PAS Annual Meeting 2011

DENVER – Provider recommendation is strongly associated with initiation of the human papillomavirus vaccine in teenage females, results from a national survey demonstrated.

"It’s important for providers to take the time to counsel and recommend the HPV vaccine and communicate the benefits and the risks of the vaccination, as well as the risk of getting HPV disease as teenagers," Dr. Christina G. Dorell said in an interview during a poster session at the annual meeting of the Pediatric Academic Societies.

Dr. Dorell of the immunization services division at the Centers for Disease Control and Prevention, Atlanta, presented findings from the 2008-2009 National Immunization Survey Teen (NIS-Teen), which was analyzed to determine human papillomavirus (HPV) vaccination coverage among females aged 13-17 years. The NIS-Teen is composed of two parts: a random-digit–dialed telephone survey of parents or guardians of adolescents aged 13-17 years, and a mailed survey to all vaccination providers identified by the parent and for which consent was granted.

The researchers evaluated associations of select socioeconomic characteristics, intention to vaccinate, and HPV status. They used multivariable logistic regression to examine associations while controlling for other factors, including state of residence.

Of the 18,288 females surveyed, 41% received at least one HPV dose. Of those, 53% completed the three-dose series.

The probability of HPV vaccination occurring is 2.6 times higher for adolescents who receive a provider recommendation than for adolescents who do not receive a provider recommendation. Other factors independently associated with HPV vaccine initiation were older age, having a preventive visit at age 11 or 12 years, being eligible for state Children’s Health Insurance Program (CHIP) or Vaccines for Children (VFC) program, having a mother younger than age 34 years, having a mother who never married, and not receiving all vaccines at public facilities.

More than half of white females (60%) completed the vaccination series, compared with 46% of blacks and 40% of Hispanics. Other factors independently associated with completing the vaccination series were having a mother aged 45 or older, being knowledgeable about HPV disease, and not receiving all vaccines at public facilities.

The main reported reasons parents do not intend for their daughters to receive the HPV vaccination in the next 12 months were lack of knowledge (19%), considering it not needed or not necessary (19%), the fact that their daughters were not sexually active (18%), and that they did not receive a provider recommendation (13%).

Dr. Dorell acknowledged certain limitations of the study, including the fact that the telephone portion of the survey was using land line phones only, thus contributing to a noncoverage bias of wireless-only households. It’s also possible that some of the provider data or vaccination histories may be incomplete, she said. However, she pointed out that one of the main strengths of the NIS-Teen "is that it is the only nationally representative survey that reports vaccination coverage estimates from provider-reported data, which is the gold standard for measuring vaccination coverage."

Dr. Dorell said that she had no relevant financial disclosures.

DENVER – Provider recommendation is strongly associated with initiation of the human papillomavirus vaccine in teenage females, results from a national survey demonstrated.

"It’s important for providers to take the time to counsel and recommend the HPV vaccine and communicate the benefits and the risks of the vaccination, as well as the risk of getting HPV disease as teenagers," Dr. Christina G. Dorell said in an interview during a poster session at the annual meeting of the Pediatric Academic Societies.

Dr. Dorell of the immunization services division at the Centers for Disease Control and Prevention, Atlanta, presented findings from the 2008-2009 National Immunization Survey Teen (NIS-Teen), which was analyzed to determine human papillomavirus (HPV) vaccination coverage among females aged 13-17 years. The NIS-Teen is composed of two parts: a random-digit–dialed telephone survey of parents or guardians of adolescents aged 13-17 years, and a mailed survey to all vaccination providers identified by the parent and for which consent was granted.

The researchers evaluated associations of select socioeconomic characteristics, intention to vaccinate, and HPV status. They used multivariable logistic regression to examine associations while controlling for other factors, including state of residence.

Of the 18,288 females surveyed, 41% received at least one HPV dose. Of those, 53% completed the three-dose series.

The probability of HPV vaccination occurring is 2.6 times higher for adolescents who receive a provider recommendation than for adolescents who do not receive a provider recommendation. Other factors independently associated with HPV vaccine initiation were older age, having a preventive visit at age 11 or 12 years, being eligible for state Children’s Health Insurance Program (CHIP) or Vaccines for Children (VFC) program, having a mother younger than age 34 years, having a mother who never married, and not receiving all vaccines at public facilities.

More than half of white females (60%) completed the vaccination series, compared with 46% of blacks and 40% of Hispanics. Other factors independently associated with completing the vaccination series were having a mother aged 45 or older, being knowledgeable about HPV disease, and not receiving all vaccines at public facilities.

The main reported reasons parents do not intend for their daughters to receive the HPV vaccination in the next 12 months were lack of knowledge (19%), considering it not needed or not necessary (19%), the fact that their daughters were not sexually active (18%), and that they did not receive a provider recommendation (13%).

Dr. Dorell acknowledged certain limitations of the study, including the fact that the telephone portion of the survey was using land line phones only, thus contributing to a noncoverage bias of wireless-only households. It’s also possible that some of the provider data or vaccination histories may be incomplete, she said. However, she pointed out that one of the main strengths of the NIS-Teen "is that it is the only nationally representative survey that reports vaccination coverage estimates from provider-reported data, which is the gold standard for measuring vaccination coverage."

Dr. Dorell said that she had no relevant financial disclosures.

DENVER – Provider recommendation is strongly associated with initiation of the human papillomavirus vaccine in teenage females, results from a national survey demonstrated.

"It’s important for providers to take the time to counsel and recommend the HPV vaccine and communicate the benefits and the risks of the vaccination, as well as the risk of getting HPV disease as teenagers," Dr. Christina G. Dorell said in an interview during a poster session at the annual meeting of the Pediatric Academic Societies.

Dr. Dorell of the immunization services division at the Centers for Disease Control and Prevention, Atlanta, presented findings from the 2008-2009 National Immunization Survey Teen (NIS-Teen), which was analyzed to determine human papillomavirus (HPV) vaccination coverage among females aged 13-17 years. The NIS-Teen is composed of two parts: a random-digit–dialed telephone survey of parents or guardians of adolescents aged 13-17 years, and a mailed survey to all vaccination providers identified by the parent and for which consent was granted.

The researchers evaluated associations of select socioeconomic characteristics, intention to vaccinate, and HPV status. They used multivariable logistic regression to examine associations while controlling for other factors, including state of residence.

Of the 18,288 females surveyed, 41% received at least one HPV dose. Of those, 53% completed the three-dose series.

The probability of HPV vaccination occurring is 2.6 times higher for adolescents who receive a provider recommendation than for adolescents who do not receive a provider recommendation. Other factors independently associated with HPV vaccine initiation were older age, having a preventive visit at age 11 or 12 years, being eligible for state Children’s Health Insurance Program (CHIP) or Vaccines for Children (VFC) program, having a mother younger than age 34 years, having a mother who never married, and not receiving all vaccines at public facilities.

More than half of white females (60%) completed the vaccination series, compared with 46% of blacks and 40% of Hispanics. Other factors independently associated with completing the vaccination series were having a mother aged 45 or older, being knowledgeable about HPV disease, and not receiving all vaccines at public facilities.

The main reported reasons parents do not intend for their daughters to receive the HPV vaccination in the next 12 months were lack of knowledge (19%), considering it not needed or not necessary (19%), the fact that their daughters were not sexually active (18%), and that they did not receive a provider recommendation (13%).

Dr. Dorell acknowledged certain limitations of the study, including the fact that the telephone portion of the survey was using land line phones only, thus contributing to a noncoverage bias of wireless-only households. It’s also possible that some of the provider data or vaccination histories may be incomplete, she said. However, she pointed out that one of the main strengths of the NIS-Teen "is that it is the only nationally representative survey that reports vaccination coverage estimates from provider-reported data, which is the gold standard for measuring vaccination coverage."

Dr. Dorell said that she had no relevant financial disclosures.

DENVER – The ratio of controller to total asthma medication fills predicts the risk of exacerbations in pediatric patients with persistent asthma, results from a large study demonstrated.

"The occurrence of asthma exacerbations requiring medical attention is a key health outcome, and may be an indicator of the quality of asthma care," Dr. Louis Vernacchio reported at the annual meeting of the Pediatric Academic Societies. "Exacerbations that are cared for in the office setting may be more common than hospital admissions or ED visits, but there is currently no standard methodology for defining exacerbations cared for in the office setting. It would be nice to develop process measures that relate to asthma outcomes, particularly to exacerbations," he said.

Dr. Vernacchio, of the Pediatric Physicians’ Organization at Children’s (PPOC) and the general pediatrics division at Children’s Hospital Boston, and his associate, Jennifer M. Muto, set out to assess the accuracy of claims-based definitions of asthma exacerbations cared for in the office setting and to evaluate potential risk factors for asthma exacerbations that could serve as process measures for quality improvement. They analyzed medical claims from a large not-for-profit insurer for patients of the PPOC, a large independent practice association affiliated with Children’s Hospital Boston. The study population included 19,469 patients aged 5-17 years who were continuously enrolled in 2008 and 19,779 patients aged 5-17 years who were continuously enrolled in 2009. Of these, 530 (2.7%) met Healthcare Effectiveness Data and Information Set (HEDIS) criteria for persistent asthma in 2008 and 507 (2.6%) did so in 2009.

Proposed definitions of asthma exacerbations cared for in an office setting included office visits for asthma with oral steroid prescription filled the day of or the day after a visit (definition 1); office visits for asthma with oral steroid prescription filled the day of or the day after a visit or with nebulizer treatment given in the office (definition 2); office visits for asthma with oral steroid prescription filled the day of or the day after a visit or with oral steroid prescription filled the day of or the day after a visit or with nebulizer treatment given in the office, or coded as "with status asthmaticus" or "with acute exacerbation" (definition 3).

The researchers compared each of those three definitions to a chart review, which was considered the gold standard. Two clinicians independently reviewed 144 asthma visits and evaluated three elements in each chart: history of present illness, physical examination, and assessment. "If they found evidence of exacerbation in two of those three areas, we counted the visit as an exacerbation visit," Dr. Vernacchio said.

Receiver operating characteristic curve analysis revealed that definition 1 had a sensitivity of 24.7% and a specificity of 90.5%, definition 2 had a sensitivity of 56.8% and a specificity of 76.2%, and definition 3 had a sensitivity of 95.1% and a specificity of 68.3%. "The overall area under the curve is best with the third definition, but there’s a tradeoff in sensitivity and specificity," he said.

Logistic regression analysis of associations with exacerbations revealed that the ratio of controller to total asthma prescription fills was the process measure that correlated most closely to the risk of asthma exacerbations, with risk ratios near 2.0 for those in the third and fourth quartiles of controller to total asthma prescription fills ratio (corresponding to ratios of 0.5-0.8 and less than 0.5, respectively).

"This ratio can serve as the basis for quality improvement projects in pediatric asthma," Dr. Vernacchio said. He noted that the proposed 2012 HEDIS measure uses a cutoff value of 0.5, "which is well below what appears optimal in our data."

Dr. Vernacchio said that he had no relevant financial conflicts to disclose.

DENVER – The ratio of controller to total asthma medication fills predicts the risk of exacerbations in pediatric patients with persistent asthma, results from a large study demonstrated.

"The occurrence of asthma exacerbations requiring medical attention is a key health outcome, and may be an indicator of the quality of asthma care," Dr. Louis Vernacchio reported at the annual meeting of the Pediatric Academic Societies. "Exacerbations that are cared for in the office setting may be more common than hospital admissions or ED visits, but there is currently no standard methodology for defining exacerbations cared for in the office setting. It would be nice to develop process measures that relate to asthma outcomes, particularly to exacerbations," he said.

Dr. Vernacchio, of the Pediatric Physicians’ Organization at Children’s (PPOC) and the general pediatrics division at Children’s Hospital Boston, and his associate, Jennifer M. Muto, set out to assess the accuracy of claims-based definitions of asthma exacerbations cared for in the office setting and to evaluate potential risk factors for asthma exacerbations that could serve as process measures for quality improvement. They analyzed medical claims from a large not-for-profit insurer for patients of the PPOC, a large independent practice association affiliated with Children’s Hospital Boston. The study population included 19,469 patients aged 5-17 years who were continuously enrolled in 2008 and 19,779 patients aged 5-17 years who were continuously enrolled in 2009. Of these, 530 (2.7%) met Healthcare Effectiveness Data and Information Set (HEDIS) criteria for persistent asthma in 2008 and 507 (2.6%) did so in 2009.

Proposed definitions of asthma exacerbations cared for in an office setting included office visits for asthma with oral steroid prescription filled the day of or the day after a visit (definition 1); office visits for asthma with oral steroid prescription filled the day of or the day after a visit or with nebulizer treatment given in the office (definition 2); office visits for asthma with oral steroid prescription filled the day of or the day after a visit or with oral steroid prescription filled the day of or the day after a visit or with nebulizer treatment given in the office, or coded as "with status asthmaticus" or "with acute exacerbation" (definition 3).

The researchers compared each of those three definitions to a chart review, which was considered the gold standard. Two clinicians independently reviewed 144 asthma visits and evaluated three elements in each chart: history of present illness, physical examination, and assessment. "If they found evidence of exacerbation in two of those three areas, we counted the visit as an exacerbation visit," Dr. Vernacchio said.

Receiver operating characteristic curve analysis revealed that definition 1 had a sensitivity of 24.7% and a specificity of 90.5%, definition 2 had a sensitivity of 56.8% and a specificity of 76.2%, and definition 3 had a sensitivity of 95.1% and a specificity of 68.3%. "The overall area under the curve is best with the third definition, but there’s a tradeoff in sensitivity and specificity," he said.

Logistic regression analysis of associations with exacerbations revealed that the ratio of controller to total asthma prescription fills was the process measure that correlated most closely to the risk of asthma exacerbations, with risk ratios near 2.0 for those in the third and fourth quartiles of controller to total asthma prescription fills ratio (corresponding to ratios of 0.5-0.8 and less than 0.5, respectively).

"This ratio can serve as the basis for quality improvement projects in pediatric asthma," Dr. Vernacchio said. He noted that the proposed 2012 HEDIS measure uses a cutoff value of 0.5, "which is well below what appears optimal in our data."

Dr. Vernacchio said that he had no relevant financial conflicts to disclose.

DENVER – The ratio of controller to total asthma medication fills predicts the risk of exacerbations in pediatric patients with persistent asthma, results from a large study demonstrated.

"The occurrence of asthma exacerbations requiring medical attention is a key health outcome, and may be an indicator of the quality of asthma care," Dr. Louis Vernacchio reported at the annual meeting of the Pediatric Academic Societies. "Exacerbations that are cared for in the office setting may be more common than hospital admissions or ED visits, but there is currently no standard methodology for defining exacerbations cared for in the office setting. It would be nice to develop process measures that relate to asthma outcomes, particularly to exacerbations," he said.

Dr. Vernacchio, of the Pediatric Physicians’ Organization at Children’s (PPOC) and the general pediatrics division at Children’s Hospital Boston, and his associate, Jennifer M. Muto, set out to assess the accuracy of claims-based definitions of asthma exacerbations cared for in the office setting and to evaluate potential risk factors for asthma exacerbations that could serve as process measures for quality improvement. They analyzed medical claims from a large not-for-profit insurer for patients of the PPOC, a large independent practice association affiliated with Children’s Hospital Boston. The study population included 19,469 patients aged 5-17 years who were continuously enrolled in 2008 and 19,779 patients aged 5-17 years who were continuously enrolled in 2009. Of these, 530 (2.7%) met Healthcare Effectiveness Data and Information Set (HEDIS) criteria for persistent asthma in 2008 and 507 (2.6%) did so in 2009.

Proposed definitions of asthma exacerbations cared for in an office setting included office visits for asthma with oral steroid prescription filled the day of or the day after a visit (definition 1); office visits for asthma with oral steroid prescription filled the day of or the day after a visit or with nebulizer treatment given in the office (definition 2); office visits for asthma with oral steroid prescription filled the day of or the day after a visit or with oral steroid prescription filled the day of or the day after a visit or with nebulizer treatment given in the office, or coded as "with status asthmaticus" or "with acute exacerbation" (definition 3).

The researchers compared each of those three definitions to a chart review, which was considered the gold standard. Two clinicians independently reviewed 144 asthma visits and evaluated three elements in each chart: history of present illness, physical examination, and assessment. "If they found evidence of exacerbation in two of those three areas, we counted the visit as an exacerbation visit," Dr. Vernacchio said.

Receiver operating characteristic curve analysis revealed that definition 1 had a sensitivity of 24.7% and a specificity of 90.5%, definition 2 had a sensitivity of 56.8% and a specificity of 76.2%, and definition 3 had a sensitivity of 95.1% and a specificity of 68.3%. "The overall area under the curve is best with the third definition, but there’s a tradeoff in sensitivity and specificity," he said.

Logistic regression analysis of associations with exacerbations revealed that the ratio of controller to total asthma prescription fills was the process measure that correlated most closely to the risk of asthma exacerbations, with risk ratios near 2.0 for those in the third and fourth quartiles of controller to total asthma prescription fills ratio (corresponding to ratios of 0.5-0.8 and less than 0.5, respectively).

"This ratio can serve as the basis for quality improvement projects in pediatric asthma," Dr. Vernacchio said. He noted that the proposed 2012 HEDIS measure uses a cutoff value of 0.5, "which is well below what appears optimal in our data."

Dr. Vernacchio said that he had no relevant financial conflicts to disclose.

DENVER – Pregnant women should avoid pumping their own gasoline or painting the nursery to get it ready for the baby, among other activities, based on the results from a study at the Medical College of Wisconsin in Milwaukee.

The advice comes from Dr. Gail McCarver, a professor of pharmacology and toxicology there and the lead author on a study that found that exposure to ethylbenzene and trichloroethylene during pregnancy is associated with an increased risk of congenital heart disease (CHD).

(c) Joni Rantasalo/iStock.com

Sources of ethylbenzene, a volatile organic compound, include gasoline vapors, vehicle exhaust, tobacco smoke, varnish, adhesives, inks, insecticides, and some paints and cleaning agents.

It was two metabolites of trichloroethylene – trichloroacetic (TCA) and dichloroacetic (DCA) acids – that the researchers linked to congenital heart disease.

Trichloroethylene is found in degreasing agents, adhesives, typewriter correction fluid, dry cleaning solvents, rug cleaners, and paint and varnish removers, among other sources.

The findings, which were reported at the annual meeting of the Pediatric Academic Societies, come from meconium analysis of 135 infants with CHD and 432 control infants without CHD. Fetal exposure to ethylbenzene and the metabolites were significantly more common among infants with CHD.

"What we saw was about a fourfold increase in CHD risk among [white] infants who had fetal exposure to ethylbenzene documented in meconium" after adjustment for race and CHD family history. "We could not document the same observation in African Americans," Dr. McCarver said.

It’s a novel finding. Ethylbenzene has not been associated with CHD until now.

The presence of the trichloroethylene metabolites was associated with a twofold increase in CHD risk in white infants and an eightfold increase in black infants.

Regarding the racial differences, "I don’t think it’s implausible that different racial groups could have different risk factors. There are racial differences in the enzymes that handle these kinds of compounds," said Dr. McCarver, who is also codirector of the birth defects research center at the Medical College of Wisconsin.

The results mean that pregnant women should avoid exposure as much as possible. "What I would tell [a pregnant woman] is, don’t pump your own gasoline; don’t smoke; don’t use cleaners if you don’t have to, [especially] cleaners that have warning labels that say use a respirator," she said.

Pregnancy isn’t a good time to paint the nursery or refinish the floors, either. "Young women are doing these kinds of things even early in pregnancy" when CHD develops, Dr. McCarver said.

In general, there are four to seven CHD cases per 1,000 live births. Previously established risk factors include smoking or heavy drinking during pregnancy, family history, and white race. Infants with diabetic mothers or chromosomal abnormalities – two additional risk factors – were excluded from the study.

When the compounds were included in the statistical analysis, "maternal obesity, smoking, illicit drugs, alcohol intake, vitamin use, other solvent exposures, and the genetic variants" dropped out as significant risk factors, the researchers said.

Because smoking in particular dropped out, Dr. McCarver and her colleagues speculated that it’s the ethylbenzene in smoke that’s responsible for prior reports linking CHD and smoking.

"If you were to say to me, ‘Which is worse, ethylbenzene or smoking?’ I’d say ethylbenzene," Dr. McCarver said.

Dr. McCarver said she had no relevant financial disclosures. The study was funded by the National Institute of Environmental Health Sciences.

DENVER – Pregnant women should avoid pumping their own gasoline or painting the nursery to get it ready for the baby, among other activities, based on the results from a study at the Medical College of Wisconsin in Milwaukee.

The advice comes from Dr. Gail McCarver, a professor of pharmacology and toxicology there and the lead author on a study that found that exposure to ethylbenzene and trichloroethylene during pregnancy is associated with an increased risk of congenital heart disease (CHD).

(c) Joni Rantasalo/iStock.com

Sources of ethylbenzene, a volatile organic compound, include gasoline vapors, vehicle exhaust, tobacco smoke, varnish, adhesives, inks, insecticides, and some paints and cleaning agents.

It was two metabolites of trichloroethylene – trichloroacetic (TCA) and dichloroacetic (DCA) acids – that the researchers linked to congenital heart disease.

Trichloroethylene is found in degreasing agents, adhesives, typewriter correction fluid, dry cleaning solvents, rug cleaners, and paint and varnish removers, among other sources.

The findings, which were reported at the annual meeting of the Pediatric Academic Societies, come from meconium analysis of 135 infants with CHD and 432 control infants without CHD. Fetal exposure to ethylbenzene and the metabolites were significantly more common among infants with CHD.

"What we saw was about a fourfold increase in CHD risk among [white] infants who had fetal exposure to ethylbenzene documented in meconium" after adjustment for race and CHD family history. "We could not document the same observation in African Americans," Dr. McCarver said.

It’s a novel finding. Ethylbenzene has not been associated with CHD until now.

The presence of the trichloroethylene metabolites was associated with a twofold increase in CHD risk in white infants and an eightfold increase in black infants.

Regarding the racial differences, "I don’t think it’s implausible that different racial groups could have different risk factors. There are racial differences in the enzymes that handle these kinds of compounds," said Dr. McCarver, who is also codirector of the birth defects research center at the Medical College of Wisconsin.

The results mean that pregnant women should avoid exposure as much as possible. "What I would tell [a pregnant woman] is, don’t pump your own gasoline; don’t smoke; don’t use cleaners if you don’t have to, [especially] cleaners that have warning labels that say use a respirator," she said.

Pregnancy isn’t a good time to paint the nursery or refinish the floors, either. "Young women are doing these kinds of things even early in pregnancy" when CHD develops, Dr. McCarver said.

In general, there are four to seven CHD cases per 1,000 live births. Previously established risk factors include smoking or heavy drinking during pregnancy, family history, and white race. Infants with diabetic mothers or chromosomal abnormalities – two additional risk factors – were excluded from the study.

When the compounds were included in the statistical analysis, "maternal obesity, smoking, illicit drugs, alcohol intake, vitamin use, other solvent exposures, and the genetic variants" dropped out as significant risk factors, the researchers said.

Because smoking in particular dropped out, Dr. McCarver and her colleagues speculated that it’s the ethylbenzene in smoke that’s responsible for prior reports linking CHD and smoking.

"If you were to say to me, ‘Which is worse, ethylbenzene or smoking?’ I’d say ethylbenzene," Dr. McCarver said.

Dr. McCarver said she had no relevant financial disclosures. The study was funded by the National Institute of Environmental Health Sciences.

DENVER – Pregnant women should avoid pumping their own gasoline or painting the nursery to get it ready for the baby, among other activities, based on the results from a study at the Medical College of Wisconsin in Milwaukee.

The advice comes from Dr. Gail McCarver, a professor of pharmacology and toxicology there and the lead author on a study that found that exposure to ethylbenzene and trichloroethylene during pregnancy is associated with an increased risk of congenital heart disease (CHD).

(c) Joni Rantasalo/iStock.com

Sources of ethylbenzene, a volatile organic compound, include gasoline vapors, vehicle exhaust, tobacco smoke, varnish, adhesives, inks, insecticides, and some paints and cleaning agents.

It was two metabolites of trichloroethylene – trichloroacetic (TCA) and dichloroacetic (DCA) acids – that the researchers linked to congenital heart disease.

Trichloroethylene is found in degreasing agents, adhesives, typewriter correction fluid, dry cleaning solvents, rug cleaners, and paint and varnish removers, among other sources.

The findings, which were reported at the annual meeting of the Pediatric Academic Societies, come from meconium analysis of 135 infants with CHD and 432 control infants without CHD. Fetal exposure to ethylbenzene and the metabolites were significantly more common among infants with CHD.

"What we saw was about a fourfold increase in CHD risk among [white] infants who had fetal exposure to ethylbenzene documented in meconium" after adjustment for race and CHD family history. "We could not document the same observation in African Americans," Dr. McCarver said.

It’s a novel finding. Ethylbenzene has not been associated with CHD until now.

The presence of the trichloroethylene metabolites was associated with a twofold increase in CHD risk in white infants and an eightfold increase in black infants.

Regarding the racial differences, "I don’t think it’s implausible that different racial groups could have different risk factors. There are racial differences in the enzymes that handle these kinds of compounds," said Dr. McCarver, who is also codirector of the birth defects research center at the Medical College of Wisconsin.

The results mean that pregnant women should avoid exposure as much as possible. "What I would tell [a pregnant woman] is, don’t pump your own gasoline; don’t smoke; don’t use cleaners if you don’t have to, [especially] cleaners that have warning labels that say use a respirator," she said.

Pregnancy isn’t a good time to paint the nursery or refinish the floors, either. "Young women are doing these kinds of things even early in pregnancy" when CHD develops, Dr. McCarver said.

In general, there are four to seven CHD cases per 1,000 live births. Previously established risk factors include smoking or heavy drinking during pregnancy, family history, and white race. Infants with diabetic mothers or chromosomal abnormalities – two additional risk factors – were excluded from the study.

When the compounds were included in the statistical analysis, "maternal obesity, smoking, illicit drugs, alcohol intake, vitamin use, other solvent exposures, and the genetic variants" dropped out as significant risk factors, the researchers said.

Because smoking in particular dropped out, Dr. McCarver and her colleagues speculated that it’s the ethylbenzene in smoke that’s responsible for prior reports linking CHD and smoking.

"If you were to say to me, ‘Which is worse, ethylbenzene or smoking?’ I’d say ethylbenzene," Dr. McCarver said.

Dr. McCarver said she had no relevant financial disclosures. The study was funded by the National Institute of Environmental Health Sciences.

DENVER – Bariatric surgery results in significant weight loss at 1 year for morbidly-obese adolescents who have a procedure at a designated center of excellence, according to a study of 890 teenagers.

"This is one of the first reports of a national scope ... revealing the prevalence estimates of weight loss among adolescent patients," Dr. Nestor de la Cruz-Munoz said at the annual meeting of the Pediatric Academic Societies. "Bariatric surgery has the potential to be a safe and effective treatment option for significant weight loss in U.S. adolescents, irrespective of gender."

Fewer than 1% of bariatric surgery cases in the country are being done on adolescents, and "very little is know about the short-term and long-term outcomes in terms of weight and associated health consequences in these patients," said Dr. de la Cruz-Munoz, a bariatric surgeon at the University of Miami.

To find out more, Dr. de la Cruz-Munoz and his coworkers evaluated all patients aged 11-19 years old who had bariatric surgery from June 2007 through October 2010 in the prospective BOLD (Bariatric Outcomes Longitudinal Database) registry.

Weight decreased from a mean 138 kg at baseline to 110 kg at 1 year in these 890 patients. Baseline mean z score changed from 2.86 to 2.31, and the weight percentile of these adolescents (compared with the general population) decreased from 99.6% to 97.1%. In addition, the body mass index z score decreased from 2.6 to 2.11 during this time. Assessments were also done at 6 months post surgery in all patients. "All of those [changes] were statistically significant," Dr. de la Cruz-Munoz said.

"Bariatric surgery results in significant weight loss among morbidly obese multiethnic adolescents at 1 year post surgery, for both boys and girls," Dr. de la Cruz-Munoz said.

Broken down by sex, the mean baseline weight was 162 kg for boys and 129 for girls. The mean z score decreased from 3.52 to 2.77 for boys and from 2.64 to 2.12 for girls. "The weight percentages for boys started at about as high as you can get (99.95%) and ended up at 98.7%," Dr. de la Cruz-Munoz said. At the same time, weight percentages for girls decreased from 99.46% to 95.97%. The BMI z score decreased from a baseline 3.15 in boys to 2.57 at 1 year. For girls, this measure decreased from 2.42 to 1.92. Again, all these changes were statistically significant.

"The most rapid weight loss was in the first 6 months," Dr. de la Cruz-Munoz said.

One patient died from cardiac failure 5 months after surgery, resulting in a mortality rate of 0.11% in the cohort. In all, 141 postoperative adverse events were reported. Nausea and vomiting were the most common (13%), followed by vitamin D deficiency (8%).

Gastric bypass was the most common type of bariatric surgery in these adolescents, performed in 454 patients (51%). Gastric banding was a close second and was performed in 436 patients (49%). No gastric sleeve procedures were done in this age group during this time.

Consistent with adult data, about 80% were females; mean age was 18 years, and 69% were white, 15% Hispanic, 11% black, and 5% other.

There are now more than 375,000 patients in the BOLD registry, so adolescents represent only 0.7%. The independent, nonprofit Surgical Review Corporation (SRC) administers the American Society for Metabolic and Bariatric Surgery Center of Excellence (BSCOE) program. The SRC developed BOLD in 2007 to help ensure compliance with the BSCOE program.

There are 440 facilities currently designated as centers of excellence, with 758 surgeons; approximately 100 additional facilities have provisional status, Dr. de la Cruz-Munoz said.

A meeting attendee said that they had a lot of issues getting insurance coverage for bariatric surgery. "Insurance is huge issue for both the kids and the adults, and maybe even larger for the kids," Dr. de la Cruz-Munoz said. "Most of the data we’re seeing are [from] adult surgeons that also do kids. There are some pediatric surgeons who do kids as well, but most of those programs are just growing. A lot of times they don’t qualify yet for the centers of excellence designation."

Dr. de la Cruz-Munoz disclosed that he is a member of the SRC’s surgical review committee and a consultant for Ethicon Endo-Surgery Inc.

DENVER – Bariatric surgery results in significant weight loss at 1 year for morbidly-obese adolescents who have a procedure at a designated center of excellence, according to a study of 890 teenagers.

"This is one of the first reports of a national scope ... revealing the prevalence estimates of weight loss among adolescent patients," Dr. Nestor de la Cruz-Munoz said at the annual meeting of the Pediatric Academic Societies. "Bariatric surgery has the potential to be a safe and effective treatment option for significant weight loss in U.S. adolescents, irrespective of gender."

Fewer than 1% of bariatric surgery cases in the country are being done on adolescents, and "very little is know about the short-term and long-term outcomes in terms of weight and associated health consequences in these patients," said Dr. de la Cruz-Munoz, a bariatric surgeon at the University of Miami.

To find out more, Dr. de la Cruz-Munoz and his coworkers evaluated all patients aged 11-19 years old who had bariatric surgery from June 2007 through October 2010 in the prospective BOLD (Bariatric Outcomes Longitudinal Database) registry.

Weight decreased from a mean 138 kg at baseline to 110 kg at 1 year in these 890 patients. Baseline mean z score changed from 2.86 to 2.31, and the weight percentile of these adolescents (compared with the general population) decreased from 99.6% to 97.1%. In addition, the body mass index z score decreased from 2.6 to 2.11 during this time. Assessments were also done at 6 months post surgery in all patients. "All of those [changes] were statistically significant," Dr. de la Cruz-Munoz said.

"Bariatric surgery results in significant weight loss among morbidly obese multiethnic adolescents at 1 year post surgery, for both boys and girls," Dr. de la Cruz-Munoz said.

Broken down by sex, the mean baseline weight was 162 kg for boys and 129 for girls. The mean z score decreased from 3.52 to 2.77 for boys and from 2.64 to 2.12 for girls. "The weight percentages for boys started at about as high as you can get (99.95%) and ended up at 98.7%," Dr. de la Cruz-Munoz said. At the same time, weight percentages for girls decreased from 99.46% to 95.97%. The BMI z score decreased from a baseline 3.15 in boys to 2.57 at 1 year. For girls, this measure decreased from 2.42 to 1.92. Again, all these changes were statistically significant.

"The most rapid weight loss was in the first 6 months," Dr. de la Cruz-Munoz said.

One patient died from cardiac failure 5 months after surgery, resulting in a mortality rate of 0.11% in the cohort. In all, 141 postoperative adverse events were reported. Nausea and vomiting were the most common (13%), followed by vitamin D deficiency (8%).

Gastric bypass was the most common type of bariatric surgery in these adolescents, performed in 454 patients (51%). Gastric banding was a close second and was performed in 436 patients (49%). No gastric sleeve procedures were done in this age group during this time.

Consistent with adult data, about 80% were females; mean age was 18 years, and 69% were white, 15% Hispanic, 11% black, and 5% other.

There are now more than 375,000 patients in the BOLD registry, so adolescents represent only 0.7%. The independent, nonprofit Surgical Review Corporation (SRC) administers the American Society for Metabolic and Bariatric Surgery Center of Excellence (BSCOE) program. The SRC developed BOLD in 2007 to help ensure compliance with the BSCOE program.

There are 440 facilities currently designated as centers of excellence, with 758 surgeons; approximately 100 additional facilities have provisional status, Dr. de la Cruz-Munoz said.

A meeting attendee said that they had a lot of issues getting insurance coverage for bariatric surgery. "Insurance is huge issue for both the kids and the adults, and maybe even larger for the kids," Dr. de la Cruz-Munoz said. "Most of the data we’re seeing are [from] adult surgeons that also do kids. There are some pediatric surgeons who do kids as well, but most of those programs are just growing. A lot of times they don’t qualify yet for the centers of excellence designation."

Dr. de la Cruz-Munoz disclosed that he is a member of the SRC’s surgical review committee and a consultant for Ethicon Endo-Surgery Inc.

DENVER – Bariatric surgery results in significant weight loss at 1 year for morbidly-obese adolescents who have a procedure at a designated center of excellence, according to a study of 890 teenagers.

"This is one of the first reports of a national scope ... revealing the prevalence estimates of weight loss among adolescent patients," Dr. Nestor de la Cruz-Munoz said at the annual meeting of the Pediatric Academic Societies. "Bariatric surgery has the potential to be a safe and effective treatment option for significant weight loss in U.S. adolescents, irrespective of gender."

Fewer than 1% of bariatric surgery cases in the country are being done on adolescents, and "very little is know about the short-term and long-term outcomes in terms of weight and associated health consequences in these patients," said Dr. de la Cruz-Munoz, a bariatric surgeon at the University of Miami.

To find out more, Dr. de la Cruz-Munoz and his coworkers evaluated all patients aged 11-19 years old who had bariatric surgery from June 2007 through October 2010 in the prospective BOLD (Bariatric Outcomes Longitudinal Database) registry.

Weight decreased from a mean 138 kg at baseline to 110 kg at 1 year in these 890 patients. Baseline mean z score changed from 2.86 to 2.31, and the weight percentile of these adolescents (compared with the general population) decreased from 99.6% to 97.1%. In addition, the body mass index z score decreased from 2.6 to 2.11 during this time. Assessments were also done at 6 months post surgery in all patients. "All of those [changes] were statistically significant," Dr. de la Cruz-Munoz said.

"Bariatric surgery results in significant weight loss among morbidly obese multiethnic adolescents at 1 year post surgery, for both boys and girls," Dr. de la Cruz-Munoz said.

Broken down by sex, the mean baseline weight was 162 kg for boys and 129 for girls. The mean z score decreased from 3.52 to 2.77 for boys and from 2.64 to 2.12 for girls. "The weight percentages for boys started at about as high as you can get (99.95%) and ended up at 98.7%," Dr. de la Cruz-Munoz said. At the same time, weight percentages for girls decreased from 99.46% to 95.97%. The BMI z score decreased from a baseline 3.15 in boys to 2.57 at 1 year. For girls, this measure decreased from 2.42 to 1.92. Again, all these changes were statistically significant.

"The most rapid weight loss was in the first 6 months," Dr. de la Cruz-Munoz said.

One patient died from cardiac failure 5 months after surgery, resulting in a mortality rate of 0.11% in the cohort. In all, 141 postoperative adverse events were reported. Nausea and vomiting were the most common (13%), followed by vitamin D deficiency (8%).

Gastric bypass was the most common type of bariatric surgery in these adolescents, performed in 454 patients (51%). Gastric banding was a close second and was performed in 436 patients (49%). No gastric sleeve procedures were done in this age group during this time.

Consistent with adult data, about 80% were females; mean age was 18 years, and 69% were white, 15% Hispanic, 11% black, and 5% other.

There are now more than 375,000 patients in the BOLD registry, so adolescents represent only 0.7%. The independent, nonprofit Surgical Review Corporation (SRC) administers the American Society for Metabolic and Bariatric Surgery Center of Excellence (BSCOE) program. The SRC developed BOLD in 2007 to help ensure compliance with the BSCOE program.

There are 440 facilities currently designated as centers of excellence, with 758 surgeons; approximately 100 additional facilities have provisional status, Dr. de la Cruz-Munoz said.

A meeting attendee said that they had a lot of issues getting insurance coverage for bariatric surgery. "Insurance is huge issue for both the kids and the adults, and maybe even larger for the kids," Dr. de la Cruz-Munoz said. "Most of the data we’re seeing are [from] adult surgeons that also do kids. There are some pediatric surgeons who do kids as well, but most of those programs are just growing. A lot of times they don’t qualify yet for the centers of excellence designation."

Dr. de la Cruz-Munoz disclosed that he is a member of the SRC’s surgical review committee and a consultant for Ethicon Endo-Surgery Inc.

DENVER – Bariatric surgery results in significant weight loss at 1 year for morbidly-obese adolescents who have a procedure at a designated center of excellence, according to a study of 890 teenagers.

"This is one of the first reports of a national scope ... revealing the prevalence estimates of weight loss among adolescent patients," Dr. Nestor de la Cruz-Munoz said at the annual meeting of the Pediatric Academic Societies. "Bariatric surgery has the potential to be a safe and effective treatment option for significant weight loss in U.S. adolescents, irrespective of gender."

Fewer than 1% of bariatric surgery cases in the country are being done on adolescents, and "very little is know about the short-term and long-term outcomes in terms of weight and associated health consequences in these patients," said Dr. de la Cruz-Munoz, a bariatric surgeon at the University of Miami.

To find out more, Dr. de la Cruz-Munoz and his coworkers evaluated all patients aged 11-19 years old who had bariatric surgery from June 2007 through October 2010 in the prospective BOLD (Bariatric Outcomes Longitudinal Database) registry.

Weight decreased from a mean 138 kg at baseline to 110 kg at 1 year in these 890 patients. Baseline mean z score changed from 2.86 to 2.31, and the weight percentile of these adolescents (compared with the general population) decreased from 99.6% to 97.1%. In addition, the body mass index z score decreased from 2.6 to 2.11 during this time. Assessments were also done at 6 months post surgery in all patients. "All of those [changes] were statistically significant," Dr. de la Cruz-Munoz said.

"Bariatric surgery results in significant weight loss among morbidly obese multiethnic adolescents at 1 year post surgery, for both boys and girls," Dr. de la Cruz-Munoz said.

Broken down by sex, the mean baseline weight was 162 kg for boys and 129 for girls. The mean z score decreased from 3.52 to 2.77 for boys and from 2.64 to 2.12 for girls. "The weight percentages for boys started at about as high as you can get (99.95%) and ended up at 98.7%," Dr. de la Cruz-Munoz said. At the same time, weight percentages for girls decreased from 99.46% to 95.97%. The BMI z score decreased from a baseline 3.15 in boys to 2.57 at 1 year. For girls, this measure decreased from 2.42 to 1.92. Again, all these changes were statistically significant.

"The most rapid weight loss was in the first 6 months," Dr. de la Cruz-Munoz said.

One patient died from cardiac failure 5 months after surgery, resulting in a mortality rate of 0.11% in the cohort. In all, 141 postoperative adverse events were reported. Nausea and vomiting were the most common (13%), followed by vitamin D deficiency (8%).

Gastric bypass was the most common type of bariatric surgery in these adolescents, performed in 454 patients (51%). Gastric banding was a close second and was performed in 436 patients (49%). No gastric sleeve procedures were done in this age group during this time.

Consistent with adult data, about 80% were females; mean age was 18 years, and 69% were white, 15% Hispanic, 11% black, and 5% other.

There are now more than 375,000 patients in the BOLD registry, so adolescents represent only 0.7%. The independent, nonprofit Surgical Review Corporation (SRC) administers the American Society for Metabolic and Bariatric Surgery Center of Excellence (BSCOE) program. The SRC developed BOLD in 2007 to help ensure compliance with the BSCOE program.

There are 440 facilities currently designated as centers of excellence, with 758 surgeons; approximately 100 additional facilities have provisional status, Dr. de la Cruz-Munoz said.

A meeting attendee said that they had a lot of issues getting insurance coverage for bariatric surgery. "Insurance is huge issue for both the kids and the adults, and maybe even larger for the kids," Dr. de la Cruz-Munoz said. "Most of the data we’re seeing are [from] adult surgeons that also do kids. There are some pediatric surgeons who do kids as well, but most of those programs are just growing. A lot of times they don’t qualify yet for the centers of excellence designation."

Dr. de la Cruz-Munoz disclosed that he is a member of the SRC’s surgical review committee and a consultant for Ethicon Endo-Surgery Inc.

DENVER – Bariatric surgery results in significant weight loss at 1 year for morbidly-obese adolescents who have a procedure at a designated center of excellence, according to a study of 890 teenagers.

"This is one of the first reports of a national scope ... revealing the prevalence estimates of weight loss among adolescent patients," Dr. Nestor de la Cruz-Munoz said at the annual meeting of the Pediatric Academic Societies. "Bariatric surgery has the potential to be a safe and effective treatment option for significant weight loss in U.S. adolescents, irrespective of gender."

Fewer than 1% of bariatric surgery cases in the country are being done on adolescents, and "very little is know about the short-term and long-term outcomes in terms of weight and associated health consequences in these patients," said Dr. de la Cruz-Munoz, a bariatric surgeon at the University of Miami.

To find out more, Dr. de la Cruz-Munoz and his coworkers evaluated all patients aged 11-19 years old who had bariatric surgery from June 2007 through October 2010 in the prospective BOLD (Bariatric Outcomes Longitudinal Database) registry.

Weight decreased from a mean 138 kg at baseline to 110 kg at 1 year in these 890 patients. Baseline mean z score changed from 2.86 to 2.31, and the weight percentile of these adolescents (compared with the general population) decreased from 99.6% to 97.1%. In addition, the body mass index z score decreased from 2.6 to 2.11 during this time. Assessments were also done at 6 months post surgery in all patients. "All of those [changes] were statistically significant," Dr. de la Cruz-Munoz said.

"Bariatric surgery results in significant weight loss among morbidly obese multiethnic adolescents at 1 year post surgery, for both boys and girls," Dr. de la Cruz-Munoz said.

Broken down by sex, the mean baseline weight was 162 kg for boys and 129 for girls. The mean z score decreased from 3.52 to 2.77 for boys and from 2.64 to 2.12 for girls. "The weight percentages for boys started at about as high as you can get (99.95%) and ended up at 98.7%," Dr. de la Cruz-Munoz said. At the same time, weight percentages for girls decreased from 99.46% to 95.97%. The BMI z score decreased from a baseline 3.15 in boys to 2.57 at 1 year. For girls, this measure decreased from 2.42 to 1.92. Again, all these changes were statistically significant.

"The most rapid weight loss was in the first 6 months," Dr. de la Cruz-Munoz said.

One patient died from cardiac failure 5 months after surgery, resulting in a mortality rate of 0.11% in the cohort. In all, 141 postoperative adverse events were reported. Nausea and vomiting were the most common (13%), followed by vitamin D deficiency (8%).

Gastric bypass was the most common type of bariatric surgery in these adolescents, performed in 454 patients (51%). Gastric banding was a close second and was performed in 436 patients (49%). No gastric sleeve procedures were done in this age group during this time.

Consistent with adult data, about 80% were females; mean age was 18 years, and 69% were white, 15% Hispanic, 11% black, and 5% other.

There are now more than 375,000 patients in the BOLD registry, so adolescents represent only 0.7%. The independent, nonprofit Surgical Review Corporation (SRC) administers the American Society for Metabolic and Bariatric Surgery Center of Excellence (BSCOE) program. The SRC developed BOLD in 2007 to help ensure compliance with the BSCOE program.

There are 440 facilities currently designated as centers of excellence, with 758 surgeons; approximately 100 additional facilities have provisional status, Dr. de la Cruz-Munoz said.

A meeting attendee said that they had a lot of issues getting insurance coverage for bariatric surgery. "Insurance is huge issue for both the kids and the adults, and maybe even larger for the kids," Dr. de la Cruz-Munoz said. "Most of the data we’re seeing are [from] adult surgeons that also do kids. There are some pediatric surgeons who do kids as well, but most of those programs are just growing. A lot of times they don’t qualify yet for the centers of excellence designation."

Dr. de la Cruz-Munoz disclosed that he is a member of the SRC’s surgical review committee and a consultant for Ethicon Endo-Surgery Inc.

DENVER – Bariatric surgery results in significant weight loss at 1 year for morbidly-obese adolescents who have a procedure at a designated center of excellence, according to a study of 890 teenagers.

"This is one of the first reports of a national scope ... revealing the prevalence estimates of weight loss among adolescent patients," Dr. Nestor de la Cruz-Munoz said at the annual meeting of the Pediatric Academic Societies. "Bariatric surgery has the potential to be a safe and effective treatment option for significant weight loss in U.S. adolescents, irrespective of gender."

Fewer than 1% of bariatric surgery cases in the country are being done on adolescents, and "very little is know about the short-term and long-term outcomes in terms of weight and associated health consequences in these patients," said Dr. de la Cruz-Munoz, a bariatric surgeon at the University of Miami.

To find out more, Dr. de la Cruz-Munoz and his coworkers evaluated all patients aged 11-19 years old who had bariatric surgery from June 2007 through October 2010 in the prospective BOLD (Bariatric Outcomes Longitudinal Database) registry.

Weight decreased from a mean 138 kg at baseline to 110 kg at 1 year in these 890 patients. Baseline mean z score changed from 2.86 to 2.31, and the weight percentile of these adolescents (compared with the general population) decreased from 99.6% to 97.1%. In addition, the body mass index z score decreased from 2.6 to 2.11 during this time. Assessments were also done at 6 months post surgery in all patients. "All of those [changes] were statistically significant," Dr. de la Cruz-Munoz said.

"Bariatric surgery results in significant weight loss among morbidly obese multiethnic adolescents at 1 year post surgery, for both boys and girls," Dr. de la Cruz-Munoz said.

Broken down by sex, the mean baseline weight was 162 kg for boys and 129 for girls. The mean z score decreased from 3.52 to 2.77 for boys and from 2.64 to 2.12 for girls. "The weight percentages for boys started at about as high as you can get (99.95%) and ended up at 98.7%," Dr. de la Cruz-Munoz said. At the same time, weight percentages for girls decreased from 99.46% to 95.97%. The BMI z score decreased from a baseline 3.15 in boys to 2.57 at 1 year. For girls, this measure decreased from 2.42 to 1.92. Again, all these changes were statistically significant.

"The most rapid weight loss was in the first 6 months," Dr. de la Cruz-Munoz said.

One patient died from cardiac failure 5 months after surgery, resulting in a mortality rate of 0.11% in the cohort. In all, 141 postoperative adverse events were reported. Nausea and vomiting were the most common (13%), followed by vitamin D deficiency (8%).

Gastric bypass was the most common type of bariatric surgery in these adolescents, performed in 454 patients (51%). Gastric banding was a close second and was performed in 436 patients (49%). No gastric sleeve procedures were done in this age group during this time.

Consistent with adult data, about 80% were females; mean age was 18 years, and 69% were white, 15% Hispanic, 11% black, and 5% other.

There are now more than 375,000 patients in the BOLD registry, so adolescents represent only 0.7%. The independent, nonprofit Surgical Review Corporation (SRC) administers the American Society for Metabolic and Bariatric Surgery Center of Excellence (BSCOE) program. The SRC developed BOLD in 2007 to help ensure compliance with the BSCOE program.

There are 440 facilities currently designated as centers of excellence, with 758 surgeons; approximately 100 additional facilities have provisional status, Dr. de la Cruz-Munoz said.

A meeting attendee said that they had a lot of issues getting insurance coverage for bariatric surgery. "Insurance is huge issue for both the kids and the adults, and maybe even larger for the kids," Dr. de la Cruz-Munoz said. "Most of the data we’re seeing are [from] adult surgeons that also do kids. There are some pediatric surgeons who do kids as well, but most of those programs are just growing. A lot of times they don’t qualify yet for the centers of excellence designation."

Dr. de la Cruz-Munoz disclosed that he is a member of the SRC’s surgical review committee and a consultant for Ethicon Endo-Surgery Inc.

DENVER – Drinking sugar-sweetened beverages, not eating breakfast, and eating too many low-nutrient, high-fat snacks were among the modifiable risk factors for obesity found in a cross-sectional survey of obese, low-income children.

Remind parents and guardians of the importance of eating breakfast every day, particularly if they have an older, obese child, Patricia Cluss, Ph.D., said at the at the annual meeting of the Pediatric Academic Societies.

Photo credit: Courtesy National Cancer Institute

In addition, younger children were significantly less likely to eat enough vegetables, according to the survey of 136 parents or guardians of children aged 2-11 years with a body mass index at the 95th percentile or greater for age and sex.

"I’m not sure we would have predicted this: As children got older, they ate more vegetables," Dr. Cluss said.

Most children – 89% – drank sugar-sweetened beverages. "This is probably not a surprise to this audience," Dr. Cluss said.

Counsel all your families with obese children to eliminate or significantly reduce their consumption of sugar-sweetened beverages, Dr. Cluss said.

The total number of meals and snacks eaten per day was another modifiable factor identified in the study. A total of 28% of parents reported their obese child ate five or more meals and snacks per day.

Intake of low-nutrient, high-fat snacks was another modifiable risk factor, according to the study. Half the children snacked "often" or "very often" on chips, cheese puffs, and similar items. "It’s horrifying to see how much of their daily calorie consumption – these are kids in the 99th percentile for BMI – can come from high-calorie snacks with almost no nutrition," said Dr. Cluss, a psychiatrist at the University of Pittsburgh.

Dr. Cluss, lead researcher Linda J. Ewing, Ph.D., and their associates assessed this population because, although approximately 30% of children and adolescents are overweight or obese, minorities and low-income groups are at higher risk.

The cohort of children skewed older (half were aged 9-11 years). In addition, 39% had a BMI in the 99th or greater percentile, "so this is a very obese sample." The majority of caregivers were women (96%) and parents (94%); most of the 6% who were guardians were close relatives. The mean age of the adults was 35 years (range, 22-71 years). A majority were black (75%), 20% were white, and 5% were other race/ethnicities. About 93% of adults had at least a high school diploma.

More than two-thirds (71%) of parents and guardians were obese themselves, "but that was not a requirement for participation," Dr. Cluss said. However, having an obese caregiver significantly increased the chances the child was eating five or more meals/snacks per day.

A meeting attendee asked Dr. Cluss if she recommends no snacks or healthy snacks. "On the surface, eating three meals and two snacks may not be all that bad, depending on how healthy the snack is," she replied.

All families in the study were insured by Medicaid. The majority (79%) lived in households with annual incomes of $25,000 or less, which included 49% with household incomes of $15,000 or less. The relatively lower-income caregivers were significantly more likely to shop for food at a convenience store versus a supermarket, Dr. Cluss said. "This could reflect their preference, but the lower-income sample may be living in areas where a convenience store is the only place they can buy food if they don’t have transportation."

The majority of surveys were completed in a pediatric primary care clinic setting, but a few were done in the child’s home when transportation was an issue, she said.

Overall, 37% of adults in the study said they "almost never" ate together with the child without the television on. However, caregivers and children from households with annual incomes of $15,000 or less were more likely to eat without the television on, which Dr. Cluss called an intriguing finding that warrants further research.

Dr. Cluss said they plan to validate these initial results using food recall data. She said, "I think future food recall data will give us a better picture versus the initial survey data."

Dr. Cluss said she had no relevant financial disclosures.

DENVER – Drinking sugar-sweetened beverages, not eating breakfast, and eating too many low-nutrient, high-fat snacks were among the modifiable risk factors for obesity found in a cross-sectional survey of obese, low-income children.

Remind parents and guardians of the importance of eating breakfast every day, particularly if they have an older, obese child, Patricia Cluss, Ph.D., said at the at the annual meeting of the Pediatric Academic Societies.

Photo credit: Courtesy National Cancer Institute

In addition, younger children were significantly less likely to eat enough vegetables, according to the survey of 136 parents or guardians of children aged 2-11 years with a body mass index at the 95th percentile or greater for age and sex.

"I’m not sure we would have predicted this: As children got older, they ate more vegetables," Dr. Cluss said.

Most children – 89% – drank sugar-sweetened beverages. "This is probably not a surprise to this audience," Dr. Cluss said.

Counsel all your families with obese children to eliminate or significantly reduce their consumption of sugar-sweetened beverages, Dr. Cluss said.

The total number of meals and snacks eaten per day was another modifiable factor identified in the study. A total of 28% of parents reported their obese child ate five or more meals and snacks per day.

Intake of low-nutrient, high-fat snacks was another modifiable risk factor, according to the study. Half the children snacked "often" or "very often" on chips, cheese puffs, and similar items. "It’s horrifying to see how much of their daily calorie consumption – these are kids in the 99th percentile for BMI – can come from high-calorie snacks with almost no nutrition," said Dr. Cluss, a psychiatrist at the University of Pittsburgh.

Dr. Cluss, lead researcher Linda J. Ewing, Ph.D., and their associates assessed this population because, although approximately 30% of children and adolescents are overweight or obese, minorities and low-income groups are at higher risk.

The cohort of children skewed older (half were aged 9-11 years). In addition, 39% had a BMI in the 99th or greater percentile, "so this is a very obese sample." The majority of caregivers were women (96%) and parents (94%); most of the 6% who were guardians were close relatives. The mean age of the adults was 35 years (range, 22-71 years). A majority were black (75%), 20% were white, and 5% were other race/ethnicities. About 93% of adults had at least a high school diploma.

More than two-thirds (71%) of parents and guardians were obese themselves, "but that was not a requirement for participation," Dr. Cluss said. However, having an obese caregiver significantly increased the chances the child was eating five or more meals/snacks per day.

A meeting attendee asked Dr. Cluss if she recommends no snacks or healthy snacks. "On the surface, eating three meals and two snacks may not be all that bad, depending on how healthy the snack is," she replied.

All families in the study were insured by Medicaid. The majority (79%) lived in households with annual incomes of $25,000 or less, which included 49% with household incomes of $15,000 or less. The relatively lower-income caregivers were significantly more likely to shop for food at a convenience store versus a supermarket, Dr. Cluss said. "This could reflect their preference, but the lower-income sample may be living in areas where a convenience store is the only place they can buy food if they don’t have transportation."

The majority of surveys were completed in a pediatric primary care clinic setting, but a few were done in the child’s home when transportation was an issue, she said.

Overall, 37% of adults in the study said they "almost never" ate together with the child without the television on. However, caregivers and children from households with annual incomes of $15,000 or less were more likely to eat without the television on, which Dr. Cluss called an intriguing finding that warrants further research.

Dr. Cluss said they plan to validate these initial results using food recall data. She said, "I think future food recall data will give us a better picture versus the initial survey data."

Dr. Cluss said she had no relevant financial disclosures.

DENVER – Drinking sugar-sweetened beverages, not eating breakfast, and eating too many low-nutrient, high-fat snacks were among the modifiable risk factors for obesity found in a cross-sectional survey of obese, low-income children.

Remind parents and guardians of the importance of eating breakfast every day, particularly if they have an older, obese child, Patricia Cluss, Ph.D., said at the at the annual meeting of the Pediatric Academic Societies.

Photo credit: Courtesy National Cancer Institute

In addition, younger children were significantly less likely to eat enough vegetables, according to the survey of 136 parents or guardians of children aged 2-11 years with a body mass index at the 95th percentile or greater for age and sex.

"I’m not sure we would have predicted this: As children got older, they ate more vegetables," Dr. Cluss said.

Most children – 89% – drank sugar-sweetened beverages. "This is probably not a surprise to this audience," Dr. Cluss said.

Counsel all your families with obese children to eliminate or significantly reduce their consumption of sugar-sweetened beverages, Dr. Cluss said.

The total number of meals and snacks eaten per day was another modifiable factor identified in the study. A total of 28% of parents reported their obese child ate five or more meals and snacks per day.

Intake of low-nutrient, high-fat snacks was another modifiable risk factor, according to the study. Half the children snacked "often" or "very often" on chips, cheese puffs, and similar items. "It’s horrifying to see how much of their daily calorie consumption – these are kids in the 99th percentile for BMI – can come from high-calorie snacks with almost no nutrition," said Dr. Cluss, a psychiatrist at the University of Pittsburgh.

Dr. Cluss, lead researcher Linda J. Ewing, Ph.D., and their associates assessed this population because, although approximately 30% of children and adolescents are overweight or obese, minorities and low-income groups are at higher risk.

The cohort of children skewed older (half were aged 9-11 years). In addition, 39% had a BMI in the 99th or greater percentile, "so this is a very obese sample." The majority of caregivers were women (96%) and parents (94%); most of the 6% who were guardians were close relatives. The mean age of the adults was 35 years (range, 22-71 years). A majority were black (75%), 20% were white, and 5% were other race/ethnicities. About 93% of adults had at least a high school diploma.

More than two-thirds (71%) of parents and guardians were obese themselves, "but that was not a requirement for participation," Dr. Cluss said. However, having an obese caregiver significantly increased the chances the child was eating five or more meals/snacks per day.

A meeting attendee asked Dr. Cluss if she recommends no snacks or healthy snacks. "On the surface, eating three meals and two snacks may not be all that bad, depending on how healthy the snack is," she replied.

All families in the study were insured by Medicaid. The majority (79%) lived in households with annual incomes of $25,000 or less, which included 49% with household incomes of $15,000 or less. The relatively lower-income caregivers were significantly more likely to shop for food at a convenience store versus a supermarket, Dr. Cluss said. "This could reflect their preference, but the lower-income sample may be living in areas where a convenience store is the only place they can buy food if they don’t have transportation."

The majority of surveys were completed in a pediatric primary care clinic setting, but a few were done in the child’s home when transportation was an issue, she said.

Overall, 37% of adults in the study said they "almost never" ate together with the child without the television on. However, caregivers and children from households with annual incomes of $15,000 or less were more likely to eat without the television on, which Dr. Cluss called an intriguing finding that warrants further research.

Dr. Cluss said they plan to validate these initial results using food recall data. She said, "I think future food recall data will give us a better picture versus the initial survey data."

Dr. Cluss said she had no relevant financial disclosures.

DENVER – Physicians can’t rely on what parents say regarding inhaled corticosteroid use. To know how many doses an asthmatic child is getting, it’s best to have parents bring the canister into the office and check the dose counter, according to pediatrician Dr. Marina Reznik.

Dr. Reznik and her colleagues at the Albert Einstein College of Medicine in the Bronx, N.Y., compared the number of puffs that parents said they gave their children vs. the number of puffs recorded on the canisters’ dose counters.

(c)xavier gallego morel/fotolia.com

They visited families’ homes as part of an asthma education study, and the parents didn’t know that the inhaled corticosteroid (ICS) use was being monitored.

Over the course of a month, 16 of 40 parents (40%) said that they gave their child two puffs twice a day, as prescribed; however, the counter revealed that only 2 parents (5%) actually did so. One parent (2.5%) reported having given the medication less than once a week, but in reality, four parents (10%) earned that distinction.

"Now we know what the reality is. They are not using the pump as they are supposed to," Dr. Reznik said at the annual meeting of the Pediatric Academic Societies.

Poor ICS adherence is nothing new, but the phenomenon hasn’t been studied very much in an urban minority population, Dr. Reznik said.

The children were aged 2-9 years and were patients at a Bronx community health center. The parents’ average age was 32 years, and 26 (65%) were Hispanic. In all, 12 parents (30%) had dropped out of high school.

Dr. Reznik said she thinks the problem is a lack of education. Parents have misconceptions about side effects, and don’t quite understand the need for controller medications in addition to rescue medications, such as albuterol.

It’s not that parents were unfamiliar with steroid inhalers. All the children had been prescribed inhalers in the past before they received a fresh one at the start of the study. Parents also knew how serious asthma can be; some of the children had been hospitalized in the past.

Even so, many parents couldn’t find the inhalers during the home visits.

Dr. Reznik said she has no relevant financial disclosures. The study was funded by the American Lung Association, the New York Community Trust, and the department of pediatrics at the Children’s Hospital at Montefiore in the Bronx.

DENVER – Physicians can’t rely on what parents say regarding inhaled corticosteroid use. To know how many doses an asthmatic child is getting, it’s best to have parents bring the canister into the office and check the dose counter, according to pediatrician Dr. Marina Reznik.

Dr. Reznik and her colleagues at the Albert Einstein College of Medicine in the Bronx, N.Y., compared the number of puffs that parents said they gave their children vs. the number of puffs recorded on the canisters’ dose counters.

(c)xavier gallego morel/fotolia.com

They visited families’ homes as part of an asthma education study, and the parents didn’t know that the inhaled corticosteroid (ICS) use was being monitored.

Over the course of a month, 16 of 40 parents (40%) said that they gave their child two puffs twice a day, as prescribed; however, the counter revealed that only 2 parents (5%) actually did so. One parent (2.5%) reported having given the medication less than once a week, but in reality, four parents (10%) earned that distinction.

"Now we know what the reality is. They are not using the pump as they are supposed to," Dr. Reznik said at the annual meeting of the Pediatric Academic Societies.

Poor ICS adherence is nothing new, but the phenomenon hasn’t been studied very much in an urban minority population, Dr. Reznik said.

The children were aged 2-9 years and were patients at a Bronx community health center. The parents’ average age was 32 years, and 26 (65%) were Hispanic. In all, 12 parents (30%) had dropped out of high school.

Dr. Reznik said she thinks the problem is a lack of education. Parents have misconceptions about side effects, and don’t quite understand the need for controller medications in addition to rescue medications, such as albuterol.

It’s not that parents were unfamiliar with steroid inhalers. All the children had been prescribed inhalers in the past before they received a fresh one at the start of the study. Parents also knew how serious asthma can be; some of the children had been hospitalized in the past.

Even so, many parents couldn’t find the inhalers during the home visits.

Dr. Reznik said she has no relevant financial disclosures. The study was funded by the American Lung Association, the New York Community Trust, and the department of pediatrics at the Children’s Hospital at Montefiore in the Bronx.

DENVER – Physicians can’t rely on what parents say regarding inhaled corticosteroid use. To know how many doses an asthmatic child is getting, it’s best to have parents bring the canister into the office and check the dose counter, according to pediatrician Dr. Marina Reznik.

Dr. Reznik and her colleagues at the Albert Einstein College of Medicine in the Bronx, N.Y., compared the number of puffs that parents said they gave their children vs. the number of puffs recorded on the canisters’ dose counters.

(c)xavier gallego morel/fotolia.com

They visited families’ homes as part of an asthma education study, and the parents didn’t know that the inhaled corticosteroid (ICS) use was being monitored.

Over the course of a month, 16 of 40 parents (40%) said that they gave their child two puffs twice a day, as prescribed; however, the counter revealed that only 2 parents (5%) actually did so. One parent (2.5%) reported having given the medication less than once a week, but in reality, four parents (10%) earned that distinction.

"Now we know what the reality is. They are not using the pump as they are supposed to," Dr. Reznik said at the annual meeting of the Pediatric Academic Societies.

Poor ICS adherence is nothing new, but the phenomenon hasn’t been studied very much in an urban minority population, Dr. Reznik said.

The children were aged 2-9 years and were patients at a Bronx community health center. The parents’ average age was 32 years, and 26 (65%) were Hispanic. In all, 12 parents (30%) had dropped out of high school.

Dr. Reznik said she thinks the problem is a lack of education. Parents have misconceptions about side effects, and don’t quite understand the need for controller medications in addition to rescue medications, such as albuterol.

It’s not that parents were unfamiliar with steroid inhalers. All the children had been prescribed inhalers in the past before they received a fresh one at the start of the study. Parents also knew how serious asthma can be; some of the children had been hospitalized in the past.

Even so, many parents couldn’t find the inhalers during the home visits.

Dr. Reznik said she has no relevant financial disclosures. The study was funded by the American Lung Association, the New York Community Trust, and the department of pediatrics at the Children’s Hospital at Montefiore in the Bronx.

DENVER – When 606 outwardly healthy, normal high school students were screened in a Florida pilot study, 14% had borderline or abnormal ECGs, 14% were hypertensive, and 12% were obese.

One student had Wolff-Parkinson-White syndrome, another left ventricular hypertrophy with strain; both carry the potential for sudden cardiac death. Hypertensive students were more likely to have evidence of end organ heart damage.

The findings reveal that "there is a significant proportion of occult disease in this community that is underrecognized, be that obesity, hypertension, or cardiac conditions," said lead author Dr. Gul H. Dadlani, a pediatric cardiologist at All Children’s Hospital in St. Petersburg, Fla., said at the annual meeting of the Pediatric Academic Societies.

However, he said that the numbers in the study are too small to argue one way or the other for universal teen ECG screening in the United States, a contentious subject pitting the cost of such a program against its potential benefits.

"I think we need a national [study] to be able to" resolve that debate, he said, adding that he is working to secure funding for at least a Florida-wide study.

The students came from seven high schools in Hillsborough county in Florida and volunteered for the screenings with their parents’ consent. Screening results were mailed to families, with follow-up care recommended as appropriate.

Body mass indexes were calculated from students’ reported heights and weights. Blood pressures were taken once with a Dinamap machine. All the students had ECGs; inverted T waves, premature ventricular contractions, prolonged QTC intervals, and right or left ventricular hypertrophy were among the findings considered abnormal.

The students’ mean age was 16.5 years, and 58% were boys; 57% were white, 16% Hispanic, 12% black, 5% Asian, and the rest were "other."

A total of 74% had normal BMIs, 14% were overweight, and 12% obese; 41% were normotensive, 45% prehypertensive, and 14% hypertensive, with hypertension most common in boys. Hypertension and obesity were significantly associated.

Twelve percent had borderline and 2% had abnormal ECGs.

"Many of these students will go into a walk-in clinic, get their height and weight done," a blood pressure check, and "they get signed off and cleared to participate" in sports, Dr. Dadlani said.

If problems are caught early with more rigorous exams – including calculating age- and sex-appropriate BMIs and age-, height-, and sex-appropriate blood pressures, among other measures – "you can really make a difference in this population" by treating problems sooner, especially with the cardiovascular effects of obesity and hypertension showing up at earlier ages.

Dr. Dadlani said he had no relevant financial disclosures. The study was funded by the Cardiac Arrhythmia Syndromes Foundation.

DENVER – When 606 outwardly healthy, normal high school students were screened in a Florida pilot study, 14% had borderline or abnormal ECGs, 14% were hypertensive, and 12% were obese.

One student had Wolff-Parkinson-White syndrome, another left ventricular hypertrophy with strain; both carry the potential for sudden cardiac death. Hypertensive students were more likely to have evidence of end organ heart damage.

The findings reveal that "there is a significant proportion of occult disease in this community that is underrecognized, be that obesity, hypertension, or cardiac conditions," said lead author Dr. Gul H. Dadlani, a pediatric cardiologist at All Children’s Hospital in St. Petersburg, Fla., said at the annual meeting of the Pediatric Academic Societies.

However, he said that the numbers in the study are too small to argue one way or the other for universal teen ECG screening in the United States, a contentious subject pitting the cost of such a program against its potential benefits.

"I think we need a national [study] to be able to" resolve that debate, he said, adding that he is working to secure funding for at least a Florida-wide study.

The students came from seven high schools in Hillsborough county in Florida and volunteered for the screenings with their parents’ consent. Screening results were mailed to families, with follow-up care recommended as appropriate.

Body mass indexes were calculated from students’ reported heights and weights. Blood pressures were taken once with a Dinamap machine. All the students had ECGs; inverted T waves, premature ventricular contractions, prolonged QTC intervals, and right or left ventricular hypertrophy were among the findings considered abnormal.

The students’ mean age was 16.5 years, and 58% were boys; 57% were white, 16% Hispanic, 12% black, 5% Asian, and the rest were "other."

A total of 74% had normal BMIs, 14% were overweight, and 12% obese; 41% were normotensive, 45% prehypertensive, and 14% hypertensive, with hypertension most common in boys. Hypertension and obesity were significantly associated.

Twelve percent had borderline and 2% had abnormal ECGs.

"Many of these students will go into a walk-in clinic, get their height and weight done," a blood pressure check, and "they get signed off and cleared to participate" in sports, Dr. Dadlani said.

If problems are caught early with more rigorous exams – including calculating age- and sex-appropriate BMIs and age-, height-, and sex-appropriate blood pressures, among other measures – "you can really make a difference in this population" by treating problems sooner, especially with the cardiovascular effects of obesity and hypertension showing up at earlier ages.

Dr. Dadlani said he had no relevant financial disclosures. The study was funded by the Cardiac Arrhythmia Syndromes Foundation.

DENVER – When 606 outwardly healthy, normal high school students were screened in a Florida pilot study, 14% had borderline or abnormal ECGs, 14% were hypertensive, and 12% were obese.

One student had Wolff-Parkinson-White syndrome, another left ventricular hypertrophy with strain; both carry the potential for sudden cardiac death. Hypertensive students were more likely to have evidence of end organ heart damage.

The findings reveal that "there is a significant proportion of occult disease in this community that is underrecognized, be that obesity, hypertension, or cardiac conditions," said lead author Dr. Gul H. Dadlani, a pediatric cardiologist at All Children’s Hospital in St. Petersburg, Fla., said at the annual meeting of the Pediatric Academic Societies.

However, he said that the numbers in the study are too small to argue one way or the other for universal teen ECG screening in the United States, a contentious subject pitting the cost of such a program against its potential benefits.

"I think we need a national [study] to be able to" resolve that debate, he said, adding that he is working to secure funding for at least a Florida-wide study.

The students came from seven high schools in Hillsborough county in Florida and volunteered for the screenings with their parents’ consent. Screening results were mailed to families, with follow-up care recommended as appropriate.

Body mass indexes were calculated from students’ reported heights and weights. Blood pressures were taken once with a Dinamap machine. All the students had ECGs; inverted T waves, premature ventricular contractions, prolonged QTC intervals, and right or left ventricular hypertrophy were among the findings considered abnormal.

The students’ mean age was 16.5 years, and 58% were boys; 57% were white, 16% Hispanic, 12% black, 5% Asian, and the rest were "other."

A total of 74% had normal BMIs, 14% were overweight, and 12% obese; 41% were normotensive, 45% prehypertensive, and 14% hypertensive, with hypertension most common in boys. Hypertension and obesity were significantly associated.

Twelve percent had borderline and 2% had abnormal ECGs.

"Many of these students will go into a walk-in clinic, get their height and weight done," a blood pressure check, and "they get signed off and cleared to participate" in sports, Dr. Dadlani said.

If problems are caught early with more rigorous exams – including calculating age- and sex-appropriate BMIs and age-, height-, and sex-appropriate blood pressures, among other measures – "you can really make a difference in this population" by treating problems sooner, especially with the cardiovascular effects of obesity and hypertension showing up at earlier ages.

Dr. Dadlani said he had no relevant financial disclosures. The study was funded by the Cardiac Arrhythmia Syndromes Foundation.

DENVER – When 606 outwardly healthy, normal high school students were screened in a Florida pilot study, 14% had borderline or abnormal ECGs, 14% were hypertensive, and 12% were obese.

One student had Wolff-Parkinson-White syndrome, another left ventricular hypertrophy with strain; both carry the potential for sudden cardiac death. Hypertensive students were more likely to have evidence of end organ heart damage.

The findings reveal that "there is a significant proportion of occult disease in this community that is underrecognized, be that obesity, hypertension, or cardiac conditions," said lead author Dr. Gul H. Dadlani, a pediatric cardiologist at All Children’s Hospital in St. Petersburg, Fla., said at the annual meeting of the Pediatric Academic Societies.

However, he said that the numbers in the study are too small to argue one way or the other for universal teen ECG screening in the United States, a contentious subject pitting the cost of such a program against its potential benefits.

"I think we need a national [study] to be able to" resolve that debate, he said, adding that he is working to secure funding for at least a Florida-wide study.

The students came from seven high schools in Hillsborough county in Florida and volunteered for the screenings with their parents’ consent. Screening results were mailed to families, with follow-up care recommended as appropriate.

Body mass indexes were calculated from students’ reported heights and weights. Blood pressures were taken once with a Dinamap machine. All the students had ECGs; inverted T waves, premature ventricular contractions, prolonged QTC intervals, and right or left ventricular hypertrophy were among the findings considered abnormal.

The students’ mean age was 16.5 years, and 58% were boys; 57% were white, 16% Hispanic, 12% black, 5% Asian, and the rest were "other."

A total of 74% had normal BMIs, 14% were overweight, and 12% obese; 41% were normotensive, 45% prehypertensive, and 14% hypertensive, with hypertension most common in boys. Hypertension and obesity were significantly associated.

Twelve percent had borderline and 2% had abnormal ECGs.

"Many of these students will go into a walk-in clinic, get their height and weight done," a blood pressure check, and "they get signed off and cleared to participate" in sports, Dr. Dadlani said.

If problems are caught early with more rigorous exams – including calculating age- and sex-appropriate BMIs and age-, height-, and sex-appropriate blood pressures, among other measures – "you can really make a difference in this population" by treating problems sooner, especially with the cardiovascular effects of obesity and hypertension showing up at earlier ages.

Dr. Dadlani said he had no relevant financial disclosures. The study was funded by the Cardiac Arrhythmia Syndromes Foundation.

DENVER – When 606 outwardly healthy, normal high school students were screened in a Florida pilot study, 14% had borderline or abnormal ECGs, 14% were hypertensive, and 12% were obese.

One student had Wolff-Parkinson-White syndrome, another left ventricular hypertrophy with strain; both carry the potential for sudden cardiac death. Hypertensive students were more likely to have evidence of end organ heart damage.

The findings reveal that "there is a significant proportion of occult disease in this community that is underrecognized, be that obesity, hypertension, or cardiac conditions," said lead author Dr. Gul H. Dadlani, a pediatric cardiologist at All Children’s Hospital in St. Petersburg, Fla., said at the annual meeting of the Pediatric Academic Societies.

However, he said that the numbers in the study are too small to argue one way or the other for universal teen ECG screening in the United States, a contentious subject pitting the cost of such a program against its potential benefits.

"I think we need a national [study] to be able to" resolve that debate, he said, adding that he is working to secure funding for at least a Florida-wide study.

The students came from seven high schools in Hillsborough county in Florida and volunteered for the screenings with their parents’ consent. Screening results were mailed to families, with follow-up care recommended as appropriate.

Body mass indexes were calculated from students’ reported heights and weights. Blood pressures were taken once with a Dinamap machine. All the students had ECGs; inverted T waves, premature ventricular contractions, prolonged QTC intervals, and right or left ventricular hypertrophy were among the findings considered abnormal.

The students’ mean age was 16.5 years, and 58% were boys; 57% were white, 16% Hispanic, 12% black, 5% Asian, and the rest were "other."

A total of 74% had normal BMIs, 14% were overweight, and 12% obese; 41% were normotensive, 45% prehypertensive, and 14% hypertensive, with hypertension most common in boys. Hypertension and obesity were significantly associated.

Twelve percent had borderline and 2% had abnormal ECGs.

"Many of these students will go into a walk-in clinic, get their height and weight done," a blood pressure check, and "they get signed off and cleared to participate" in sports, Dr. Dadlani said.

If problems are caught early with more rigorous exams – including calculating age- and sex-appropriate BMIs and age-, height-, and sex-appropriate blood pressures, among other measures – "you can really make a difference in this population" by treating problems sooner, especially with the cardiovascular effects of obesity and hypertension showing up at earlier ages.

Dr. Dadlani said he had no relevant financial disclosures. The study was funded by the Cardiac Arrhythmia Syndromes Foundation.

DENVER – When 606 outwardly healthy, normal high school students were screened in a Florida pilot study, 14% had borderline or abnormal ECGs, 14% were hypertensive, and 12% were obese.

One student had Wolff-Parkinson-White syndrome, another left ventricular hypertrophy with strain; both carry the potential for sudden cardiac death. Hypertensive students were more likely to have evidence of end organ heart damage.

The findings reveal that "there is a significant proportion of occult disease in this community that is underrecognized, be that obesity, hypertension, or cardiac conditions," said lead author Dr. Gul H. Dadlani, a pediatric cardiologist at All Children’s Hospital in St. Petersburg, Fla., said at the annual meeting of the Pediatric Academic Societies.

However, he said that the numbers in the study are too small to argue one way or the other for universal teen ECG screening in the United States, a contentious subject pitting the cost of such a program against its potential benefits.

"I think we need a national [study] to be able to" resolve that debate, he said, adding that he is working to secure funding for at least a Florida-wide study.

The students came from seven high schools in Hillsborough county in Florida and volunteered for the screenings with their parents’ consent. Screening results were mailed to families, with follow-up care recommended as appropriate.

Body mass indexes were calculated from students’ reported heights and weights. Blood pressures were taken once with a Dinamap machine. All the students had ECGs; inverted T waves, premature ventricular contractions, prolonged QTC intervals, and right or left ventricular hypertrophy were among the findings considered abnormal.

The students’ mean age was 16.5 years, and 58% were boys; 57% were white, 16% Hispanic, 12% black, 5% Asian, and the rest were "other."

A total of 74% had normal BMIs, 14% were overweight, and 12% obese; 41% were normotensive, 45% prehypertensive, and 14% hypertensive, with hypertension most common in boys. Hypertension and obesity were significantly associated.

Twelve percent had borderline and 2% had abnormal ECGs.

"Many of these students will go into a walk-in clinic, get their height and weight done," a blood pressure check, and "they get signed off and cleared to participate" in sports, Dr. Dadlani said.

If problems are caught early with more rigorous exams – including calculating age- and sex-appropriate BMIs and age-, height-, and sex-appropriate blood pressures, among other measures – "you can really make a difference in this population" by treating problems sooner, especially with the cardiovascular effects of obesity and hypertension showing up at earlier ages.

Dr. Dadlani said he had no relevant financial disclosures. The study was funded by the Cardiac Arrhythmia Syndromes Foundation.

DENVER – Provider recommendation is strongly associated with initiation of the human papillomavirus vaccine in teenage females, results from a national survey demonstrated.

"It’s important for providers to take the time to counsel and recommend the HPV vaccine and communicate the benefits and the risks of the vaccination, as well as the risk of getting HPV disease as teenagers," Dr. Christina G. Dorell said in an interview during a poster session at the annual meeting of the Pediatric Academic Societies.

Dr. Dorell of the immunization services division at the Centers for Disease Control and Prevention, Atlanta, presented findings from the 2008-2009 National Immunization Survey Teen (NIS-Teen), which was analyzed to determine human papillomavirus (HPV) vaccination coverage among females aged 13-17 years. The NIS-Teen is composed of two parts: a random-digit–dialed telephone survey of parents or guardians of adolescents aged 13-17 years, and a mailed survey to all vaccination providers identified by the parent and for which consent was granted.

The researchers evaluated associations of select socioeconomic characteristics, intention to vaccinate, and HPV status. They used multivariable logistic regression to examine associations while controlling for other factors, including state of residence.

Of the 18,288 females surveyed, 41% received at least one HPV dose. Of those, 53% completed the three-dose series.

The probability of HPV vaccination occurring is 2.6 times higher for adolescents who receive a provider recommendation than for adolescents who do not receive a provider recommendation. Other factors independently associated with HPV vaccine initiation were older age, having a preventive visit at age 11 or 12 years, being eligible for state Children’s Health Insurance Program (CHIP) or Vaccines for Children (VFC) program, having a mother younger than age 34 years, having a mother who never married, and not receiving all vaccines at public facilities.

More than half of white females (60%) completed the vaccination series, compared with 46% of blacks and 40% of Hispanics. Other factors independently associated with completing the vaccination series were having a mother aged 45 or older, being knowledgeable about HPV disease, and not receiving all vaccines at public facilities.

The main reported reasons parents do not intend for their daughters to receive the HPV vaccination in the next 12 months were lack of knowledge (19%), considering it not needed or not necessary (19%), the fact that their daughters were not sexually active (18%), and that they did not receive a provider recommendation (13%).

Dr. Dorell acknowledged certain limitations of the study, including the fact that the telephone portion of the survey was using land line phones only, thus contributing to a noncoverage bias of wireless-only households. It’s also possible that some of the provider data or vaccination histories may be incomplete, she said. However, she pointed out that one of the main strengths of the NIS-Teen "is that it is the only nationally representative survey that reports vaccination coverage estimates from provider-reported data, which is the gold standard for measuring vaccination coverage."

Dr. Dorell said that she had no relevant financial disclosures.

DENVER – Provider recommendation is strongly associated with initiation of the human papillomavirus vaccine in teenage females, results from a national survey demonstrated.

"It’s important for providers to take the time to counsel and recommend the HPV vaccine and communicate the benefits and the risks of the vaccination, as well as the risk of getting HPV disease as teenagers," Dr. Christina G. Dorell said in an interview during a poster session at the annual meeting of the Pediatric Academic Societies.

Dr. Dorell of the immunization services division at the Centers for Disease Control and Prevention, Atlanta, presented findings from the 2008-2009 National Immunization Survey Teen (NIS-Teen), which was analyzed to determine human papillomavirus (HPV) vaccination coverage among females aged 13-17 years. The NIS-Teen is composed of two parts: a random-digit–dialed telephone survey of parents or guardians of adolescents aged 13-17 years, and a mailed survey to all vaccination providers identified by the parent and for which consent was granted.

The researchers evaluated associations of select socioeconomic characteristics, intention to vaccinate, and HPV status. They used multivariable logistic regression to examine associations while controlling for other factors, including state of residence.

Of the 18,288 females surveyed, 41% received at least one HPV dose. Of those, 53% completed the three-dose series.

The probability of HPV vaccination occurring is 2.6 times higher for adolescents who receive a provider recommendation than for adolescents who do not receive a provider recommendation. Other factors independently associated with HPV vaccine initiation were older age, having a preventive visit at age 11 or 12 years, being eligible for state Children’s Health Insurance Program (CHIP) or Vaccines for Children (VFC) program, having a mother younger than age 34 years, having a mother who never married, and not receiving all vaccines at public facilities.

More than half of white females (60%) completed the vaccination series, compared with 46% of blacks and 40% of Hispanics. Other factors independently associated with completing the vaccination series were having a mother aged 45 or older, being knowledgeable about HPV disease, and not receiving all vaccines at public facilities.

The main reported reasons parents do not intend for their daughters to receive the HPV vaccination in the next 12 months were lack of knowledge (19%), considering it not needed or not necessary (19%), the fact that their daughters were not sexually active (18%), and that they did not receive a provider recommendation (13%).

Dr. Dorell acknowledged certain limitations of the study, including the fact that the telephone portion of the survey was using land line phones only, thus contributing to a noncoverage bias of wireless-only households. It’s also possible that some of the provider data or vaccination histories may be incomplete, she said. However, she pointed out that one of the main strengths of the NIS-Teen "is that it is the only nationally representative survey that reports vaccination coverage estimates from provider-reported data, which is the gold standard for measuring vaccination coverage."

Dr. Dorell said that she had no relevant financial disclosures.

DENVER – Provider recommendation is strongly associated with initiation of the human papillomavirus vaccine in teenage females, results from a national survey demonstrated.

"It’s important for providers to take the time to counsel and recommend the HPV vaccine and communicate the benefits and the risks of the vaccination, as well as the risk of getting HPV disease as teenagers," Dr. Christina G. Dorell said in an interview during a poster session at the annual meeting of the Pediatric Academic Societies.

Dr. Dorell of the immunization services division at the Centers for Disease Control and Prevention, Atlanta, presented findings from the 2008-2009 National Immunization Survey Teen (NIS-Teen), which was analyzed to determine human papillomavirus (HPV) vaccination coverage among females aged 13-17 years. The NIS-Teen is composed of two parts: a random-digit–dialed telephone survey of parents or guardians of adolescents aged 13-17 years, and a mailed survey to all vaccination providers identified by the parent and for which consent was granted.

The researchers evaluated associations of select socioeconomic characteristics, intention to vaccinate, and HPV status. They used multivariable logistic regression to examine associations while controlling for other factors, including state of residence.

Of the 18,288 females surveyed, 41% received at least one HPV dose. Of those, 53% completed the three-dose series.

The probability of HPV vaccination occurring is 2.6 times higher for adolescents who receive a provider recommendation than for adolescents who do not receive a provider recommendation. Other factors independently associated with HPV vaccine initiation were older age, having a preventive visit at age 11 or 12 years, being eligible for state Children’s Health Insurance Program (CHIP) or Vaccines for Children (VFC) program, having a mother younger than age 34 years, having a mother who never married, and not receiving all vaccines at public facilities.

More than half of white females (60%) completed the vaccination series, compared with 46% of blacks and 40% of Hispanics. Other factors independently associated with completing the vaccination series were having a mother aged 45 or older, being knowledgeable about HPV disease, and not receiving all vaccines at public facilities.

The main reported reasons parents do not intend for their daughters to receive the HPV vaccination in the next 12 months were lack of knowledge (19%), considering it not needed or not necessary (19%), the fact that their daughters were not sexually active (18%), and that they did not receive a provider recommendation (13%).

Dr. Dorell acknowledged certain limitations of the study, including the fact that the telephone portion of the survey was using land line phones only, thus contributing to a noncoverage bias of wireless-only households. It’s also possible that some of the provider data or vaccination histories may be incomplete, she said. However, she pointed out that one of the main strengths of the NIS-Teen "is that it is the only nationally representative survey that reports vaccination coverage estimates from provider-reported data, which is the gold standard for measuring vaccination coverage."

Dr. Dorell said that she had no relevant financial disclosures.