Dr. Brandy E Strahan

Public acceptance of the HPV vaccine has not matched that of other common adolescent vaccines, and HPV vaccination rates remain below the Healthy People 2020 target of 80% compliance. The purpose of this study was to evaluate the capacity of nine pediatric clinics in a Federally Qualified Health Center organization to implement a systems-based intervention targeting office staff and providers using EHRs and a statewide immunization information system to increase HPV vaccination rates in girls and boys, ages 11 to 16 over a 16-month period. System changes included automated HPV prompts to staff, postcard reminders to parents when youths turned 11 or 12 years old, and monthly assessment of provider vaccination rates. During the intervention, 8960 patients (11–16 yo) were followed, with 48.8% girls (n=4370) and 51.2% boys (n=4590). For this study period, 80.5% of total patients received the first dose of the HPV vaccine and 47% received the second dose. For the first dose, 55.5% of 11 year old girls and 54.3% of 11 year old boys were vaccinated. For ages 12 to 16, first dose
vaccination rates ranged from the lowest rate of 84.5% for 14 yo girls up to the highest rate of 90.5% for 13 yo boys. Logistic regression showed age was highly significantly associated with first dose completion (OR 1.565, 95% CI 1.501, 1.631) while males did not have a significant association with first dose completion compared to females. The intervention increased overall counts of first and second HPV vaccination rates.

A meta-analysis of 10 randomized control studies published in 2003-2013 was conducted to provide a summary of the effects of exercise interventions on obese adolescents. Outcomes of the reviewed trials included body mass index, weight, glucose, and triglycerides. Data were combined using an inverse
variance weighted random effects model. The effect size estimate for BMI was 1.354 kg/m2 (p < 0.001,SE 0.321), indicating that the BMI of individuals in treatment groups improved, as compared to control groups. A statistically significant reduction in weight was greater in the intervention groups than the
control groups by 3.815 kg (p = 0.001, SE 1.101). The findings of this meta-analysis show that exercise interventions may improve control of weight and BMI and in turn be a factor in decreasing obesity.

Background: Food selectivity has been documented in children and is more prevalent in children with autism spectrum disorder (ASD). This can create feeding difficulties that may present as restricted food intake, texture based food selectivity, food refusal, and/or repetitive food choices.
Objective: To describe food selectivity in obese adolescent with ASD and suggests directions for future research.
Methods: Previous research assessed the effects of video game playing on obese adolescents with ASD utilizing a single subject multiple baseline design. Over 12 weeks, the participant played inactive (6 weeks) and active video games (6 weeks) on the Wii console. Physiological data (weight, height, waist-to-hip ratio, tricep skinfold) were evaluated weekly at home. Participants logged food intake each week during all phases (baseline, inactive video gaming, and active video gaming). Foods were grouped into the following categories: fruits, vegetables, proteins, starches, juices and other sweetened non-dairy drinks, and dairy.
Results: Similar to previous research, participants preferred starches to other categories of food (50-75% of food intake). Proteins were the second most chosen food group. Fruits and vegetables were comprised less than 5% of the participants’ diet. Conclusions: Although numerous studies have examined food selectivity, none have assessed it in adolescents exclusively. This study describes food selectivity in obese adolescents and provides direction for future research.

Background: Food selectivity has been documented in children and is more prevalent in children with autism spectrum disorder (ASD). This can create feeding difficulties that may present as restricted food intake, texture based food selectivity, food refusal, and/or repetitive food choices. Objective: To describe food selectivity in obese adolescent with ASD and suggests directions for future research. Methods: Previous research assessed the effects of video game playing on obese adolescents with ASD utilizing a single subject multiple baseline design. Over 12 weeks, the participant played inactive (6 weeks) and active video games (6 weeks) on the Wii console. Physiological data (weight, height, waist-to-hip ratio, tricep skinfold) were evaluated weekly at home. Participants logged food intake each week during all phases (baseline, inactive video gaming, and active video gaming). Foods were grouped into the following categories: fruits, vegetables, proteins, starches, juices and other sweetened non-dairy drinks, and dairy. Results: Similar to previous research, participants preferred starches to other categories of food (50-75% of food intake). Proteins were the second most chosen food group. Fruits and vegetables were comprised less than 5% of the participants’ diet. Conclusions: Although numerous studies have examined food selectivity, none have assessed it in adolescents exclusively. This study describes food selectivity in obese adolescents and provides direction for future research.

Adolescent obesity has tripled in the past two decades, and adolescents with disabilities, specifically autism spectrum disorders (ASD), may be at greater risk for obesity due to the behavioral, physical, and psychosocial complications related to their disorder. This case study reports the effects of video game playing on an obese adolescent with ASD and illustrates the use of a multiple baseline single subject design. Over 12 weeks, the participant played inactive (6 weeks) and active video games (6 weeks) on the Wii console. Physiological data were evaluated weekly at home. Stress and anxiety were measured via the Stress Survey Schedule for Individuals with Autism and Other Pervasive Non-Developmental Disorders (SSS) and the Behavior Assessment System for Children Second Edition (BASC-2) pre- and postintervention. The Therapy Attitude Inventory (TAI) was used to determine parental perception of video game playing as a socially valid intervention to reduce stress and anxiety. Results demonstrated that active video game playing slowed and/or reduced weight and BMI with minimal changes to waist-to-hip ratios, triceps skinfolds, and stress and anxiety. This study demonstrates how alternative methods for physical activity may be used to improve health outcomes of overweight/obese adolescents with ASD and suggests directions for future research.

•A lit review was done for interventions with obese adolescents and those with ASD.•We provide a case study revealing unique challenges for obese adolescents with ASD.•Physical activity interventions prove to be powerful for weight loss.•Future ASD research should focus on physical activity and health outcomes.
Adolescents with developmental disabilities such as autism spectrum disorder (ASD) may be particularly vulnerable to obesity due to the behavioral, physical, and psychosocial complications related to their condition. This article provides a general background related to obesity in adolescence with specific emphasis on obesity in the ASD population. A search of PubMed, CINAHL, and ProQuest databases revealed several studies which demonstrated that interventions involving physical activity with typically developing, obese adolescents can have positive effects on body mass index, weight, and body composition. However, these findings also suggest that more research is needed to help tailor these interventions to meet the needs of similar adolescents with ASD. To clarify these needs, we present a case study that illustrates the special challenges of treating an obese adolescent with ASD and then offer suggestions for future research.