Judith U. Cope, MD, MPH Center for Devices and Radiological Health, Food and Drug Administration, Rockville, MD
Background: Despite the removal of certain brands of tampons from the market, tampon-related TSS may still lead to lengthy hospitalization and morbidity for adolescent girls. Importantly TSS may be confused with other acute illnesses. Because of increasing reports to the FDA and no active surveillance plan in place we further investigated national rates of TSS hospitalizations among adolescent girls. Methods: Data from the Healthcare Cost and Utilization Project (HCUP), collected by the US Agency for Healthcare Research and Quality, were used for these analyses. The HCUP Nationwide Inpatient Sample (NIS), years 1996–2001, was obtained for ages 10–19, 20–39, and 40–59. Tampon-related TSS was computed as the age-specific rate in females minus the agespecific rate in males. Weighted national estimates for each sex-specific age group were calculated by month of the year and by year. The HCUP Kids’ Inpatient Database (KID), 1997, was divided into ages 0–4, 5–9, 10–14, and 15–18 years. Numbers of TSS cases were compared by sex-specific age group. Results: The highest national annual number of tampon-related TSS hospitalizations was for 10–19 year olds, averaging 197 during the years 1996–2001. By contrast, the national average annual number of TSS hospitalization for boys age 10–19 was 76, of tamponrelated TSS hospitalizations for 20–39 year old women was 278, and of tampon-related TSS hospitalizations for 40–59 year old women was 94. TSS death rates were lowest for teens. Teen girls demonstrated a unique pattern of elevated rates during the school months. The KID data showed that TSS peaked for girls age 15–18. Below age 10 similar numbers of TSS occurred for boys and girls. The greatest numbers of TSS cases were among older adolescent females with nearly half of all female TSS cases occurring between 15 to 18 years of age.
Conclusion: These data highlight the need for health care providers to consider tampon-related TSS in the differential diagnosis of acute flu-like illness among teenage girls. Although our data suggest rates of tampon-related TSS are low, they indicate this problem has not gone away. While hospital discharge data does not establish a tampon link with TSS among adolescent females, it highlights the need for more active surveillance and an update of our understanding of this disease. Increased awareness of TSS and related conditions should be further defined for subpopulations of adolescent girls who may be at higher risk.
Objective Knowledge, Perceived Knowledge, and Condom Use Among Adolescent Males Ellen M. Rock, MD, Marjorie Ireland, Ph.D, Michael D. Resnick, Ph.D, and Clea A. McNeely, Dr.PH Division of General Pediatrics and Adolescent Health, University of Minnesota, Minneapolis, MN
Background: The role of knowledge as a protective antecedent to sexual behavior is questionable, perhaps because studies have focused only on objective knowledge. We examined the functions that both objective and perceived knowledge about condoms play in male adolescents’ condom use at first intercourse. Methods: A secondary analysis of Waves 1 and 2 of the National Longitudinal Study of Adolescent Health was undertaken. The sample included 404 adolescent males who were virgins at Wave 1 but reported being sexually experienced at Wave 2. The relationship between objective and perceived knowledge was determined using Pearson correlations. Bivariate and multivariate relationships between the knowledge variables and report of condom use at first intercourse were then examined using Student’s t-tests and multivariate logistic regression. Participants were dichotomized into high or low levels of objective and perceived knowledge; four categories were created to examine the role of discordance between knowledge domains in predicting condom use, using serial chisquare tests and multivariate logistic regression. Results: The correlation between the objective and knowledge variables was moderate (r ⫽ 0.43). Multivariate analysis revealed that higher objective knowledge and lower perceived knowledge significantly predicted condom use at first intercourse (OR ⫽ 1.48, p ⬍ 0.001, OR ⫽ 0.6, p ⫽ 0.01 respectively). Bivariate testing among the 4 groups revealed that those with