Abstracts / 46 (2010) S17S81
136.
ACCEPTABILITY & FEASIBILITY OF AN INTERACTIVE
COMPUTER ASSISTED INTERVENTION TO INCREASE
CHLAMYDIA SCREENING DURING URGENT
CARE VISITS
Kathleen Tebb, PhD, Ralph Gonzales, MD, Chelsea Nelson, BA,
Rosanna Sansone, MS, NP, Mary-Ann Shafer, MD. University of
California San Francisco
Purpose: Background: Chlamydia trachomatis (CT) is the most
common reportable bacterial STI. Untreated CT can result in pelvic
inflammatory disease with its sequelae of ectopic pregnancy,
chronic pelvic pain, infertility, transmission to offspring and sex
partners, and may increase HIV risk. CT can be easily diagnosed
and treated, but detecting it requires routine screening as most
infections are asymptomatic. Despite recommendations for annual
CT screening for sexually active 15-24 yo females, screening rates
remain low. Most at-risk females do not access primary care where
CT screening should be routine and many providers lack the skill
and comfort to discuss sexual health topics and screen for CT
especially outside of a preventive health visit. Therefore, interven-
tions are needed to reach at-risk females at a common point of
contact with the health care system urgent care (UC) and emer-
gency department (ED) settings. Objective: To develop an interac-
tive, individually-tailored computer module to facilitate CT
screening during UC/ED visits.
Methods: This study utilizes a multi-method design. To inform
module development, we conducted focus groups and interviews
of young women (in English & Spanish) from three clinical settings
that serve low-income, racially/ethnically diverse women in San
Francisco, CA. Based loosely on the stages of change model, the
module allows the client to choose one of three video vignettes of
a young women that resonates most closely with their current atti-
tudes toward CT testing: (1) one who does not know about CT; (2)
one who has some information and is interested in getting tested,
but wants to learn more; and (3) one who acknowledges her risk
and decides to get tested. Clients who do not want the educational
messages or who feel time constrained can proceed directly to CT
testing. Testing the acceptability of this intervention was based on
a consecutive sample of young women in three settings: (1) univer-
sity-based UC clinic; (2) community-based UC clinic and (3)
community-based ED.
Results: Preliminary findings are from the first 100 females (18-25
yo) who consented to use the module (mean age 21). Race/
ethnicity: 31% Af. Am., 9% As/PI, 7% W, 19% Latina, and 34%
multi/other. Educational levels (years): 35% had >14years, 52%
had 11-13 years, 6% had 7-10 years, and 7% had < 6 years. More
than half (51%) needed to be screened for CT. Of these, 73% agreed
to have a CT test at their UC/ED visit. Those who declined testing
(27%) stated that they were: not at risk of a CT infection (n 5,
36%); concerned about cost of test (n 5, 36%); not feeling well
(n 3, 21%); and did not respond 1 (7%). Most (> 94%) strongly
agreed or agreed with statements that the computer module was
easy to use; they trusted the information it provided; they would
recommend the kiosk to friends; and they were comfortable using
it during their urgent care health visit. Most participants (86%) re-
ported that they learned something new from the module. The few
who reported not learning something new had been tested for CT in
the past.
Conclusions: This CT kiosk module implemented during UC/ED
visits is a feasible and acceptable tool to screen for sexual health
risk behaviors and facilitates CT screening for underserved
populations.
Sources of Support: MCHB/HRSA R40MC08719 and in part by the
LEAH training grant.
S79
137.
LACK OF CLINICAL UTILITY OF HGBA1C AND FASTING
GLUCOSE (FG) IN IDENTIFYING IMPAIRED GLUCOSE
TOLERANCE (IGT) IN A HIGH-RISK OBESE, MINORITY
PEDIATRIC POPULATION
Wendi Ehrman, MD, Ramin Alemzadeh, Pippa Simpson, PhD,
Shun-hwa Li, PhD. Medical College of Wisconsin
Purpose: The incidence of IGT and Type 2 Diabetes Mellitus
(T2DM) appears to parallel the significant increase in pediatric
obesity. To evaluate both the prevalence of IGT/T2DM and the clin-
ical utility of FG and HgbA1c in identifying T2DM and IGT we per-
formed 2-h oral glucose tolerance tests (OGTT) in a high-risk obese
pediatric population.
Methods: A convenience sample of 250 subjects (189F/61 M); aged
14.5 2.8 years with BMI >85th % and mean BMI: 35.3 7.1 met the
ADA criteria for screening for T2DM and IGT. Acanthosis Nigri-
cans was present in 88% (219) of subjects, hypertension was present
in 11% (28) and 83% (206) had a family history of T2DM. African
Americans and Hispanics represented 97% of pediatric subjects.
All subjects underwent a 2-h OGTT and HgbA1c. Subjects with
a FG of >126 mg/dl or a 2-hour glucose of > 200 mg/dl were iden-
tified as diabetic while those with FG >100 mg/dl or 2-hour
glucose of >140 mg/dl were identified as abnormal. The subjects
who are abnormal but not diabetic were identified as IGT.
Results: Nineteen (7.6%) subjects had an abnormal OGTT. Five
subjects (2%) had blood glucose levels consistent with T2DM,
whereas the remaining 14 subjects (5.6%) had levels consistent
with IGT. The mean SD fasting glucose in subjects with IGT
and T2DM was 97.1 15.7 mg/dL and 141 41.1 mg/dL, respec-
tively. FG alone identified 80% of subjects with T2DM in compar-
ison with 50% of IGT subjects. However, 2-h glucose alone
identified 80% of T2DM and 71% of IGT subjects. Only 60% of
T2DM subjects and 21% of IGT subjects had both abnormal FG
and 2-h glucose levels. HgbA1c was positively correlated with FG
(r .57; p < .011) and 2-h glucose (r .72; p < .0005) for the
abnormal glucose groups only. The mean SD HgbA1c in subjects
with normal OGTT, IGT, and T2DM were 5.5% .5, 6.0% .5% and
6.9% .8%, respectively. Using HgbA1c value of 6.3% as a cutoff,
only 21% (3/14) with IGT had abnormal HgbA1c and 80% (4/5)
patients with T2DM demonstrated abnormal HgbA1c (p < .038).
Conclusions: FG coupled with HgbA1c appears to be an adequate
clinical tool for identification of subjects with T2DM. However
OGTT is needed to identify high-risk pediatric subjects with IGT.
Early identification of subjects with IGT is critical in order to
modify lifestyle factors that may influence progression to T2DM.
Sources of Support: Childrens Research Institute and Childrens
Hospital (of Wisconsin) and Health System Foundation.
138.
CARDIAC CRP AS A SCREENING TOOL FOR
CARDIOVASCULAR RISK IN OVERWEIGHT HISPANIC
ADOLESCENTS WITH AND WITHOUT PCOS
Marcela Nur, MD, FAAP2, Lorena Siqueira, MD, MSPH1. 1Miami
Childrens Hospital; 2Procare Womens Health Clinic
Purpose: Females with polycystic ovary syndrome (PCOS) have an
increased risk of hypertension, dyslipidemia, type 2 diabetes and
ultimately cardiovascular disease. Studies in adults indicate that
PCOS, independent of weight status is a risk factor for cardiovas-
cular disease. Cardiac CRP is a marker of endothelial inflammation
and a strong independent predictor of future cardiovascular
disease. The aim of our study was to determine if overweight
S80 Abstracts / 46 (2010) S17S81
Hispanic adolescents with PCOS had higher levels of cardiac CRP
than those without PCOS.
Methods: A retrospective chart review of 62 subjects with PCOS
and 25 without PCOS was conducted. Systolic and diastolic blood
pressure, BMI, total, LDL and HDL cholesterol, triglycerides, fast-
ing and two hour postprandial glucose, fasting and two hour post-
prandial insulin and cardiac CRP (cCRP) were extracted. HOMA,
QUICKI and FGIR indices were calculated. Pearson correlations,
independent T-tests for one sample and stepwise forward logistic
regression using SPSS software were conducted.
Results: There was no difference in age (15.4 6 1.9 vs. 15.2 6 2.5),
BMI (33.0 6 5.6 vs. 34.4 6 5.3 kg/m2), cCRP (3.2 6 3.7 vs.
4.1 6 3.8), nor any of the other above parameters, between the
PCOS and non-PCOS subjects. Next we correlated each of the
above parameters with cCRP in the PCOS and non-PCOS groups
and found no correlation within each group. We further subdivided
these two groups into overweight PCOS (n 14, BMI 85-95%),
obese PCOS (n 48, > 95%), overweight non-PCOS (n 4) and
obese non-PCOS (n 21). There was no significant difference in
the cCRP between the two overweight and the two obese subcate-
gories. Disregarding the PCOS status, the total sample was then
divided into overweight (n 18) and obese (n 69) subjects, and
the following factors were found to be statistically different
between the groups: systolic BP (114 6 7 vs. 119 6 13, p .03), fast-
ing insulin (9.9 6 6.1 vs. 16.8 6 11.4, p .016), HDL (50.7 6 12.9 vs.
42.8 6 9.6, p .028), cCRP (1.2 6 1.3 vs. 4.1 6 4.0, p .000), QUICKI
(.35 6 .04 vs. .33 6 .04, p .04), and FGIR (13.93 6 11.4 vs.
7.55 6 5.99, p .036). Running correlations within each group
with cCRP, we found an inverse correlation between cCRP and
the HDL cholesterol in the overweight group (-.537, p .026) and
a direct correlation between cCRP and age in years (.295,
p .014), as well as between cCRP and BMI (.273, p .023) in the
obese group. Lastly, we conducted a stepwise forward regression
using the entire sample, with cCRP as the dependant variable
and only BMI remained in the model at a significance level of
p .010.
Conclusions: Contrary to what has been found in adults, in this
retrospective study, the cardiac CRP was influenced by the weight
status rather than by the presence of PCOS in overweight Hispanic
adolescents. Given that age and BMI correlated with cCRP in the
obese group, perhaps it is the duration of PCOS that plays a role
in the prognosis , and the CRP level may rise in the future in those
with PCOS to add to the burden of their weight status.
Sources of Support: None.
139.
ADOLESCENTS AND THEIR PARENTS APPROACHES
TO GENETIC TESTING
Lynn Rew, EdD, RN, FAAN, Michael Mackert, PhD,
Daniel Bonevac, PhD. The University of Texas at Austin
Purpose: Direct-to-consumer advertising of genetic testing via the
Internet poses potential risks to individuals with limited knowl-
edge about the human genome and without benefit of genetic coun-
seling to make decisions about testing. Adolescents can be both
targeted and tempted by such advertising, but we know little about
their approach to such opportunities. The purpose of this study
was to determine what adolescents and their parents know, what
sources they would consult for additional information, and what
points they would consider in making decisions about genetic
testing.
Methods: A qualitative descriptive design was used. The study
was approved by an institutional review board for protection of
human subjects. After providing informed and written consent/
assent, a multi-ethnic non-probability sample of 22 middle
adolescents (n 11) and their parents (n 11) were interviewed
and responded to hypothetical scenarios involving genetic testing.
Each was paid $20 for their participation. Adolescents were an
average of 14.45 years (range 14-17 years) and parents were an
average of 42.4 years of age range 31-61 years). The largest ethnic
group of participants was non-Hispanic white (45.5%), but the
sample also included Hispanics (27.3%), African Americans
(18.2%), and one Asian. Audio-tapes were transcribed verbatim
and coded for manifest and latent content.
Results: None of the adolescents and only three of their parents had
heard about the Human Genome Project. Both adolescents and
their parents had limited knowledge of the human genome and
the risks involved in genetic testing. Most of the adolescents
thought genetic testing sounded cool, but this sentiment was not
shared by parents. Some of the knowledge of both adolescents
and their parents was inaccurate or incomplete. For example, one
adolescent responded, I think it s where you prick your finger.
One parent thought genetic testing was so couples could pull
what they want to pull out of their genetics and make a human.
In response to the question, At what age do you think an individual
can or should be able to make his or her own decision about genetic
testing? adolescents responses ranged from 12 (n 2) to 21 (n 2)
years. Nine of the 11 (81.8%) parents responded 18. Adolescents
were likely to seek additional information from their parents and
both groups identified physicians and the Internet as resources
for additional information. Both groups would seek more informa-
tion about how and why genetic testing is done, including its
history and benefits. Parents would also consider cost, accuracy
of tests results, and credibility of testing site in deciding to have
genetic testing.
Conclusions: Adolescents are maturing in the Genomic Era and are
interested in the potential for genetic testing. Adolescents and their
parents need more factual, accurate information and under-
standing of genetics to make decisions about genetic testing. Find-
ings point to the importance of physicians as a source of credible
information for both adolescents and their parents. Findings have
implications for developing educational interventions and public
policy.
Sources of Support: Enhancement grant from Center for Health
Promotion and Disease Prevention for Underserved Populations,
The University of Texas at Austin School of Nursing [P30-
NR05051-03S, National Institute of Nursing Research, NIH].
Special Research Grant from the Vice President for Research, The
University of Texas at Austin T71MC00003.
140.
HIV TESTING AMONG ADJUDICATED ADOLESCENTS
Rosanne Chien, MS1, Matthew Aalsma, PhD2. 1Indiana University;
2
Indiana University School of Medicine
Purpose: Youth in the juvenile justice system engage in sexual risk
behavior and are at increased risk for HIV. However, most research
exploring sexual risk behavior has been completed with detained,
rather than adjudicated, youth. One of 5 adjudicated youth are
actually detained, hence adjudicated youth represent a significant
group whose sexual risk and HIV testing behavior has been
explored much less frequently than detained youth. It is also
unknown how willing either adjudicated or detained youth are to
be tested for HIV. Lastly, educational background, specifically re-
maining in school, is an important protective factor and may be
a marker of sexual risk behavior through social disconnection.
Hence, we will explore the association between those who have
and have not been tested for HIV and explore their willingness to
get tested in the future. Furthermore, the association between risky