Search

Introduction Increased fiber intake has been associated with decreased breast cancer risk, while increased animal protein intake with increased risk. The objective of this study is to examine the relationship of dietary fiber and protein intake to estrogen and sex hormone–binding globulin (SHBG) concentrations at puberty onset. Methods These analyses were conducted using the Cincinnati puberty cohort of the Breast Cancer and the Environment Research Program, with girls followed every 6 months from ages 6 and 7. The analyses included serum measurements at 6-month intervals for estrogen and SHBG concentrations, from 18 months prior to breast stage 2 (onset of puberty). Dietary intake was documented via 24-hour dietary recalls every 3 months. Dietary factors of interest included total energy intake; total and animal protein; total, soluble, and insoluble fiber; and lignan and flavanol intake. Results This study included 260 participants who generated 871 serum specimens and 3,000 days of diet intake. In longitudinal models, estradiol was associated inversely with insoluble fiber intake; estrone positively with animal protein intake; SHBG with greater insoluble fiber and lower total protein intake; and ratio of estrone to SHBG, a measure of bioavailable estrogen, positively with animal protein. Conclusions Greater protein intake, especially animal protein, led to greater estrogen concentrations and lower SHBG; greater animal protein and greater caloric intake led to increased bioavailable estrogen. This relationship may have served an evolutionary advantage in the past for greater fertility with adequate high-quality protein; in contemporary women, a modest decrease in animal protein may be beneficial in reducing breast cancer risk.

Purpose Risk markers for breast cancer include earlier onset of menarche (age at menarche [AAM]) and peak height velocity (PHV). Insulin-like growth factor-1 (IGF-1) is associated with pubertal milestones, as well as cancer risk. This study examined the relationships between pubertal milestones associated with breast cancer risk and hormone changes in puberty. Methods This is a longitudinal study of pubertal maturation in 183 girls, recruited at ages 6–7, followed up between 2004 and 2018. Measures included age at onset of puberty, and adult height attained; PHV; AAM; adult height, and serum IGF-1, and estrone-to-androstenedione (E:A) ratio. Results PHV was greatest in early, and least in late maturing girls; length of the pubertal growth spurt was longest in early, and shortest in late maturing girls. Earlier AAM was related to greater PHV. IGF-1 concentrations tracked significantly during puberty; higher IGF-1 was related to earlier age of PHV, earlier AAM, greater PHV, and taller adult height. Greater E:A ratio was associated with earlier AAM. Conclusions Factors driving the association of earlier menarche and pubertal growth with breast cancer risk may be explained through a unifying concept relating higher IGF-1 concentrations, greater lifelong estrogen exposure, and longer pubertal growth period, with an expanded pubertal window of susceptibility.

Purpose Early life exposures during times of rapid growth and development are recognized increasingly to impact later life. Epidemiologic studies document an association between exposures at critical windows of susceptibility with outcomes as diverse as childhood and adult obesity, timing of menarche, and risk for hypertension or breast cancer. Methods This article briefly reviews the concept of windows of susceptibility for providers who care for adolescent patients. Results The theoretical bases for windows of susceptibility is examined, evaluating the relationship between pubertal change and breast cancer as a paradigm, and reviewing the underlying mechanisms, such as epigenetic modification. Conclusions The long-term sequela of responses to early exposures may impact other adult morbidities; addressing these exposures represents an important challenge for contemporary medicine.

Purpose (1) To propose a new method using statistical modeling to determine relative timing of pubertal maturation; (2) to validate the new method by evaluating its relationship with pubertal growth and timing parameters, including age at menarche, age onset of areolar maturation, age of peak height velocity, age at attainment of adult height, adult height, peak height velocity, body mass index, and percent body fat; and (3) to contrast the new method with relative timing of menarche on these pubertal parameters. Background The timing of puberty has a well-known impact on anthropometric and psychosocial outcomes. Multiple methods have been used to determine pubertal timing, but all with limitations. A uniformly applicable method is needed for different study designs and study populations. Methods Using the National Heart Lung and Blood Institute Growth and Health Study data, an ordinal logistic modeling was used to assess relative timing of pubertal maturation. Results The proposed method demonstrated good reliability and strong associations with all pubertal timing parameters, also body mass index and percent body fat. Timing was not significantly associated with adult height and peak height velocity. Conclusions The proposed method is highly feasible, easy to implement, and valid. The study demonstrated important differences between the relationships of relative timing of secondary sexual characteristics and the timing of menarche on pubertal parameters. The study also demonstrates that individuals with early or late timing at one point of time are likely to maintain the same relative timing throughout puberty.

Self-esteem is a major "predictor" of satisfaction with life. This longitudinal study examined mean and individual changes in self-esteem, and how self-esteem is affected by race and body mass.Girls were recruited at ages 9 and 10 years, and followed to age 22 years. The Harter Self-Perception Profile was administered every other year, analyzing scores from the Global Self-Worth Scale, by age or developmental phase: ages 9-12 (I), 13-16 (II), and 17-22 (III). Regression modeling included main effects and interactions between age/phase, race, and body mass index (BMI).Self-worth was greater in black than white women, and greater with lower BMI in both races. In the model with age ("traditional model") (with race and BMI), significant variables included BMI (inverse relationship) and the interactions between age and race, race and BMI, and the triple interaction between age, race, and BMI. In the model with phase ("transitional model") (with race and BMI), BMI, and the interactions between BMI and race, and race and phase, were significant. For example, self-worth was generally lower in Phase II (middle adolescence) for white women. Self-esteem tracked significantly (correlation 0.22, p.001). An individual's self-worth during any given phase of adolescence was correlated significantly with the other two phases.In this longitudinal analysis of self-esteem in adolescent girls, race and BMI are important predictors of self-esteem. Self-esteem is consistent across the phases of adolescence, and comparable with other personality traits. As noted by others, lower levels of self-esteem may increase the vulnerability of adolescents to risky behaviors.

Purpose: We examined changes in self-esteem and feelings of competence with physical appearance and social acceptance over approximately 5 years in 1166 white and 1213 black girls, aged 9 and 10 years at baseline. >Methods: Maturation stage and body mass index (BMI) were assessed annually. Biennially girls completed Harter's Self-Perception Profile for Children. Changes were analyzed in the context of race, sexual maturation, BMI, and household income. Longitudinal regression models were used to compare trends with age in global self-worth, physical appearance, and social acceptance. Results: Mean global self-worth showed little change over ages 9–14 years in blacks ( p = 0.09) but decreased in whites ( p p p p p p values, ≤ 0.002). Adjustment for maturation stage, BMI, and household income did not alter the significance or direction of racial differences in the changes with age in global self-worth and physical appearance scores. Self-worth, physical appearance, and social acceptance scores decreased with increasing BMI. Decreases in physical appearance and social acceptance scores with increasing BMI were smaller in blacks than in whites ( p p p = 0.08). Conclusions: This article reports the first data on self-esteem scores by age for a large population of black girls aged 9 and 14 years and concludes that self-esteem does not follow the same developmental pattern in black as in white girls. A reason for black girls' higher and more stable self-worth and their greater satisfaction with their physical appearance compared to white girls may be racial differences in attitudes toward physical appearance and obesity.

Purpose: The purpose of this study is to determine the reliability of sexual histories obtained from adolescents and the adequacy of chart documentation by providers of adolescent health care. Methods: Responses to an interview by a female research assistant about sexual activity were compared to chart-documented sexual histories taken by physicians and nurse practitioners. The setting was an urban, hospital-based adolescent clinic. The subjects were 106 females, 15–18 years old; 82% were African—American and 18% Caucasian. Results: Significant correlations between interview and chart were seen for information about menarche, age at first intercourse, number of sexually transmitted diseases (STDs), and number of sexual partners. Accuracy of reporting sexually transmitted infections varied according to the organism; HPV infection was underreported more than other infections. Chart documentation of sexual histories was inadequate. Conclusions: Adolescents generally provide reliable sexual histories, but health care providers may not be documenting these histories adequately.

Purpose: The purpose of this study was to examine the relationship between age and number of sexually transmitted diseases (STD) episodes in sexually active girls with their perceptions of the interpersonal implications of STD acquisition. Methods: The sample consisted of 248 girls (mean age=16.9 years); 74% had an STD history. Adolescents responded to statements using a five-point Likert scale regarding their interpersonal expectations, and rated the perceived prevalence of STD among their friends and among all adolescents. Results: The results of logistic regression analyses indicated that older girls were less likely to tell their parents but did not perceive parental support differently than younger girls. Older girls were more likely to tell their partners and to be more embarrassed by the acquisition. Those with a greater number of STD episodes perceived the acquisition as a less negative event. Girls with a greater number of STD episodes perceived the prevalence of STD to be significantly greater among their friends and among all adolescents than those girls with fewer episodes. Overall, the perceived prevalence among friends (40%) was significantly lower than the perceived prevalence among teens in general (74%). Conclusions: Future research and practice in aiding adolescent girls to manage STD acquisition must incorporate developmental theory, and, when appropriate, methods to involve families while preserving privacy.

A group of 46 women attending an adolescent dysplasia clinic were surveyed regarding the reported impact of cervical dysplasia on sexual beliefs and behaviors. The adolescents reported being concerned about their future health and having changed their sexual practices. There were no clear relationships between demographic variables or sexual attitudes and changes. The adolescents' self-reports of their behavior were not consistent; those adolescents who reported safer sex practices did not have lower rates of sexually transmitted diseases postbiopsy. The results of this study indicate the important but complex impact of sexually transmitted disease on adolescents and suggests that this impact on adolescents may be different from that on adults.

Clinicians use several measures to estimate adiposity. Body mass index (BMI), although not a measure of adiposity, is commonly used to define weight status. Percent body fat (%BF) measures total body fatness, which is composed of central and peripheral fat, estimated by waist circumference (WC) and skinfold thickness, respectively. Abnormal increases in fat during puberty may reflect an increased risk of developing cardiovascular disease. Therefore, it is important to establish the normal patterns of change in clinically relevant measures of adiposity.To describe the normal patterns of change in clinical measures of adiposity during puberty.Multilevel modeling and linear regression analyses of 642 children in Project HeartBeat!, aged 8-18 years (non-black and black), who had assessments of BMI, %BF, WC, sums of 2- and 6-skinfolds, and pubertal stage (PS) triennially between 1991 and 1995.In males, the normal pattern from PS1 to PS5 is for %BF to decrease, skinfold thickness to remain stable, and WC to increase. However, after adjusting for height, WC does not change. In females, %BF remains stable from PS1 to PS5, whereas skinfold thickness increases. As in males waist-height ratio does not change, indicating that central adiposity does not normally increase during puberty. Although BMI increases in both genders and races from PS1 to PS5, mean values at PS5 were well below 25 kg/m(2).During puberty, increase in %BF is abnormal in females and even more so in males. Likewise, increase in waist-height ratio is also abnormal and may suggest an increased risk for adiposity-associated morbidity.

Conclusions: Adolescents in China who were low birth weight (LBW) lag behind normal birth weight peers in height cognitive ability and school achievement. As the first study in China of long-term outcome our findings suggest that LBW adolescents represent a population in need of support. The isolation of China during the research period and the homogeneity of its social and family structures provide a unique setting for the study of LBW outcome but also highlight the importance of additional studies with larger cohorts from other regions of the country. (excerpt)

Purpose: Urinary symptoms (sx) are common in sexually active females, and differentiating urinary pathogens from sexually transmitted infections (STIs) is challenging. Our objectives were to determine 1) if urinary sx or urinary tract infections (UTIs) were associated with Chlamydia trachomatis (CT), Neisseria gonorrhoea (NG), or Trichomonas vaginalis (Tv) infections and 2) which clinical and lab findings could distinguish UTI from STI. Methods:The cross sectional sample included 301 sexuallyactive females aged 14-21 years attending a hospital-based teen health center or emergency department visit. Subjects completed a structured interview about genitourinary sx (vaginal itching or discharge, dysuria, frequency or urgency) and sexual history, provided a vaginal swab for Tv culture and a clean catch mid-stream urine sample for urinalysis (UA), bacterial culture and nucleic acid amplification testing (NAAT) for NG and CT. UTI was defined as growth of 10 colonies of single pathogenic organism. UA results (nitrites, leukocyte esterase (LE), protein or blood) were deemed positive if 1. Bivariate associations were assessed with chi-square and Fischer’s exact tests. Logistic regression models (LR) produced adjusted odds ratios (OR) for each outcome. Classification and regression tree (CART) analysis identified significant combinations of variables to predict STI, UTI, or both. Results: Subjects had a mean age of 18.0 years; 78% were black. Overall, 145 (51%) reported urinary sx; 47 (16.7%) had a UTI and 99 (33%) had an STI. The prevalence of Tv, CT and NG was 18 %, 17.7% and 9.9% respectively. Urinary sx alone or in combination did not predict STI. UTI was not associated with STI either in the full or symptomatic sample. For the full sample, significant (p .05) variables that comprised the LR model for CT included LE (OR 2.5) and 1 partner in the last 3 months (OR 2.7). NG was associated with LE (OR 3.4) and 1 partner in the last 3 months (OR 5.3). Tv was predicted by LE (OR 3.6), vaginal sx (OR 2.5), and history of prior STI (OR 3.4). CART analysis of the full sample did not identify any sx or history variables that reliably predicted any outcome. However, it identified four groups based on UA results.1) 23.4% of the group with normal UA results had STI and 6% had UTI. 2) Those with nitrites or protein had increased UTI risk (30%). 3) Those with LE or blood had increased STI risk (54.3%). 4) The group with both nitrites/protein and LE/blood had increased STI (36%) and UTI (60%) (p 0.001). A decision tree using only UA results correctly classified 65% of the full sample. Among the 145 with urinary sx, 19.3% had UTI only, 29.7% had STI only, and 6.9% had both. In this group, 62% with sterile pyuria (negative urine culture and LE) had an STI. In addition, LE increased the odds of NG (OR 6.4) and Tv (OR 4.6), and vaginal sx increased the odds of any STI (OR 2.5) without decreasing the odds of UTI. Conclusions: A single clean catch urine sample allows UA, culture and NAAT for STIs. UA results are useful in differentiating STI and UTI, and can guide patient management. In those at high risk for STIs, sterile pyuria suggests NG or Tv infection. Support: NIH/ NIAID grant R03 A1054616-02 (Huppert, PI).

The objectives of this study were to examine the reasons for discontinuation of the long-acting contraceptives Depo-Provera and Norplant in adolescents, and to assess the adolescents' experience after discontinuation of the methods.A total of 35 adolescents [gynecologic age 4.7 +/- 0.3 years, and body mass index (BMI) 24.2 +/- 0.6] who discontinued Depo-Provera, and 31 adolescents (gynecologic age 3.4 +/- 0.3 years, BMI 24.1 +/- 0.9) who discontinued Norplant were periodically assessed during use of the methods and up to 12 months after discontinuation.The most common reasons for discontinuation of both Norplant (after 21.8 +/- 1.6 months of use) and Depo-Provera (9.2 + 0.9 months of use) were irregular menstrual bleeding (64%), weight gain (41%), and increased headaches (30%). Resumption of menstrual regularity and dysmenorrhea was noted sooner after discontinuation of Norplant, compared with Depo-Provera. The increase in BMI noted at discontinuation of Depo-Provera (1.1, P = .0005) and Norplant (1.3, P = .03) persisted up to 6 months after discontinuation of either method (0.6, P = .01 post-Depo-Provera discontinuation; and 0.9, P = 0.02 post-Norplant discontinuation). Only 62% of the adolescents reported no break in contraceptive practice. The condom was the most popular method (37%) after discontinuation of Depo-Provera, and oral contraceptive (39%) after discontinuation of Norplant. The cumulative conception proportion reached 0.93 at 12 months after discontinuation of Norplant, and was significantly higher (P = .01) compared with the cumulative proportion of conception after discontinuation of Depo-Provera (P = .50).Health care providers should aggressively manage physical problems associated with Depo-Provera and Norplant use, and expedite the transition to a new contraceptive method to minimize the high pregnancy rate observed after discontinuation of these methods in adolescents.The authors present their findings from the study of adolescents' reasons for discontinuing the use of Norplant and Depo-Provera. Their experiences after method discontinuation were also assessed. 35 adolescents of mean gynecologic age 4.7 years and body mass index (BMI) 24.2 who discontinued Depo-Provera, and 31 adolescents of mean gynecologic age 3.4 years and BMI 24.1 who discontinued Norplant were periodically assessed during use of the methods and up to 12 months after discontinuation. The most common reasons for discontinuation of both Norplant and Depo-Provera after mean periods of 21.8 and 9.2 months use, respectively, were irregular menstrual bleeding (64%), weight gain (41%), and increased headaches (30%). The resumption of menstrual regularity and dysmenorrhea was noted sooner after discontinuation of Norplant, compared to Depo-Provera. The increase in BMI noted at the discontinuation of Depo-Provera persisted up to 6 months after discontinuation of either method. 62% of adolescents reported no break in contraceptive practice. The condom was the most popular method (37%) after discontinuation of Depo-Provera, and oral contraceptives (39%) after discontinuation of Norplant. The authors conclude that health care providers should aggressively manage physical problems associated with Depo-Provera and Norplant use, and expedite the transition to new contraceptive methods in an effort to minimize the high pregnancy rates observed after discontinuation of these methods in adolescents.