Transcript Diamondback_Adolescents_6_12_2011

Natasha E. Robinson, Pharm.D.
Jackson Health System
Miami, Florida
Objectives
 Describe the Youth Risk Behavior Surveillance
System (YRBSS) and discuss results related to the
following:
 Use of prescription drugs and steroids as well as other
performance enhancing agents
 Sexual risk behaviors and trends of activity among
adolescents
 Obesity epidemic and physical inactivity trends a and
strategies to improve nutrition among adolescents
Objectives
 State common sexually transmitted infections and
treatment in adolescents
 Discuss human papilloma virus, available vaccines
and vaccination recommendations for adolescent
females and males
Youth Risk Behavior Surveillance (YRBSS)
 Consists of national, state and local surveys
 High school students grades 9-12
 Focuses on 6 major categories
 Behaviors that contribute to unintentional injuries and
violence
 Tobacco use
 Alcohol and other drug use
 Sexual behaviors that contribute to unintended pregnancy
and STDs
 Unhealthy dietary behaviors
 Physical inactivity
 Asthma and Obesity prevalence also assessed
Adolescent Athletes and
Drugs of Abuse
Adolescent Athletes
 Estimated 7.6 million students participate in high
school sports annually
 Attitudes of winning permeate all levels of sports
activities down to youth leagues
 Society rewards success in sports with celebrity,
status, monetary incentives and favoritism
 Success is considered by many to be the most
important goal of sports
Adolescent Athletes
 Adolescents are vulnerable to the imbalance
between fair competition and winning at all costs
 Reasons for Use of Performance Enhancing
Substances
 Enhancement of physical appearance
 Augment performance in sports and competitions
 Many users of enhancing substances are non
athletes consumed with body image and being
accepted by peers
Percentage of High School Students Who Ever
Took Prescription Drugs Without a Doctor’s Prescription,*
by Sex and Race/Ethnicity,† 2009
100
Percent
80
60
40
20.2
19.8
20.4
23.0
17.2
20
11.8
0
Total
Female
Male
White
Black
Hispanic
Prescription Drugs
 Illegal drug use is waning
 Prescription drugs are being widely abused by
adolescents
 NIDA-funded 2010 Monitoring the Future Study
 Surveys approximately 50,000 8th, 10th and 12th
grade students
 Results


2.7% of 8th graders, 7.7% of 10th graders, and 8.0% of 12th
graders had abused Vicodin
2.1% of 8th graders, 4.6% of 10th graders, and 5.1% of 12th
graders had abused OxyContin
Prescription Drug Abuse
 Commonly abused classes of prescription
medications include:
 opioids
 central nervous system depressants
 stimulants
 Can lead to physical dependence and addiction
Prescription Drug Abuse
Common Slang Terms describing Prescription Abuse
Big boys, cotton, kicker
Prescription pain relievers
Chill pills, french fries, tranqs
Prescription sedatives and tranquilizers
Pharming
Searching for pharmaceuticals in parents
medicine cabinets
Pharm parties
Bring prescription drugs from home, mix them
together and grab a handful
Pilz
Prescription and over-the-counter medications
Recipe
Prescription drugs mixed with alcoholic or
other beverages
Trail mix
A mixture of various prescription drugs, usually
served in a big bag or bowl at pharm parties
Percentage of High School Students Who Ever Took
Steroids Without a Doctor’s Prescription
100
Percent
80
60
40
20
3.3
2.2
4.3
3.1
2.8
3.9
Total
Female
Male
White
Black
Hispanic
0
* Took steroid pills or shots without a doctor’s prescription one or more times during their life.
†M > F
Definition
 American Academy of Pediatrics (AAP) -
Performance Enhancing Substance
 Any substance taken in non pharmacologic doses
specifically for the purposes of improving sports
performance by increasing strength, power, speed, or
endurance or by altering body weight or body
composition
 Also any substances that improve performance by
causing changes in behavior, arousal level and/or
perception of pain
Performance Enhancing Agents
 Creatinine use prevalence has been reported to be
between 8 -13% of adolescents
 Nationwide survey of > 3,000 boys
 6.6% of male high school students had tried steroids
 67% beginning using by 16 years of age and used
multiple cycles
 Drugs often used as cocktails in combination with
other agents
 Energy drinks containing caffeine added to enhance
the effects of many performance enhancing agents
Performance Enhancing Agents
Goal or Potential Effect
Adverse Effects
Anabolic steroids
Increase muscle mass or
strength
Hypertension, physeal closure,
aggression and depression
Creatinine
Increase muscle stores and
strength
Muscle cramps, GI upset,
weight gain and compromised
renal function
DHEA
Increase testosterone
Acne, hair loss, hypertension,
and increase in sex hormones
Diuretics
Rapid fluid loss or dilution
of banned substances
Dehydration, muscle cramping,
and electrolyte imbalance
Erythropoeitin
Increase oxygen carrying
capacity
Headache, fever, nausea,
dizziness, hypertension and
increased blood viscosity
Energy Drinks
 Consumed by 30 – 50% of adolescents and young
adults
 Contain high amounts of caffeine which exceed
sodas and no therapeutic benefit
 5,548 caffeine overdose reports in 2007
 46% occurred in persons younger than 19 years of
age
 Energy drinks are available in > 140 countries and
the fastest growing US beverage market
Performance Enhancing Agents
Goal or Potential Effects
Adverse Effects
Growth Hormone
Increase muscle mass, strength
and definition
Acromegaly effects,
increased lipids, physeal
closure, glucose
intolerance and
myopathy
Stimulants
Weight loss, appetite
Headaches, dizziness,
suppression, increase energy and anxiety, arrhythmias,
sharpen reflexes
hallucinations and
tremors
Definition
 Energy drinks
 Beverages that contain caffeine, taurine, vitamins,
herbal supplements and sugar or sweeteners
marketed to improve energy, weight loss, stamina,
athletic performance and concentration
 No regulation by the US Food and Drug Administration
(FDA) because the drinks are classified as dietary
supplements
 FDA limits caffeine content of soft drinks
Energy Drinks
 National Federation of State High School
Associations
 Cited absence of benefit and did not recommend
energy drinks for consumption by high school athletes
 Listed several potential risks and drug interactions
 Caffeine is main ingredient
 70 to 80 mg / 8 oz serving
 Often contain additional amounts of caffeine as
guarana, kola nut, yerba mate and cocoa
 Manufacturers not required to list caffeine content
Energy Drinks
Symptoms
Product
4 middle school students
Tachycardia, jitters/ anxiety
hypertension, hypokalemia and
hypertension
Redline energy drink
7 high school students
Shortness of breath, heart
palpitations, nausea
SPIKE shooter
18 year old girl
Died after sharing 4 cans of
Red Bull / playing basketball
Red Bull
17 year old girl
Collapsed after reporting chest
pain and fatigue
2-3 cans of Red Bull
In 2010 Energy Drinks uniquely coded to track toxicity and overdosage by Poison
Centers
Recommendations
 Use of performance enhancing substances alone or
in conjunction with energy drinks may have serious
health consequences in adolescents
 Strongly discourage use of these substances in both
non athletes and athletes
 Sports Nutrition should be emphasized to promote
appropriate caloric intake and hydration for optimal
performance
 Health risks must be communicated to adolescents in
an unbiased manner to promote acceptance
Obesity
Adolescent Obesity
 Affects approximately 12.5 million children and teens
age 2-19 years of age
 Prevalence of obesity among adolescents aged 12
to 19 years increased from 5.0% to 18.1%
 Direct medical expenses for childhood obesity
estimated at 14 billion annually
 Obesity is the result of caloric imbalance (too few
calories expended for the amount of calories
consumed) and is mediated by genetic, behavioral,
and environmental factors
Adolescent Obesity
 80% predictability that obese teens will become
obese adults
 Adolescents who are obese are at greater risk for
bone and joint problems, sleep apnea, and social
and psychological problems
 Rejection by peers
 Poor self esteem
 Depression
 More likely to miss school
Sleep and Obesity
 Data that correlates lack of sleep with metabolic
alterations and obesity
 Sleep questionnaire completed by parents on sleep
habits and compensation for week day sleep deficits
on weekends and holidays
 5159 children in Hong Kong
 Results
 Measured BMI z scores and found association
between shorter sleep duration and higher BMI z
scores
 Suggest that obesity linked to additional factors
Obesity
 Overweight Children and Adolescents –
The Bogalusa Heart Study
 5 -17 year olds
 BMI ≥95th percentile 39% had at least two risk
factors for cardiovascular disease and 65% had
excess adiposity
 BMI ≥99th percentile 59% had at least two risk
factors for cardiovascular disease and 94% had
excess adiposity
Obesity
Obesity
US YRBSS Results
 12% of the students were obese
 Unhealthy dietary behaviors
 78% ate fruits and vegetables less than five times per
day during the 7 days before the survey
 66% ate fruit or drank 100% fruit juices less than two
times per day during the 7 days before the survey
 86% ate vegetables less than three times per day
during the 7 days before the survey
 29% drank a can, bottle or glass of soda pop at least
one time per day during the 7 days before the survey
US YRBSS Results
 Physical Inactivity
 67% did not attend PE classes daily when they were in
school
 33% watched television 3 or more hours per day on an
average school day.
 25% used computers 3 or more hours per day on an
average school day
US YRBSS Results
 Physical Inactivity
 23% did not participate in at least 60 minutes of
physical activity on any day during the 7 days before
the survey
 82% were physically active at least 60 minutes per day
on less than 7 days during the 7 days before the
survey
 44% did not attend physical education (PE) classes in
an average week when they were in school
US YRBSS Data 2009
Percentage of high school students who were obese* —
selected U.S. states, Youth Risk Behavior Survey
YRBSS - Miami Dade
 10% of the students were obese
 Unhealthy dietary behaviors
 75% ate fruits and vegetables less than five times per
day during the 7 days before the survey
 65% ate fruit or drank 100% fruit juices less than two
times per day during the 7 days before the survey
 84% ate vegetables less than three times per day
during the 7 days before the survey
 27% drank a can, bottle or glass of soda pop at least
one time per day during the 7 days before the survey
YRBSS – Miami Dade
 Physical Inactivity
 19% did not participate in at least 60 minutes of
physical activity on any day during the 7 days before
the survey
 79% were physically active at least 60 minutes per day
on less than 7 days during the 7 days before the
survey
 55% did not attend physical education (PE) classes in
an average week when they were in school
 88% did not attend PE classes daily when they were in
school
Physical Activity Guidelines
for Americans
• Developed in 2008 to provide information and
guidance on:
 Types and amounts of exercise required to promote
sustainable benefits and disease prevention
 Recommend 3 days/week of physical activity at least
60 minutes or more



Moderate to vigorous aerobic activity
Muscle-strengthening exercises
Bone-strengthening exercises
Let’s Move
 Initiative launched by the First Lady Michelle Obama
dedicated to solving the problem of obesity within a
generation
 Focuses on combining comprehensive steps with
common sense for parents, caregivers, healthcare
providers, and schools to help children view food
and nutrition differently
 More info – www.letsmove.org
Recommendations
Healthy Eating Tips
Calories
Adolescent boys = 2,500-2,800 per day
Adolescent girls = 2,200 per day
Protein
Teens need 45-60 grams per day
Easily meet this need eating meat, fish, and dairy, but vegetarians
may need to increase their protein intake from non-animal sources
like soy foods, beans and nuts
Calcium
1,200 mg of calcium needed per day
Should come from dairy, calcium-fortified juice and cereal, and
other calcium-rich foods such as sesame seeds and leafy greens like
spinach
Iron
Adolescent boys = 12 mg each day
Adolescent girls = 15 mg each day
Iron deficiency can lead to anemia, fatigue, and weakness Iron-rich
foods include red meat, chicken, beans, nuts, enriched whole
grains, and leafy greens like spinach and kale
Recommendations
 Improving Nutrition
 Have regular family meals
 Limit snacking with empty calories
 Increase physical activity
 Limit foods and drinks high in sugar content
 Decreasing television viewing, video game and
internet surfing times
 Improve access to healthier choices at home and at
schools
 Reading food labels and understanding portion control
 Maintain a food journal to help estimate daily intake
Recommendations
 Very obese or overweight adolescents
 Stop Light diet
 Divides foods into 3 major groups
 Green - low calorie food choices eaten freely
 Yellow – moderate calorie foods eaten occasionally
 Red – high calorie foods that should be eaten rarely
Sexual Risk Behaviors and
Sexually Transmitted Infections
YRBSS - US results
 Sexual Risk Behavior
 46% of high school students had sexual intercourse
 14% of high school students had had four or more sex
partners during their life.1
 34% of currently sexually active high school students
did not use a condom during last sexual intercourse.1
 22% of high school students who had sexual
intercourse during the past three months drank alcohol
or used drugs before last sexual intercourse.1
YRBSS – US results
 Sexual Risk Behavior
 11% of males and females aged 15-19 had engaged in
anal sex with someone of the opposite sex
 3% of males aged 15-19 had had anal sex with a
male.
 55% of males and 54% of females aged 15-19 had
engaged in oral sex with someone of the opposite sex.
Florida YRBSS – Miami Dade
 Sexual Risk Behavior
 36% did not use a condom during last sexual
intercourse experience
 90% did not use birth control pills or Depo – Provera
before last sexual intercourse to prevent pregnancy
 15% were never taught in school about AIDS or HIV
prevention
 19% drank alcohol or used drugs before last sexual
intercourse
Florida YRBSS – Miami Dade
 Sexual Risk Behavior
 53% had sexual intercourse
 10% had sexual intercourse for the first time before 13
years of age
 18% had sexual intercourse with 4 or more persons
during their life
 38% with at least 1 person in the 3 months prior to the
survey
Sexually Transmitted Infections
(STIs)
 Direct medical costs estimated at $701 million
dollars annually
 Definition
 Any disease transmitted by sexual contact; caused by
microorganisms that survive on the skin or mucus
membranes of the genital area; or transmitted via
semen, vaginal secretions, or blood during intercourse
 Most commonly diagnosed STIs in adolescents
 Chlamydia
 Gonorrhea
Chlamydia
 Sexually transmitted infection caused by the
bacterium Chlamydia trachomatis
 Various routes of transmission
 Vaginal, anal or oral sex
 Majority of cases in males and females are
asymptomatic
 Cause long term health consequences
 Females – PID, chronic pelvic pain, ectopic
pregnancy and infertility
 Males – infection of the epididymis, Reiter’s (rare)
Barriers to Preventative Care
 Access to care
 Transition of responsibility
 Lack of insurance
 Lack of transportation
 Confidentiality concerns
Chlamydia
 Five times more prevalent among non hispanic
blacks compared to non-hispanic whites
 Adolescent females predisposed due to cervical ectopy
 Reinfection occurs within 9 months in up to 40% of
females
 Studies have shown that inflammatory infections can
increase risk of transmission of HIV
 Routine screening recommended for all sexually active
females < 25 years of age and older women with
increased risk factors
Chlamydia
Rates by Age and Sex, US, 2009

Chlamydia
Rate (per 100,000 population)
Men
2,500
2,000
1,500
1,000
Race/
0 Ethnicity 0
500
500
Women
1,000
AI/AN*
323.8
72.0
A/PI*
237.7
84.0
219.3
Total
2,500
221.9
2,095.5
Hispanics
Whites
2,000
1,214.9
Blacks
970.0
1,500
788.8
270.2
592.2
*AI/AN = American Indians and Alaska natives, *A/ PI = Asians and Pacific Islanders
Chlamydia
 Treatment
 Azithromycin 1 g orally X 1 dose
 Doxycycline 100 mg orally twice daily X 7 days
 Treatment Alternatives
 Erythromycin base 500 mg orally four times a day X 7 days
 Levofloxacin 500 mg orally once daily for 7 days
 Abstinence for at least 7 days after treatment or 7 days of
treatment
 Retesting 3 months post treatment
Chlamydia
 Expedited Partner Therapy
 Practice of delivery of medications or prescriptions by
persons infected with an STI to their sex partners without
clinical assessment of the partners. providing prescriptions
to diagnosed patients to take to their partners without
partners being first examined by health care provider
 Comparison of method of partner notification in S. Africa
 14-25 year olds diagnosed with an STI
 89% preferred self delivery of medications to their partner
 7% chose to refer their partner for treatment
Gonorrhea
 Second most common STD in adolescents
 Infection caused by Neisseria Gonorrhoeae which
can affect the uterus, fallopian tubes
 Various routes of transmission
 Vaginal, anal or oral sex
 May be asymptomatic or symptoms vary by gender
 Males –burning during urination, white,yellow or green
discharge from penis, or swollen testicles
 Females – vaginal bleeding or increased discharge
Gonorrhea
 Cause long term health consequences if untreated
 Females – PID, chronic pelvic pain, ectopic
pregnancy and infertility
 Males – infection of the epididymis, infection of the
joints or bloodstream
Gonorrhea
Rates by Age and Sex, US, 2009
Gonorrhea
Rate (per 100,000 population)
Men
750
600
450
300
Race/
0 Ethnicity 0
150
78.2
17.6
150
AI/AN*
A/PI*
54.5
21.5
91.9
Hispanics
Whites
Total
300
450
600
750
147.3
18.5
Blacks
555.2
Women
557.5
63.0
32.8
105.5
*AI/AN = American Indians and Alaska natives, *A/ PI = Asians and Pacific Islanders
Gonorrhea
 Treatment – Uncomplicated Gonococcal Infections
 Ceftriaxone 250 mg IM X 1 dose
 Cefixime 400 mg orally X 1 dose
 Dual Therapy for both Chlamydia and Gonorrhea due
to presence of coinfection in many patients

Add Azithromycin or Doxycycline
 Antimicrobial Resistance
 Azithromycin 2 g effective but should be
limited due to macrolide resistance
Disparities
 Young black women bear the heaviest burden for
chlamydia and gonorrhea
 Chlamydia

among aged 15-24 one chlamydia case reported for every 10
black women in that age group =10,629.7 per 100,000
 Gonorrhea


rate among those aged 15-19: 2,613.8 per 100,000
rate among those aged 20-24: 2,548.7 per 100,000
Sex Myths and Trends
 Sexting
 Combination of the words sex and texting
 slang term for the sending of sexually explicit
photographs or messages via mobile phone
 Implicated in the deaths of teens over the last several
years
 Many states have tried to enact some type of
legislation making sexting illegal
Sex Myths and Trends
 December 2009 - Pew Research Center's Internet &
American Life Project found:
 4% of cell-owning teens ages 12-17 say they have sent
sexually suggestive nude or nearly nude images of
themselves to someone else via text messaging
 30% have received a nude or nearly nude image on their
phone.
Sex Myths and Trends
 Oral and anal sex
 Falsely believed to be safer
 Maintain their virginity
 Often precludes other sexual experiences
 Predisposes them to sexually transmitted diseases
 Combined with alcohol and drug use
Human Papilloma Virus (HPV)
 More than 40 types have been isolated and known to
be sexually transmitted
 High risk are associated with cervical, vulvar, vaginal,
penile, anal as well as head and neck cancers
 Low risk are associated with genital warts
 50% of sexually experienced persons will develop
HPV infection
Human Papilloma Virus (HPV)
 Non enveloped DNA virus
 >100 different types identified
 ~40 types are sexually transmitted
• “Low-risk” types (6, 11 and others)
 Genital warts and recurrent respiratory papillomatosis
• “High-risk” types (16, 18 and others)
 Cervical and other anogenital cancers
 Subset of oral cavity and oropharyngeal cancers
Cervical Cancer Statistics
 Most preventable cancer in women
 US Cancer Statistics Working Group – 2007
 12,280 women diagnosed with cervical cancer
 4,021 women died from cervical cancer
 Rates are highest in Central America and Sub-
saharan Africa due to lack of screening and access
to preventative care
Cervical Cancer
Cervical Cancer
Cervical Cancer
Cervical Cancer
Available HPV Vaccines
HPV 4 Quadrivalent Vaccine
HPV
2
Manufacturer – Merck
Manufacturer – Glaxo Smith Kline
Brand Name – Gardasil®
Brand Name – Ceravix®
Approval - 2006
Approval - 2009
Virus types : 6, 11, 16 and 18
Virus types: 16 and 18
Indication - Males and Females
Indication - Females
Dose - 0.5 ml IM
Dose – 0.5 ml IM
Bivalent Vaccine
Schedule - o , 2 months and 6 months Schedule – 0, 1 month and 6 months
Prevention of HPV 6, 11, 16 or 18 Related
Genital Disease in Females 16-26
Endpoint
N
Prophylactic Efficacy
HPV 16 or 18 related CIN 2/3 or AIS
9346
97%
HPV 16 or 18 related VIN 2/3 or VaIN 2 /3
8642
97%
HPV 6, 11, 16, 18 related CIN 2/3 or AIS
(CIN 1, CIN 2/3) or AIS
8630
95%
HPV 6, 11, 16 or 18 related Genital Warts
8761
96%
Includes all individuals who received at least 1 vaccination and who were HPV
naïve at Day 1 to vaccine type being analyzed. Case counting started 1 month post
dose 1.
Efficacy for Prevention of HPV 6,11,16,18
External Genital Lesions in Males 16 - 26
N=1397
Efficacy %
HPV 6/11/16/18-related EGL
3
90
HPV 6/11/16/18-related condyloma
3
89
HPV 6/11/16/18-related PIN* 1/2/3
0
100
Endpoint
*Penile/perineal/perianal intraepithelial neoplasia (PIN) grades 1/2/3; too few
cases identified to reach statistical significance.
Efficacy of CERVARIX® Against
Histopathological Lesions Associated
With HPV-16 or HPV-18
Females 15-25 years of age
N
Number of
cases
Efficacy %
96.1 CI
CIN 2/3 or AIS
7,344
4
92.9
CIN 1/2 /3 or
AIS
7, 344
8
91.7
Adverse Events Females
1 to 15 days post vaccination
®
Gardasil
Percentage
Pyrexia
13.0
Nausea
6.7
Dizziness
4.0
Diarrhea
3.6
Vomiting
2.4
Cough
2.0
Toothache
1.5
Upper respiratory infection
1.5
Malaise
1.4
Arthralgia
1.2
Insomnia
1.2
Nasal Congestion
1.1
Adverse Events Males
1 to 15 days post vaccination
®
Gardasil
Percentage
Headache
12.3
Pyrexia
8.3
Oropharyngeal pain
2.8
Diarrhea
2.7
Nasopharyngitis
2.6
Nausea
2.0
Upper respiratory infection
1.5
Abdominal pain upper
1.4
Myalgia
1.3
Dizziness
1.2
Vomiting
1.0
Adverse Effects Within 30 days post vaccination
®
Ceravix
Percentage
Headache
5.3
Nasopharyngitis
3.6
Influenza
3.2
Pharyngolaryngeal pain
2.9
Dizziness
2.2
Upper respiratory infection
2.0
Chlamydia infection
2.0
Adverse Events Within 30 days of vaccination
®
Ceravix
Percentage
Dysmenorrhea
2.0
Pharyngitis
1.5
Injection site bruising
1.4
Vaginal infection
1.4
Injection site pruritus
1.3
Back pain
1.1
Urinary tract infection
1.0
Contraindications HPV2 and
HPV4
 Anyone with history of immediate hypersensitivity to
any component of either vaccine
 HPV4
 produced in Saccharomyces cerevisiae - bakers yeast
 HPV2
 prefilled syringes contain latex in tip cap and rubber
plunger
Post Marketing Data
 Vaccine Adverse Event Reporting System (VAERS)
 Gardasil® - 18, 354 events reported in females as
February 2011
 92% non serious events

Majority of events were syncope, injection site reactions,
headache, nausea and fever
 8 % serious events



Guillain-Barré Syndrome (GBS)
Blood Clots – heart, lungs and legs
Deaths – 51 reported and 32 confirmed
Post Marketing Data
 Vaccine Adverse Event Reporting System (VAERS)
 Gardasil® - 205 reports in males as February 2011
 15 serious reports

2 reports of death – 1 confirmed and 1 unconfirmed
 Ceravix® – 26 reports in females as February 2011

96% of reports non serious
Recommendations
 Advisory Committee on Immunization Practices
(ACIP)
 Administer the first dose to females at age 11 or 12
years
 Administer the series to females at age 13 through 26
years if not previously vaccinated or completed the
series
 HPV4 may be administered in a 3-dose series to
males aged 9 through 26 years to reduce their
likelihood of acquiring genital warts
 Series of 3 doses can be started at age 9
Recommendations
 ACIP
 Vaccinate before first sexual activity
 Infection occurs in early years of sexual activity
 HPV 2 not approved for males of any age or for the
prevention of genital warts
 Consider post-vaccination waiting period for syncope
episodes
HPV Vaccine Acceptance
 Questionnaire Survey conducted among Caribbean
and African Americans
 175 girls age 13-19 year and their parents
 Describe attitudes and perceptions toward acceptability
of HPV vaccine
 Results
 48.9% sexually active and reported having more than
one lifetime partner
 44.5% were interested in receiving the HPV vaccine
 37.5% of parents were interested in daughters receiving
vaccine
Healthcare Professionals
 Resource of accurate information on infections for
patients, parents or caregivers
 Patient counseling on completion of therapies to
prevent patterns of resistance and incomplete cure
of infection
 Options for safe sex methods and use appropriately
Questions
 What is the length of immunity?
 What is the minimum titer required for immunity?
 Will booster immunization be required?
 What will the data provide for vaccination in persons
older than 26 years?
Concerns
 Vaccines should ideally be administered prior to
onset of sexual activity
 Can be given without parental consent???
 Patients that do not complete full series
 Controversial to many parent and caregivers
Pre-teen and Teen
vaccination program
 Targets parents, teens and providers to increase
awareness and promote vaccination
 Focuses on newer vaccines specifically for children
9-18 years of age
 Meningococcal, Tdap and HPV vaccines
 Recommendations for vaccination of boys and girls
Resources
 www.itsyoursexlife.com
 GYT – get yourself tested
 CDC partners with MTV Networks, the Kaiser Family
Foundation, and Planned Parenthood Federation of
America
 www.vaccinesforteens.net
 Collaboration of NBA, WNBA, Society for Adolescent
Health Medicine and sanofi - pasteur
 Educate parents and teens on the need to get
vaccinated and of the dangers of diseases without
vaccination
Resources
 April – STD Awareness Month
 CDC – Get Yourself Tested
 Aimed at promoting awareness about STDs since
many are asymptomatic
 Not only target vaginal intercourse also include oral
sex
References
 Ali Mir M. and Dwyer Debra S, Estimating peer effects in sexual behavior among
adolescents. Journal of Adolescence 2011(34): 183-190.
 American Academy of Pediatrics. Policy Statement Committee on Sports Medicine
and Fitness - Use of Performance- Enhancing Substances Pediatrics April 2005
115(4): 1103-1106.
 Baker, Nicole A , et. al. Ergogenic Substance Use and Detection in Adolescent
Athletes: An Overview. California Journal of Health-System Pharmacy May/ June
2008:6-15.
 Bonci Leslie, Sports Nutrition for Young Athletes Pediatric Annals. 2010 May;
39(5):300-306
 Calfee Ryan and Fadale Paul popular Ergogenic Drugs and Supplements in Young
Athletes Pediatrics 117(3): e577-589.
 Centers for Disease Control and Prevention. MMWR 2011;60(No. RR-20):626-9,
630-2.
 Centers for Disease Control and Prevention. 2009 Youth Risk Behavior Survey.
Available at: www.cdc.gov/yrbs. Accessed May 2011.
References
 Chesson H, Blandford J, Gift T, et al. The estimated direct medical cost of sexually
transmitted diseases among American youth, 2000. Perspectives in Sexual
Reproductive Health 2004
36:11-9.
 Cohen H. Dangerous jolt:energy drink dangers for children. Miami Herald April 1,
2008:E10, 10E
 Daniels SR, Arnett DK, Eckel RH, et al. Overweight in children and adolescents:
pathophysiology, consequences, prevention, and treatment. Circulation.
2005;111;1999–2002
 Freedman DS, Mei Z, Srinivasan SR, Berenson GS, Dietz WH. Cardiovascular risk
factors and excess adiposity among overweight children and adolescents: The
Bogalusa Heart Study. Journal of Pediatrics 2007;150:12--7.
 Giuliano AR. Efficacy of quadrivalent HPV vaccine against HPV Infection and disease
in males. N Engl J Med. 2011 Feb 3;364(5):401-11.
 High School Students warned about energy drink: Smokey hill student hospitalized
after drinking SPIKE. Available at
www.thedenverchannel.com/news/1107908/detail.html Accessed May 27, 2011
References
 http://apps.nccd.cdc.gov/uscs/index.aspx
 http://www.health.gov/paguidelines/default.aspx
 http://www.medterms.com
 http://oxforddictionaries.com/definition/sexting
 http://utsa.edu/today/2009/02/chlamydia.cfm
 http://notinmyhouse.drugfree.org/cultural_lingo.aspx
 Immunization 2011: Expanding Coverage, Enhancing Protection. Annals of Internal
Medicine. 2011;154:204-206
 Lee J. Energy drinks vs. sports drinks: know thy difference. Available at
http;//speedendurance.com/2009/07/09/energy-drinks-vs-sports-drinks-know-thydifference. Accessed June 1, 2011
 Mosher W, Chandra A, Jones J. Sexual behavior and selected health measures: men
and women 15-44 years of age, United States, 2002. September 15, 2005; Number
362:21-26
 National Center for Health Statistics. Health, United States, 2004 with Chartbook on
Trends in the Health of Americans [pdf 3.8M]. Hyattsville, MD; 2004.
References
 Ogden CL, Carroll MD, Curtin LR, Lamb MM, Flegal KM. Prevalence of high body
mass index in US children and adolescents, 2007–2008. JAMA 2010;303(3):242–9.
 Ott Mary A, Examining the Development and Sexual Behavior of Adolescent Males
Journal of Adolescent Health 2010(46): S3- S11
 Position Statement Human Papillomavirus Vaccine: An Updated Position Statement of
the Society for Adolescent Health and Medicine, Journal of Adolescent Health
2011(48):215-216
 Position paper Expedited Partner Therapy for Adolescents Diagnosed with Chlamydia
or Gonorrhea: A Position Paper of the Society of Adolescent Medicine. Journal of
Adolescent Health 2009(45): 303-309.
 Read, Dalan S et al. Attitudes and Perception of the HPV Vaccine in Caribbean and
African American Adolescent Girls and their Parents, Journal of Pediatric and
Adolescent Gynecology 2010;23:242-245
 Rogol Alan D, Drugs of abuse and the adolescent athlete. Italian Journal of Pediatrics
2010, 36:19
References
 Savage Michael P and Holcomb, Derek R, Adolescent female athletes’ sexual risktaking behaviors. Journal of Youth and Adolescence 1999: 595-602
 Seifert, Sara M, et. al., Health Effects of Energy Drinks on Children, Adolescents and
Young Adults. Pediatrics March 2011 127(3):511-528
 Simon M, Mosher J. Alcohol, energy drinks, and youth: a dangerous mix. Available at
www.marininstitute.org/alcopops/resourcese/EnergyDrinkReport.pdf Accessed May
25, 2011 Savage Michael P and Holcomb, Derek R, Adolescent female athletes’
sexual risk-taking behaviors. Journal of Youth and Adolescence 1999: 595-602.
 Takakura , Minoru, et. al, Adolescent health brief: Relationship of Condom Use with
Other Sexual Risk Behaviors among Selected Japanese Adolescents. Journal of
Adolescent Health 2007; 40: 85-88
 Treasande, Leonardo, Liu, Yinghua, Fryer, George and Weitzman, Michael, Effects of
Childhood Obesity on Hospital Care and Costs, 1999 – 2005. Health Affairs 2009;
28(3/4):W751-W760
 Van den Berg, Patricia et al. Steroid Use Among Adolescents: Longitudinal Findings
From Project EAT, Pediatrics 119(3):476-486
References
 Lee J. Energy drinks vs. sports drinks: know thy difference. Available at
http;//speedendurance.com/2009/07/09/energy-drinks-vs-sports-drinks-know-thydifference. Accessed June 1, 2011
 Cohen H. Dangerous jolt:energy drink dangers for children. Miami Herald April 1,
2008:E10, 10E
 High School Students warned about energy drink: Smokey hill student hospitalized
after drinking SPIKE. Available at
www.thedenverchannel.com/news/1107908/detail.html Accessed May 27, 2011
 Simon M, Mosher J. Alcohol, energy drinks, and youth: a dangerous mix. Available at
www.marininstitute.org/alcopops/resourcese/EnergyDrinkReport.pdf Accessed May
25, 2011
 www.ceravix.com – Accessed June 2011
 www. Gardasil.com – Accessed May 2011
 www.monitoringthefuture.org – Acessed June 2011