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Biomedical subjects

A B Middleman

Publications and source records attributed to A B Middleman.

15 recordsLinked to original sources
PubMed2001

The importance of hepatitis B vaccination among adolescents.

OBJECTIVE: To examine whether teens who have received an education about hepatitis B and demonstrated content mastery can apply this knowledge to evaluate their own risk of acquiring hepatitis B. METHODS: Nine hundred forty-three participants received a standard education and completed a questionnaire about hepatitis B; 769 participants who correctly answered the questions pertaining to risk factors for transmission participated. The questionnaire assessed demographic factors, self-reported risk behaviors, and attitudes toward hepatitis B and the immunization. Self-reported likelihood of acquiring hepatitis B and importance of hepatitis B immunization were measured on a 10-point Likert scale and served as outcome variables. Relationships were analyzed using frequency analysis, Mann-Whitney U and Kruskal-Wallis analysis of variance. RESULTS: Participants who were nonwhite (p <.001), had their bills paid by Medicaid (p =.007), were lower academic achievers (p =.011), had had sexual intercourse (p =.003), and had had a sexually transmitted disease (STD) (p =.028) were more likely to report that the hepatitis B immunization was more important to their health. Participants who reported they had smoked tobacco (p =.018) or consumed alcohol (p =.001) recently, had had sexual intercourse (p <.001), or had been diagnosed with an STD (p <.001) were more likely to report being at higher risk for acquiring hepatitis B. CONCLUSIONS: Most teens considered the hepatitis B immunization important to their health. Most adolescents did not think they were at significant risk for contracting hepatitis B; however, teens who reported increased individual risk factors also reported increased perceived risk of disease.

Adolescent↗
PubMed2001

The effect of late doses on the achievement of seroprotection and antibody titer levels with hepatitis b immunization among adolescents.

OBJECTIVE: To determine the effect of varying dosing schedules and predictor variables on the seroprotection rates and geometric mean titer levels resulting from the hepatitis B vaccination series among adolescents. METHODS: Adolescents received the hepatitis B vaccination series at varying schedules according to their natural adherence patterns. Data collected included participants' medication use; chronic illness; use of cigarettes, alcohol, and marijuana; age; race/ethnicity; and body mass index. Participants' dates of vaccinations were recorded and titer levels for hepatitis B surface antibody were drawn ~12 and 24 months after study enrollment. The data for 498 participants were analyzed using chi(2) tests, Student t tests, logistic regression models, and analysis of variance. RESULTS: Seroprotection rates among adolescents were not affected by late vaccinations. The only factors affecting the achievement of seroprotection ~12 and 24 months after the first vaccination were body mass index and the number of immunizations received. Increased time between doses 1 and 2 and doses 2 and 3 showed a trend toward correlating with increasing titer levels. CONCLUSIONS: Although adolescents at risk of acquiring hepatitis B should receive the hepatitis B vaccination series in a timely fashion, late doses are not detrimental, and may be beneficial, to achieving high antibody levels against the hepatitis B virus.

Adolescent↗
PubMed1999

Predictors of time to completion of the hepatitis B vaccination series among adolescents.

OBJECTIVES: To determine adolescents' completion rates and factors affecting completion time of hepatitis B (HBV) vaccination. METHODS: Prior to vaccination, participants from a hospital-based and school-based adolescent clinic completed questionnaires assessing sociodemographic variables, family/friend experience with HBV and the vaccine, likelihood of completing the vaccinations, HBV and vaccine knowledge, risk behaviors, chronic illness, and access to clinic. Vaccination times were recorded. RESULTS: Twenty-six months after initiation of the study, 72% of 896 eligible participants had completed the vaccination series. The independent predictors of shorter time to completion were: higher estimated mean household income [odds ratio (OR) = 1.15, 95% confidence interval (CI) = 1.06-1.25), white race (OR = 1.27, 95% CI = 1.01-1.58), female gender (OR = 1.58, 95% CI = 1.31-1.92], and not having smoked cigarettes (OR for smoking in the past 30 days = 0.74, 95% CI = 0.60-0.92). Site of care, risk factors for acquiring HBV, disease and vaccine knowledge, and self-reported desire to complete the series were not associated with completion time. CONCLUSIONS: The primary factors associated with completion of immunization may not be amenable to intervention; mandated strategies for immunization may be more likely to result in protection for adolescents.

Adolescent↗
PubMed1999

Review of sexuality education in the United States for health professionals working with adolescents.

Interactive sexuality education programs have proven to be an effective way to delay sexual debut and to reduce the frequency of sexual encounters among teens. In 1998, several papers were published that reflect the importance of continuing sexuality education in the schools. Despite this research, many schools provide inadequate sexuality education for youth. The development and success of political opposition to sexuality education programs when over 80% of adults in the United States support such education in the schools are discussed. The implications for each health care provider are clear: to educate patients about sexual issues and advocate for effective sexuality education in each community.

Adolescent↗
PubMed1998

Eating patterns, physical activity, and attempts to change weight among adolescents.

OBJECTIVE: To determine eating patterns and demographic and dietary factors associated with adolescents' attempts to change weight. METHODS: Data from students participating in the Massachusetts Youth Risk Behavior Survey (YRBS) were analyzed. Race, age, school grade, academic achievement, gender, body image, eating patterns, level of exercise, participation in team sports, cigarette use, diet pill use, and vomiting were examined. The weighted sample included 3055 students: 49% female and 78% white. Mean age was 16 years (+/- 1.2 years). Associations were measured using Spearman's r, Chi-square, Mantel-Haenszel test for trend, and logistic regression analyses. RESULTS: A total of 61.5% of females and 21.5% of males reported trying to lose weight; 6.8% of females and 36.3% of males were trying to gain weight. There was a strong correlation (r = 0.62, p < 0.0001) between attempting to gain weight and self-perception of underweight for both genders. Females reported having changed their intake of several foods if attempting to change weight; males changed their intake of dessert foods. Hard exercise, stretching, and toning were associated with trying to lose weight among females and with trying to gain weight among males. CONCLUSIONS: High-calorie food consumption and exercise were associated with attempts at weight change. Unhealthy eating to change weight highlights the need for effective nutrition and weight counseling among adolescents.

Adolescent↗
PubMed1998

Knowledge of health insurance coverage by adolescents and young adults attending a hospital-based clinic.

PURPOSE: To describe adolescents' and young adults' knowledge about their health insurance, and to identify factors associated with correct knowledge of health insurance in this population. METHODS: Data were analyzed from a confidential questionnaire administered to 830 patients at a hospital-based adolescent medicine clinic. The questionnaire contained items pertaining to insurance type, demographics, health status, and health-risk behaviors. Actual health insurance data and information regarding utilization of health services were obtained from the hospital billing data-base. Predictors of health insurance knowledge were determined through bivariate analyses followed by stepwise logistic regression. RESULTS: A total of 50.7% of respondents correctly identified their type of health insurance. Those who correctly identified their insurance had a higher mean age. Only 48.5% of participants who were 11-18 years old could identify their insurance type, versus 53.1% of 19-21-year-olds and 64.7% of 22-24-year-olds (p = 0.02). Sixty-five percent of Medicaid patients and 76.3% of hospital free care patients knew how their medical bills were paid, versus 17.9% of self-pay patients and 47.3% of patients with private insurance (p < 0.01). Greater utilization of health services was associated with increased rates of insurance knowledge among 19-24-year-olds on bivariate analysis; however, this factor was not significant when controlling for other factors. Regression analysis revealed that older age and insurance type other than self-payment were independent predictors of health insurance knowledge in adolescents (11-18 years old), while female gender and insurance type other than self-payment were independent predictors of insurance knowledge in young adults (19-24 years old). CONCLUSIONS: Approximately half of adolescents and young adults do not know how their medical bills are paid. Validation of self-reported insurance data is, therefore, critical both in clinical practice and health services research.

Adolescent↗
PubMed1997

Low prevalence of antibody to hepatitis C virus in an urban adolescent population.

We tested 869 subjects attending either an urban adolescent medicine clinic or a school-based clinic for antibody to hepatitis C virus. Demographic data indicated a representative study sample, and behaviors associated with hepatitis C virus transmission. One subject (0.1%) was seropositive for antibody to hepatitis C virus, indicating a very low prevalence of hepatitis C virus exposure in adolescents.

Adolescent↗
PubMed1997

Use of hormonal methods of birth control among sexually active adolescent girls.

OBJECTIVE: To identify factors associated with the use of various birth control methods among sexually active adolescent girls. DESIGN: A survey distributed as part of a larger study measuring compliance with hepatitis B vaccination. SETTING: A hospital-based and a school-based clinic. MEASURES: Demographic and health behavior data including sexual activity, contraceptive method, substance use, condom use, and history of sexually transmitted diseases (STDs) were collected. Birth control method was confirmed by medical record review. Associations with the outcome variable of birth control method were analyzed using chi square, Kruskal-Wallis analyses of variance, and t-tests, followed by logistic regression analysis. RESULTS: Among sexually experienced girls, 39% (n = 123) reported using oral contraceptive pills (OCPs), 5.4% (n = 17) used Depo-Provera (medroxyprogesterone acetate) or Norplant (levonorgestrel), and 55.6% (n = 175) used no hormonal method. Logistic regression analysis revealed that the factors most significantly associated with the use of hormonal methods were older age (odds ratio [OR] = 1.19; 95% confidence interval [CI], 1.07-1.33), not using a condom at last intercourse (OR = 0.55; CI, 0.34-0.90), and having had a well visit within 1 year (OR = 2.11; CI, 1.12-3.70). OCP users were less likely than Depo-Provera or Norplant users to have used alcohol (p = 0.041), cigarettes (p = 0.002), or marijuana (p = 0.018) in the past 30 days. OCP users were less likely than nonusers of hormonal methods to have smoked cigarettes (p = 0.034) or marijuana (p = 0.052). The school-based clinic had a greater proportion of subjects using long-acting progestins (p < 0.001). CONCLUSIONS: The decreased rate of condom use among those who used hormonal birth control methods and the different rates of health risk behaviors among users of various methods require targeted counseling efforts to decrease pregnancy and STD rates among young women.

Adolescent↗
PubMed1996

Anabolic steroid use and associated health risk behaviours.

Androgenic-anabolic steroid use is a significant problem among young people. The abuse of steroids may cause significant medical problems. Adolescent steroid users have also been found to be more likely than non-users to be engaging in other high risk behaviours including multiple drug use, cigarette and smokeless tobacco use, suicidal behaviours, high risk sexual behaviours, carrying a weapon, and fighting behaviours. It is critical that clinicians and athletic coaches and trainers are aware of these associations in order to more carefully screen and advise adolescents for health risk behaviours.

Adolescent↗
PubMed1995

Factors affecting pediatric residents' intentions to screen for high risk behaviors.

PURPOSE: To determine the factors associated with the intentions of pediatric residents to: 1) screen adolescents for high risk behaviors using the Guidelines for Adolescent Preventive Services (GAPS) and 2) to record the results in the medical record. METHODS: 64 pediatric residents at a university children's hospital were given seven scenarios and were asked to rate on a five point Likert scale (1 = always, 5 = never) the likelihood that they would ask and document adolescent patient responses about sexual activity/birth control, alcohol/drug use, depression/suicidal ideation, fighting/coping with anger, and nutrition/eating disorders. The association of patient-related factors (e.g., gender, presenting symptom, medical setting, known private provider, and presence of a chronic illness) and resident-related factors (e.g. gender, post graduate level, future plans, and a prior adolescent rotation) on intentions to screen was determined using analysis of variance for ranked data. RESULTS: Residents indicated they were most likely to ask adolescents about sexual activity (mean Likert = 2.6, median Likert = 2, range 1-5) (P=0.014). Residents were more likely to screen for substance use (2.8, 3, 1-5) than nutritional issues (3.5, 4, 1-5) (P < or = 0.0001), and were least likely to ask about depression (3.8, 4, 1-5) and fighting (3.9, 4, 1-5) (P < or = 0.0001). Although residents reported that they were likely to record screening results in the medical record (median Likert score = 1), they noted the most common reasons for not recording to be fear that parents would see the record, lack of time, and the feeling that negative responses to screening need not be recorded. The patient-related factors that significantly affected residents' intentions to screen included: presenting symptom, medical setting, and the presence of a chronic illness (P < or = 0.05). Female gender of the patient increased only the likelihood of nutrition screening. Male residents reported a greater intention to screen for depression (P = 0.046). Post-graduate level and a prior adolescent rotation influenced the intention to screen for most behaviors. CONCLUSIONS: This study found that residents are more likely to indicate that they would screen for sexual activity and substance use than for nutritional disorders, depression, and fighting. Several patient-related and resident-related factors influence the likelihood of residents to screen for various high risk behaviors. Educational efforts are needed to increase residents' screening for high risk behaviors.

Adolescent↗
PubMed1995

Hepatitis B immunization among adolescents.

Prior to this year, little has been written regarding the immunization of the adolescent population against hepatitis B. Most studies have focused on the immunization of infants, children, and adults, highlighting concerns about adolescent compliance with such an immunization program. The body of literature about hepatitis B immunization among adolescents has grown, and there is much to learn in preparation for the implementation of the immunization Practices Advisory Committee's most recent recommendation to immunize all 11- and 12-year-old children in the United States who have not previously been immunized against hepatitis B.

Adolescent↗
PubMed1995

High-risk behaviors among high school students in Massachusetts who use anabolic steroids.

OBJECTIVE: To assess the association between the frequency of anabolic steroid use and the frequency of other health risk and problem behaviors among high school students in Massachusetts. METHODS: The 1993 Massachusetts Youth Risk Behavior Survey was conducted on a random sample of 3054 high school students (49% male; mean age, 16 +/- 1.2 years). The frequency of lifetime anabolic steroid use was measured on an ordinal scale from 1 to 6, representing "0" to "40 or more times." Other health risk and problem behaviors measured were sexual behaviors, suicidal behaviors, frequency of not wearing a passenger seat belt, riding a motorcycle, not wearing a helmet while riding a motorcycle, driving after drinking alcohol, riding with a driver who had been drinking alcohol, fighting, and carrying a weapon. The associations between the frequency of anabolic steroid use and other high-risk behaviors were determined using the Spearman correlation coefficient for ordinal data and the Kruskall-Wallis analysis of variance for categorical data. Representative indicators of each risk behavior significantly associated with anabolic steroid use were then analyzed using a stepwise multiple-regression analysis. RESULTS: The frequency of anabolic steroid use was associated with all of the other high-risk behaviors analyzed. Using multiple-regression analysis, driving after drinking alcohol accounted for 12.5% of the variance of the model. Carrying a gun, the number of sexual partners within the past 3 months, not using a condom during last intercourse, injury in a physical fight requiring medical attention, history of a sexually transmitted disease, not wearing a helmet on a motorcycle, not wearing a passenger seatbelt, and a suicide attempt requiring medical attention accounted for an additional 9.0% of the variance. The full model accounted for greater than 21% of the variation. CONCLUSIONS: The frequency of anabolic steroid use among adolescents is associated with other high-risk behaviors, thus supporting the hypothesis that anabolic steroid use is part of a "risk behavior syndrome" rather than an isolated behavior. This finding emphasizes the need for comprehensive high-risk behavior screening and counseling among teens who use anabolic steroids.

Adolescent↗