Diana Mahoney

Mistaking the population reference range of thyroid-stimulating hormone for an individual's “normal” range can lead to suboptimal diagnosis and treatment of thyroid disease, according to Carole Spencer, Ph.D., professor of medicine and director of the Endocrine Services Laboratory at the University of Southern California in Los Angeles.

Population reference ranges for thyroid function tests are based on statistical averages, not on standards of biologic activity at different levels of thyroid hormones, Dr. Spencer stressed in an audioconference on the challenges of thyroid testing sponsored by the American Association of Clinical Chemistry. “Because individuals have different pathophysiologic factors that influence TSH [thyroid stimulating hormone], the combination of these variables in cohorts of individuals widen the TSH population reference range,” she said.

For example, “the typical [National Health and Nutrition Examination Survey] U.S. population reference range for TSH is 0.4–4.1 mU/L, which is much wider than the annual fluctuations in TSH typical of individuals,” said Dr. Spencer. “In fact, a TSH change in an individual that exceeds 0.75 mU/L, which is well within the population range, is biologically significant.”

Although the TSH population reference range is a crude parameter for detecting disease in individual patients, its accuracy is considered critical “because TSH is the first abnormality to appear as disease develops,” said Dr. Spencer. Additionally, “there is growing data suggesting that mild subclinical hypothyroidism can exacerbate the risk for cardiovascular disease in susceptible individuals,” she said. As such, identifying patients at risk for developing this condition is important.

There has been much debate among endocrinologists over the upper reference limit for TSH in particular. Over the past 3 decades, “the reference ranges have contracted as a result of improvements in TSH assay sensitivity and specificity, coupled with more sensitive thyroid antibody tests that are used to eliminate individuals with thyroid autoimmunities from reference range calculations,” said Dr. Spencer. “While the lower reference has been established as being around 0.3 mU/L, the upper reference limit has steadily declined from approximately 10 mU/L to between 4.0 and 4.5 mU/L.”

Additionally, there is strong clinical rationale for adopting the even narrower TSH reference range of 0.3–3.0 mU/L recommended by the American Association of Clinical Endocrinologists in 2003, Dr. Spencer noted. “We know from a 20-year follow-up survey of the Wickham thyroid survey [a historical cohort study that provided incidence data for thyroid disease for a representative cross-sectional sample of the population] that a TSH above approximately 2.0 mU/L is a risk factor for future development of hypothyroidism, especially when thyroid peroxidase [TPO] antibody is detected.” This is true “even in the absence of thyroid antibodies,” she said.

The empiric lowering of the upper reference limit is further justified in light of the growing recognition that even mild subclinical thyroxine deficiency in early pregnancy is detrimental to the mother and fetus, Dr. Spencer added.

Despite the data supporting the narrower reference ranges, many U.S. laboratories have not revised their “normal range” criteria, nor have all clinicians adopted the new range for diagnostic and treatment purposes, according to Dr. Spencer. One perceived roadblock has been the lack of data on the patient management implications of making the change, she said.

“Patients with TSH outside the narrower reference range do not necessarily require treatment,” said Dr. Spencer. “Rather, the degree of TSH abnormality outside the range should be viewed as a risk factor for current or future development of hyper- or hypothyroidism.”

The threshold for treatment has to be adjusted for patient-specific factors, such as the degree of TSH abnormality, family history of cardiovascular disease, diabetes, insulin resistance, hypertension, smoking, age, and presenting symptoms, Dr. Spencer noted. Additionally, the presence and concentration of thyroid autoantibodies is an important factor. “The higher the thyroid peroxidase autoantibody concentration, the more rapid the progression of disease,” she said.

Ultimately, the diagnosis and efficacy of treating subclinical hypothyroidism should not be based on the TSH reference range alone, “but should integrate the degree of TSH elevation with patient-specific risk factors and the concentration of TPO antibodies,” Dr. Spencer said.

Mistaking the population reference range of thyroid-stimulating hormone for an individual's “normal” range can lead to suboptimal diagnosis and treatment of thyroid disease, according to Carole Spencer, Ph.D., professor of medicine and director of the Endocrine Services Laboratory at the University of Southern California in Los Angeles.

Population reference ranges for thyroid function tests are based on statistical averages, not on standards of biologic activity at different levels of thyroid hormones, Dr. Spencer stressed in an audioconference on the challenges of thyroid testing sponsored by the American Association of Clinical Chemistry. “Because individuals have different pathophysiologic factors that influence TSH [thyroid stimulating hormone], the combination of these variables in cohorts of individuals widen the TSH population reference range,” she said.

For example, “the typical [National Health and Nutrition Examination Survey] U.S. population reference range for TSH is 0.4–4.1 mU/L, which is much wider than the annual fluctuations in TSH typical of individuals,” said Dr. Spencer. “In fact, a TSH change in an individual that exceeds 0.75 mU/L, which is well within the population range, is biologically significant.”

Although the TSH population reference range is a crude parameter for detecting disease in individual patients, its accuracy is considered critical “because TSH is the first abnormality to appear as disease develops,” said Dr. Spencer. Additionally, “there is growing data suggesting that mild subclinical hypothyroidism can exacerbate the risk for cardiovascular disease in susceptible individuals,” she said. As such, identifying patients at risk for developing this condition is important.

There has been much debate among endocrinologists over the upper reference limit for TSH in particular. Over the past 3 decades, “the reference ranges have contracted as a result of improvements in TSH assay sensitivity and specificity, coupled with more sensitive thyroid antibody tests that are used to eliminate individuals with thyroid autoimmunities from reference range calculations,” said Dr. Spencer. “While the lower reference has been established as being around 0.3 mU/L, the upper reference limit has steadily declined from approximately 10 mU/L to between 4.0 and 4.5 mU/L.”

Additionally, there is strong clinical rationale for adopting the even narrower TSH reference range of 0.3–3.0 mU/L recommended by the American Association of Clinical Endocrinologists in 2003, Dr. Spencer noted. “We know from a 20-year follow-up survey of the Wickham thyroid survey [a historical cohort study that provided incidence data for thyroid disease for a representative cross-sectional sample of the population] that a TSH above approximately 2.0 mU/L is a risk factor for future development of hypothyroidism, especially when thyroid peroxidase [TPO] antibody is detected.” This is true “even in the absence of thyroid antibodies,” she said.

The empiric lowering of the upper reference limit is further justified in light of the growing recognition that even mild subclinical thyroxine deficiency in early pregnancy is detrimental to the mother and fetus, Dr. Spencer added.

Despite the data supporting the narrower reference ranges, many U.S. laboratories have not revised their “normal range” criteria, nor have all clinicians adopted the new range for diagnostic and treatment purposes, according to Dr. Spencer. One perceived roadblock has been the lack of data on the patient management implications of making the change, she said.

“Patients with TSH outside the narrower reference range do not necessarily require treatment,” said Dr. Spencer. “Rather, the degree of TSH abnormality outside the range should be viewed as a risk factor for current or future development of hyper- or hypothyroidism.”

The threshold for treatment has to be adjusted for patient-specific factors, such as the degree of TSH abnormality, family history of cardiovascular disease, diabetes, insulin resistance, hypertension, smoking, age, and presenting symptoms, Dr. Spencer noted. Additionally, the presence and concentration of thyroid autoantibodies is an important factor. “The higher the thyroid peroxidase autoantibody concentration, the more rapid the progression of disease,” she said.

Ultimately, the diagnosis and efficacy of treating subclinical hypothyroidism should not be based on the TSH reference range alone, “but should integrate the degree of TSH elevation with patient-specific risk factors and the concentration of TPO antibodies,” Dr. Spencer said.

Mistaking the population reference range of thyroid-stimulating hormone for an individual's “normal” range can lead to suboptimal diagnosis and treatment of thyroid disease, according to Carole Spencer, Ph.D., professor of medicine and director of the Endocrine Services Laboratory at the University of Southern California in Los Angeles.

Population reference ranges for thyroid function tests are based on statistical averages, not on standards of biologic activity at different levels of thyroid hormones, Dr. Spencer stressed in an audioconference on the challenges of thyroid testing sponsored by the American Association of Clinical Chemistry. “Because individuals have different pathophysiologic factors that influence TSH [thyroid stimulating hormone], the combination of these variables in cohorts of individuals widen the TSH population reference range,” she said.

For example, “the typical [National Health and Nutrition Examination Survey] U.S. population reference range for TSH is 0.4–4.1 mU/L, which is much wider than the annual fluctuations in TSH typical of individuals,” said Dr. Spencer. “In fact, a TSH change in an individual that exceeds 0.75 mU/L, which is well within the population range, is biologically significant.”

Although the TSH population reference range is a crude parameter for detecting disease in individual patients, its accuracy is considered critical “because TSH is the first abnormality to appear as disease develops,” said Dr. Spencer. Additionally, “there is growing data suggesting that mild subclinical hypothyroidism can exacerbate the risk for cardiovascular disease in susceptible individuals,” she said. As such, identifying patients at risk for developing this condition is important.

There has been much debate among endocrinologists over the upper reference limit for TSH in particular. Over the past 3 decades, “the reference ranges have contracted as a result of improvements in TSH assay sensitivity and specificity, coupled with more sensitive thyroid antibody tests that are used to eliminate individuals with thyroid autoimmunities from reference range calculations,” said Dr. Spencer. “While the lower reference has been established as being around 0.3 mU/L, the upper reference limit has steadily declined from approximately 10 mU/L to between 4.0 and 4.5 mU/L.”

Additionally, there is strong clinical rationale for adopting the even narrower TSH reference range of 0.3–3.0 mU/L recommended by the American Association of Clinical Endocrinologists in 2003, Dr. Spencer noted. “We know from a 20-year follow-up survey of the Wickham thyroid survey [a historical cohort study that provided incidence data for thyroid disease for a representative cross-sectional sample of the population] that a TSH above approximately 2.0 mU/L is a risk factor for future development of hypothyroidism, especially when thyroid peroxidase [TPO] antibody is detected.” This is true “even in the absence of thyroid antibodies,” she said.

The empiric lowering of the upper reference limit is further justified in light of the growing recognition that even mild subclinical thyroxine deficiency in early pregnancy is detrimental to the mother and fetus, Dr. Spencer added.

Despite the data supporting the narrower reference ranges, many U.S. laboratories have not revised their “normal range” criteria, nor have all clinicians adopted the new range for diagnostic and treatment purposes, according to Dr. Spencer. One perceived roadblock has been the lack of data on the patient management implications of making the change, she said.

“Patients with TSH outside the narrower reference range do not necessarily require treatment,” said Dr. Spencer. “Rather, the degree of TSH abnormality outside the range should be viewed as a risk factor for current or future development of hyper- or hypothyroidism.”

The threshold for treatment has to be adjusted for patient-specific factors, such as the degree of TSH abnormality, family history of cardiovascular disease, diabetes, insulin resistance, hypertension, smoking, age, and presenting symptoms, Dr. Spencer noted. Additionally, the presence and concentration of thyroid autoantibodies is an important factor. “The higher the thyroid peroxidase autoantibody concentration, the more rapid the progression of disease,” she said.

Ultimately, the diagnosis and efficacy of treating subclinical hypothyroidism should not be based on the TSH reference range alone, “but should integrate the degree of TSH elevation with patient-specific risk factors and the concentration of TPO antibodies,” Dr. Spencer said.

ATLANTA — Knowledge of intrauterine devices among adolescent and young adult women is limited, according to a study presented at the annual meeting of the North American Society for Pediatric and Adolescent Gynecology.

In a cross-sectional survey of 144 young women between the ages of 14 and 24 recruited from an adolescent gynecology clinic, gynecology outpatient clinics, and the community, more than half of the participants had never heard of an intrauterine device (IUD) and 97% had never used one, said Dr. Lisa Johnson of the adolescent medicine division of the Nassau (Bahamas) Department of Public Health.

The 20-minute, 44-item, semistructured interview assessed demographics, sexual history, contraceptive use and attitudes, and IUD knowledge and attitudes, Dr. Johnson said. The mean age of the respondents was 18.8 years. Nearly all (97%) of them were single, 58% were African American, and 39% were white. Approximately 84% of the group had ever been sexually active, with a mean age of 15.8 years at first sexual intercourse and a median of three lifetime partners. Among those who had ever had sex, 76% had ever been pregnant and 67% had ever had a sexually transmitted disease.

According to the survey results, 60% of the young women surveyed had never heard of an IUD, yet a majority of them “agreed” or “strongly agreed” that they would consider a birth control method that resulted in less painful (93%) and lighter (91%) periods and gave them control over when to stop (85%) and start it (80%), Dr. Johnson said. In addition, 61% reported being “willing” or “very willing” to use a birth control method that causes irregular vaginal bleeding if it was 99% effective at preventing pregnancy, she said.

However, only 30% of the respondents said they would consider a birth control method that involved placing a small plastic object in the uterus and only 27% said they would be interested in a device that had to be placed and removed by a health care provider, she noted.

An analysis of the survey responses showed that those who had heard of IUDs were significantly more likely to be older and sexually active compared with those who had not heard of them, and they were more likely to be white, Dr. Johnson said. “There was no association between knowledge of IUDs and ever being pregnant, parity, ever having a sexually transmitted disease, or number of sexual partners,” she said.

Following participation in the survey, each of the young women was given a 2-minute description and demonstration of IUDs, followed by a test of knowledge about the birth control method. “After the IUD demonstration, knowledge scores were significantly increased,” said Dr. Johnson. “Nearly 65% of the young women liked the idea of an IUD for themselves, while 12% were neutral and 24% said they disliked the idea,” she reported.

Those who liked the IUDs for themselves were significantly more likely to be sexually active than those who did not or who were neutral, Dr. Johnson reported. “There was no association between liking IUDs and age, race, ever being pregnant, parity, ever having a sexually transmitted disease or number of sexual partners,” she said.

Among the young women who liked the idea of an IUD, the most appealing characteristics were that it did not require them to remember to use it every day, that it would not affect their ability to have children in the future, and that it did not need to be remembered with each sex act, Dr. Johnson said.

The findings suggest that “young women may not be getting sufficient information on all of the contraceptive options available to them, particularly IUDs,” said Dr. Johnson. “Clinicians should discuss IUDs as an option with these patients and demonstrate how they are used in order for [patients] to make an informed decision about contraception.”

ATLANTA — Knowledge of intrauterine devices among adolescent and young adult women is limited, according to a study presented at the annual meeting of the North American Society for Pediatric and Adolescent Gynecology.

In a cross-sectional survey of 144 young women between the ages of 14 and 24 recruited from an adolescent gynecology clinic, gynecology outpatient clinics, and the community, more than half of the participants had never heard of an intrauterine device (IUD) and 97% had never used one, said Dr. Lisa Johnson of the adolescent medicine division of the Nassau (Bahamas) Department of Public Health.

The 20-minute, 44-item, semistructured interview assessed demographics, sexual history, contraceptive use and attitudes, and IUD knowledge and attitudes, Dr. Johnson said. The mean age of the respondents was 18.8 years. Nearly all (97%) of them were single, 58% were African American, and 39% were white. Approximately 84% of the group had ever been sexually active, with a mean age of 15.8 years at first sexual intercourse and a median of three lifetime partners. Among those who had ever had sex, 76% had ever been pregnant and 67% had ever had a sexually transmitted disease.

According to the survey results, 60% of the young women surveyed had never heard of an IUD, yet a majority of them “agreed” or “strongly agreed” that they would consider a birth control method that resulted in less painful (93%) and lighter (91%) periods and gave them control over when to stop (85%) and start it (80%), Dr. Johnson said. In addition, 61% reported being “willing” or “very willing” to use a birth control method that causes irregular vaginal bleeding if it was 99% effective at preventing pregnancy, she said.

However, only 30% of the respondents said they would consider a birth control method that involved placing a small plastic object in the uterus and only 27% said they would be interested in a device that had to be placed and removed by a health care provider, she noted.

An analysis of the survey responses showed that those who had heard of IUDs were significantly more likely to be older and sexually active compared with those who had not heard of them, and they were more likely to be white, Dr. Johnson said. “There was no association between knowledge of IUDs and ever being pregnant, parity, ever having a sexually transmitted disease, or number of sexual partners,” she said.

Following participation in the survey, each of the young women was given a 2-minute description and demonstration of IUDs, followed by a test of knowledge about the birth control method. “After the IUD demonstration, knowledge scores were significantly increased,” said Dr. Johnson. “Nearly 65% of the young women liked the idea of an IUD for themselves, while 12% were neutral and 24% said they disliked the idea,” she reported.

Those who liked the IUDs for themselves were significantly more likely to be sexually active than those who did not or who were neutral, Dr. Johnson reported. “There was no association between liking IUDs and age, race, ever being pregnant, parity, ever having a sexually transmitted disease or number of sexual partners,” she said.

Among the young women who liked the idea of an IUD, the most appealing characteristics were that it did not require them to remember to use it every day, that it would not affect their ability to have children in the future, and that it did not need to be remembered with each sex act, Dr. Johnson said.

The findings suggest that “young women may not be getting sufficient information on all of the contraceptive options available to them, particularly IUDs,” said Dr. Johnson. “Clinicians should discuss IUDs as an option with these patients and demonstrate how they are used in order for [patients] to make an informed decision about contraception.”

ATLANTA — Knowledge of intrauterine devices among adolescent and young adult women is limited, according to a study presented at the annual meeting of the North American Society for Pediatric and Adolescent Gynecology.

In a cross-sectional survey of 144 young women between the ages of 14 and 24 recruited from an adolescent gynecology clinic, gynecology outpatient clinics, and the community, more than half of the participants had never heard of an intrauterine device (IUD) and 97% had never used one, said Dr. Lisa Johnson of the adolescent medicine division of the Nassau (Bahamas) Department of Public Health.

The 20-minute, 44-item, semistructured interview assessed demographics, sexual history, contraceptive use and attitudes, and IUD knowledge and attitudes, Dr. Johnson said. The mean age of the respondents was 18.8 years. Nearly all (97%) of them were single, 58% were African American, and 39% were white. Approximately 84% of the group had ever been sexually active, with a mean age of 15.8 years at first sexual intercourse and a median of three lifetime partners. Among those who had ever had sex, 76% had ever been pregnant and 67% had ever had a sexually transmitted disease.

According to the survey results, 60% of the young women surveyed had never heard of an IUD, yet a majority of them “agreed” or “strongly agreed” that they would consider a birth control method that resulted in less painful (93%) and lighter (91%) periods and gave them control over when to stop (85%) and start it (80%), Dr. Johnson said. In addition, 61% reported being “willing” or “very willing” to use a birth control method that causes irregular vaginal bleeding if it was 99% effective at preventing pregnancy, she said.

However, only 30% of the respondents said they would consider a birth control method that involved placing a small plastic object in the uterus and only 27% said they would be interested in a device that had to be placed and removed by a health care provider, she noted.

An analysis of the survey responses showed that those who had heard of IUDs were significantly more likely to be older and sexually active compared with those who had not heard of them, and they were more likely to be white, Dr. Johnson said. “There was no association between knowledge of IUDs and ever being pregnant, parity, ever having a sexually transmitted disease, or number of sexual partners,” she said.

Following participation in the survey, each of the young women was given a 2-minute description and demonstration of IUDs, followed by a test of knowledge about the birth control method. “After the IUD demonstration, knowledge scores were significantly increased,” said Dr. Johnson. “Nearly 65% of the young women liked the idea of an IUD for themselves, while 12% were neutral and 24% said they disliked the idea,” she reported.

Those who liked the IUDs for themselves were significantly more likely to be sexually active than those who did not or who were neutral, Dr. Johnson reported. “There was no association between liking IUDs and age, race, ever being pregnant, parity, ever having a sexually transmitted disease or number of sexual partners,” she said.

Among the young women who liked the idea of an IUD, the most appealing characteristics were that it did not require them to remember to use it every day, that it would not affect their ability to have children in the future, and that it did not need to be remembered with each sex act, Dr. Johnson said.

The findings suggest that “young women may not be getting sufficient information on all of the contraceptive options available to them, particularly IUDs,” said Dr. Johnson. “Clinicians should discuss IUDs as an option with these patients and demonstrate how they are used in order for [patients] to make an informed decision about contraception.”

ATLANTA — Advanced provision of emergency contraceptive pills did not significantly decrease the rapid repeat pregnancy rate in a racially and ethnically diverse group of adolescents enrolled in a Colorado study “because many of the young women failed to use them,” Jeanelle Sheeder reported at the annual meeting of the North American Society for Pediatric and Adolescent Gynecology.

To better understand why emergency contraceptive pills (ECPs) have not had the anticipated impact on teen pregnancy, Ms. Sheeder and colleagues in the department of pediatrics at the University of Colorado Health Sciences Center in Denver assessed the sexual and contraceptive behavior of 382 predominantly primiparous 14- to 21-year-old women in that institution's adolescent maternity program. At the time of enrollment, all of the young women expressed a desire not to get pregnant again for at least 2 years and understood the necessity of using abstinence or effective contraceptives to do so.

Additionally, each participant received either a prescription for or a packet of ECPs, with no limit on refills, Ms. Sheeder said.

At each clinic visit, conducted at 6- to 8-week intervals through the sixth postpartum month, the study participants completed a questionnaire that asked about their interval sexual and contraceptive behavior, Ms. Sheeder said.

The outcome measures for the study were episodes of unprotected intercourse, ECP use, a composite index for group pregnancy risk computed by summing the products of the method-specific failure rates and the proportion of sexually active teenagers using each method, and unwanted conception, she reported.

Controlling for age, race/ethnicity, education level, reason for not using contraception before conception, future family plans, and postpartum month, the investigators also analyzed the use of ECP in relation to unprotected intercourse, whereby a 1:1 ratio was considered appropriate ECP use. A ratio of less than 1:1 was deemed underuse and a ratio greater than 1:1 was considered augmented use, she said.

During the course of the study, 44% of the young mothers had episodes of unprotected intercourse, said Ms. Sheeder, noting that “of these women, 15% reported one episode of unprotected intercourse, 24% had two to four episodes, and 5% had more than four episodes.”

While more than half (54%) of the women reporting unprotected intercourse used ECPs, only 28% used them appropriately, Ms. Sheeder noted. “They were underutilized by 65% of the women and 7% engaged in augmented use,” she said.

The prevalence of unprotected intercourse and ECP use did not vary significantly in relation to age, race/ethnicity, education level and participation, reason for not using contraception before conception, future family plans, or postpartum month, Ms. Sheeder reported.

The group pregnancy risk did not change during the study period, she said.

A total of 19 pregnancies occurred during the study period. “Teens who experienced unwanted pregnancies did not engage in more unprotected intercourse or ECP underuse than those who did not,” Ms. Sheeder noted.

Of the 19 pregnancies, 9 were in young women who reported using some contraceptive method during the study period but their contraceptive use was inconsistent or incorrect, said Ms. Sheeder. The remaining 10 pregnancies were not attributable to unrecognized contraceptive or ECP failure, she said.

ATLANTA — Advanced provision of emergency contraceptive pills did not significantly decrease the rapid repeat pregnancy rate in a racially and ethnically diverse group of adolescents enrolled in a Colorado study “because many of the young women failed to use them,” Jeanelle Sheeder reported at the annual meeting of the North American Society for Pediatric and Adolescent Gynecology.

To better understand why emergency contraceptive pills (ECPs) have not had the anticipated impact on teen pregnancy, Ms. Sheeder and colleagues in the department of pediatrics at the University of Colorado Health Sciences Center in Denver assessed the sexual and contraceptive behavior of 382 predominantly primiparous 14- to 21-year-old women in that institution's adolescent maternity program. At the time of enrollment, all of the young women expressed a desire not to get pregnant again for at least 2 years and understood the necessity of using abstinence or effective contraceptives to do so.

Additionally, each participant received either a prescription for or a packet of ECPs, with no limit on refills, Ms. Sheeder said.

At each clinic visit, conducted at 6- to 8-week intervals through the sixth postpartum month, the study participants completed a questionnaire that asked about their interval sexual and contraceptive behavior, Ms. Sheeder said.

The outcome measures for the study were episodes of unprotected intercourse, ECP use, a composite index for group pregnancy risk computed by summing the products of the method-specific failure rates and the proportion of sexually active teenagers using each method, and unwanted conception, she reported.

Controlling for age, race/ethnicity, education level, reason for not using contraception before conception, future family plans, and postpartum month, the investigators also analyzed the use of ECP in relation to unprotected intercourse, whereby a 1:1 ratio was considered appropriate ECP use. A ratio of less than 1:1 was deemed underuse and a ratio greater than 1:1 was considered augmented use, she said.

During the course of the study, 44% of the young mothers had episodes of unprotected intercourse, said Ms. Sheeder, noting that “of these women, 15% reported one episode of unprotected intercourse, 24% had two to four episodes, and 5% had more than four episodes.”

While more than half (54%) of the women reporting unprotected intercourse used ECPs, only 28% used them appropriately, Ms. Sheeder noted. “They were underutilized by 65% of the women and 7% engaged in augmented use,” she said.

The prevalence of unprotected intercourse and ECP use did not vary significantly in relation to age, race/ethnicity, education level and participation, reason for not using contraception before conception, future family plans, or postpartum month, Ms. Sheeder reported.

The group pregnancy risk did not change during the study period, she said.

A total of 19 pregnancies occurred during the study period. “Teens who experienced unwanted pregnancies did not engage in more unprotected intercourse or ECP underuse than those who did not,” Ms. Sheeder noted.

Of the 19 pregnancies, 9 were in young women who reported using some contraceptive method during the study period but their contraceptive use was inconsistent or incorrect, said Ms. Sheeder. The remaining 10 pregnancies were not attributable to unrecognized contraceptive or ECP failure, she said.

ATLANTA — Advanced provision of emergency contraceptive pills did not significantly decrease the rapid repeat pregnancy rate in a racially and ethnically diverse group of adolescents enrolled in a Colorado study “because many of the young women failed to use them,” Jeanelle Sheeder reported at the annual meeting of the North American Society for Pediatric and Adolescent Gynecology.

To better understand why emergency contraceptive pills (ECPs) have not had the anticipated impact on teen pregnancy, Ms. Sheeder and colleagues in the department of pediatrics at the University of Colorado Health Sciences Center in Denver assessed the sexual and contraceptive behavior of 382 predominantly primiparous 14- to 21-year-old women in that institution's adolescent maternity program. At the time of enrollment, all of the young women expressed a desire not to get pregnant again for at least 2 years and understood the necessity of using abstinence or effective contraceptives to do so.

Additionally, each participant received either a prescription for or a packet of ECPs, with no limit on refills, Ms. Sheeder said.

At each clinic visit, conducted at 6- to 8-week intervals through the sixth postpartum month, the study participants completed a questionnaire that asked about their interval sexual and contraceptive behavior, Ms. Sheeder said.

The outcome measures for the study were episodes of unprotected intercourse, ECP use, a composite index for group pregnancy risk computed by summing the products of the method-specific failure rates and the proportion of sexually active teenagers using each method, and unwanted conception, she reported.

Controlling for age, race/ethnicity, education level, reason for not using contraception before conception, future family plans, and postpartum month, the investigators also analyzed the use of ECP in relation to unprotected intercourse, whereby a 1:1 ratio was considered appropriate ECP use. A ratio of less than 1:1 was deemed underuse and a ratio greater than 1:1 was considered augmented use, she said.

During the course of the study, 44% of the young mothers had episodes of unprotected intercourse, said Ms. Sheeder, noting that “of these women, 15% reported one episode of unprotected intercourse, 24% had two to four episodes, and 5% had more than four episodes.”

While more than half (54%) of the women reporting unprotected intercourse used ECPs, only 28% used them appropriately, Ms. Sheeder noted. “They were underutilized by 65% of the women and 7% engaged in augmented use,” she said.

The prevalence of unprotected intercourse and ECP use did not vary significantly in relation to age, race/ethnicity, education level and participation, reason for not using contraception before conception, future family plans, or postpartum month, Ms. Sheeder reported.

The group pregnancy risk did not change during the study period, she said.

A total of 19 pregnancies occurred during the study period. “Teens who experienced unwanted pregnancies did not engage in more unprotected intercourse or ECP underuse than those who did not,” Ms. Sheeder noted.

Of the 19 pregnancies, 9 were in young women who reported using some contraceptive method during the study period but their contraceptive use was inconsistent or incorrect, said Ms. Sheeder. The remaining 10 pregnancies were not attributable to unrecognized contraceptive or ECP failure, she said.

BOSTON — Intracranial plaques and stenoses are highly prevalent in fatal ischemic stroke patients, according to the results of a study presented at the annual meeting of the American Academy of Neurology.

The findings suggest that intracranial atherosclerosis might not be as rare a condition as previously believed and that intracranial stenoses in particular might be the cause of fatal brain infarction in many cases, according to Dr. Mikael Mazighi of the Hôpital Lariboisière in Paris.

Dr. Mazighi and colleagues performed a systematic analysis of intracranial and extracranial arteries, the aortic arch, and the heart in 339 consecutive autopsies of ischemic stroke patients. The analysis also included clinical history, risk factors, imaging data, and general autopsy reports for each patient. The control group comprised hemorrhagic stroke patients.

The prevalence rates of intracranial plaques and stenoses in the brain infarction patients were significantly higher, at 62% and 42%, respectively, compared with 49% and 18% in patients with brain hemorrhage, Dr. Mazighi reported. Additionally, in more than 5% of the ischemic stroke victims with at least one stenosis of 30%–75%, the stenosis was considered the cause of the infarction, he said.

Diabetes and male gender were significantly associated with intracranial plaques and stenosis in multivariate analysis, said Dr. Mazighi. In addition, a history of previous myocardial infarction was significantly associated with intracranial plaques, and previous stroke was associated with intracranial stenosis, he said.

The high prevalence of the intracranial atherosclerotic findings and the apparent causal role of moderate stenoses in fatal ischemic stroke observed in this investigation suggest that the prevalence of intracranial atherosclerosis is likely underestimated, probably because of the lack of appropriate diagnostic procedures, said Dr. Mazighi. The frequency and role of intracranial artery plaques in stroke patients should be reevaluated using new intravital imaging techniques, he said.

BOSTON — Intracranial plaques and stenoses are highly prevalent in fatal ischemic stroke patients, according to the results of a study presented at the annual meeting of the American Academy of Neurology.

The findings suggest that intracranial atherosclerosis might not be as rare a condition as previously believed and that intracranial stenoses in particular might be the cause of fatal brain infarction in many cases, according to Dr. Mikael Mazighi of the Hôpital Lariboisière in Paris.

Dr. Mazighi and colleagues performed a systematic analysis of intracranial and extracranial arteries, the aortic arch, and the heart in 339 consecutive autopsies of ischemic stroke patients. The analysis also included clinical history, risk factors, imaging data, and general autopsy reports for each patient. The control group comprised hemorrhagic stroke patients.

The prevalence rates of intracranial plaques and stenoses in the brain infarction patients were significantly higher, at 62% and 42%, respectively, compared with 49% and 18% in patients with brain hemorrhage, Dr. Mazighi reported. Additionally, in more than 5% of the ischemic stroke victims with at least one stenosis of 30%–75%, the stenosis was considered the cause of the infarction, he said.

Diabetes and male gender were significantly associated with intracranial plaques and stenosis in multivariate analysis, said Dr. Mazighi. In addition, a history of previous myocardial infarction was significantly associated with intracranial plaques, and previous stroke was associated with intracranial stenosis, he said.

The high prevalence of the intracranial atherosclerotic findings and the apparent causal role of moderate stenoses in fatal ischemic stroke observed in this investigation suggest that the prevalence of intracranial atherosclerosis is likely underestimated, probably because of the lack of appropriate diagnostic procedures, said Dr. Mazighi. The frequency and role of intracranial artery plaques in stroke patients should be reevaluated using new intravital imaging techniques, he said.

BOSTON — Intracranial plaques and stenoses are highly prevalent in fatal ischemic stroke patients, according to the results of a study presented at the annual meeting of the American Academy of Neurology.

The findings suggest that intracranial atherosclerosis might not be as rare a condition as previously believed and that intracranial stenoses in particular might be the cause of fatal brain infarction in many cases, according to Dr. Mikael Mazighi of the Hôpital Lariboisière in Paris.

Dr. Mazighi and colleagues performed a systematic analysis of intracranial and extracranial arteries, the aortic arch, and the heart in 339 consecutive autopsies of ischemic stroke patients. The analysis also included clinical history, risk factors, imaging data, and general autopsy reports for each patient. The control group comprised hemorrhagic stroke patients.

The prevalence rates of intracranial plaques and stenoses in the brain infarction patients were significantly higher, at 62% and 42%, respectively, compared with 49% and 18% in patients with brain hemorrhage, Dr. Mazighi reported. Additionally, in more than 5% of the ischemic stroke victims with at least one stenosis of 30%–75%, the stenosis was considered the cause of the infarction, he said.

Diabetes and male gender were significantly associated with intracranial plaques and stenosis in multivariate analysis, said Dr. Mazighi. In addition, a history of previous myocardial infarction was significantly associated with intracranial plaques, and previous stroke was associated with intracranial stenosis, he said.

The high prevalence of the intracranial atherosclerotic findings and the apparent causal role of moderate stenoses in fatal ischemic stroke observed in this investigation suggest that the prevalence of intracranial atherosclerosis is likely underestimated, probably because of the lack of appropriate diagnostic procedures, said Dr. Mazighi. The frequency and role of intracranial artery plaques in stroke patients should be reevaluated using new intravital imaging techniques, he said.

ATLANTA — Current cervical cancer screening guidelines may be insufficient for a subgroup of adolescent girls with high-grade dysplasia who are at risk for the development of invasive lesions, Dr. Michelle Vichnin reported at the annual meeting of the North American Society for Pediatric and Adolescent Gynecology.

The American Cancer Society and the American College of Obstetricians and Gynecologists recommend that cervical cancer screening should begin approximately 3 years after the first vaginal intercourse, but no later than 21 years of age.

In light of recent data suggesting that waiting even 3 years may be too long in adolescents living in a high-risk urban setting, Dr. Vichnin and colleagues at the Hospital of the University of Pennsylvania in Philadelphia conducted a retrospective study to quantify how many adolescent girls aged 21 years or younger who were evaluated at the hospital's colposcopy clinic over a 2-year period developed high-grade dysplasia on pap smears and cervical biopsies, and to determine whether the lesions would have gone undetected if the recommended screening guidelines had been strictly followed.

The investigators reviewed the charts of 275 adolescent girls for demographic information, including age, race, gravidity and parity, history of prior sexually transmitted diseases, age at first vaginal intercourse, and age at first abnormal Pap smear. They then compiled these data along with the Pap smear, colposcopy, and biopsy results, said Dr. Vichnin. “Records that did not have age at first intercourse were considered incomplete and were not included in the final analysis,” she said.

Of the 275 patient charts included in the initial review, only 195 had complete information for analysis. Of these, 96% of the patients were African American, 88% had at least one pregnancy, and 73% had given birth to at least one child, Dr. Vichnin reported. The average age at first intercourse was 14.9 years and the average age at first abnormal Pap smear was 18 years. Prior history of sexually transmitted diseases was confirmed in 62% of the patients, she said.

The final data analysis showed that 34 of the 195 young women had biopsy-proven cervical intraepithelial neoplasia grade 2 or 3 (CIN2, CIN3) disease. Of these 34 patients, 9 developed high-grade disease in less than 3 years from initiation of intercourse and 4 developed high-grade disease at 3 years, said Dr. Vichnin. “This is a significant number of patients with biopsy-confirmed high-grade disease,” said Dr. Vichnin.

For the purposes of this investigation, “we considered patients lost to follow-up if they were not seen within 12 months after initial presentation to the colposcopy clinic,” Dr. Vichnin said. “We have a very good follow-up protocol that includes letters, certified letters, and phone calls by nurses dedicated specifically to the colposcopy clinic, so if patients didn't come back, it isn't because we didn't try to get them in.” Patients were deemed noncompliant with treatment if they failed to initiate treatment or follow-up evaluation within 3 months, she said.

Of the girls diagnosed with CIN2 or CIN3 disease, “nearly half [49%] were either lost to follow-up or noncompliant with treatment recommendations,” said Dr. Vichnin. “This leaves a large number of girls who are vulnerable to progression to cervical cancer untreated.”

The findings show “a small but significant rate of progression to high-grade disease within 3 years of initiation of intercourse among these urban adolescent females and a high rate of failure to follow up on treatment recommendations,” said Dr. Vichnin. “We're concerned that the 3-year waiting period for these high-risk adolescents is potentially dangerous, and so we are advocating for closer scrutiny in this population to guard against the development of invasive lesions,” Additionally, she said, “further studies are needed to confirm our findings and to appropriately amend current guidelines for this unique population.”

ATLANTA — Current cervical cancer screening guidelines may be insufficient for a subgroup of adolescent girls with high-grade dysplasia who are at risk for the development of invasive lesions, Dr. Michelle Vichnin reported at the annual meeting of the North American Society for Pediatric and Adolescent Gynecology.

The American Cancer Society and the American College of Obstetricians and Gynecologists recommend that cervical cancer screening should begin approximately 3 years after the first vaginal intercourse, but no later than 21 years of age.

In light of recent data suggesting that waiting even 3 years may be too long in adolescents living in a high-risk urban setting, Dr. Vichnin and colleagues at the Hospital of the University of Pennsylvania in Philadelphia conducted a retrospective study to quantify how many adolescent girls aged 21 years or younger who were evaluated at the hospital's colposcopy clinic over a 2-year period developed high-grade dysplasia on pap smears and cervical biopsies, and to determine whether the lesions would have gone undetected if the recommended screening guidelines had been strictly followed.

The investigators reviewed the charts of 275 adolescent girls for demographic information, including age, race, gravidity and parity, history of prior sexually transmitted diseases, age at first vaginal intercourse, and age at first abnormal Pap smear. They then compiled these data along with the Pap smear, colposcopy, and biopsy results, said Dr. Vichnin. “Records that did not have age at first intercourse were considered incomplete and were not included in the final analysis,” she said.

Of the 275 patient charts included in the initial review, only 195 had complete information for analysis. Of these, 96% of the patients were African American, 88% had at least one pregnancy, and 73% had given birth to at least one child, Dr. Vichnin reported. The average age at first intercourse was 14.9 years and the average age at first abnormal Pap smear was 18 years. Prior history of sexually transmitted diseases was confirmed in 62% of the patients, she said.

The final data analysis showed that 34 of the 195 young women had biopsy-proven cervical intraepithelial neoplasia grade 2 or 3 (CIN2, CIN3) disease. Of these 34 patients, 9 developed high-grade disease in less than 3 years from initiation of intercourse and 4 developed high-grade disease at 3 years, said Dr. Vichnin. “This is a significant number of patients with biopsy-confirmed high-grade disease,” said Dr. Vichnin.

For the purposes of this investigation, “we considered patients lost to follow-up if they were not seen within 12 months after initial presentation to the colposcopy clinic,” Dr. Vichnin said. “We have a very good follow-up protocol that includes letters, certified letters, and phone calls by nurses dedicated specifically to the colposcopy clinic, so if patients didn't come back, it isn't because we didn't try to get them in.” Patients were deemed noncompliant with treatment if they failed to initiate treatment or follow-up evaluation within 3 months, she said.

Of the girls diagnosed with CIN2 or CIN3 disease, “nearly half [49%] were either lost to follow-up or noncompliant with treatment recommendations,” said Dr. Vichnin. “This leaves a large number of girls who are vulnerable to progression to cervical cancer untreated.”

The findings show “a small but significant rate of progression to high-grade disease within 3 years of initiation of intercourse among these urban adolescent females and a high rate of failure to follow up on treatment recommendations,” said Dr. Vichnin. “We're concerned that the 3-year waiting period for these high-risk adolescents is potentially dangerous, and so we are advocating for closer scrutiny in this population to guard against the development of invasive lesions,” Additionally, she said, “further studies are needed to confirm our findings and to appropriately amend current guidelines for this unique population.”

ATLANTA — Current cervical cancer screening guidelines may be insufficient for a subgroup of adolescent girls with high-grade dysplasia who are at risk for the development of invasive lesions, Dr. Michelle Vichnin reported at the annual meeting of the North American Society for Pediatric and Adolescent Gynecology.

The American Cancer Society and the American College of Obstetricians and Gynecologists recommend that cervical cancer screening should begin approximately 3 years after the first vaginal intercourse, but no later than 21 years of age.

In light of recent data suggesting that waiting even 3 years may be too long in adolescents living in a high-risk urban setting, Dr. Vichnin and colleagues at the Hospital of the University of Pennsylvania in Philadelphia conducted a retrospective study to quantify how many adolescent girls aged 21 years or younger who were evaluated at the hospital's colposcopy clinic over a 2-year period developed high-grade dysplasia on pap smears and cervical biopsies, and to determine whether the lesions would have gone undetected if the recommended screening guidelines had been strictly followed.

The investigators reviewed the charts of 275 adolescent girls for demographic information, including age, race, gravidity and parity, history of prior sexually transmitted diseases, age at first vaginal intercourse, and age at first abnormal Pap smear. They then compiled these data along with the Pap smear, colposcopy, and biopsy results, said Dr. Vichnin. “Records that did not have age at first intercourse were considered incomplete and were not included in the final analysis,” she said.

Of the 275 patient charts included in the initial review, only 195 had complete information for analysis. Of these, 96% of the patients were African American, 88% had at least one pregnancy, and 73% had given birth to at least one child, Dr. Vichnin reported. The average age at first intercourse was 14.9 years and the average age at first abnormal Pap smear was 18 years. Prior history of sexually transmitted diseases was confirmed in 62% of the patients, she said.

The final data analysis showed that 34 of the 195 young women had biopsy-proven cervical intraepithelial neoplasia grade 2 or 3 (CIN2, CIN3) disease. Of these 34 patients, 9 developed high-grade disease in less than 3 years from initiation of intercourse and 4 developed high-grade disease at 3 years, said Dr. Vichnin. “This is a significant number of patients with biopsy-confirmed high-grade disease,” said Dr. Vichnin.

For the purposes of this investigation, “we considered patients lost to follow-up if they were not seen within 12 months after initial presentation to the colposcopy clinic,” Dr. Vichnin said. “We have a very good follow-up protocol that includes letters, certified letters, and phone calls by nurses dedicated specifically to the colposcopy clinic, so if patients didn't come back, it isn't because we didn't try to get them in.” Patients were deemed noncompliant with treatment if they failed to initiate treatment or follow-up evaluation within 3 months, she said.

Of the girls diagnosed with CIN2 or CIN3 disease, “nearly half [49%] were either lost to follow-up or noncompliant with treatment recommendations,” said Dr. Vichnin. “This leaves a large number of girls who are vulnerable to progression to cervical cancer untreated.”

The findings show “a small but significant rate of progression to high-grade disease within 3 years of initiation of intercourse among these urban adolescent females and a high rate of failure to follow up on treatment recommendations,” said Dr. Vichnin. “We're concerned that the 3-year waiting period for these high-risk adolescents is potentially dangerous, and so we are advocating for closer scrutiny in this population to guard against the development of invasive lesions,” Additionally, she said, “further studies are needed to confirm our findings and to appropriately amend current guidelines for this unique population.”

A projected shortage of the quadrivalent measles-mumps-rubella-varicella vaccine means that children who require immunization for these diseases will need to get two shots instead of the single combination vaccine until supplies of the latter are replenished, according to the Centers for Disease Control and Prevention.

The quadrivalent vaccine (ProQuad) shortage is expected to begin in July, although actual timing will depend on market demand, and last at least through the end of 2007 (MMWR 2007 May 11;56:453).

ProQuad's manufacturer, Merck & Co., is attributing the shortfall to lower-than-expected amounts of varicella zoster virus (VZV) in its recent batch of bulk vaccine.

Merck notified the CDC earlier this year of its intent to use its available supply of VZV in the production of its varicella-only vaccine (Varivax) and its zoster vaccine (Zostavax) and to temporarily halt the production of ProQuad.

In anticipation of the shortage, Merck is requesting that physicians begin transitioning from the quadrivalent vaccine to the measles-mumps-rubella vaccine (MMR-II) and the varicella vaccine.

The company expects to have adequate supplies of both of the latter vaccines to fully implement the recommended immunization schedules, according to the notice.

“This will allow for continued use of varicella vaccine for all age groups, including the routine two-dose schedule for children aged 12–15 months and 4–6 years, catch-up vaccination with the second dose for children or adolescents who received only one dose, and vaccination with two doses for other children, adolescents, and adults without evidence of immunity,” the notice said.

Additionally, the company expects to have an adequate supply of zoster vaccine for routine vaccination of adults who are aged 60 years and over.

A projected shortage of the quadrivalent measles-mumps-rubella-varicella vaccine means that children who require immunization for these diseases will need to get two shots instead of the single combination vaccine until supplies of the latter are replenished, according to the Centers for Disease Control and Prevention.

The quadrivalent vaccine (ProQuad) shortage is expected to begin in July, although actual timing will depend on market demand, and last at least through the end of 2007 (MMWR 2007 May 11;56:453).

ProQuad's manufacturer, Merck & Co., is attributing the shortfall to lower-than-expected amounts of varicella zoster virus (VZV) in its recent batch of bulk vaccine.

Merck notified the CDC earlier this year of its intent to use its available supply of VZV in the production of its varicella-only vaccine (Varivax) and its zoster vaccine (Zostavax) and to temporarily halt the production of ProQuad.

In anticipation of the shortage, Merck is requesting that physicians begin transitioning from the quadrivalent vaccine to the measles-mumps-rubella vaccine (MMR-II) and the varicella vaccine.

The company expects to have adequate supplies of both of the latter vaccines to fully implement the recommended immunization schedules, according to the notice.

“This will allow for continued use of varicella vaccine for all age groups, including the routine two-dose schedule for children aged 12–15 months and 4–6 years, catch-up vaccination with the second dose for children or adolescents who received only one dose, and vaccination with two doses for other children, adolescents, and adults without evidence of immunity,” the notice said.

Additionally, the company expects to have an adequate supply of zoster vaccine for routine vaccination of adults who are aged 60 years and over.

A projected shortage of the quadrivalent measles-mumps-rubella-varicella vaccine means that children who require immunization for these diseases will need to get two shots instead of the single combination vaccine until supplies of the latter are replenished, according to the Centers for Disease Control and Prevention.

The quadrivalent vaccine (ProQuad) shortage is expected to begin in July, although actual timing will depend on market demand, and last at least through the end of 2007 (MMWR 2007 May 11;56:453).

ProQuad's manufacturer, Merck & Co., is attributing the shortfall to lower-than-expected amounts of varicella zoster virus (VZV) in its recent batch of bulk vaccine.

Merck notified the CDC earlier this year of its intent to use its available supply of VZV in the production of its varicella-only vaccine (Varivax) and its zoster vaccine (Zostavax) and to temporarily halt the production of ProQuad.

In anticipation of the shortage, Merck is requesting that physicians begin transitioning from the quadrivalent vaccine to the measles-mumps-rubella vaccine (MMR-II) and the varicella vaccine.

The company expects to have adequate supplies of both of the latter vaccines to fully implement the recommended immunization schedules, according to the notice.

“This will allow for continued use of varicella vaccine for all age groups, including the routine two-dose schedule for children aged 12–15 months and 4–6 years, catch-up vaccination with the second dose for children or adolescents who received only one dose, and vaccination with two doses for other children, adolescents, and adults without evidence of immunity,” the notice said.

Additionally, the company expects to have an adequate supply of zoster vaccine for routine vaccination of adults who are aged 60 years and over.

BOSTON – Positive parenting practices can minimize the impact that negative peer influence has on early-maturing girls and thus can reduce the risk of externalizing problems, results of a study have shown.

For this reason, psychosocial interventions targeting at-risk girls should focus on the parent-family relationship, Sylvie Mrug, Ph.D., reported in a poster presentation at a meeting of the Society for Research in Child Development.

Previous studies have shown that early puberty in girls predicts disruptive behavior, delinquency, and earlier initiation of substance use, and that psychological immaturity and affiliations with older, more deviant peers exacerbate these problems, said Dr. Mrug of the University of Alabama, Birmingham.

To determine the degree to which parenting practices buffer or amplify these effects of early puberty, Dr. Mrug and colleagues analyzed data on 330 fifth grade girls from the three metropolitan areas who participated in phase I of Healthy Passages, a multisite longitudinal study of adolescent health and behavior. The mean age of the girls in the study was 11.25 years. Thirty-nine percent were African American, 35% were Hispanic, and 19% were white; the remaining participants were other ethnicities.

Outcome measures included onset of menarche; caregiver-reported parental monitoring; self-reported aggression (physical, nonphysical, relational); delinquency (fighting, running away from home, truancy); maternal nurturance; and communication with parents about anger, aggression, smoking, puberty, and sex.

As in previous studies, significant, independent associations were observed between early maturation and delinquency plus all three types of aggression, according to Dr. Mrug. The results of multiple hierarchical regression analyses showed that parental monitoring, maternal nurturance, and effective communication each moderated this link.

“Early maturation predicted delinquency at low levels of monitoring, but not when parental monitoring was high,” Dr. Mrug said. “Early maturation predicted higher levels of aggression only when combined with low levels of nurturance, and [early maturation] predicted higher levels of aggression only when girls reported lower levels of parental communication,” she said.

From these results, “we can conclude that positive parenting offers some protection against the various externalizing problems associated with early puberty in girls,” said Dr. Mrug. It's possible that parental monitoring may limit affiliations with more deviant peers and opportunities for delinquent behavior, and that parental nurturance and communication “may improve coping and refusal skills, and thus decrease susceptibility to negative peer influence.”

Interventions that promote and encourage open communication with parents as well as those that foster greater parental involvement are likely to be most successful, Dr. Mrug suggested.

BOSTON – Positive parenting practices can minimize the impact that negative peer influence has on early-maturing girls and thus can reduce the risk of externalizing problems, results of a study have shown.

For this reason, psychosocial interventions targeting at-risk girls should focus on the parent-family relationship, Sylvie Mrug, Ph.D., reported in a poster presentation at a meeting of the Society for Research in Child Development.

Previous studies have shown that early puberty in girls predicts disruptive behavior, delinquency, and earlier initiation of substance use, and that psychological immaturity and affiliations with older, more deviant peers exacerbate these problems, said Dr. Mrug of the University of Alabama, Birmingham.

To determine the degree to which parenting practices buffer or amplify these effects of early puberty, Dr. Mrug and colleagues analyzed data on 330 fifth grade girls from the three metropolitan areas who participated in phase I of Healthy Passages, a multisite longitudinal study of adolescent health and behavior. The mean age of the girls in the study was 11.25 years. Thirty-nine percent were African American, 35% were Hispanic, and 19% were white; the remaining participants were other ethnicities.

Outcome measures included onset of menarche; caregiver-reported parental monitoring; self-reported aggression (physical, nonphysical, relational); delinquency (fighting, running away from home, truancy); maternal nurturance; and communication with parents about anger, aggression, smoking, puberty, and sex.

As in previous studies, significant, independent associations were observed between early maturation and delinquency plus all three types of aggression, according to Dr. Mrug. The results of multiple hierarchical regression analyses showed that parental monitoring, maternal nurturance, and effective communication each moderated this link.

“Early maturation predicted delinquency at low levels of monitoring, but not when parental monitoring was high,” Dr. Mrug said. “Early maturation predicted higher levels of aggression only when combined with low levels of nurturance, and [early maturation] predicted higher levels of aggression only when girls reported lower levels of parental communication,” she said.

From these results, “we can conclude that positive parenting offers some protection against the various externalizing problems associated with early puberty in girls,” said Dr. Mrug. It's possible that parental monitoring may limit affiliations with more deviant peers and opportunities for delinquent behavior, and that parental nurturance and communication “may improve coping and refusal skills, and thus decrease susceptibility to negative peer influence.”

Interventions that promote and encourage open communication with parents as well as those that foster greater parental involvement are likely to be most successful, Dr. Mrug suggested.

BOSTON – Positive parenting practices can minimize the impact that negative peer influence has on early-maturing girls and thus can reduce the risk of externalizing problems, results of a study have shown.

For this reason, psychosocial interventions targeting at-risk girls should focus on the parent-family relationship, Sylvie Mrug, Ph.D., reported in a poster presentation at a meeting of the Society for Research in Child Development.

Previous studies have shown that early puberty in girls predicts disruptive behavior, delinquency, and earlier initiation of substance use, and that psychological immaturity and affiliations with older, more deviant peers exacerbate these problems, said Dr. Mrug of the University of Alabama, Birmingham.

To determine the degree to which parenting practices buffer or amplify these effects of early puberty, Dr. Mrug and colleagues analyzed data on 330 fifth grade girls from the three metropolitan areas who participated in phase I of Healthy Passages, a multisite longitudinal study of adolescent health and behavior. The mean age of the girls in the study was 11.25 years. Thirty-nine percent were African American, 35% were Hispanic, and 19% were white; the remaining participants were other ethnicities.

Outcome measures included onset of menarche; caregiver-reported parental monitoring; self-reported aggression (physical, nonphysical, relational); delinquency (fighting, running away from home, truancy); maternal nurturance; and communication with parents about anger, aggression, smoking, puberty, and sex.

As in previous studies, significant, independent associations were observed between early maturation and delinquency plus all three types of aggression, according to Dr. Mrug. The results of multiple hierarchical regression analyses showed that parental monitoring, maternal nurturance, and effective communication each moderated this link.

“Early maturation predicted delinquency at low levels of monitoring, but not when parental monitoring was high,” Dr. Mrug said. “Early maturation predicted higher levels of aggression only when combined with low levels of nurturance, and [early maturation] predicted higher levels of aggression only when girls reported lower levels of parental communication,” she said.

From these results, “we can conclude that positive parenting offers some protection against the various externalizing problems associated with early puberty in girls,” said Dr. Mrug. It's possible that parental monitoring may limit affiliations with more deviant peers and opportunities for delinquent behavior, and that parental nurturance and communication “may improve coping and refusal skills, and thus decrease susceptibility to negative peer influence.”

Interventions that promote and encourage open communication with parents as well as those that foster greater parental involvement are likely to be most successful, Dr. Mrug suggested.

BOSTON – Adolescents' beliefs in their own coping abilities can help mediate the psychosocial impact of relational victimization in school, results of a study have shown.

Students who can disengage themselves from the role of victim, who avoid self-blame, and who use active coping strategies–such as addressing problems or seeking help–are less vulnerable to the negative effects of peer behavior that is purposefully intended to damage social relationships, such as exclusion or rumor spreading, Puneet Singh reported in a poster presentation at the biennial meeting of the Society for Research in Child Development.

Such relational victimization by peers has been identified as a significant predictor of internalizing distress, including depression and social anxiety, among school-age children. Coping self-efficacy, which refers to an individual's belief in his or her ability to handle adversity, has consistently been shown to be central in an individual's ability to recover from distressing events, said Ms. Singh, a doctoral candidate at Macquarie (Sydney) University.

To examine the relationship between coping strategies and the negative outcomes of relational victimization in adolescents, Ms. Singh and her colleagues considered the experiences of 2,162 predominantly white middle-class children recruited from 18 schools and four grades (sixth to ninth). All of the students completed a three-item peer relational victimization survey and a coping self-efficacy questionnaire that included items relating to active coping strategies, avoiding negative construal (self-blame), victim role disengagement, positive construal, and avoiding aggressive behavior.

In addition, the investigators measured social anxiety and depression using the Social Anxiety Scale for Adolescents (SAS-A) and the Center for Epidemiological Studies for Depression Scale for Children (CES-DC), and they conducted hierarchical multiple regression analyses to examine the contribution of coping self-efficacy in predicting social anxiety and depression scores.

The results showed that relational victimization predicted both depression and social anxiety, Ms. Singh said.

When the models were controlled for age, gender, and relational victimization, coping efficacy was associated with an 18% reduction in social anxiety levels and a 9% reduction in depression scores, she said.

“A student's efficacy for victim role disengagement, avoiding self-blame, and active coping mediated the relationship between relational victimization and both social anxiety and depression,” Ms. Singh noted.

Teaching children “to avoid blaming themselves and to develop and practice active coping strategies, including problem solving, support seeking, conflict resolution, and assertiveness should be central to intervention efforts,” she said.

BOSTON – Adolescents' beliefs in their own coping abilities can help mediate the psychosocial impact of relational victimization in school, results of a study have shown.

Students who can disengage themselves from the role of victim, who avoid self-blame, and who use active coping strategies–such as addressing problems or seeking help–are less vulnerable to the negative effects of peer behavior that is purposefully intended to damage social relationships, such as exclusion or rumor spreading, Puneet Singh reported in a poster presentation at the biennial meeting of the Society for Research in Child Development.

Such relational victimization by peers has been identified as a significant predictor of internalizing distress, including depression and social anxiety, among school-age children. Coping self-efficacy, which refers to an individual's belief in his or her ability to handle adversity, has consistently been shown to be central in an individual's ability to recover from distressing events, said Ms. Singh, a doctoral candidate at Macquarie (Sydney) University.

To examine the relationship between coping strategies and the negative outcomes of relational victimization in adolescents, Ms. Singh and her colleagues considered the experiences of 2,162 predominantly white middle-class children recruited from 18 schools and four grades (sixth to ninth). All of the students completed a three-item peer relational victimization survey and a coping self-efficacy questionnaire that included items relating to active coping strategies, avoiding negative construal (self-blame), victim role disengagement, positive construal, and avoiding aggressive behavior.

In addition, the investigators measured social anxiety and depression using the Social Anxiety Scale for Adolescents (SAS-A) and the Center for Epidemiological Studies for Depression Scale for Children (CES-DC), and they conducted hierarchical multiple regression analyses to examine the contribution of coping self-efficacy in predicting social anxiety and depression scores.

The results showed that relational victimization predicted both depression and social anxiety, Ms. Singh said.

When the models were controlled for age, gender, and relational victimization, coping efficacy was associated with an 18% reduction in social anxiety levels and a 9% reduction in depression scores, she said.

“A student's efficacy for victim role disengagement, avoiding self-blame, and active coping mediated the relationship between relational victimization and both social anxiety and depression,” Ms. Singh noted.

Teaching children “to avoid blaming themselves and to develop and practice active coping strategies, including problem solving, support seeking, conflict resolution, and assertiveness should be central to intervention efforts,” she said.

BOSTON – Adolescents' beliefs in their own coping abilities can help mediate the psychosocial impact of relational victimization in school, results of a study have shown.

Students who can disengage themselves from the role of victim, who avoid self-blame, and who use active coping strategies–such as addressing problems or seeking help–are less vulnerable to the negative effects of peer behavior that is purposefully intended to damage social relationships, such as exclusion or rumor spreading, Puneet Singh reported in a poster presentation at the biennial meeting of the Society for Research in Child Development.

Such relational victimization by peers has been identified as a significant predictor of internalizing distress, including depression and social anxiety, among school-age children. Coping self-efficacy, which refers to an individual's belief in his or her ability to handle adversity, has consistently been shown to be central in an individual's ability to recover from distressing events, said Ms. Singh, a doctoral candidate at Macquarie (Sydney) University.

To examine the relationship between coping strategies and the negative outcomes of relational victimization in adolescents, Ms. Singh and her colleagues considered the experiences of 2,162 predominantly white middle-class children recruited from 18 schools and four grades (sixth to ninth). All of the students completed a three-item peer relational victimization survey and a coping self-efficacy questionnaire that included items relating to active coping strategies, avoiding negative construal (self-blame), victim role disengagement, positive construal, and avoiding aggressive behavior.

In addition, the investigators measured social anxiety and depression using the Social Anxiety Scale for Adolescents (SAS-A) and the Center for Epidemiological Studies for Depression Scale for Children (CES-DC), and they conducted hierarchical multiple regression analyses to examine the contribution of coping self-efficacy in predicting social anxiety and depression scores.

The results showed that relational victimization predicted both depression and social anxiety, Ms. Singh said.

When the models were controlled for age, gender, and relational victimization, coping efficacy was associated with an 18% reduction in social anxiety levels and a 9% reduction in depression scores, she said.

“A student's efficacy for victim role disengagement, avoiding self-blame, and active coping mediated the relationship between relational victimization and both social anxiety and depression,” Ms. Singh noted.

Teaching children “to avoid blaming themselves and to develop and practice active coping strategies, including problem solving, support seeking, conflict resolution, and assertiveness should be central to intervention efforts,” she said.

BOSTON — Prenatal smoking exposure is associated with significant increases in irritability among newborn girls but not boys, according to a study presented at a meeting of the Society for Research in Child Development.

The fact that significant differences were not evident among male infants in the large, epidemiologic sample might suggest early links to later gender-specific differences in behavioral outcomes, said lead author Rachel L. Paster, a research assistant in the Centers for Behavioral and Preventive Medicine, Brown University, Providence, R.I.

All of the infants exposed to prenatal smoking exhibited increases in muscle tension, compared with unexposed infants, Ms. Paster reported in a poster presentation.

Using data from the New England Cohort of the National Collaborative Perinatal Project (NCPP), Ms. Paster and colleagues examined the effects of smoking during pregnancy on the neurobehavior of male and female newborns in a sample of 991 healthy mother-infant pairs recruited between 1959 and 1962.

As part of the NCPP, smoking was measured prospectively at each prenatal visit and newborn neurobehavior was assessed using the Graham-Rosenblith behavioral examination. For the current investigation, study participants were classified as nonsmokers, moderate smokers (between 1 and 19 cigarettes per day), and heavy smokers (20 or more cigarettes per day).

The investigators reduced the Graham-Rosenblith measure into three subscales—irritability, muscle tone, and response to respiratory occlusion—and then stratified the sample by sex. They used analysis of variance to examine group differences overall and by gender.

“We found significant differences between smoking groups for irritability in females, but not in males,” Ms. Paster reported. “[Least significant difference] tests revealed significant differences between the heavy smoking group and both the moderate and no smoking groups only for female infants, while significant effects of maternal smoking group on muscle tone emerged for both male and female infants.”

Least significant difference tests also showed different patterns of effects for males and females with respect to muscle tone. “For females, the heavy smoking group was significantly different from both the moderate and no smoking groups, while for males, the moderate smoking group differed significantly from the no smoking and heavy smoking groups,” Ms. Paster said.

Regarding the irritability findings, excessive irritability could indicate an infant withdrawal syndrome, Ms. Paster noted. Additionally, “irritability could potentially affect bonding and attachment with caregivers and may represent an early link to emotional dysregulation,” she said.

The hypertonicity findings “may be due to acute effects of nicotine and suggests problems with motor control,” Ms. Paster stated.

The findings of this study might be useful in identifying infants at risk for neurodevelopmental deficits and should provide additional incentives for abstaining from smoking during pregnancy, the investigators noted.

BOSTON — Prenatal smoking exposure is associated with significant increases in irritability among newborn girls but not boys, according to a study presented at a meeting of the Society for Research in Child Development.

The fact that significant differences were not evident among male infants in the large, epidemiologic sample might suggest early links to later gender-specific differences in behavioral outcomes, said lead author Rachel L. Paster, a research assistant in the Centers for Behavioral and Preventive Medicine, Brown University, Providence, R.I.

All of the infants exposed to prenatal smoking exhibited increases in muscle tension, compared with unexposed infants, Ms. Paster reported in a poster presentation.

Using data from the New England Cohort of the National Collaborative Perinatal Project (NCPP), Ms. Paster and colleagues examined the effects of smoking during pregnancy on the neurobehavior of male and female newborns in a sample of 991 healthy mother-infant pairs recruited between 1959 and 1962.

As part of the NCPP, smoking was measured prospectively at each prenatal visit and newborn neurobehavior was assessed using the Graham-Rosenblith behavioral examination. For the current investigation, study participants were classified as nonsmokers, moderate smokers (between 1 and 19 cigarettes per day), and heavy smokers (20 or more cigarettes per day).

The investigators reduced the Graham-Rosenblith measure into three subscales—irritability, muscle tone, and response to respiratory occlusion—and then stratified the sample by sex. They used analysis of variance to examine group differences overall and by gender.

“We found significant differences between smoking groups for irritability in females, but not in males,” Ms. Paster reported. “[Least significant difference] tests revealed significant differences between the heavy smoking group and both the moderate and no smoking groups only for female infants, while significant effects of maternal smoking group on muscle tone emerged for both male and female infants.”

Least significant difference tests also showed different patterns of effects for males and females with respect to muscle tone. “For females, the heavy smoking group was significantly different from both the moderate and no smoking groups, while for males, the moderate smoking group differed significantly from the no smoking and heavy smoking groups,” Ms. Paster said.

Regarding the irritability findings, excessive irritability could indicate an infant withdrawal syndrome, Ms. Paster noted. Additionally, “irritability could potentially affect bonding and attachment with caregivers and may represent an early link to emotional dysregulation,” she said.

The hypertonicity findings “may be due to acute effects of nicotine and suggests problems with motor control,” Ms. Paster stated.

The findings of this study might be useful in identifying infants at risk for neurodevelopmental deficits and should provide additional incentives for abstaining from smoking during pregnancy, the investigators noted.

BOSTON — Prenatal smoking exposure is associated with significant increases in irritability among newborn girls but not boys, according to a study presented at a meeting of the Society for Research in Child Development.

The fact that significant differences were not evident among male infants in the large, epidemiologic sample might suggest early links to later gender-specific differences in behavioral outcomes, said lead author Rachel L. Paster, a research assistant in the Centers for Behavioral and Preventive Medicine, Brown University, Providence, R.I.

All of the infants exposed to prenatal smoking exhibited increases in muscle tension, compared with unexposed infants, Ms. Paster reported in a poster presentation.

Using data from the New England Cohort of the National Collaborative Perinatal Project (NCPP), Ms. Paster and colleagues examined the effects of smoking during pregnancy on the neurobehavior of male and female newborns in a sample of 991 healthy mother-infant pairs recruited between 1959 and 1962.

As part of the NCPP, smoking was measured prospectively at each prenatal visit and newborn neurobehavior was assessed using the Graham-Rosenblith behavioral examination. For the current investigation, study participants were classified as nonsmokers, moderate smokers (between 1 and 19 cigarettes per day), and heavy smokers (20 or more cigarettes per day).

The investigators reduced the Graham-Rosenblith measure into three subscales—irritability, muscle tone, and response to respiratory occlusion—and then stratified the sample by sex. They used analysis of variance to examine group differences overall and by gender.

“We found significant differences between smoking groups for irritability in females, but not in males,” Ms. Paster reported. “[Least significant difference] tests revealed significant differences between the heavy smoking group and both the moderate and no smoking groups only for female infants, while significant effects of maternal smoking group on muscle tone emerged for both male and female infants.”

Least significant difference tests also showed different patterns of effects for males and females with respect to muscle tone. “For females, the heavy smoking group was significantly different from both the moderate and no smoking groups, while for males, the moderate smoking group differed significantly from the no smoking and heavy smoking groups,” Ms. Paster said.

Regarding the irritability findings, excessive irritability could indicate an infant withdrawal syndrome, Ms. Paster noted. Additionally, “irritability could potentially affect bonding and attachment with caregivers and may represent an early link to emotional dysregulation,” she said.

The hypertonicity findings “may be due to acute effects of nicotine and suggests problems with motor control,” Ms. Paster stated.

The findings of this study might be useful in identifying infants at risk for neurodevelopmental deficits and should provide additional incentives for abstaining from smoking during pregnancy, the investigators noted.

BOSTON — Long-term use of nonsteroidal anti-inflammatory drugs other than aspirin may significantly reduce breast cancer risk in African American and Caucasian women, according to data from a multiethnic study.

Among women overall, however, no associations were seen between breast cancer risk and the use of aspirin or other nonsteroidal anti-inflammatory drugs (NSAIDs), Jasmeet Gill, Ph.D., reported at the annual international conference of the American Association for Cancer Research.

Previous studies looking at NSAID use and breast cancer have yielded mixed results, said Dr. Gill, a postdoctoral fellow at the University of Hawaii, Honolulu. “Although the relationship between cyclooxygenase-2 expression and breast cancer has been shown to be biologically plausible, the use of NSAIDs to reduce the risk of breast cancer is not well established,” she said.

Dr. Gill and her colleagues identified 4,010 incident breast cancer cases among American women who participated in the University of Hawaii/University of Southern California Multiethnic Cohort Study from 1993 to 2002, and reviewed NSAID exposure data gleaned from a self-administered questionnaire completed at baseline. The study includes African Americans, Caucasians, Japanese, native Hawaiians, and Hispanics from Hawaii and Los Angeles County.

Cox regression analyses showed no association overall between breast cancer risk and duration of aspirin use, other NSAID use for 6 or more years, or total NSAID use for 11 or more years. Neither were there consistent associations between medication use and breast cancer risk across strata of ethnicity, body mass index, tumor stage, or patient age, Dr. Gill reported in a poster presentation.

“The only associations observed were for other NSAID use among African American and Caucasian women,” she said. The use of NSAIDs other than aspirin for 6 or more years was associated with a 54% reduction in breast cancer risk among African American women and a 31% reduction in risk among Caucasian women.

“It is unclear why aspirin use was not associated with breast cancer risk reduction as has been shown in other studies, although we are intrigued by the reduced risk associated with other NSAID use in African American and Caucasian women,” Dr. Gill said. She had no financial disclosures related to her presentation.

BOSTON — Long-term use of nonsteroidal anti-inflammatory drugs other than aspirin may significantly reduce breast cancer risk in African American and Caucasian women, according to data from a multiethnic study.

Among women overall, however, no associations were seen between breast cancer risk and the use of aspirin or other nonsteroidal anti-inflammatory drugs (NSAIDs), Jasmeet Gill, Ph.D., reported at the annual international conference of the American Association for Cancer Research.

Previous studies looking at NSAID use and breast cancer have yielded mixed results, said Dr. Gill, a postdoctoral fellow at the University of Hawaii, Honolulu. “Although the relationship between cyclooxygenase-2 expression and breast cancer has been shown to be biologically plausible, the use of NSAIDs to reduce the risk of breast cancer is not well established,” she said.

Dr. Gill and her colleagues identified 4,010 incident breast cancer cases among American women who participated in the University of Hawaii/University of Southern California Multiethnic Cohort Study from 1993 to 2002, and reviewed NSAID exposure data gleaned from a self-administered questionnaire completed at baseline. The study includes African Americans, Caucasians, Japanese, native Hawaiians, and Hispanics from Hawaii and Los Angeles County.

Cox regression analyses showed no association overall between breast cancer risk and duration of aspirin use, other NSAID use for 6 or more years, or total NSAID use for 11 or more years. Neither were there consistent associations between medication use and breast cancer risk across strata of ethnicity, body mass index, tumor stage, or patient age, Dr. Gill reported in a poster presentation.

“The only associations observed were for other NSAID use among African American and Caucasian women,” she said. The use of NSAIDs other than aspirin for 6 or more years was associated with a 54% reduction in breast cancer risk among African American women and a 31% reduction in risk among Caucasian women.

“It is unclear why aspirin use was not associated with breast cancer risk reduction as has been shown in other studies, although we are intrigued by the reduced risk associated with other NSAID use in African American and Caucasian women,” Dr. Gill said. She had no financial disclosures related to her presentation.

BOSTON — Long-term use of nonsteroidal anti-inflammatory drugs other than aspirin may significantly reduce breast cancer risk in African American and Caucasian women, according to data from a multiethnic study.

Among women overall, however, no associations were seen between breast cancer risk and the use of aspirin or other nonsteroidal anti-inflammatory drugs (NSAIDs), Jasmeet Gill, Ph.D., reported at the annual international conference of the American Association for Cancer Research.

Previous studies looking at NSAID use and breast cancer have yielded mixed results, said Dr. Gill, a postdoctoral fellow at the University of Hawaii, Honolulu. “Although the relationship between cyclooxygenase-2 expression and breast cancer has been shown to be biologically plausible, the use of NSAIDs to reduce the risk of breast cancer is not well established,” she said.

Dr. Gill and her colleagues identified 4,010 incident breast cancer cases among American women who participated in the University of Hawaii/University of Southern California Multiethnic Cohort Study from 1993 to 2002, and reviewed NSAID exposure data gleaned from a self-administered questionnaire completed at baseline. The study includes African Americans, Caucasians, Japanese, native Hawaiians, and Hispanics from Hawaii and Los Angeles County.

Cox regression analyses showed no association overall between breast cancer risk and duration of aspirin use, other NSAID use for 6 or more years, or total NSAID use for 11 or more years. Neither were there consistent associations between medication use and breast cancer risk across strata of ethnicity, body mass index, tumor stage, or patient age, Dr. Gill reported in a poster presentation.

“The only associations observed were for other NSAID use among African American and Caucasian women,” she said. The use of NSAIDs other than aspirin for 6 or more years was associated with a 54% reduction in breast cancer risk among African American women and a 31% reduction in risk among Caucasian women.

“It is unclear why aspirin use was not associated with breast cancer risk reduction as has been shown in other studies, although we are intrigued by the reduced risk associated with other NSAID use in African American and Caucasian women,” Dr. Gill said. She had no financial disclosures related to her presentation.