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1.  Accuracy of Brief Screening Tools for Identifying Postpartum Depression Among Adolescent Mothers 
Pediatrics  2014;133(1):e45-e53.
To evaluate the accuracy of the Edinburgh Postnatal Depression Scale (EPDS) and 3 subscales for identifying postpartum depression among primiparous adolescent mothers.
Mothers enrolled in a randomized controlled trial to prevent postpartum depression completed a psychiatric diagnostic interview and the 10-item EPDS at 6 weeks, 3 months, and 6 months postpartum. Three subscales of the EPDS were assessed as brief screening tools: 3-item anxiety subscale (EPDS-3), 7-item depressive symptoms subscale (EPDS-7), and 2-item subscale (EPDS-2) that resemble the Patient Health Questionnaire-2. Receiver operating characteristic curves and the areas under the curves for each tool were compared to assess accuracy. The sensitivities and specificities of each screening tool were calculated in comparison with diagnostic criteria for a major depressive disorder. Repeated-measures longitudinal analytical techniques were used.
A total of 106 women contributed 289 postpartum visits; 18% of the women met criteria for incident postpartum depression by psychiatric diagnostic interview. When used as continuous measures, the full EPDS, EPDS-7, and EPDS-2 performed equally well (area under the curve >0.9). Optimal cutoff scores for a positive depression screen for the EPDS and EPDS-7 were lower (≥9 and ≥7, respectively) than currently recommended cutoff scores (≥10). At optimal cutoff scores, the EPDS and EPDS-7 both had sensitivities of 90% and specificities of >85%.
The EPDS, EPDS-7, and EPDS-2 are highly accurate at identifying postpartum depression among adolescent mothers. In primary care pediatric settings, the EPDS and its shorter subscales have potential for use as effective depression screening tools.
PMCID: PMC3876181  PMID: 24344102
teenage; pregnancy; screening; postpartum depression; validity
2.  HIV Risk Among Pregnant Teenagers With a History of Interpersonal Violence 
This study examined the relationship between interpersonal violence, depressive symptoms, and HIV risk behaviors among pregnant teenagers. A sample of 116 pregnant teenagers was recruited in Rhode Island. Multivariate logistic regressions tested whether the relationship between history of interpersonal violence and HIV risk remained after controlling for age and education. Participants reported a young age of sexual debut and low rates of condom use. Multivariate logistic regressions indicate a significant relationship between interpersonal violence and HIV risk but not in degree of depression symptoms and HIV risk. Pregnant teenagers with a history of interpersonal violence may benefit from interventions that address HIV risk.
PMCID: PMC4191835  PMID: 25309117
HIV; sexually transmitted infections; pregnancy; teenagers; interpersonal violence; depression
3.  Psychosocial factors associated with depression severity in pregnant adolescents 
Archives of women's mental health  2012;15(5):397-401.
Adolescent depression during pregnancy is associated with increased morbidity for the teen and her infant. This cross-sectional study explored the relationships among the independent histories of alcohol use, drug use, depression, and abuse (physical or sexual) on depression severity in a diverse group of 116 pregnant adolescents (mean age=16) who attended an urban prenatal clinic. Ever having had an alcoholic drink was a significant predictor of higher depressive scores on Children's Depression Rating Scale-Revised, β=3.3 (0.8, 5.7); p<0.05. History of abuse was associated with a significant 4.3-point higher mean depressive score, β=4.3 (1.8, 6.7), p<0.001, and remained a statistically significant predictor of more severe depressive symptoms after adjustment for history of alcohol use, history of drug use, and history of depression. This study identified that a history of physical or sexual abuse is a significant factor related to the severity of depressive symptoms in pregnant adolescents, independent of a history of alcohol, drug use, or depression. These findings suggest that an assessment of history of alcohol use, as well as abuse history, may increase the likelihood of identifying adolescents at risk for antenatal depression.
PMCID: PMC4026299  PMID: 22777309
Adolescents; Pregnancy; Violence; Depression; Alcohol use; Drug use
4.  Practitioner Advice and Gestational Weight Gain 
Journal of Women's Health  2011;20(4):585-591.
The purpose of this study was to investigate receipt of gestational weight gain advice in prenatal care and ideal and expected gestational weight gain outcomes for normal weight and overweight/obese women.
This was a cross-sectional study of normal weight (n = 203) and overweight/obese (n = 198) women in early (<16 weeks) pregnancy.
Less than half of participants (41.7%) reported receiving weight gain advice from a practitioner. In multivariate models, pregravid weight status was not significantly related to receiving advice. However, women with lower income (odds ratio [OR] 0.31, 95% confidence interval [CI] 0.13-0.77, p = 0.01), younger age (OR 0.93, 95% CI 0.87-0.99, p = 0.02), and multiparity (OR 0.49, 95% CI 0.28-0.87, p = 0.02) were least likely to report receiving advice. Among those receiving advice, most (85%) received accurate advice; however, overweight/obese women were more likely to be advised to overgain compared with normal weight women (22.2% vs. 2.3%, p = 0.0001). Overweight/obese women were also more likely than normal weight women to report ideal (OR 7.2, 95% CI 2.3-22.7, p = 0.001) and expected (OR 4.7, 95% CI 2.6-8.4, p = 0.0001) pregnancy weight gains above Institute of Medicine guidelines. Further, a consistent relationship was observed between higher ideal and expected weight gains and greater first trimester weight gain (p < 0.03).
Clinicians should be encouraged to provide timely and accurate advice to women about gestational weight gain. Interventions to promote healthy gestational weight gain may benefit from targeting women's beliefs about ideal and expected gestational weight gain.
PMCID: PMC3075048  PMID: 21413898
We randomized 332 women, 18–24 years old who were not explicitly seeking treatment for their marijuana use, to either a two-session motivationally-focused intervention or an assessment only condition. Assessed by time-line follow-back methodology, participants reported using marijuana 57 % of days in the three months prior to study entry. Intervention effects on the likelihood of marijuana use were not statistically significant at 1-month (OR = 0.77, p = .17), significant at 3-months (OR = 0.53, p=.01), and no longer significant at 6-months (OR = .74; p = .20). Among the 61% of participants endorsing any desire to quit using marijuana at baseline, significant intervention effects on the likelihood of marijuana use days were observed at 1- (OR = 0.42, p = .03), 3- (OR = 0.31, p = .02), and 6-months (OR = 0.35, p = .03). A two-session brief motivational intervention reduced marijuana use among young women not seeking treatment. Women with a desire to quit showed a greater and more durable response.
PMCID: PMC2996851  PMID: 17869051
marijuana; motivational interviewing; women; motivation to change; clinical trial
6.  The Heart Truth Professional Education Campaign on Women and Heart Disease: Needs Assessment and Evaluation Results 
Journal of Women's Health  2009;18(10):1541-1547.
Heart disease is the leading cause of death for women in the United States. Research has identified that women are less likely than men to receive medical interventions for the prevention and treatment of heart disease.
Methods and Results
As part of a campaign to educate healthcare professionals, 1245 healthcare professionals in 11 states attended a structured 1-hour continuing medical education (CME) program based on the 2004 AHA Evidence-Based Guidelines for Cardiovascular Disease Prevention in Women and completed a pretest and posttest evaluation. We identified significant knowledge deficits in the pretest: 45% of attendees would initially recommend lifestyle changes alone, rather than statin therapy, for women diagnosed with coronary artery disease (CAD); 38% identified statin therapy as less effective in women compared with men for preventing CAD events; 27% identified Asian American women at low risk (rather than high risk) for type 2 diabetes mellitus (DM); and 21% identified processed meat (rather than baked goods) as the principal dietary source of trans fatty acids. Overall, healthcare professionals answered 5.1 of 8 knowledge questions correctly in the pretest, improving to 6.8 questions in the posttest (p < 0.001). Family physicians, obstetrician/gynecologists, general internists, nurse practitioners/physician assistants, and registered nurses all statistically significantly improved knowledge and self-assessed skills and attitudes as measured by the posttest.
Significant knowledge deficits are apparent in a cross-section of healthcare providers attending a CME lecture on women and heart disease. A 1-hour presentation was successful in improving knowledge and self-assessed skills and attitudes among primary care physicians, nurse practitioners, physician assistants, and registered nurses.
PMCID: PMC2864468  PMID: 19772369
7.  The National Children’s Study: How obstetricians can contribute 
The National Children’s Study is an observational prospective cohort study that is designed to assess the multiple factors that can affect pregnancy outcomes and children’s development. It promises to overcome the limitations of previous observational studies with regard to sample size (105,000), generalizability, breadth of environmental exposures, and the time frame of follow-up (21 years). As gynecologic and obstetric care providers, we have an integrally important role in facilitating the success of the NCS. This article enumerates the multiple ways in which we can be of invaluable assistance.
PMCID: PMC2841047  PMID: 19375564
National Children's Study; obstetricians; review
8.  Marijuana Use among Young Women in a Primary Care Setting 
To evaluate the prevalence of marijuana use among young women, ages 18–24, within a primary care setting.
From 2/05 to 12/05, women completed a brief, anonymous self-report screening instrument in two urban primary care clinics for potential participation in a randomized controlled trial of an intervention to reduce marijuana use and sexual risk-taking behavior. During the last few months of recruitment, women who completed the screening instrument were also asked to provide a urine sample to test for the presence of marijuana and other drugs.
Of the 607 women who completed the screening instrument, 38.6% reported lifetime marijuana use, 8.4% used marijuana at least monthly, and 1.7% reported using marijuana daily. Within this ethnically diverse sample (45% Hispanic), women who used marijuana at least monthly were more likely to smoke cigarettes (OR = 2.03, 95% CI = 1.04, 3.96), binge drink at least once a month (OR = 2.66, 95% CI = 1.34, 5.28), and to have ever used other drugs (OR = 2.91, 95% CI = 1.31, 6.45). Of the 67 urine samples provided, 60 (89.6%) were concordant with self-reported use, but six of the seven discordant samples were positive despite negative self-report.
The prevalence of marijuana use and binge drinking in this ethnically diverse sample of young, female primary care patients was lower than rates reported in national surveys. Providers should consider marijuana use as a part of a process that addresses more prevalent high-risk behaviors, bearing in mind that these behaviors may be underreported during routine screening.
PMCID: PMC2219851  PMID: 17372785
marijuana use; young women; primary care
9.  Adolescent Pregnancy Intentions and Pregnancy Outcomes: A Longitudinal Examination 
(a) To examine different methods of assessing pregnancy intention; (b) to identify psychosocial differences between those who indicate pregnancy intentions and those who do not; and (c) to examine the relationship between pregnancy intentions and subsequent pregnancy at 6-month follow-up in nonpregnant (at baseline), sexually experienced adolescent females.
Longitudinal cohort study of 354 sexually experienced female adolescents attending either a STD clinic or HMO adolescent medicine clinic in northern California. Student’s t-tests and regressions examined psychosocial differences between females who reported “any” and “no” pregnancy intentions. ANOVAs examined differences among different combinations of pregnancy plans/likelihood. Chi-square analyses assessed associations between baseline pregnancy intentions and subsequent pregnancy.
Adolescents’ reports of their pregnancy plans and their assessments of pregnancy likelihood differed from one another (χ2 = 50.39, df = 1, p < .001). Pregnancy attitudes and baseline contraceptive use differentiated those with inconsistent pregnancy intentions (Not Planning, but Likely) from those with clear pregnancy intentions (Planning and Likely, and Not Planning and Not Likely) (Pregnancy Attitudes: F [2,338] = 68.96, p < .0001; Contraceptive Use: F [2,308] = 14.87, p < .0001). Suspected pregnancies and positive pregnancy test results were associated with baseline pregnancy intentions (Suspected: χ2 = 19.08, df = 2, p < .01; Positive Results: χ2 = 8.84, df = 2, p = .015).
To reduce adolescent childbearing we must assess pregnancy intentions in multiple ways. Information/education might benefit those female adolescents with inconsistent reports of pregnancy intentions.
PMCID: PMC1602042  PMID: 15581524
Pregnancy intentions; Adolescent females; Attitudes; Intentions; Contraceptive use
10.  Psychosocial Correlates of Adolescent Males’ Pregnancy Intention 
Pediatrics  2005;116(3):e414-e419.
To identify psychosocial differences between sexually experienced male adolescents who indicate intentions to get someone pregnant and those who do not.
Cross-sectional study of 101 sexually experienced adolescent males recruited from an STD clinic in northern California. Student’s t-tests and regressions examined psychosocial differences between males who reported any intention versus no intention to get someone pregnant in the next six months. ANOVAs examined differences among different combinations of pregnancy plans/likelihood.
Adolescents’ reports of their plans for getting someone pregnant differed from their assessments of the likelihood that they would do so (χ2 = 24.33, df = 1, p < .0001). Attitudes toward pregnancy and participants’ mothers’ educational attainment differentiated those with clear pregnancy intentions (Planning, and Likely) from those with clear intentions to avoid pregnancy (Not Planning & Not Likely)
To reduce the rates of adolescent childbearing, males’ pregnancy intentions must be assessed and asked about in multiple ways.
PMCID: PMC1351209  PMID: 16140687
Adolescent Males; Pregnancy Intentions; Psychosocial Variables
11.  Management of Cervical Intraepithelial Neoplasia 2 in Adolescent and Young Women 
Study Objective
To evaluate regression rates among adolescents (aged ≤21) with CIN 2 managed expectantly and to determine factors associated with disease regression.
Cohort study using a colposcopic database of 2,996 women seen between August 1999 and November 2005
Colposcopy clinic in urban, tertiary care medical center
Adolescents with CIN 2. Routine management consisted of two options: immediate treatment or repeat colposcopic evaluation in 6 months.
Main Outcome Measures
For those managed conservatively, regression was defined either as a subsequent normal colposcopy and/or biopsy and at least 2 smears read as negative for epithelial abnormality or at least 3 consecutive negative smears if repeat colposcopy was not performed. Demographic information, including age, was assessed to determine possible associations with disease regression.
Of the 93 adolescents, 53 (57%) elected to undergo immediate treatment with a diagnostic excisional procedure, and 40 (43%) chose management with colposcopic follow-up. Of those treated, high-grade disease (CIN 2+) was found in 40 (75%). Of the 36 young women followed conservatively (4 were lost to follow-up), regression after a median follow-up time of 378 days was documented in 14 (39%). Of the 22 adolescents not fulfilling our criteria for regression, only 3 had evidence of CIN 2 or worse during follow-up. The remaining 19 had either CIN 1 or mildly abnormal cytologic results. Kaplan-Meier survival estimates indicated younger age (≤16 years) tended to be associated with decreased time to regression.
Based on significant regression of CIN 2 among adolescent women, primary management in this population should consist of cytologic and colposcopic follow-up.
PMCID: PMC2095115  PMID: 17868892
CIN 2; adolescent; management

Results 1-11 (11)