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Biomedical subjects

Melanie A Gold

Publications and source records attributed to Melanie A Gold.

16 recordsLinked to original sources
PubMed2006

Development and validation of a smoking media literacy scale for adolescents.

OBJECTIVES: To develop a smoking media literacy (SML) scale by using empiric survey data from a large sample of high school students and to assess reliability and criterion validity of the scale. DESIGN: On the basis of an established theoretical framework, 120 potential items were generated, and items were eliminated or altered on the basis of input from experts and students. Cross-sectional responses to scale items, demographics, smoking-related variables, and multiple covariates were obtained to refine the scale and determine its reliability and validity. SETTING: One large Pittsburgh, Pa, high school. PARTICIPANTS: A total of 1211 high school students aged 14 to 18 years. MAIN OUTCOME MEASURES: Current smoking, susceptibility to smoking, attitudes toward smoking, and smoking norms. RESULTS: Factor analysis demonstrated a strong 1-factor scale with 18 items (alpha = 0.87). After controlling for all covariate data, SML had a statistically significant and independent association with current smoking (P = .01), susceptibility (P<.001), and attitudes (P<.001), but not norms (P = .42). Controlling for all covariates, an increase of 1 point on the 10-point SML scale was associated with a 22% decrease in the odds of being a smoker and a 31% decrease in the odds of being susceptible to smoking. CONCLUSIONS: Smoking media literacy can be measured with excellent reliability and concurrent criterion validity. Given the independent association between SML and smoking, media literacy may be a promising tool for future tobacco control interventions.

Adolescent↗
PubMed2006

Association of cigarette smoking and media literacy about smoking among adolescents.

PURPOSE: To determine whether media literacy concerning tobacco use is independently associated with two clinically relevant outcome measures in adolescents: current smoking and susceptibility to smoking. METHODS: We asked high school students aged 14-18 years to complete a survey that included a validated 18-item smoking media literacy (SML) scale, items assessing current smoking and susceptibility to future smoking, and covariates shown to be related to smoking. We used logistic regression to assess independent associations between the two outcome measures and SML. RESULTS: Of the 1211 students who completed the survey, 19% reported current smoking. Controlling for all potential confounders of smoking, we found that an increase of one point (out of 10) in SML was independently associated with an odds ratio for smoking of .84 (95% confidence interval [CI] .71-.99). Compared with students below the median score on the SML scale, students above the median had an odds ratio for smoking of .57 (95% CI .37-.87). Of the students who were nonsmokers, 40% were classified as susceptible to future smoking. Controlling for all potential confounders of smoking, we found that an increase of one point (out of 10) was independently associated with and an odds ratio for smoking susceptibility of .68 (95% CI .58-.79). Compared with students below the median SML, students above the median SML had an odds ratio for smoking susceptibility of .49 (95% CI .35-.68). CONCLUSIONS: In this sample of high school students, higher SML is independently associated with reduced current smoking and reduced susceptibility to future smoking.

Adolescent↗
PubMed2005

Emergency contraception.

Emergency contraception is increasing in use and has become a universal standard of care in the United States. This article reviews available forms of emergency contraception, their indications, contraindications, adverse effects and efficacy at preventing pregnancy. This article describes the mechanism of action of different forms of emergency contraception and provides recommendations on when to start or restart an ongoing method of contraceptive after emergency contraception use. Literature on the impact of the advance provision of emergency contraception on contracepting behaviors is reviewed, and behavior change counseling related to emergency contraception is described.

Adolescent↗
PubMed2005

Preadmission patterns of physical activity in a sample of juvenile detainees.

Preadmission patterns of physical activity were examined in a sample of 537 juvenile detainees and compared with the 2001 Youth Risk Behavior Survey (YRBS), a national sample of high school students. Overall, detained youth reported similar participation in physical activity, surpassing the student sample in some areas.

Adolescent↗
PubMed2005

Body piercing practices and attitudes among urban adolescents.

PURPOSE: This article describes adolescents' attitudes and practices toward body piercing and their awareness of associated health risks. METHODS: An anonymous, 32-item, random, convenience-sample survey was administered to 225 participants, ages 12-21 years, at an urban, hospital-based, adolescent clinic. RESULTS: The mean participant age was 16.5 +/- 2.1 years; 78% were female; and 58% were African-American and 30% were Caucasian. Forty-eight percent had a body piercing. About half of participants (range, 45%-62%) endorsed each site as accepted by the public, except for nipple and genital sites, which fewer than 10% endorsed as accepted. African-Americans were more likely to have pierced noses, and to find that site acceptable, whereas Caucasians were more likely to have pierced navels and nipples, and to find those sites acceptable (odds ratio [OR] range, 3.05-19.37). Youth tended to see their own pierced site as more acceptable and less risky than others did (OR range, 8.99-23.61; effect sizes [r] range, .15-.60). The most common health problems from body piercing reported by participants from their personal experience were infection (10%), allergic reaction (1%), and bruising (1%). The most common health problems from body piercing reported by participants based on others' experiences were infection (74%), bleeding (30%), allergic reaction (26%), bruising (19%), and keloids (19%). Those who were pierced in a body-piercing shop reported more infections (18.4%) than those pierced in other places (1.9%) (OR, 11.49; 95% confidence interval [CI], 1.39-90.91). Youth who had pierced themselves perceived less risk from piercing from a nonprofessional (50%) compared with those pierced by a professional (77%) (p = .003). CONCLUSIONS: Youth from this hospital-based urban adolescent clinic considered body piercings to be generally accepted by the public. Pierced youth in our survey often participated in body piercing practices that they perceived as minimally risky and that they defined as normative. Based on these findings, clinicians should discuss body piercing in the context of providing routine anticipatory guidance to adolescents and should educate adolescents about safer piercing strategies to help minimize associated health risks.

Adolescent↗
PubMed2005

Changes in young women's awareness, attitudes, and perceived barriers to using emergency contraception.

BACKGROUND: In a 1996 survey, most young women ages 13-20 years from an urban, hospital-based clinic and a drug treatment center had inadequate awareness of emergency contraception (EC), and perceived several barriers to its use. Since that time, the FDA has approved two products for EC, media coverage has increased, and physicians have provided more counseling about EC. PURPOSE: The purpose of this study is to compare the awareness, attitudes, and perceived barriers to using EC among a sample of young women from 1996 with a different sample of women from 2002. METHODS: We recruited 139 young women (mean age 16.7 +/- 1.8 yrs) from the same adolescent clinic and drug treatment center as the 1996 sample. They had similar demographic characteristics, with the majority (63%) being African-American or multi-ethnic; 85% had ever been sexually active. They were interviewed using a questionnaire about their sexual and contraceptive history as well as their knowledge of and experience with EC. They then watched a 4(1/2) minute video and received a 5-minute didactic review of EC. Following the educational intervention, participants' knowledge, attitudes, and perceived barriers to using EC were assessed. The questionnaire used to guide the interviews was nearly identical to that used in 1996. RESULTS: Between 1996 and 2002, the percentage of participants reporting that they had ever heard of EC grew (44% vs. 73%, P < 0.001), as well as the percentage reporting that they had ever used EC (4% vs. 13%, P = 0.02). Of those participants who had ever heard of EC, fewer 1996 participants knew where to obtain it compared to 2002 participants (78% vs. 95%, P = 0.002) and fewer 1996 participants knew the correct time limits for use (20% vs. 51%, P < 0.001). The above data were collected prior to a didactic review session about EC. After receiving information about EC, the percentage of participants reporting a positive attitude toward EC grew between 1996 and 2002 (72% vs. 96%, P < 0.001). Young women also had fewer concerns about safety and side effects in 2002. The 1996 participants were more likely to report barriers to using EC compared to the 2002 participants. In 1996, EC side effects and impact on fertility were the most commonly perceived barriers to EC use. However, in 2002 the frequency of all reported barriers decreased and cost had become the number one perceived barrier. CONCLUSION: Since 1996, young women at an urban hospital-based adolescent clinic and drug treatment center increased their awareness, use, and positive attitudes towards EC, as well as decreased their perceived barriers to using EC. Educational interventions that focus on improving knowledge among younger adolescents, specifically about correct time limits and identifying ways to find affordable EC, will address the most common knowledge deficits and perceived barriers to EC use among adolescents.

Adolescent↗
PubMed2004

Adolescents define sexual orientation and suggest ways to measure it.

Researchers disagree on how to assess adolescent sexual orientation. The relative importance of various dimensions (e.g. attraction, relationships, behavior, self-labeling) is unknown, which calls into question the validity of studies assessing adolescent sexual orientation. To address this issue, 50 male and female adolescents of varied sexual orientations participated in focus groups and interviews. Two types of sexual attraction-one a physiologic reaction and the other a cognitive response-were central to adolescent sexual orientation. Participants did not perceive sexual behavior and self-identification as necessarily relevant. Preliminary items to measure sexual attraction were developed based on these adolescents' perceptions.

Adolescent↗
PubMed2004

The effects of advance provision of emergency contraception on adolescent women's sexual and contraceptive behaviors.

CONTEXT: Advance provision of emergency contraception (EC) may increase timely access and improve effectiveness, but the impact on adolescent sexual and contraceptive behaviors is not known. OBJECTIVE: To determine whether adolescents given advance EC have higher sexual and contraceptive risk-taking behaviors compared to those obtaining it on an as-needed basis. DESIGN AND SETTING: Randomized trial conducted at urban, hospital-based adolescent clinic in Pittsburgh, PA, from June 1997 to June 2002. PARTICIPANTS: 301 predominantly minority, low-income, sexually active adolescent women, age 15-20 years, not using long-acting contraception. INTERVENTIONS: Advance EC vs instruction on how to get emergency contraception. OUTCOME MEASURES: Self-reported unprotected intercourse and use of condoms, EC, and hormonal contraception ascertained by monthly 10-minute telephone interviews for 6 months post-enrollment. Reported timing of EC use after unprotected intercourse. RESULTS: At both 1- and 6-month followup interviews, there were no differences between advance EC and control groups in reported unprotected intercourse within the past month or at last intercourse. At 6 months, more advance EC participants reported condom use in the past month compared to control group participants (77% vs 62%, P=0.02), but not at last intercourse (advance EC 83% vs control 78%, P=0.34). There were no significant differences by group in hormonal contraception use reported by advance EC or control groups in the past month (44% vs 53%, P=0.19) or at last intercourse (48% vs 58%, P=0.20). At the first followup, the advance group reported nearly twice as much EC use as the control group (15% vs 8%, P=0.05) but not at the final followup (8% vs 6%, P=0.54). Advance EC group participants began their EC significantly sooner (11.4 hours vs 21.8 hours, P=0.005). CONCLUSIONS: Providing advance EC to adolescents is not associated with more unprotected intercourse or less condom or hormonal contraception use. In the first month after enrollment, adolescents provided with advance EC were nearly twice as likely to use it and began EC sooner, when it is known to be more effective.

Adolescent↗
PubMed2004

Poland's syndrome and premature ovarian failure.

A 19-year-old female with Poland's Syndrome with associated left amastia, scoliosis, and left Sprengel deformity developed secondary amenorrhea from premature ovarian failure. Her menarche was at 13 years of age, and periods were regular and monthly until 15 years of age when her periods suddenly stopped. Her hormonal evaluation was significant for elevated FSH (46.5 mIU/ml) and LH (28.5 mIU/ml), and low estradiol (23 pg/ml). Anti-ovarian antibody level was less than 2 units (normal < 4 units). Her chromosomes were 46XX, by both standard karyotype and by fluorescence in situ hybridization. On transabdominal and transvaginal ultrasonography, ovaries were not visualized, the uterus was of normal size and anteverted and both kidneys were normal. The patient began hormone replacement therapy with conjugated estrogen (Premarin) 0.625 mg po daily and progestin (Provera) 5 mg on days 20 to 25. Because of menopausal symptoms, she was switched to a combination oral contraceptive (OC) with 20 mcg ethinyl estradiol that was eventually increased to 30 mcg. Her menopausal symptoms (hot flashes and sweating) improved on the continuous 30 mcg ethinyl estradiol combination OC. Following a comprehensive review of the literature, this is the first reported case of Poland's Syndrome associated with premature ovarian failure; however, this association may be coincidental.

Adult↗
PubMed2004

Emergency contraceptive pills: a review of the recent literature.

PURPOSE OF REVIEW: The purpose of this review is to inform the reader of new information published since early 2003 about emergency contraception, with a particular focus on issues of access. RECENT FINDINGS: Research continues to document low but increasing levels of knowledge about emergency contraception, increasing use, and more positive attitudes towards emergency contraception by both patients and healthcare providers. Additional information is available about efficacy and mechanisms of action. More reports of side-effects have been published, as have studies relating to the impact of emergency contraception on sexual and contracepting behaviors. Advance provision, provision by pharmacists, and over-the-counter status have been studied as ways to improve access to emergency contraception. SUMMARY: Knowledge about the efficacy, safety, types and use of emergency contraception continues to increase. Although patients have greater awareness of and more access to emergency contraception, there are still numerous barriers to its use even in countries where it is available over the counter. Healthcare providers must continue to educate themselves and their patients about emergency contraception even when it becomes available over the counter. In countries where emergency contraception is only available by prescription, providers should offer an advance prescription or supply (where available), and use newer dosing regimens for levonorgestrel-only emergency contraception to increase adherence and efficacy. Developing collaborative practice agreements with pharmacists to increase access is also recommended. Patients should be counseled to seek follow-up if no menses occurs within 3 weeks of taking emergency contraception or if symptoms such as lower abdominal pain occur after the use of emergency contraception.

Contraceptives, Postcoital↗
PubMed2003

The impact of using emergency contraception on reproductive health outcomes: a retrospective review in an urban adolescent clinic.

The effort to make emergency contraception (EC) more easily available has been challenged by concerns that prescribing EC may tempt adolescents to have unprotected intercourse, resulting in higher rates of pregnancy and sexually transmitted infections (STIs). This study examined differences in reproductive health history and outcomes among girls who were prescribed EC compared with those seeking other reproductive health care. In a retrospective chart review, the subjects (182 total: 92 EC, 90 control) were girls aged 13 to 21 years, 63% black and 31% white, in an urban, hospital-based adolescent outpatient clinic. Pregnancies, STIs, and visits for first pelvic examination and Pap smear were compared for the 12 months before the identifying visit (IDV) and for up to 2 years after the IDV (mean: 10.9 months+/-8.2 months). Twenty-six subjects became pregnant with no significant difference between groups. Control subjects were found to have a higher incidence of chlamydia. Before the IDV, EC users were more likely than controls to have never had a pelvic examination (23% vs. 6%, P<0.002) or a Pap smear (24% vs. 6%, P<0.002). However, 80% of EC subjects who had never had a pelvic examination received one as a result of the initial visit and follow-up related to receiving EC. Using EC is not associated with increased risk for future STIs and pregnancy among adolescent girls. Requesting EC may initiate routine gynecologic care.

Adolescent↗