Susan London

SEATTLE – Efforts to promote vaccination of boys against human papillomavirus may be more successful if they de-emphasize infection-related outcomes that make parents uncomfortable because of their sexual associations, according to a study of 158 parents of boys.

Surveyed parents were less likely to intend to vaccinate their son if they ranked anal cancer or oropharyngeal cancer as the most severe possible outcome of human papillomavirus (HPV) infection, investigators reported at the annual meeting of the Society for Adolescent Health and Medicine.

Comments made in focus groups suggested that these cancers elicited negative emotions: stigma in the case of anal cancer because it was associated with anal sex and homosexuality, and anxiety in the case of oropharyngeal cancer because it was associated with oral sex.

"Parents seemed to dwell on the sexual transmission of HPV," commented lead investigator Abigail C. Lees, a research assistant in the pediatrics department at the University of North Carolina, Chapel Hill.

"HPV awareness campaigns should decrease emphasis on outcomes that elicited either stigma associated with anal cancer or increased anxiety associated with oral cancer, and instead focus on prevalence," she recommended. "Furthermore, the parental preoccupation with the sexual transmission of HPV could be entirely avoided by vaccinating children at younger ages, when parents are less likely to associate stigmas or anxiety with their child's behavior and the vaccine."

A quarter of the HPV-associated cancers that occurred in 2009 were in males, according to Ms. Lees. The quadrivalent HPV vaccine is now licensed for prevention of genital warts and anal cancer in both males and females, as well as for prevention of cervical, vulvar, and vaginal cancer in females.

To assess parental knowledge about male HPV outcomes and attitudes about vaccinating sons, the investigators recruited to their study parents of boys aged 11-17 years from a pediatric clinic, university listservs, craigslist, and other venues.

They completed surveys asking about perceived susceptibility (at least a 40% chance) of their son experiencing HPV infection and its outcomes, and perceived severity of the outcomes. They also participated in single-sex focus groups, conducted separately in English and Spanish.

The majority of the parents, 72%, were the boy's mother. By race/ethnicity, 54% were white, 23% were black, 15% were Hispanic, and the rest were other. About a third had a high school diploma or less education. Slightly more than half were currently married. And 61% also had a daughter.

"Overall, parents believed their sons to have a low susceptibility to HPV infection and its outcomes," Ms. Lees reported. Just 22% thought their son was susceptible to infection. And smaller proportions thought he was susceptible to genital warts (18%), oropharyngeal cancer (11%), anal cancer (9%), and penile cancer (9%).

However, 82% of parents believed the consequence of HPV infection in their son would be severe; of these, 31% ranked penile cancer as the most severe possible outcome, 30% oropharyngeal cancer, 23% anal cancer, and 16% genital warts.

Eighty-three percent of parents indicated that they intended to vaccinate their sons against HPV. In a multivariate analysis, parents were more likely to intend to do so if they were older (odds ratio 1.14) and believed that the consequences of HPV infection could be severe (OR 9.94).

On the other hand, they were less likely to intend to vaccinate if they were more educated (OR 0.62). And there were trends whereby they were less likely to intend to do so if they ranked anal cancer or oropharyngeal cancer as the most severe possible outcome (OR 0.25 and 0.67, respectively).

"The most striking finding from our focus groups was that parents had very limited knowledge of HPV infection in males, despite an awareness of HPV in females," commented Ms. Lees. For example, parents were often unaware that HPV infection pertained to boys.

Their comments also provided some insight into why high rankings of certain HPV-related outcomes might have been associated with lower odds of intending to vaccinate. "Parents responded to the sexual nature of transmission, in particular, in focus groups, which revealed parental stigmatization of anal cancer by association with homosexuality among males," she noted.

In addition, "parents expressed an anxiety associated with oral sex practices they perceived youth to be engaging in," Ms. Lees elaborated. "Parents alluded to the frequency of oral sex among youth" and expressed "concerns that youth believe oral sex can be used to avoid infidelity, is safer than intercourse, and preserves their virginity."

Taken together, the study’s findings should help to inform provider and public health efforts to increase uptake of the HPV vaccine among boys, she concluded.

Ms. Lees reported that the investigators received grant support from Merck to conduct the study.

SEATTLE – Efforts to promote vaccination of boys against human papillomavirus may be more successful if they de-emphasize infection-related outcomes that make parents uncomfortable because of their sexual associations, according to a study of 158 parents of boys.

Surveyed parents were less likely to intend to vaccinate their son if they ranked anal cancer or oropharyngeal cancer as the most severe possible outcome of human papillomavirus (HPV) infection, investigators reported at the annual meeting of the Society for Adolescent Health and Medicine.

Comments made in focus groups suggested that these cancers elicited negative emotions: stigma in the case of anal cancer because it was associated with anal sex and homosexuality, and anxiety in the case of oropharyngeal cancer because it was associated with oral sex.

"Parents seemed to dwell on the sexual transmission of HPV," commented lead investigator Abigail C. Lees, a research assistant in the pediatrics department at the University of North Carolina, Chapel Hill.

"HPV awareness campaigns should decrease emphasis on outcomes that elicited either stigma associated with anal cancer or increased anxiety associated with oral cancer, and instead focus on prevalence," she recommended. "Furthermore, the parental preoccupation with the sexual transmission of HPV could be entirely avoided by vaccinating children at younger ages, when parents are less likely to associate stigmas or anxiety with their child's behavior and the vaccine."

A quarter of the HPV-associated cancers that occurred in 2009 were in males, according to Ms. Lees. The quadrivalent HPV vaccine is now licensed for prevention of genital warts and anal cancer in both males and females, as well as for prevention of cervical, vulvar, and vaginal cancer in females.

To assess parental knowledge about male HPV outcomes and attitudes about vaccinating sons, the investigators recruited to their study parents of boys aged 11-17 years from a pediatric clinic, university listservs, craigslist, and other venues.

They completed surveys asking about perceived susceptibility (at least a 40% chance) of their son experiencing HPV infection and its outcomes, and perceived severity of the outcomes. They also participated in single-sex focus groups, conducted separately in English and Spanish.

The majority of the parents, 72%, were the boy's mother. By race/ethnicity, 54% were white, 23% were black, 15% were Hispanic, and the rest were other. About a third had a high school diploma or less education. Slightly more than half were currently married. And 61% also had a daughter.

"Overall, parents believed their sons to have a low susceptibility to HPV infection and its outcomes," Ms. Lees reported. Just 22% thought their son was susceptible to infection. And smaller proportions thought he was susceptible to genital warts (18%), oropharyngeal cancer (11%), anal cancer (9%), and penile cancer (9%).

However, 82% of parents believed the consequence of HPV infection in their son would be severe; of these, 31% ranked penile cancer as the most severe possible outcome, 30% oropharyngeal cancer, 23% anal cancer, and 16% genital warts.

Eighty-three percent of parents indicated that they intended to vaccinate their sons against HPV. In a multivariate analysis, parents were more likely to intend to do so if they were older (odds ratio 1.14) and believed that the consequences of HPV infection could be severe (OR 9.94).

On the other hand, they were less likely to intend to vaccinate if they were more educated (OR 0.62). And there were trends whereby they were less likely to intend to do so if they ranked anal cancer or oropharyngeal cancer as the most severe possible outcome (OR 0.25 and 0.67, respectively).

"The most striking finding from our focus groups was that parents had very limited knowledge of HPV infection in males, despite an awareness of HPV in females," commented Ms. Lees. For example, parents were often unaware that HPV infection pertained to boys.

Their comments also provided some insight into why high rankings of certain HPV-related outcomes might have been associated with lower odds of intending to vaccinate. "Parents responded to the sexual nature of transmission, in particular, in focus groups, which revealed parental stigmatization of anal cancer by association with homosexuality among males," she noted.

In addition, "parents expressed an anxiety associated with oral sex practices they perceived youth to be engaging in," Ms. Lees elaborated. "Parents alluded to the frequency of oral sex among youth" and expressed "concerns that youth believe oral sex can be used to avoid infidelity, is safer than intercourse, and preserves their virginity."

Taken together, the study’s findings should help to inform provider and public health efforts to increase uptake of the HPV vaccine among boys, she concluded.

Ms. Lees reported that the investigators received grant support from Merck to conduct the study.

SEATTLE – Efforts to promote vaccination of boys against human papillomavirus may be more successful if they de-emphasize infection-related outcomes that make parents uncomfortable because of their sexual associations, according to a study of 158 parents of boys.

Surveyed parents were less likely to intend to vaccinate their son if they ranked anal cancer or oropharyngeal cancer as the most severe possible outcome of human papillomavirus (HPV) infection, investigators reported at the annual meeting of the Society for Adolescent Health and Medicine.

Comments made in focus groups suggested that these cancers elicited negative emotions: stigma in the case of anal cancer because it was associated with anal sex and homosexuality, and anxiety in the case of oropharyngeal cancer because it was associated with oral sex.

"Parents seemed to dwell on the sexual transmission of HPV," commented lead investigator Abigail C. Lees, a research assistant in the pediatrics department at the University of North Carolina, Chapel Hill.

"HPV awareness campaigns should decrease emphasis on outcomes that elicited either stigma associated with anal cancer or increased anxiety associated with oral cancer, and instead focus on prevalence," she recommended. "Furthermore, the parental preoccupation with the sexual transmission of HPV could be entirely avoided by vaccinating children at younger ages, when parents are less likely to associate stigmas or anxiety with their child's behavior and the vaccine."

A quarter of the HPV-associated cancers that occurred in 2009 were in males, according to Ms. Lees. The quadrivalent HPV vaccine is now licensed for prevention of genital warts and anal cancer in both males and females, as well as for prevention of cervical, vulvar, and vaginal cancer in females.

To assess parental knowledge about male HPV outcomes and attitudes about vaccinating sons, the investigators recruited to their study parents of boys aged 11-17 years from a pediatric clinic, university listservs, craigslist, and other venues.

They completed surveys asking about perceived susceptibility (at least a 40% chance) of their son experiencing HPV infection and its outcomes, and perceived severity of the outcomes. They also participated in single-sex focus groups, conducted separately in English and Spanish.

The majority of the parents, 72%, were the boy's mother. By race/ethnicity, 54% were white, 23% were black, 15% were Hispanic, and the rest were other. About a third had a high school diploma or less education. Slightly more than half were currently married. And 61% also had a daughter.

"Overall, parents believed their sons to have a low susceptibility to HPV infection and its outcomes," Ms. Lees reported. Just 22% thought their son was susceptible to infection. And smaller proportions thought he was susceptible to genital warts (18%), oropharyngeal cancer (11%), anal cancer (9%), and penile cancer (9%).

However, 82% of parents believed the consequence of HPV infection in their son would be severe; of these, 31% ranked penile cancer as the most severe possible outcome, 30% oropharyngeal cancer, 23% anal cancer, and 16% genital warts.

Eighty-three percent of parents indicated that they intended to vaccinate their sons against HPV. In a multivariate analysis, parents were more likely to intend to do so if they were older (odds ratio 1.14) and believed that the consequences of HPV infection could be severe (OR 9.94).

On the other hand, they were less likely to intend to vaccinate if they were more educated (OR 0.62). And there were trends whereby they were less likely to intend to do so if they ranked anal cancer or oropharyngeal cancer as the most severe possible outcome (OR 0.25 and 0.67, respectively).

"The most striking finding from our focus groups was that parents had very limited knowledge of HPV infection in males, despite an awareness of HPV in females," commented Ms. Lees. For example, parents were often unaware that HPV infection pertained to boys.

Their comments also provided some insight into why high rankings of certain HPV-related outcomes might have been associated with lower odds of intending to vaccinate. "Parents responded to the sexual nature of transmission, in particular, in focus groups, which revealed parental stigmatization of anal cancer by association with homosexuality among males," she noted.

In addition, "parents expressed an anxiety associated with oral sex practices they perceived youth to be engaging in," Ms. Lees elaborated. "Parents alluded to the frequency of oral sex among youth" and expressed "concerns that youth believe oral sex can be used to avoid infidelity, is safer than intercourse, and preserves their virginity."

Taken together, the study’s findings should help to inform provider and public health efforts to increase uptake of the HPV vaccine among boys, she concluded.

Ms. Lees reported that the investigators received grant support from Merck to conduct the study.

SEATTLE – Awareness is not enough when it comes to promoting uptake of the meningococcal vaccine among adolescents, suggest results of a recent North Carolina survey.

Two-thirds of the more than 1,000 parents of adolescents polled had heard of the vaccine, which the Advisory Committee on Immunization Practices (ACIP) recommends be given at the age of 11-12 years and, because of waning immunity, again as a booster at the age of 16 years.

But just 44% of these parents had had their adolescent vaccinated, lead investigator Dr. Tamera Coyne-Beasley reported at the annual meeting of the Society for Adolescent Health and Medicine. In addition, 39% of the parents of unvaccinated adolescents indicated that they probably or definitely would not vaccinate them in the next year.

The leading reason parents cited for nonvaccination was that their health care provider had not mentioned or recommended the vaccine. Some also gave as a reason not having seen their doctor recently.

"Interventions are urgently needed to increase the uptake of meningococcal conjugate vaccine, particularly in light of the new recommendation for a booster dose, and the substantial proportion of parents ... who reported that they still definitely or probably will not get the vaccine," Dr. Coyne-Beasley said. "Strategies such as increasing provider recommendations and increasing regular preventive visits may be important."

"One of the things I would like to explore is what are those issues [behind nonvaccination] and how can we overcome them," she commented. Some people "may have just an inherent philosophy that we may not understand about why they don’t want to get vaccines. But I do think that there are things we can work with, with families."

The investigators analyzed data from the 2008 Child Health Assessment and Monitoring Program (CHAMP) telephone survey conducted in North Carolina, a state that does not mandate receipt of the meningococcal vaccine for school entry. The survey involved households from a larger, random, population-based survey that had at least one child under age 18.

The individual in the household most knowledgeable about the child’s health was read a list of possible names of the meningococcal vaccine (meningitis shot, meningococcal shot, Menactra) and asked whether they had heard of it, and if they had, whether the child had received it.

Data from parents of adolescents aged 11-17 years were weighted to provide population-based estimates, according to Dr. Coyne-Beasley, who is an associate professor of pediatrics and internal medicine at the University of North Carolina, Chapel Hill.

In all, 1,281 parents completed the survey. Some 48% were 40-49 years old, and two-thirds were female. Some 74% were married or cohabiting with a partner, and 71% were employed.

On average, the adolescents were 14.1 years old. They were equally split by sex. Some 63% were white, 23% were black, 9% were Hispanic, and 5% were of other races/ethnicities.

The majority of the adolescents attended public school (88%), had health insurance (93%), had a regular health care provider (83%), and had had a preventive checkup in the past 12 months (78%).

Fully 65% of the surveyed parents were aware of the meningococcal vaccine, according to Dr. Coyne-Beasley. She noted that the state did not have any meningitis outbreaks during the survey year, which usually increase awareness.

In multivariate analyses, parents were significantly more likely to be aware of the vaccine if their child was aged 16-17 years compared with 11-12 years (odds ratio 1.82), attended private school compared with public school (OR 1.95), and had health insurance (OR 1.90).

On the other hand, parents were significantly less likely to be aware of the vaccine if their child was Hispanic compared with white (OR 0.50).

Just 44% of the parents who were aware of the meningococcal vaccine had had their adolescent vaccinated.

In multivariate analyses, adolescents were significantly more likely to have been vaccinated if they were black versus white (OR 2.17), had had a preventive health checkup in the past 12 months (OR 3.03), and lived in a household having two or more children under age 18 (OR 1.83).

Among the parents who had not had their adolescent vaccinated, the single most common reason, cited by 25%, was that their health care provider did not mention or recommend the vaccine, Dr. Coyne-Beasley reported. Other reasons cited included believing that their adolescent did not need the vaccine (14%), wanting to wait until he or she was older (10%), concerns about vaccine safety (9%), and not having been to a doctor recently (8%).

More than half of these parents of unvaccinated children said that in the next year, they definitely would (21%) or probably would (33%) have them vaccinated, and a small minority (8%) were unsure.

However, sizable proportions said they probably would not (29%) or definitely would not (10%) have their child vaccinated in the next year.

"Awareness of a vaccine doesn’t necessarily mean that one will get it," Dr. Coyne-Beasley concluded, and it will be important to ascertain the reasons for the observed disconnect between awareness and uptake of the meningococcal vaccine among adolescents.

The study had its limitations, she acknowledged. They included the self-reported nature of the data, potential limited generalizability, inclusion of only households having a landline telephone, and availability of just a single meningococcal conjugate vaccine at the time of the survey.

Dr. Coyne-Beasley reported that she did not have any relevant financial disclosures.

SEATTLE – Awareness is not enough when it comes to promoting uptake of the meningococcal vaccine among adolescents, suggest results of a recent North Carolina survey.

Two-thirds of the more than 1,000 parents of adolescents polled had heard of the vaccine, which the Advisory Committee on Immunization Practices (ACIP) recommends be given at the age of 11-12 years and, because of waning immunity, again as a booster at the age of 16 years.

But just 44% of these parents had had their adolescent vaccinated, lead investigator Dr. Tamera Coyne-Beasley reported at the annual meeting of the Society for Adolescent Health and Medicine. In addition, 39% of the parents of unvaccinated adolescents indicated that they probably or definitely would not vaccinate them in the next year.

The leading reason parents cited for nonvaccination was that their health care provider had not mentioned or recommended the vaccine. Some also gave as a reason not having seen their doctor recently.

"Interventions are urgently needed to increase the uptake of meningococcal conjugate vaccine, particularly in light of the new recommendation for a booster dose, and the substantial proportion of parents ... who reported that they still definitely or probably will not get the vaccine," Dr. Coyne-Beasley said. "Strategies such as increasing provider recommendations and increasing regular preventive visits may be important."

"One of the things I would like to explore is what are those issues [behind nonvaccination] and how can we overcome them," she commented. Some people "may have just an inherent philosophy that we may not understand about why they don’t want to get vaccines. But I do think that there are things we can work with, with families."

The investigators analyzed data from the 2008 Child Health Assessment and Monitoring Program (CHAMP) telephone survey conducted in North Carolina, a state that does not mandate receipt of the meningococcal vaccine for school entry. The survey involved households from a larger, random, population-based survey that had at least one child under age 18.

The individual in the household most knowledgeable about the child’s health was read a list of possible names of the meningococcal vaccine (meningitis shot, meningococcal shot, Menactra) and asked whether they had heard of it, and if they had, whether the child had received it.

Data from parents of adolescents aged 11-17 years were weighted to provide population-based estimates, according to Dr. Coyne-Beasley, who is an associate professor of pediatrics and internal medicine at the University of North Carolina, Chapel Hill.

In all, 1,281 parents completed the survey. Some 48% were 40-49 years old, and two-thirds were female. Some 74% were married or cohabiting with a partner, and 71% were employed.

On average, the adolescents were 14.1 years old. They were equally split by sex. Some 63% were white, 23% were black, 9% were Hispanic, and 5% were of other races/ethnicities.

The majority of the adolescents attended public school (88%), had health insurance (93%), had a regular health care provider (83%), and had had a preventive checkup in the past 12 months (78%).

Fully 65% of the surveyed parents were aware of the meningococcal vaccine, according to Dr. Coyne-Beasley. She noted that the state did not have any meningitis outbreaks during the survey year, which usually increase awareness.

In multivariate analyses, parents were significantly more likely to be aware of the vaccine if their child was aged 16-17 years compared with 11-12 years (odds ratio 1.82), attended private school compared with public school (OR 1.95), and had health insurance (OR 1.90).

On the other hand, parents were significantly less likely to be aware of the vaccine if their child was Hispanic compared with white (OR 0.50).

Just 44% of the parents who were aware of the meningococcal vaccine had had their adolescent vaccinated.

In multivariate analyses, adolescents were significantly more likely to have been vaccinated if they were black versus white (OR 2.17), had had a preventive health checkup in the past 12 months (OR 3.03), and lived in a household having two or more children under age 18 (OR 1.83).

Among the parents who had not had their adolescent vaccinated, the single most common reason, cited by 25%, was that their health care provider did not mention or recommend the vaccine, Dr. Coyne-Beasley reported. Other reasons cited included believing that their adolescent did not need the vaccine (14%), wanting to wait until he or she was older (10%), concerns about vaccine safety (9%), and not having been to a doctor recently (8%).

More than half of these parents of unvaccinated children said that in the next year, they definitely would (21%) or probably would (33%) have them vaccinated, and a small minority (8%) were unsure.

However, sizable proportions said they probably would not (29%) or definitely would not (10%) have their child vaccinated in the next year.

"Awareness of a vaccine doesn’t necessarily mean that one will get it," Dr. Coyne-Beasley concluded, and it will be important to ascertain the reasons for the observed disconnect between awareness and uptake of the meningococcal vaccine among adolescents.

The study had its limitations, she acknowledged. They included the self-reported nature of the data, potential limited generalizability, inclusion of only households having a landline telephone, and availability of just a single meningococcal conjugate vaccine at the time of the survey.

Dr. Coyne-Beasley reported that she did not have any relevant financial disclosures.

SEATTLE – Awareness is not enough when it comes to promoting uptake of the meningococcal vaccine among adolescents, suggest results of a recent North Carolina survey.

Two-thirds of the more than 1,000 parents of adolescents polled had heard of the vaccine, which the Advisory Committee on Immunization Practices (ACIP) recommends be given at the age of 11-12 years and, because of waning immunity, again as a booster at the age of 16 years.

But just 44% of these parents had had their adolescent vaccinated, lead investigator Dr. Tamera Coyne-Beasley reported at the annual meeting of the Society for Adolescent Health and Medicine. In addition, 39% of the parents of unvaccinated adolescents indicated that they probably or definitely would not vaccinate them in the next year.

The leading reason parents cited for nonvaccination was that their health care provider had not mentioned or recommended the vaccine. Some also gave as a reason not having seen their doctor recently.

"Interventions are urgently needed to increase the uptake of meningococcal conjugate vaccine, particularly in light of the new recommendation for a booster dose, and the substantial proportion of parents ... who reported that they still definitely or probably will not get the vaccine," Dr. Coyne-Beasley said. "Strategies such as increasing provider recommendations and increasing regular preventive visits may be important."

"One of the things I would like to explore is what are those issues [behind nonvaccination] and how can we overcome them," she commented. Some people "may have just an inherent philosophy that we may not understand about why they don’t want to get vaccines. But I do think that there are things we can work with, with families."

The investigators analyzed data from the 2008 Child Health Assessment and Monitoring Program (CHAMP) telephone survey conducted in North Carolina, a state that does not mandate receipt of the meningococcal vaccine for school entry. The survey involved households from a larger, random, population-based survey that had at least one child under age 18.

The individual in the household most knowledgeable about the child’s health was read a list of possible names of the meningococcal vaccine (meningitis shot, meningococcal shot, Menactra) and asked whether they had heard of it, and if they had, whether the child had received it.

Data from parents of adolescents aged 11-17 years were weighted to provide population-based estimates, according to Dr. Coyne-Beasley, who is an associate professor of pediatrics and internal medicine at the University of North Carolina, Chapel Hill.

In all, 1,281 parents completed the survey. Some 48% were 40-49 years old, and two-thirds were female. Some 74% were married or cohabiting with a partner, and 71% were employed.

On average, the adolescents were 14.1 years old. They were equally split by sex. Some 63% were white, 23% were black, 9% were Hispanic, and 5% were of other races/ethnicities.

The majority of the adolescents attended public school (88%), had health insurance (93%), had a regular health care provider (83%), and had had a preventive checkup in the past 12 months (78%).

Fully 65% of the surveyed parents were aware of the meningococcal vaccine, according to Dr. Coyne-Beasley. She noted that the state did not have any meningitis outbreaks during the survey year, which usually increase awareness.

In multivariate analyses, parents were significantly more likely to be aware of the vaccine if their child was aged 16-17 years compared with 11-12 years (odds ratio 1.82), attended private school compared with public school (OR 1.95), and had health insurance (OR 1.90).

On the other hand, parents were significantly less likely to be aware of the vaccine if their child was Hispanic compared with white (OR 0.50).

Just 44% of the parents who were aware of the meningococcal vaccine had had their adolescent vaccinated.

In multivariate analyses, adolescents were significantly more likely to have been vaccinated if they were black versus white (OR 2.17), had had a preventive health checkup in the past 12 months (OR 3.03), and lived in a household having two or more children under age 18 (OR 1.83).

Among the parents who had not had their adolescent vaccinated, the single most common reason, cited by 25%, was that their health care provider did not mention or recommend the vaccine, Dr. Coyne-Beasley reported. Other reasons cited included believing that their adolescent did not need the vaccine (14%), wanting to wait until he or she was older (10%), concerns about vaccine safety (9%), and not having been to a doctor recently (8%).

More than half of these parents of unvaccinated children said that in the next year, they definitely would (21%) or probably would (33%) have them vaccinated, and a small minority (8%) were unsure.

However, sizable proportions said they probably would not (29%) or definitely would not (10%) have their child vaccinated in the next year.

"Awareness of a vaccine doesn’t necessarily mean that one will get it," Dr. Coyne-Beasley concluded, and it will be important to ascertain the reasons for the observed disconnect between awareness and uptake of the meningococcal vaccine among adolescents.

The study had its limitations, she acknowledged. They included the self-reported nature of the data, potential limited generalizability, inclusion of only households having a landline telephone, and availability of just a single meningococcal conjugate vaccine at the time of the survey.

Dr. Coyne-Beasley reported that she did not have any relevant financial disclosures.

SEATTLE – Awareness is not enough when it comes to promoting uptake of the meningococcal vaccine among adolescents, suggest results of a recent North Carolina survey.

Two-thirds of the more than 1,000 parents of adolescents polled had heard of the vaccine, which the Advisory Committee on Immunization Practices (ACIP) recommends be given at the age of 11-12 years and, because of waning immunity, again as a booster at the age of 16 years.

But just 44% of these parents had had their adolescent vaccinated, lead investigator Dr. Tamera Coyne-Beasley reported at the annual meeting of the Society for Adolescent Health and Medicine. In addition, 39% of the parents of unvaccinated adolescents indicated that they probably or definitely would not vaccinate them in the next year.

The leading reason parents cited for nonvaccination was that their health care provider had not mentioned or recommended the vaccine. Some also gave as a reason not having seen their doctor recently.

"Interventions are urgently needed to increase the uptake of meningococcal conjugate vaccine, particularly in light of the new recommendation for a booster dose, and the substantial proportion of parents ... who reported that they still definitely or probably will not get the vaccine," Dr. Coyne-Beasley said. "Strategies such as increasing provider recommendations and increasing regular preventive visits may be important."

"One of the things I would like to explore is what are those issues [behind nonvaccination] and how can we overcome them," she commented. Some people "may have just an inherent philosophy that we may not understand about why they don’t want to get vaccines. But I do think that there are things we can work with, with families."

The investigators analyzed data from the 2008 Child Health Assessment and Monitoring Program (CHAMP) telephone survey conducted in North Carolina, a state that does not mandate receipt of the meningococcal vaccine for school entry. The survey involved households from a larger, random, population-based survey that had at least one child under age 18.

The individual in the household most knowledgeable about the child’s health was read a list of possible names of the meningococcal vaccine (meningitis shot, meningococcal shot, Menactra) and asked whether they had heard of it, and if they had, whether the child had received it.

Data from parents of adolescents aged 11-17 years were weighted to provide population-based estimates, according to Dr. Coyne-Beasley, who is an associate professor of pediatrics and internal medicine at the University of North Carolina, Chapel Hill.

In all, 1,281 parents completed the survey. Some 48% were 40-49 years old, and two-thirds were female. Some 74% were married or cohabiting with a partner, and 71% were employed.

On average, the adolescents were 14.1 years old. They were equally split by sex. Some 63% were white, 23% were black, 9% were Hispanic, and 5% were of other races/ethnicities.

The majority of the adolescents attended public school (88%), had health insurance (93%), had a regular health care provider (83%), and had had a preventive checkup in the past 12 months (78%).

Fully 65% of the surveyed parents were aware of the meningococcal vaccine, according to Dr. Coyne-Beasley. She noted that the state did not have any meningitis outbreaks during the survey year, which usually increase awareness.

In multivariate analyses, parents were significantly more likely to be aware of the vaccine if their child was aged 16-17 years compared with 11-12 years (odds ratio 1.82), attended private school compared with public school (OR 1.95), and had health insurance (OR 1.90).

On the other hand, parents were significantly less likely to be aware of the vaccine if their child was Hispanic compared with white (OR 0.50).

Just 44% of the parents who were aware of the meningococcal vaccine had had their adolescent vaccinated.

In multivariate analyses, adolescents were significantly more likely to have been vaccinated if they were black versus white (OR 2.17), had had a preventive health checkup in the past 12 months (OR 3.03), and lived in a household having two or more children under age 18 (OR 1.83).

Among the parents who had not had their adolescent vaccinated, the single most common reason, cited by 25%, was that their health care provider did not mention or recommend the vaccine, Dr. Coyne-Beasley reported. Other reasons cited included believing that their adolescent did not need the vaccine (14%), wanting to wait until he or she was older (10%), concerns about vaccine safety (9%), and not having been to a doctor recently (8%).

More than half of these parents of unvaccinated children said that in the next year, they definitely would (21%) or probably would (33%) have them vaccinated, and a small minority (8%) were unsure.

However, sizable proportions said they probably would not (29%) or definitely would not (10%) have their child vaccinated in the next year.

"Awareness of a vaccine doesn’t necessarily mean that one will get it," Dr. Coyne-Beasley concluded, and it will be important to ascertain the reasons for the observed disconnect between awareness and uptake of the meningococcal vaccine among adolescents.

The study had its limitations, she acknowledged. They included the self-reported nature of the data, potential limited generalizability, inclusion of only households having a landline telephone, and availability of just a single meningococcal conjugate vaccine at the time of the survey.

Dr. Coyne-Beasley reported that she did not have any relevant financial disclosures.

SEATTLE – Awareness is not enough when it comes to promoting uptake of the meningococcal vaccine among adolescents, suggest results of a recent North Carolina survey.

Two-thirds of the more than 1,000 parents of adolescents polled had heard of the vaccine, which the Advisory Committee on Immunization Practices (ACIP) recommends be given at the age of 11-12 years and, because of waning immunity, again as a booster at the age of 16 years.

But just 44% of these parents had had their adolescent vaccinated, lead investigator Dr. Tamera Coyne-Beasley reported at the annual meeting of the Society for Adolescent Health and Medicine. In addition, 39% of the parents of unvaccinated adolescents indicated that they probably or definitely would not vaccinate them in the next year.

The leading reason parents cited for nonvaccination was that their health care provider had not mentioned or recommended the vaccine. Some also gave as a reason not having seen their doctor recently.

"Interventions are urgently needed to increase the uptake of meningococcal conjugate vaccine, particularly in light of the new recommendation for a booster dose, and the substantial proportion of parents ... who reported that they still definitely or probably will not get the vaccine," Dr. Coyne-Beasley said. "Strategies such as increasing provider recommendations and increasing regular preventive visits may be important."

"One of the things I would like to explore is what are those issues [behind nonvaccination] and how can we overcome them," she commented. Some people "may have just an inherent philosophy that we may not understand about why they don’t want to get vaccines. But I do think that there are things we can work with, with families."

The investigators analyzed data from the 2008 Child Health Assessment and Monitoring Program (CHAMP) telephone survey conducted in North Carolina, a state that does not mandate receipt of the meningococcal vaccine for school entry. The survey involved households from a larger, random, population-based survey that had at least one child under age 18.

The individual in the household most knowledgeable about the child’s health was read a list of possible names of the meningococcal vaccine (meningitis shot, meningococcal shot, Menactra) and asked whether they had heard of it, and if they had, whether the child had received it.

Data from parents of adolescents aged 11-17 years were weighted to provide population-based estimates, according to Dr. Coyne-Beasley, who is an associate professor of pediatrics and internal medicine at the University of North Carolina, Chapel Hill.

In all, 1,281 parents completed the survey. Some 48% were 40-49 years old, and two-thirds were female. Some 74% were married or cohabiting with a partner, and 71% were employed.

On average, the adolescents were 14.1 years old. They were equally split by sex. Some 63% were white, 23% were black, 9% were Hispanic, and 5% were of other races/ethnicities.

The majority of the adolescents attended public school (88%), had health insurance (93%), had a regular health care provider (83%), and had had a preventive checkup in the past 12 months (78%).

Fully 65% of the surveyed parents were aware of the meningococcal vaccine, according to Dr. Coyne-Beasley. She noted that the state did not have any meningitis outbreaks during the survey year, which usually increase awareness.

In multivariate analyses, parents were significantly more likely to be aware of the vaccine if their child was aged 16-17 years compared with 11-12 years (odds ratio 1.82), attended private school compared with public school (OR 1.95), and had health insurance (OR 1.90).

On the other hand, parents were significantly less likely to be aware of the vaccine if their child was Hispanic compared with white (OR 0.50).

Just 44% of the parents who were aware of the meningococcal vaccine had had their adolescent vaccinated.

In multivariate analyses, adolescents were significantly more likely to have been vaccinated if they were black versus white (OR 2.17), had had a preventive health checkup in the past 12 months (OR 3.03), and lived in a household having two or more children under age 18 (OR 1.83).

Among the parents who had not had their adolescent vaccinated, the single most common reason, cited by 25%, was that their health care provider did not mention or recommend the vaccine, Dr. Coyne-Beasley reported. Other reasons cited included believing that their adolescent did not need the vaccine (14%), wanting to wait until he or she was older (10%), concerns about vaccine safety (9%), and not having been to a doctor recently (8%).

More than half of these parents of unvaccinated children said that in the next year, they definitely would (21%) or probably would (33%) have them vaccinated, and a small minority (8%) were unsure.

However, sizable proportions said they probably would not (29%) or definitely would not (10%) have their child vaccinated in the next year.

"Awareness of a vaccine doesn’t necessarily mean that one will get it," Dr. Coyne-Beasley concluded, and it will be important to ascertain the reasons for the observed disconnect between awareness and uptake of the meningococcal vaccine among adolescents.

The study had its limitations, she acknowledged. They included the self-reported nature of the data, potential limited generalizability, inclusion of only households having a landline telephone, and availability of just a single meningococcal conjugate vaccine at the time of the survey.

Dr. Coyne-Beasley reported that she did not have any relevant financial disclosures.

SEATTLE – Awareness is not enough when it comes to promoting uptake of the meningococcal vaccine among adolescents, suggest results of a recent North Carolina survey.

Two-thirds of the more than 1,000 parents of adolescents polled had heard of the vaccine, which the Advisory Committee on Immunization Practices (ACIP) recommends be given at the age of 11-12 years and, because of waning immunity, again as a booster at the age of 16 years.

But just 44% of these parents had had their adolescent vaccinated, lead investigator Dr. Tamera Coyne-Beasley reported at the annual meeting of the Society for Adolescent Health and Medicine. In addition, 39% of the parents of unvaccinated adolescents indicated that they probably or definitely would not vaccinate them in the next year.

The leading reason parents cited for nonvaccination was that their health care provider had not mentioned or recommended the vaccine. Some also gave as a reason not having seen their doctor recently.

"Interventions are urgently needed to increase the uptake of meningococcal conjugate vaccine, particularly in light of the new recommendation for a booster dose, and the substantial proportion of parents ... who reported that they still definitely or probably will not get the vaccine," Dr. Coyne-Beasley said. "Strategies such as increasing provider recommendations and increasing regular preventive visits may be important."

"One of the things I would like to explore is what are those issues [behind nonvaccination] and how can we overcome them," she commented. Some people "may have just an inherent philosophy that we may not understand about why they don’t want to get vaccines. But I do think that there are things we can work with, with families."

The investigators analyzed data from the 2008 Child Health Assessment and Monitoring Program (CHAMP) telephone survey conducted in North Carolina, a state that does not mandate receipt of the meningococcal vaccine for school entry. The survey involved households from a larger, random, population-based survey that had at least one child under age 18.

The individual in the household most knowledgeable about the child’s health was read a list of possible names of the meningococcal vaccine (meningitis shot, meningococcal shot, Menactra) and asked whether they had heard of it, and if they had, whether the child had received it.

Data from parents of adolescents aged 11-17 years were weighted to provide population-based estimates, according to Dr. Coyne-Beasley, who is an associate professor of pediatrics and internal medicine at the University of North Carolina, Chapel Hill.

In all, 1,281 parents completed the survey. Some 48% were 40-49 years old, and two-thirds were female. Some 74% were married or cohabiting with a partner, and 71% were employed.

On average, the adolescents were 14.1 years old. They were equally split by sex. Some 63% were white, 23% were black, 9% were Hispanic, and 5% were of other races/ethnicities.

The majority of the adolescents attended public school (88%), had health insurance (93%), had a regular health care provider (83%), and had had a preventive checkup in the past 12 months (78%).

Fully 65% of the surveyed parents were aware of the meningococcal vaccine, according to Dr. Coyne-Beasley. She noted that the state did not have any meningitis outbreaks during the survey year, which usually increase awareness.

In multivariate analyses, parents were significantly more likely to be aware of the vaccine if their child was aged 16-17 years compared with 11-12 years (odds ratio 1.82), attended private school compared with public school (OR 1.95), and had health insurance (OR 1.90).

On the other hand, parents were significantly less likely to be aware of the vaccine if their child was Hispanic compared with white (OR 0.50).

Just 44% of the parents who were aware of the meningococcal vaccine had had their adolescent vaccinated.

In multivariate analyses, adolescents were significantly more likely to have been vaccinated if they were black versus white (OR 2.17), had had a preventive health checkup in the past 12 months (OR 3.03), and lived in a household having two or more children under age 18 (OR 1.83).

Among the parents who had not had their adolescent vaccinated, the single most common reason, cited by 25%, was that their health care provider did not mention or recommend the vaccine, Dr. Coyne-Beasley reported. Other reasons cited included believing that their adolescent did not need the vaccine (14%), wanting to wait until he or she was older (10%), concerns about vaccine safety (9%), and not having been to a doctor recently (8%).

More than half of these parents of unvaccinated children said that in the next year, they definitely would (21%) or probably would (33%) have them vaccinated, and a small minority (8%) were unsure.

However, sizable proportions said they probably would not (29%) or definitely would not (10%) have their child vaccinated in the next year.

"Awareness of a vaccine doesn’t necessarily mean that one will get it," Dr. Coyne-Beasley concluded, and it will be important to ascertain the reasons for the observed disconnect between awareness and uptake of the meningococcal vaccine among adolescents.

The study had its limitations, she acknowledged. They included the self-reported nature of the data, potential limited generalizability, inclusion of only households having a landline telephone, and availability of just a single meningococcal conjugate vaccine at the time of the survey.

Dr. Coyne-Beasley reported that she did not have any relevant financial disclosures.

SEATTLE – A new index that captures the multiple and complex aspects of media use among today’s youth helps identify those at high risk for drinking, new data show.

In a cross-sectional study among 126 middle school students, relative to their peers having a media involvement index (MII) in the bottom tertile, those having an MII in the top tertile had four- to fivefold higher odds of being current drinkers after potential confounders were taken into account.

Students with a top-tertile MII also had similarly elevated odds of having alcohol risk factors in general, such as planning to drink in the next year, principal investigator Craig S. Ross reported at the annual meeting of the Society for Adolescent Health and Medicine.

In contrast, measures that have traditionally been used to assess media use among adolescents, such as time spent watching television, showed little or no association with these outcomes.

"Adolescents are really avid experimenters, and the new media environment provides inexpensive and powerful tools to facilitate experimentation," he said. "We need new measures in public health to reflect the changing media environment, and the MII shows promise as one such new measure."

The observed associations have several possible explanations, according to Mr. Ross, who is a doctoral student in the epidemiology department at the Boston University School of Public Health.

"Heavy media use may be a marker for sensation seeking or self-medication, or a need to belong among these young adolescents," he speculated. "It may expose them to more normalizing portrayals of alcohol use, and it may enable them to share potentially unhealthful messages with their peers."

Past studies have linked traditional measures of media use to both initiation and frequency of drinking among adolescents, Mr. Ross noted. "The key challenge we face today is that the media environment is rapidly changing, and adolescents really are at the vanguard of this change."

"In this changing media environment, we set out to determine which traditional measures of media use would be associated with alcohol risk factors among young adolescents, and whether we could identify new measures that capture the ubiquity of media access and multitasking behaviors," he explained.

The investigators studied 126 middle school students aged 13-15 years from a small New England city who were participants in the Measuring Youth Media Exposure Study. All were recruited from school and community settings.

Analyses were based on students’ self-reported data from computer-assisted interviews conducted at baseline between January and November 2009. Overall, 53% of the students were boys, 37% were black or Hispanic, and 44% lived with a single mother.

The MII captured multiple facets of media access and activity among the youth, including the presence of media in their bedroom, possession of portable media, media multitasking behaviors (such as using the phone while watching television), use of media while traveling, and home background media (such as having the television on while nobody is watching). Possible scores ranged from 0 to 23 points.

In terms of alcohol outcomes, 18% of the students fell into a general alcohol risk group because they were current drinkers, had positive attitudes about alcohol, and/or intended to drink within a year. Some 10% specifically were current drinkers.

Traditional measures of media use showed only limited associations with these outcomes, according to Mr. Ross. Time spent listening to music was associated with both having alcohol risk factors (P = .01) and being a current drinker (P = .01). And overall time spent using nonprint media was associated with the latter (P = .03).

But a variety of other individual measures – television time, video game time, cell phone time, and e-mail/chat time, among others – were not significantly associated with alcohol outcomes. "These isolated measures of time spent with different media really don’t reflect the modern media environment," he commented.

The students had MIIs ranging from 4 to 19, with an average of 10. When they were split into tertiles by MII, the bottom tertile had values of 4-7, and the top tertile had values of 12-19.

"Just to give you a sense of what these kids might look like from a media perspective, a typical participant in the upper tertile has a full complement of bedroom media, including a television hooked up to premium cable, a video game console, and a computer hooked up to the Internet. They will have a cell phone and a notebook computer, and they are going to be multitasking with these devices frequently," Mr. Ross explained.

"On the other end of the scale, a typical participant in the lower tertile may have a television in their bedroom, but it’s not hooked up to premium cable. They do not have a computer in their bedroom, and only half have a cell phone. Very few will have a notebook computer, and in this group, media multitasking is infrequent," he said.

Compared with their counterparts in the bottom tertile of MII, students in the top tertile were significantly more likely to fall into the alcohol risk group in unadjusted analysis (odds ratio 6.01) and also in analyses that adjusted for age (OR 4.9) and for race (OR 5.2).

Similarly, students with a top-tertile MII were significantly more likely to fall into the current drinker group in unadjusted analysis (OR 6.6) and in analyses adjusting for age (OR 4.6), time with friends (OR 4.6), parental media monitoring (OR 4.9), and minutes spent listening to music (OR 4.3).

Additional analyses showed that potential confounders that might influence both media use and alcohol use, such as anxiety disorders, did not explain the observed associations, according to Mr. Ross.

Might it be possible, a person in attendance asked, that adolescents spending more time using media also are spending less time developing social skills and building supportive family relationships that could be protective in this context?

"The simple answer is, this is a very complex, changing dynamic right now," Mr. Ross replied. "What we are hypothesizing is that kids are getting a chance to experiment much more rapidly and get feedback much more rapidly on different kinds of identities through these media, and that can lead to higher-risk behaviors and an acceleration of a lot of other factors.

"We hope to explore prospective associations between the MII and a number of outcomes in future research," he concluded, including sexual activity, use of tobacco and other substances, and personal injury from high-risk activities.

Mr. Ross reported that he had no relevant conflicts of interest.

SEATTLE – A new index that captures the multiple and complex aspects of media use among today’s youth helps identify those at high risk for drinking, new data show.

In a cross-sectional study among 126 middle school students, relative to their peers having a media involvement index (MII) in the bottom tertile, those having an MII in the top tertile had four- to fivefold higher odds of being current drinkers after potential confounders were taken into account.

Students with a top-tertile MII also had similarly elevated odds of having alcohol risk factors in general, such as planning to drink in the next year, principal investigator Craig S. Ross reported at the annual meeting of the Society for Adolescent Health and Medicine.

In contrast, measures that have traditionally been used to assess media use among adolescents, such as time spent watching television, showed little or no association with these outcomes.

"Adolescents are really avid experimenters, and the new media environment provides inexpensive and powerful tools to facilitate experimentation," he said. "We need new measures in public health to reflect the changing media environment, and the MII shows promise as one such new measure."

The observed associations have several possible explanations, according to Mr. Ross, who is a doctoral student in the epidemiology department at the Boston University School of Public Health.

"Heavy media use may be a marker for sensation seeking or self-medication, or a need to belong among these young adolescents," he speculated. "It may expose them to more normalizing portrayals of alcohol use, and it may enable them to share potentially unhealthful messages with their peers."

Past studies have linked traditional measures of media use to both initiation and frequency of drinking among adolescents, Mr. Ross noted. "The key challenge we face today is that the media environment is rapidly changing, and adolescents really are at the vanguard of this change."

"In this changing media environment, we set out to determine which traditional measures of media use would be associated with alcohol risk factors among young adolescents, and whether we could identify new measures that capture the ubiquity of media access and multitasking behaviors," he explained.

The investigators studied 126 middle school students aged 13-15 years from a small New England city who were participants in the Measuring Youth Media Exposure Study. All were recruited from school and community settings.

Analyses were based on students’ self-reported data from computer-assisted interviews conducted at baseline between January and November 2009. Overall, 53% of the students were boys, 37% were black or Hispanic, and 44% lived with a single mother.

The MII captured multiple facets of media access and activity among the youth, including the presence of media in their bedroom, possession of portable media, media multitasking behaviors (such as using the phone while watching television), use of media while traveling, and home background media (such as having the television on while nobody is watching). Possible scores ranged from 0 to 23 points.

In terms of alcohol outcomes, 18% of the students fell into a general alcohol risk group because they were current drinkers, had positive attitudes about alcohol, and/or intended to drink within a year. Some 10% specifically were current drinkers.

Traditional measures of media use showed only limited associations with these outcomes, according to Mr. Ross. Time spent listening to music was associated with both having alcohol risk factors (P = .01) and being a current drinker (P = .01). And overall time spent using nonprint media was associated with the latter (P = .03).

But a variety of other individual measures – television time, video game time, cell phone time, and e-mail/chat time, among others – were not significantly associated with alcohol outcomes. "These isolated measures of time spent with different media really don’t reflect the modern media environment," he commented.

The students had MIIs ranging from 4 to 19, with an average of 10. When they were split into tertiles by MII, the bottom tertile had values of 4-7, and the top tertile had values of 12-19.

"Just to give you a sense of what these kids might look like from a media perspective, a typical participant in the upper tertile has a full complement of bedroom media, including a television hooked up to premium cable, a video game console, and a computer hooked up to the Internet. They will have a cell phone and a notebook computer, and they are going to be multitasking with these devices frequently," Mr. Ross explained.

"On the other end of the scale, a typical participant in the lower tertile may have a television in their bedroom, but it’s not hooked up to premium cable. They do not have a computer in their bedroom, and only half have a cell phone. Very few will have a notebook computer, and in this group, media multitasking is infrequent," he said.

Compared with their counterparts in the bottom tertile of MII, students in the top tertile were significantly more likely to fall into the alcohol risk group in unadjusted analysis (odds ratio 6.01) and also in analyses that adjusted for age (OR 4.9) and for race (OR 5.2).

Similarly, students with a top-tertile MII were significantly more likely to fall into the current drinker group in unadjusted analysis (OR 6.6) and in analyses adjusting for age (OR 4.6), time with friends (OR 4.6), parental media monitoring (OR 4.9), and minutes spent listening to music (OR 4.3).

Additional analyses showed that potential confounders that might influence both media use and alcohol use, such as anxiety disorders, did not explain the observed associations, according to Mr. Ross.

Might it be possible, a person in attendance asked, that adolescents spending more time using media also are spending less time developing social skills and building supportive family relationships that could be protective in this context?

"The simple answer is, this is a very complex, changing dynamic right now," Mr. Ross replied. "What we are hypothesizing is that kids are getting a chance to experiment much more rapidly and get feedback much more rapidly on different kinds of identities through these media, and that can lead to higher-risk behaviors and an acceleration of a lot of other factors.

"We hope to explore prospective associations between the MII and a number of outcomes in future research," he concluded, including sexual activity, use of tobacco and other substances, and personal injury from high-risk activities.

Mr. Ross reported that he had no relevant conflicts of interest.

SEATTLE – A new index that captures the multiple and complex aspects of media use among today’s youth helps identify those at high risk for drinking, new data show.

In a cross-sectional study among 126 middle school students, relative to their peers having a media involvement index (MII) in the bottom tertile, those having an MII in the top tertile had four- to fivefold higher odds of being current drinkers after potential confounders were taken into account.

Students with a top-tertile MII also had similarly elevated odds of having alcohol risk factors in general, such as planning to drink in the next year, principal investigator Craig S. Ross reported at the annual meeting of the Society for Adolescent Health and Medicine.

In contrast, measures that have traditionally been used to assess media use among adolescents, such as time spent watching television, showed little or no association with these outcomes.

"Adolescents are really avid experimenters, and the new media environment provides inexpensive and powerful tools to facilitate experimentation," he said. "We need new measures in public health to reflect the changing media environment, and the MII shows promise as one such new measure."

The observed associations have several possible explanations, according to Mr. Ross, who is a doctoral student in the epidemiology department at the Boston University School of Public Health.

"Heavy media use may be a marker for sensation seeking or self-medication, or a need to belong among these young adolescents," he speculated. "It may expose them to more normalizing portrayals of alcohol use, and it may enable them to share potentially unhealthful messages with their peers."

Past studies have linked traditional measures of media use to both initiation and frequency of drinking among adolescents, Mr. Ross noted. "The key challenge we face today is that the media environment is rapidly changing, and adolescents really are at the vanguard of this change."

"In this changing media environment, we set out to determine which traditional measures of media use would be associated with alcohol risk factors among young adolescents, and whether we could identify new measures that capture the ubiquity of media access and multitasking behaviors," he explained.

The investigators studied 126 middle school students aged 13-15 years from a small New England city who were participants in the Measuring Youth Media Exposure Study. All were recruited from school and community settings.

Analyses were based on students’ self-reported data from computer-assisted interviews conducted at baseline between January and November 2009. Overall, 53% of the students were boys, 37% were black or Hispanic, and 44% lived with a single mother.

The MII captured multiple facets of media access and activity among the youth, including the presence of media in their bedroom, possession of portable media, media multitasking behaviors (such as using the phone while watching television), use of media while traveling, and home background media (such as having the television on while nobody is watching). Possible scores ranged from 0 to 23 points.

In terms of alcohol outcomes, 18% of the students fell into a general alcohol risk group because they were current drinkers, had positive attitudes about alcohol, and/or intended to drink within a year. Some 10% specifically were current drinkers.

Traditional measures of media use showed only limited associations with these outcomes, according to Mr. Ross. Time spent listening to music was associated with both having alcohol risk factors (P = .01) and being a current drinker (P = .01). And overall time spent using nonprint media was associated with the latter (P = .03).

But a variety of other individual measures – television time, video game time, cell phone time, and e-mail/chat time, among others – were not significantly associated with alcohol outcomes. "These isolated measures of time spent with different media really don’t reflect the modern media environment," he commented.

The students had MIIs ranging from 4 to 19, with an average of 10. When they were split into tertiles by MII, the bottom tertile had values of 4-7, and the top tertile had values of 12-19.

"Just to give you a sense of what these kids might look like from a media perspective, a typical participant in the upper tertile has a full complement of bedroom media, including a television hooked up to premium cable, a video game console, and a computer hooked up to the Internet. They will have a cell phone and a notebook computer, and they are going to be multitasking with these devices frequently," Mr. Ross explained.

"On the other end of the scale, a typical participant in the lower tertile may have a television in their bedroom, but it’s not hooked up to premium cable. They do not have a computer in their bedroom, and only half have a cell phone. Very few will have a notebook computer, and in this group, media multitasking is infrequent," he said.

Compared with their counterparts in the bottom tertile of MII, students in the top tertile were significantly more likely to fall into the alcohol risk group in unadjusted analysis (odds ratio 6.01) and also in analyses that adjusted for age (OR 4.9) and for race (OR 5.2).

Similarly, students with a top-tertile MII were significantly more likely to fall into the current drinker group in unadjusted analysis (OR 6.6) and in analyses adjusting for age (OR 4.6), time with friends (OR 4.6), parental media monitoring (OR 4.9), and minutes spent listening to music (OR 4.3).

Additional analyses showed that potential confounders that might influence both media use and alcohol use, such as anxiety disorders, did not explain the observed associations, according to Mr. Ross.

Might it be possible, a person in attendance asked, that adolescents spending more time using media also are spending less time developing social skills and building supportive family relationships that could be protective in this context?

"The simple answer is, this is a very complex, changing dynamic right now," Mr. Ross replied. "What we are hypothesizing is that kids are getting a chance to experiment much more rapidly and get feedback much more rapidly on different kinds of identities through these media, and that can lead to higher-risk behaviors and an acceleration of a lot of other factors.

"We hope to explore prospective associations between the MII and a number of outcomes in future research," he concluded, including sexual activity, use of tobacco and other substances, and personal injury from high-risk activities.

Mr. Ross reported that he had no relevant conflicts of interest.

SEATTLE – A new index that captures the multiple and complex aspects of media use among today’s youth helps identify those at high risk for drinking, new data show.

In a cross-sectional study among 126 middle school students, relative to their peers having a media involvement index (MII) in the bottom tertile, those having an MII in the top tertile had four- to fivefold higher odds of being current drinkers after potential confounders were taken into account.

Students with a top-tertile MII also had similarly elevated odds of having alcohol risk factors in general, such as planning to drink in the next year, principal investigator Craig S. Ross reported at the annual meeting of the Society for Adolescent Health and Medicine.

In contrast, measures that have traditionally been used to assess media use among adolescents, such as time spent watching television, showed little or no association with these outcomes.

"Adolescents are really avid experimenters, and the new media environment provides inexpensive and powerful tools to facilitate experimentation," he said. "We need new measures in public health to reflect the changing media environment, and the MII shows promise as one such new measure."

The observed associations have several possible explanations, according to Mr. Ross, who is a doctoral student in the epidemiology department at the Boston University School of Public Health.

"Heavy media use may be a marker for sensation seeking or self-medication, or a need to belong among these young adolescents," he speculated. "It may expose them to more normalizing portrayals of alcohol use, and it may enable them to share potentially unhealthful messages with their peers."

Past studies have linked traditional measures of media use to both initiation and frequency of drinking among adolescents, Mr. Ross noted. "The key challenge we face today is that the media environment is rapidly changing, and adolescents really are at the vanguard of this change."

"In this changing media environment, we set out to determine which traditional measures of media use would be associated with alcohol risk factors among young adolescents, and whether we could identify new measures that capture the ubiquity of media access and multitasking behaviors," he explained.

The investigators studied 126 middle school students aged 13-15 years from a small New England city who were participants in the Measuring Youth Media Exposure Study. All were recruited from school and community settings.

Analyses were based on students’ self-reported data from computer-assisted interviews conducted at baseline between January and November 2009. Overall, 53% of the students were boys, 37% were black or Hispanic, and 44% lived with a single mother.

The MII captured multiple facets of media access and activity among the youth, including the presence of media in their bedroom, possession of portable media, media multitasking behaviors (such as using the phone while watching television), use of media while traveling, and home background media (such as having the television on while nobody is watching). Possible scores ranged from 0 to 23 points.

In terms of alcohol outcomes, 18% of the students fell into a general alcohol risk group because they were current drinkers, had positive attitudes about alcohol, and/or intended to drink within a year. Some 10% specifically were current drinkers.

Traditional measures of media use showed only limited associations with these outcomes, according to Mr. Ross. Time spent listening to music was associated with both having alcohol risk factors (P = .01) and being a current drinker (P = .01). And overall time spent using nonprint media was associated with the latter (P = .03).

But a variety of other individual measures – television time, video game time, cell phone time, and e-mail/chat time, among others – were not significantly associated with alcohol outcomes. "These isolated measures of time spent with different media really don’t reflect the modern media environment," he commented.

The students had MIIs ranging from 4 to 19, with an average of 10. When they were split into tertiles by MII, the bottom tertile had values of 4-7, and the top tertile had values of 12-19.

"Just to give you a sense of what these kids might look like from a media perspective, a typical participant in the upper tertile has a full complement of bedroom media, including a television hooked up to premium cable, a video game console, and a computer hooked up to the Internet. They will have a cell phone and a notebook computer, and they are going to be multitasking with these devices frequently," Mr. Ross explained.

"On the other end of the scale, a typical participant in the lower tertile may have a television in their bedroom, but it’s not hooked up to premium cable. They do not have a computer in their bedroom, and only half have a cell phone. Very few will have a notebook computer, and in this group, media multitasking is infrequent," he said.

Compared with their counterparts in the bottom tertile of MII, students in the top tertile were significantly more likely to fall into the alcohol risk group in unadjusted analysis (odds ratio 6.01) and also in analyses that adjusted for age (OR 4.9) and for race (OR 5.2).

Similarly, students with a top-tertile MII were significantly more likely to fall into the current drinker group in unadjusted analysis (OR 6.6) and in analyses adjusting for age (OR 4.6), time with friends (OR 4.6), parental media monitoring (OR 4.9), and minutes spent listening to music (OR 4.3).

Additional analyses showed that potential confounders that might influence both media use and alcohol use, such as anxiety disorders, did not explain the observed associations, according to Mr. Ross.

Might it be possible, a person in attendance asked, that adolescents spending more time using media also are spending less time developing social skills and building supportive family relationships that could be protective in this context?

"The simple answer is, this is a very complex, changing dynamic right now," Mr. Ross replied. "What we are hypothesizing is that kids are getting a chance to experiment much more rapidly and get feedback much more rapidly on different kinds of identities through these media, and that can lead to higher-risk behaviors and an acceleration of a lot of other factors.

"We hope to explore prospective associations between the MII and a number of outcomes in future research," he concluded, including sexual activity, use of tobacco and other substances, and personal injury from high-risk activities.

Mr. Ross reported that he had no relevant conflicts of interest.

SEATTLE – A new index that captures the multiple and complex aspects of media use among today’s youth helps identify those at high risk for drinking, new data show.

In a cross-sectional study among 126 middle school students, relative to their peers having a media involvement index (MII) in the bottom tertile, those having an MII in the top tertile had four- to fivefold higher odds of being current drinkers after potential confounders were taken into account.

Students with a top-tertile MII also had similarly elevated odds of having alcohol risk factors in general, such as planning to drink in the next year, principal investigator Craig S. Ross reported at the annual meeting of the Society for Adolescent Health and Medicine.

In contrast, measures that have traditionally been used to assess media use among adolescents, such as time spent watching television, showed little or no association with these outcomes.

"Adolescents are really avid experimenters, and the new media environment provides inexpensive and powerful tools to facilitate experimentation," he said. "We need new measures in public health to reflect the changing media environment, and the MII shows promise as one such new measure."

The observed associations have several possible explanations, according to Mr. Ross, who is a doctoral student in the epidemiology department at the Boston University School of Public Health.

"Heavy media use may be a marker for sensation seeking or self-medication, or a need to belong among these young adolescents," he speculated. "It may expose them to more normalizing portrayals of alcohol use, and it may enable them to share potentially unhealthful messages with their peers."

Past studies have linked traditional measures of media use to both initiation and frequency of drinking among adolescents, Mr. Ross noted. "The key challenge we face today is that the media environment is rapidly changing, and adolescents really are at the vanguard of this change."

"In this changing media environment, we set out to determine which traditional measures of media use would be associated with alcohol risk factors among young adolescents, and whether we could identify new measures that capture the ubiquity of media access and multitasking behaviors," he explained.

The investigators studied 126 middle school students aged 13-15 years from a small New England city who were participants in the Measuring Youth Media Exposure Study. All were recruited from school and community settings.

Analyses were based on students’ self-reported data from computer-assisted interviews conducted at baseline between January and November 2009. Overall, 53% of the students were boys, 37% were black or Hispanic, and 44% lived with a single mother.

The MII captured multiple facets of media access and activity among the youth, including the presence of media in their bedroom, possession of portable media, media multitasking behaviors (such as using the phone while watching television), use of media while traveling, and home background media (such as having the television on while nobody is watching). Possible scores ranged from 0 to 23 points.

In terms of alcohol outcomes, 18% of the students fell into a general alcohol risk group because they were current drinkers, had positive attitudes about alcohol, and/or intended to drink within a year. Some 10% specifically were current drinkers.

Traditional measures of media use showed only limited associations with these outcomes, according to Mr. Ross. Time spent listening to music was associated with both having alcohol risk factors (P = .01) and being a current drinker (P = .01). And overall time spent using nonprint media was associated with the latter (P = .03).

But a variety of other individual measures – television time, video game time, cell phone time, and e-mail/chat time, among others – were not significantly associated with alcohol outcomes. "These isolated measures of time spent with different media really don’t reflect the modern media environment," he commented.

The students had MIIs ranging from 4 to 19, with an average of 10. When they were split into tertiles by MII, the bottom tertile had values of 4-7, and the top tertile had values of 12-19.

"Just to give you a sense of what these kids might look like from a media perspective, a typical participant in the upper tertile has a full complement of bedroom media, including a television hooked up to premium cable, a video game console, and a computer hooked up to the Internet. They will have a cell phone and a notebook computer, and they are going to be multitasking with these devices frequently," Mr. Ross explained.

"On the other end of the scale, a typical participant in the lower tertile may have a television in their bedroom, but it’s not hooked up to premium cable. They do not have a computer in their bedroom, and only half have a cell phone. Very few will have a notebook computer, and in this group, media multitasking is infrequent," he said.

Compared with their counterparts in the bottom tertile of MII, students in the top tertile were significantly more likely to fall into the alcohol risk group in unadjusted analysis (odds ratio 6.01) and also in analyses that adjusted for age (OR 4.9) and for race (OR 5.2).

Similarly, students with a top-tertile MII were significantly more likely to fall into the current drinker group in unadjusted analysis (OR 6.6) and in analyses adjusting for age (OR 4.6), time with friends (OR 4.6), parental media monitoring (OR 4.9), and minutes spent listening to music (OR 4.3).

Additional analyses showed that potential confounders that might influence both media use and alcohol use, such as anxiety disorders, did not explain the observed associations, according to Mr. Ross.

Might it be possible, a person in attendance asked, that adolescents spending more time using media also are spending less time developing social skills and building supportive family relationships that could be protective in this context?

"The simple answer is, this is a very complex, changing dynamic right now," Mr. Ross replied. "What we are hypothesizing is that kids are getting a chance to experiment much more rapidly and get feedback much more rapidly on different kinds of identities through these media, and that can lead to higher-risk behaviors and an acceleration of a lot of other factors.

"We hope to explore prospective associations between the MII and a number of outcomes in future research," he concluded, including sexual activity, use of tobacco and other substances, and personal injury from high-risk activities.

Mr. Ross reported that he had no relevant conflicts of interest.

SEATTLE – A new index that captures the multiple and complex aspects of media use among today’s youth helps identify those at high risk for drinking, new data show.

In a cross-sectional study among 126 middle school students, relative to their peers having a media involvement index (MII) in the bottom tertile, those having an MII in the top tertile had four- to fivefold higher odds of being current drinkers after potential confounders were taken into account.

Students with a top-tertile MII also had similarly elevated odds of having alcohol risk factors in general, such as planning to drink in the next year, principal investigator Craig S. Ross reported at the annual meeting of the Society for Adolescent Health and Medicine.

In contrast, measures that have traditionally been used to assess media use among adolescents, such as time spent watching television, showed little or no association with these outcomes.

"Adolescents are really avid experimenters, and the new media environment provides inexpensive and powerful tools to facilitate experimentation," he said. "We need new measures in public health to reflect the changing media environment, and the MII shows promise as one such new measure."

The observed associations have several possible explanations, according to Mr. Ross, who is a doctoral student in the epidemiology department at the Boston University School of Public Health.

"Heavy media use may be a marker for sensation seeking or self-medication, or a need to belong among these young adolescents," he speculated. "It may expose them to more normalizing portrayals of alcohol use, and it may enable them to share potentially unhealthful messages with their peers."

Past studies have linked traditional measures of media use to both initiation and frequency of drinking among adolescents, Mr. Ross noted. "The key challenge we face today is that the media environment is rapidly changing, and adolescents really are at the vanguard of this change."

"In this changing media environment, we set out to determine which traditional measures of media use would be associated with alcohol risk factors among young adolescents, and whether we could identify new measures that capture the ubiquity of media access and multitasking behaviors," he explained.

The investigators studied 126 middle school students aged 13-15 years from a small New England city who were participants in the Measuring Youth Media Exposure Study. All were recruited from school and community settings.

Analyses were based on students’ self-reported data from computer-assisted interviews conducted at baseline between January and November 2009. Overall, 53% of the students were boys, 37% were black or Hispanic, and 44% lived with a single mother.

The MII captured multiple facets of media access and activity among the youth, including the presence of media in their bedroom, possession of portable media, media multitasking behaviors (such as using the phone while watching television), use of media while traveling, and home background media (such as having the television on while nobody is watching). Possible scores ranged from 0 to 23 points.

In terms of alcohol outcomes, 18% of the students fell into a general alcohol risk group because they were current drinkers, had positive attitudes about alcohol, and/or intended to drink within a year. Some 10% specifically were current drinkers.

Traditional measures of media use showed only limited associations with these outcomes, according to Mr. Ross. Time spent listening to music was associated with both having alcohol risk factors (P = .01) and being a current drinker (P = .01). And overall time spent using nonprint media was associated with the latter (P = .03).

But a variety of other individual measures – television time, video game time, cell phone time, and e-mail/chat time, among others – were not significantly associated with alcohol outcomes. "These isolated measures of time spent with different media really don’t reflect the modern media environment," he commented.

The students had MIIs ranging from 4 to 19, with an average of 10. When they were split into tertiles by MII, the bottom tertile had values of 4-7, and the top tertile had values of 12-19.

"Just to give you a sense of what these kids might look like from a media perspective, a typical participant in the upper tertile has a full complement of bedroom media, including a television hooked up to premium cable, a video game console, and a computer hooked up to the Internet. They will have a cell phone and a notebook computer, and they are going to be multitasking with these devices frequently," Mr. Ross explained.

"On the other end of the scale, a typical participant in the lower tertile may have a television in their bedroom, but it’s not hooked up to premium cable. They do not have a computer in their bedroom, and only half have a cell phone. Very few will have a notebook computer, and in this group, media multitasking is infrequent," he said.

Compared with their counterparts in the bottom tertile of MII, students in the top tertile were significantly more likely to fall into the alcohol risk group in unadjusted analysis (odds ratio 6.01) and also in analyses that adjusted for age (OR 4.9) and for race (OR 5.2).

Similarly, students with a top-tertile MII were significantly more likely to fall into the current drinker group in unadjusted analysis (OR 6.6) and in analyses adjusting for age (OR 4.6), time with friends (OR 4.6), parental media monitoring (OR 4.9), and minutes spent listening to music (OR 4.3).

Additional analyses showed that potential confounders that might influence both media use and alcohol use, such as anxiety disorders, did not explain the observed associations, according to Mr. Ross.

Might it be possible, a person in attendance asked, that adolescents spending more time using media also are spending less time developing social skills and building supportive family relationships that could be protective in this context?

"The simple answer is, this is a very complex, changing dynamic right now," Mr. Ross replied. "What we are hypothesizing is that kids are getting a chance to experiment much more rapidly and get feedback much more rapidly on different kinds of identities through these media, and that can lead to higher-risk behaviors and an acceleration of a lot of other factors.

"We hope to explore prospective associations between the MII and a number of outcomes in future research," he concluded, including sexual activity, use of tobacco and other substances, and personal injury from high-risk activities.

Mr. Ross reported that he had no relevant conflicts of interest.

SAN DIEGO – Ventricular assist devices appear to be a "reasonable strategy" for supporting certain patients who have failing cardiac grafts and are waiting for a new heart, concludes a retrospective review of more than 1,500 patients who had a second transplant.

In the group who had retransplantation at least 1 year after their first transplantation, median survival was about 7 years. There was no difference between patients bridged with a ventricular assist device (VAD) and those who did not have bridging with any type of mechanical circulatory support (MCS), according to results reported at the annual meeting of the International Society for Heart and Lung Transplantation.

But survival was poor for those who were bridged after any interval with extracorporeal membrane oxygenation (ECMO) and for those who underwent retransplantation because they had primary graft failure or a hyperacute rejection, regardless of whether they were mechanically supported.

"The use of ECMO to bridge any patient to retransplantation does not appear judicious, nor does the use of MCS to bridge patients with primary graft failure or hyperacute rejection to retransplantation," said coinvestigator Dr. David L.S. Morales of the departments of surgery and pediatrics at the Texas Children’s Hospital in Houston. "However, the use of VADs to bridge patients to transplant after a year could be a reasonable strategy."

Although MCS is widely accepted for bridging patients to initial heart transplantation, its use for bridging to retransplantation has not been well studied. The investigators therefore took a closer look at this issue, analyzing data from the United Network for Organ Sharing (UNOS) database for 1,535 patients who underwent cardiac retransplantation during 1982-2009.

Results showed that just 8% of the patients were bridged to retransplantation, with a VAD in about two-thirds of cases and ECMO in the other third. The mean age was 41 years in the former and 35 years in the latter, with children (younger than age 18) comprising 15% and 35%, respectively.

The patients bridged to retransplantation were significantly more likely than were their nonbridged counterparts to have primary graft failure or hyperacute rejection (54% vs. 11%) and significantly less likely to have chronic rejection (16% vs. 63%).

And the bridged patients by and large underwent retransplantation early, with 64% in the VAD group and 76% in the ECMO group retransplanted within 3 months of their primary transplantation, compared with just 12% of their nonbridged peers.

"Regardless of MCS, patients retransplanted for primary graft failure or hyperacute rejection do not do well," Dr. Morales commented. Specifically, in patients with these indications for retransplantation, the 1-year mortality rate was 83%, with essentially no difference according to whether they received bridging or the type.

In the entire study population, median overall survival after retransplantation was 6.1 years in nonbridged patients, significantly longer than the 1.5 years in VAD-bridged patients and the 30 days in ECMO-bridged patients.

But when analyses were restricted to patients who underwent retransplantation at least 1 year after primary transplantation, median survival was similar in nonbridged and VAD-bridged patients, at 7.0 and 6.9 years. Compared with those groups, however, survival was significantly shorter – just 6 months – in the ECMO group.

"Patients bridged to retransplant with ECMO have poor outcomes regardless of timing or indication," Dr. Morales concluded of the findings. "And all patients retransplanted for hyperacute rejection or primary graft failure do poorly, regardless of MCS," he said. "However, patients who are bridged with a VAD to retransplant that is done a year post–primary transplant do have similar outcomes as compared to retransplant patients without MCS."

As for study limitations, "it is very important to note that we do not know the number of patients placed on MCS as a bridge to transplant who died while on support," he pointed out.

Despite the more favorable findings for VAD bridging, his pediatric patients needing retransplantation in adolescence often have chronic vasculopathy in their graft, Dr. Morales said. "They are a very, very difficult group to support with mechanical support with LVADs because we have to continue the immunosuppression," and the patients often die from infections as a result.

"It’s one of the reasons I’m interested in the total artificial heart, because the ability to take the heart out completely and stop immunosuppression I think will help bridge those patients," he commented. "The total artificial heart has lasted in patients for quite a long period of time, and I think eventually will start to be used maybe as a bridge to destination, as it was originally intended."

Dr. Morales disclosed having relationships with Berlin Heart Inc., Syncardia Systems Inc., and CircuLite Inc. as an investigator and/or consultant.

SAN DIEGO – Ventricular assist devices appear to be a "reasonable strategy" for supporting certain patients who have failing cardiac grafts and are waiting for a new heart, concludes a retrospective review of more than 1,500 patients who had a second transplant.

In the group who had retransplantation at least 1 year after their first transplantation, median survival was about 7 years. There was no difference between patients bridged with a ventricular assist device (VAD) and those who did not have bridging with any type of mechanical circulatory support (MCS), according to results reported at the annual meeting of the International Society for Heart and Lung Transplantation.

But survival was poor for those who were bridged after any interval with extracorporeal membrane oxygenation (ECMO) and for those who underwent retransplantation because they had primary graft failure or a hyperacute rejection, regardless of whether they were mechanically supported.

"The use of ECMO to bridge any patient to retransplantation does not appear judicious, nor does the use of MCS to bridge patients with primary graft failure or hyperacute rejection to retransplantation," said coinvestigator Dr. David L.S. Morales of the departments of surgery and pediatrics at the Texas Children’s Hospital in Houston. "However, the use of VADs to bridge patients to transplant after a year could be a reasonable strategy."

Although MCS is widely accepted for bridging patients to initial heart transplantation, its use for bridging to retransplantation has not been well studied. The investigators therefore took a closer look at this issue, analyzing data from the United Network for Organ Sharing (UNOS) database for 1,535 patients who underwent cardiac retransplantation during 1982-2009.

Results showed that just 8% of the patients were bridged to retransplantation, with a VAD in about two-thirds of cases and ECMO in the other third. The mean age was 41 years in the former and 35 years in the latter, with children (younger than age 18) comprising 15% and 35%, respectively.

The patients bridged to retransplantation were significantly more likely than were their nonbridged counterparts to have primary graft failure or hyperacute rejection (54% vs. 11%) and significantly less likely to have chronic rejection (16% vs. 63%).

And the bridged patients by and large underwent retransplantation early, with 64% in the VAD group and 76% in the ECMO group retransplanted within 3 months of their primary transplantation, compared with just 12% of their nonbridged peers.

"Regardless of MCS, patients retransplanted for primary graft failure or hyperacute rejection do not do well," Dr. Morales commented. Specifically, in patients with these indications for retransplantation, the 1-year mortality rate was 83%, with essentially no difference according to whether they received bridging or the type.

In the entire study population, median overall survival after retransplantation was 6.1 years in nonbridged patients, significantly longer than the 1.5 years in VAD-bridged patients and the 30 days in ECMO-bridged patients.

But when analyses were restricted to patients who underwent retransplantation at least 1 year after primary transplantation, median survival was similar in nonbridged and VAD-bridged patients, at 7.0 and 6.9 years. Compared with those groups, however, survival was significantly shorter – just 6 months – in the ECMO group.

"Patients bridged to retransplant with ECMO have poor outcomes regardless of timing or indication," Dr. Morales concluded of the findings. "And all patients retransplanted for hyperacute rejection or primary graft failure do poorly, regardless of MCS," he said. "However, patients who are bridged with a VAD to retransplant that is done a year post–primary transplant do have similar outcomes as compared to retransplant patients without MCS."

As for study limitations, "it is very important to note that we do not know the number of patients placed on MCS as a bridge to transplant who died while on support," he pointed out.

Despite the more favorable findings for VAD bridging, his pediatric patients needing retransplantation in adolescence often have chronic vasculopathy in their graft, Dr. Morales said. "They are a very, very difficult group to support with mechanical support with LVADs because we have to continue the immunosuppression," and the patients often die from infections as a result.

"It’s one of the reasons I’m interested in the total artificial heart, because the ability to take the heart out completely and stop immunosuppression I think will help bridge those patients," he commented. "The total artificial heart has lasted in patients for quite a long period of time, and I think eventually will start to be used maybe as a bridge to destination, as it was originally intended."

Dr. Morales disclosed having relationships with Berlin Heart Inc., Syncardia Systems Inc., and CircuLite Inc. as an investigator and/or consultant.

SAN DIEGO – Ventricular assist devices appear to be a "reasonable strategy" for supporting certain patients who have failing cardiac grafts and are waiting for a new heart, concludes a retrospective review of more than 1,500 patients who had a second transplant.

In the group who had retransplantation at least 1 year after their first transplantation, median survival was about 7 years. There was no difference between patients bridged with a ventricular assist device (VAD) and those who did not have bridging with any type of mechanical circulatory support (MCS), according to results reported at the annual meeting of the International Society for Heart and Lung Transplantation.

But survival was poor for those who were bridged after any interval with extracorporeal membrane oxygenation (ECMO) and for those who underwent retransplantation because they had primary graft failure or a hyperacute rejection, regardless of whether they were mechanically supported.

"The use of ECMO to bridge any patient to retransplantation does not appear judicious, nor does the use of MCS to bridge patients with primary graft failure or hyperacute rejection to retransplantation," said coinvestigator Dr. David L.S. Morales of the departments of surgery and pediatrics at the Texas Children’s Hospital in Houston. "However, the use of VADs to bridge patients to transplant after a year could be a reasonable strategy."

Although MCS is widely accepted for bridging patients to initial heart transplantation, its use for bridging to retransplantation has not been well studied. The investigators therefore took a closer look at this issue, analyzing data from the United Network for Organ Sharing (UNOS) database for 1,535 patients who underwent cardiac retransplantation during 1982-2009.

Results showed that just 8% of the patients were bridged to retransplantation, with a VAD in about two-thirds of cases and ECMO in the other third. The mean age was 41 years in the former and 35 years in the latter, with children (younger than age 18) comprising 15% and 35%, respectively.

The patients bridged to retransplantation were significantly more likely than were their nonbridged counterparts to have primary graft failure or hyperacute rejection (54% vs. 11%) and significantly less likely to have chronic rejection (16% vs. 63%).

And the bridged patients by and large underwent retransplantation early, with 64% in the VAD group and 76% in the ECMO group retransplanted within 3 months of their primary transplantation, compared with just 12% of their nonbridged peers.

"Regardless of MCS, patients retransplanted for primary graft failure or hyperacute rejection do not do well," Dr. Morales commented. Specifically, in patients with these indications for retransplantation, the 1-year mortality rate was 83%, with essentially no difference according to whether they received bridging or the type.

In the entire study population, median overall survival after retransplantation was 6.1 years in nonbridged patients, significantly longer than the 1.5 years in VAD-bridged patients and the 30 days in ECMO-bridged patients.

But when analyses were restricted to patients who underwent retransplantation at least 1 year after primary transplantation, median survival was similar in nonbridged and VAD-bridged patients, at 7.0 and 6.9 years. Compared with those groups, however, survival was significantly shorter – just 6 months – in the ECMO group.

"Patients bridged to retransplant with ECMO have poor outcomes regardless of timing or indication," Dr. Morales concluded of the findings. "And all patients retransplanted for hyperacute rejection or primary graft failure do poorly, regardless of MCS," he said. "However, patients who are bridged with a VAD to retransplant that is done a year post–primary transplant do have similar outcomes as compared to retransplant patients without MCS."

As for study limitations, "it is very important to note that we do not know the number of patients placed on MCS as a bridge to transplant who died while on support," he pointed out.

Despite the more favorable findings for VAD bridging, his pediatric patients needing retransplantation in adolescence often have chronic vasculopathy in their graft, Dr. Morales said. "They are a very, very difficult group to support with mechanical support with LVADs because we have to continue the immunosuppression," and the patients often die from infections as a result.

"It’s one of the reasons I’m interested in the total artificial heart, because the ability to take the heart out completely and stop immunosuppression I think will help bridge those patients," he commented. "The total artificial heart has lasted in patients for quite a long period of time, and I think eventually will start to be used maybe as a bridge to destination, as it was originally intended."

Dr. Morales disclosed having relationships with Berlin Heart Inc., Syncardia Systems Inc., and CircuLite Inc. as an investigator and/or consultant.

SAN DIEGO – Ventricular assist devices appear to be a "reasonable strategy" for supporting certain patients who have failing cardiac grafts and are waiting for a new heart, concludes a retrospective review of more than 1,500 patients who had a second transplant.

In the group who had retransplantation at least 1 year after their first transplantation, median survival was about 7 years. There was no difference between patients bridged with a ventricular assist device (VAD) and those who did not have bridging with any type of mechanical circulatory support (MCS), according to results reported at the annual meeting of the International Society for Heart and Lung Transplantation.

But survival was poor for those who were bridged after any interval with extracorporeal membrane oxygenation (ECMO) and for those who underwent retransplantation because they had primary graft failure or a hyperacute rejection, regardless of whether they were mechanically supported.

"The use of ECMO to bridge any patient to retransplantation does not appear judicious, nor does the use of MCS to bridge patients with primary graft failure or hyperacute rejection to retransplantation," said coinvestigator Dr. David L.S. Morales of the departments of surgery and pediatrics at the Texas Children’s Hospital in Houston. "However, the use of VADs to bridge patients to transplant after a year could be a reasonable strategy."

Although MCS is widely accepted for bridging patients to initial heart transplantation, its use for bridging to retransplantation has not been well studied. The investigators therefore took a closer look at this issue, analyzing data from the United Network for Organ Sharing (UNOS) database for 1,535 patients who underwent cardiac retransplantation during 1982-2009.

Results showed that just 8% of the patients were bridged to retransplantation, with a VAD in about two-thirds of cases and ECMO in the other third. The mean age was 41 years in the former and 35 years in the latter, with children (younger than age 18) comprising 15% and 35%, respectively.

The patients bridged to retransplantation were significantly more likely than were their nonbridged counterparts to have primary graft failure or hyperacute rejection (54% vs. 11%) and significantly less likely to have chronic rejection (16% vs. 63%).

And the bridged patients by and large underwent retransplantation early, with 64% in the VAD group and 76% in the ECMO group retransplanted within 3 months of their primary transplantation, compared with just 12% of their nonbridged peers.

"Regardless of MCS, patients retransplanted for primary graft failure or hyperacute rejection do not do well," Dr. Morales commented. Specifically, in patients with these indications for retransplantation, the 1-year mortality rate was 83%, with essentially no difference according to whether they received bridging or the type.

In the entire study population, median overall survival after retransplantation was 6.1 years in nonbridged patients, significantly longer than the 1.5 years in VAD-bridged patients and the 30 days in ECMO-bridged patients.

But when analyses were restricted to patients who underwent retransplantation at least 1 year after primary transplantation, median survival was similar in nonbridged and VAD-bridged patients, at 7.0 and 6.9 years. Compared with those groups, however, survival was significantly shorter – just 6 months – in the ECMO group.

"Patients bridged to retransplant with ECMO have poor outcomes regardless of timing or indication," Dr. Morales concluded of the findings. "And all patients retransplanted for hyperacute rejection or primary graft failure do poorly, regardless of MCS," he said. "However, patients who are bridged with a VAD to retransplant that is done a year post–primary transplant do have similar outcomes as compared to retransplant patients without MCS."

As for study limitations, "it is very important to note that we do not know the number of patients placed on MCS as a bridge to transplant who died while on support," he pointed out.

Despite the more favorable findings for VAD bridging, his pediatric patients needing retransplantation in adolescence often have chronic vasculopathy in their graft, Dr. Morales said. "They are a very, very difficult group to support with mechanical support with LVADs because we have to continue the immunosuppression," and the patients often die from infections as a result.

"It’s one of the reasons I’m interested in the total artificial heart, because the ability to take the heart out completely and stop immunosuppression I think will help bridge those patients," he commented. "The total artificial heart has lasted in patients for quite a long period of time, and I think eventually will start to be used maybe as a bridge to destination, as it was originally intended."

Dr. Morales disclosed having relationships with Berlin Heart Inc., Syncardia Systems Inc., and CircuLite Inc. as an investigator and/or consultant.

SAN DIEGO – Ventricular assist devices appear to be a "reasonable strategy" for supporting certain patients who have failing cardiac grafts and are waiting for a new heart, concludes a retrospective review of more than 1,500 patients who had a second transplant.

In the group who had retransplantation at least 1 year after their first transplantation, median survival was about 7 years. There was no difference between patients bridged with a ventricular assist device (VAD) and those who did not have bridging with any type of mechanical circulatory support (MCS), according to results reported at the annual meeting of the International Society for Heart and Lung Transplantation.

But survival was poor for those who were bridged after any interval with extracorporeal membrane oxygenation (ECMO) and for those who underwent retransplantation because they had primary graft failure or a hyperacute rejection, regardless of whether they were mechanically supported.

"The use of ECMO to bridge any patient to retransplantation does not appear judicious, nor does the use of MCS to bridge patients with primary graft failure or hyperacute rejection to retransplantation," said coinvestigator Dr. David L.S. Morales of the departments of surgery and pediatrics at the Texas Children’s Hospital in Houston. "However, the use of VADs to bridge patients to transplant after a year could be a reasonable strategy."

Although MCS is widely accepted for bridging patients to initial heart transplantation, its use for bridging to retransplantation has not been well studied. The investigators therefore took a closer look at this issue, analyzing data from the United Network for Organ Sharing (UNOS) database for 1,535 patients who underwent cardiac retransplantation during 1982-2009.

Results showed that just 8% of the patients were bridged to retransplantation, with a VAD in about two-thirds of cases and ECMO in the other third. The mean age was 41 years in the former and 35 years in the latter, with children (younger than age 18) comprising 15% and 35%, respectively.

The patients bridged to retransplantation were significantly more likely than were their nonbridged counterparts to have primary graft failure or hyperacute rejection (54% vs. 11%) and significantly less likely to have chronic rejection (16% vs. 63%).

And the bridged patients by and large underwent retransplantation early, with 64% in the VAD group and 76% in the ECMO group retransplanted within 3 months of their primary transplantation, compared with just 12% of their nonbridged peers.

"Regardless of MCS, patients retransplanted for primary graft failure or hyperacute rejection do not do well," Dr. Morales commented. Specifically, in patients with these indications for retransplantation, the 1-year mortality rate was 83%, with essentially no difference according to whether they received bridging or the type.

In the entire study population, median overall survival after retransplantation was 6.1 years in nonbridged patients, significantly longer than the 1.5 years in VAD-bridged patients and the 30 days in ECMO-bridged patients.

But when analyses were restricted to patients who underwent retransplantation at least 1 year after primary transplantation, median survival was similar in nonbridged and VAD-bridged patients, at 7.0 and 6.9 years. Compared with those groups, however, survival was significantly shorter – just 6 months – in the ECMO group.

"Patients bridged to retransplant with ECMO have poor outcomes regardless of timing or indication," Dr. Morales concluded of the findings. "And all patients retransplanted for hyperacute rejection or primary graft failure do poorly, regardless of MCS," he said. "However, patients who are bridged with a VAD to retransplant that is done a year post–primary transplant do have similar outcomes as compared to retransplant patients without MCS."

As for study limitations, "it is very important to note that we do not know the number of patients placed on MCS as a bridge to transplant who died while on support," he pointed out.

Despite the more favorable findings for VAD bridging, his pediatric patients needing retransplantation in adolescence often have chronic vasculopathy in their graft, Dr. Morales said. "They are a very, very difficult group to support with mechanical support with LVADs because we have to continue the immunosuppression," and the patients often die from infections as a result.

"It’s one of the reasons I’m interested in the total artificial heart, because the ability to take the heart out completely and stop immunosuppression I think will help bridge those patients," he commented. "The total artificial heart has lasted in patients for quite a long period of time, and I think eventually will start to be used maybe as a bridge to destination, as it was originally intended."

Dr. Morales disclosed having relationships with Berlin Heart Inc., Syncardia Systems Inc., and CircuLite Inc. as an investigator and/or consultant.

SAN DIEGO – Ventricular assist devices appear to be a "reasonable strategy" for supporting certain patients who have failing cardiac grafts and are waiting for a new heart, concludes a retrospective review of more than 1,500 patients who had a second transplant.

In the group who had retransplantation at least 1 year after their first transplantation, median survival was about 7 years. There was no difference between patients bridged with a ventricular assist device (VAD) and those who did not have bridging with any type of mechanical circulatory support (MCS), according to results reported at the annual meeting of the International Society for Heart and Lung Transplantation.

But survival was poor for those who were bridged after any interval with extracorporeal membrane oxygenation (ECMO) and for those who underwent retransplantation because they had primary graft failure or a hyperacute rejection, regardless of whether they were mechanically supported.

"The use of ECMO to bridge any patient to retransplantation does not appear judicious, nor does the use of MCS to bridge patients with primary graft failure or hyperacute rejection to retransplantation," said coinvestigator Dr. David L.S. Morales of the departments of surgery and pediatrics at the Texas Children’s Hospital in Houston. "However, the use of VADs to bridge patients to transplant after a year could be a reasonable strategy."

Although MCS is widely accepted for bridging patients to initial heart transplantation, its use for bridging to retransplantation has not been well studied. The investigators therefore took a closer look at this issue, analyzing data from the United Network for Organ Sharing (UNOS) database for 1,535 patients who underwent cardiac retransplantation during 1982-2009.

Results showed that just 8% of the patients were bridged to retransplantation, with a VAD in about two-thirds of cases and ECMO in the other third. The mean age was 41 years in the former and 35 years in the latter, with children (younger than age 18) comprising 15% and 35%, respectively.

The patients bridged to retransplantation were significantly more likely than were their nonbridged counterparts to have primary graft failure or hyperacute rejection (54% vs. 11%) and significantly less likely to have chronic rejection (16% vs. 63%).

And the bridged patients by and large underwent retransplantation early, with 64% in the VAD group and 76% in the ECMO group retransplanted within 3 months of their primary transplantation, compared with just 12% of their nonbridged peers.

"Regardless of MCS, patients retransplanted for primary graft failure or hyperacute rejection do not do well," Dr. Morales commented. Specifically, in patients with these indications for retransplantation, the 1-year mortality rate was 83%, with essentially no difference according to whether they received bridging or the type.

In the entire study population, median overall survival after retransplantation was 6.1 years in nonbridged patients, significantly longer than the 1.5 years in VAD-bridged patients and the 30 days in ECMO-bridged patients.

But when analyses were restricted to patients who underwent retransplantation at least 1 year after primary transplantation, median survival was similar in nonbridged and VAD-bridged patients, at 7.0 and 6.9 years. Compared with those groups, however, survival was significantly shorter – just 6 months – in the ECMO group.

"Patients bridged to retransplant with ECMO have poor outcomes regardless of timing or indication," Dr. Morales concluded of the findings. "And all patients retransplanted for hyperacute rejection or primary graft failure do poorly, regardless of MCS," he said. "However, patients who are bridged with a VAD to retransplant that is done a year post–primary transplant do have similar outcomes as compared to retransplant patients without MCS."

As for study limitations, "it is very important to note that we do not know the number of patients placed on MCS as a bridge to transplant who died while on support," he pointed out.

Despite the more favorable findings for VAD bridging, his pediatric patients needing retransplantation in adolescence often have chronic vasculopathy in their graft, Dr. Morales said. "They are a very, very difficult group to support with mechanical support with LVADs because we have to continue the immunosuppression," and the patients often die from infections as a result.

"It’s one of the reasons I’m interested in the total artificial heart, because the ability to take the heart out completely and stop immunosuppression I think will help bridge those patients," he commented. "The total artificial heart has lasted in patients for quite a long period of time, and I think eventually will start to be used maybe as a bridge to destination, as it was originally intended."

Dr. Morales disclosed having relationships with Berlin Heart Inc., Syncardia Systems Inc., and CircuLite Inc. as an investigator and/or consultant.

SAN DIEGO – Ventricular assist devices appear to be a "reasonable strategy" for supporting certain patients who have failing cardiac grafts and are waiting for a new heart, concludes a retrospective review of more than 1,500 patients who had a second transplant.

In the group who had retransplantation at least 1 year after their first transplantation, median survival was about 7 years. There was no difference between patients bridged with a ventricular assist device (VAD) and those who did not have bridging with any type of mechanical circulatory support (MCS), according to results reported at the annual meeting of the International Society for Heart and Lung Transplantation.

But survival was poor for those who were bridged after any interval with extracorporeal membrane oxygenation (ECMO) and for those who underwent retransplantation because they had primary graft failure or a hyperacute rejection, regardless of whether they were mechanically supported.

"The use of ECMO to bridge any patient to retransplantation does not appear judicious, nor does the use of MCS to bridge patients with primary graft failure or hyperacute rejection to retransplantation," said coinvestigator Dr. David L.S. Morales of the departments of surgery and pediatrics at the Texas Children’s Hospital in Houston. "However, the use of VADs to bridge patients to transplant after a year could be a reasonable strategy."

Although MCS is widely accepted for bridging patients to initial heart transplantation, its use for bridging to retransplantation has not been well studied. The investigators therefore took a closer look at this issue, analyzing data from the United Network for Organ Sharing (UNOS) database for 1,535 patients who underwent cardiac retransplantation during 1982-2009.

Results showed that just 8% of the patients were bridged to retransplantation, with a VAD in about two-thirds of cases and ECMO in the other third. The mean age was 41 years in the former and 35 years in the latter, with children (younger than age 18) comprising 15% and 35%, respectively.

The patients bridged to retransplantation were significantly more likely than were their nonbridged counterparts to have primary graft failure or hyperacute rejection (54% vs. 11%) and significantly less likely to have chronic rejection (16% vs. 63%).

And the bridged patients by and large underwent retransplantation early, with 64% in the VAD group and 76% in the ECMO group retransplanted within 3 months of their primary transplantation, compared with just 12% of their nonbridged peers.

"Regardless of MCS, patients retransplanted for primary graft failure or hyperacute rejection do not do well," Dr. Morales commented. Specifically, in patients with these indications for retransplantation, the 1-year mortality rate was 83%, with essentially no difference according to whether they received bridging or the type.

In the entire study population, median overall survival after retransplantation was 6.1 years in nonbridged patients, significantly longer than the 1.5 years in VAD-bridged patients and the 30 days in ECMO-bridged patients.

But when analyses were restricted to patients who underwent retransplantation at least 1 year after primary transplantation, median survival was similar in nonbridged and VAD-bridged patients, at 7.0 and 6.9 years. Compared with those groups, however, survival was significantly shorter – just 6 months – in the ECMO group.

"Patients bridged to retransplant with ECMO have poor outcomes regardless of timing or indication," Dr. Morales concluded of the findings. "And all patients retransplanted for hyperacute rejection or primary graft failure do poorly, regardless of MCS," he said. "However, patients who are bridged with a VAD to retransplant that is done a year post–primary transplant do have similar outcomes as compared to retransplant patients without MCS."

As for study limitations, "it is very important to note that we do not know the number of patients placed on MCS as a bridge to transplant who died while on support," he pointed out.

Despite the more favorable findings for VAD bridging, his pediatric patients needing retransplantation in adolescence often have chronic vasculopathy in their graft, Dr. Morales said. "They are a very, very difficult group to support with mechanical support with LVADs because we have to continue the immunosuppression," and the patients often die from infections as a result.

"It’s one of the reasons I’m interested in the total artificial heart, because the ability to take the heart out completely and stop immunosuppression I think will help bridge those patients," he commented. "The total artificial heart has lasted in patients for quite a long period of time, and I think eventually will start to be used maybe as a bridge to destination, as it was originally intended."

Dr. Morales disclosed having relationships with Berlin Heart Inc., Syncardia Systems Inc., and CircuLite Inc. as an investigator and/or consultant.

SAN DIEGO – Ventricular assist devices appear to be a "reasonable strategy" for supporting certain patients who have failing cardiac grafts and are waiting for a new heart, concludes a retrospective review of more than 1,500 patients who had a second transplant.

In the group who had retransplantation at least 1 year after their first transplantation, median survival was about 7 years. There was no difference between patients bridged with a ventricular assist device (VAD) and those who did not have bridging with any type of mechanical circulatory support (MCS), according to results reported at the annual meeting of the International Society for Heart and Lung Transplantation.

But survival was poor for those who were bridged after any interval with extracorporeal membrane oxygenation (ECMO) and for those who underwent retransplantation because they had primary graft failure or a hyperacute rejection, regardless of whether they were mechanically supported.

"The use of ECMO to bridge any patient to retransplantation does not appear judicious, nor does the use of MCS to bridge patients with primary graft failure or hyperacute rejection to retransplantation," said coinvestigator Dr. David L.S. Morales of the departments of surgery and pediatrics at the Texas Children’s Hospital in Houston. "However, the use of VADs to bridge patients to transplant after a year could be a reasonable strategy."

Although MCS is widely accepted for bridging patients to initial heart transplantation, its use for bridging to retransplantation has not been well studied. The investigators therefore took a closer look at this issue, analyzing data from the United Network for Organ Sharing (UNOS) database for 1,535 patients who underwent cardiac retransplantation during 1982-2009.

Results showed that just 8% of the patients were bridged to retransplantation, with a VAD in about two-thirds of cases and ECMO in the other third. The mean age was 41 years in the former and 35 years in the latter, with children (younger than age 18) comprising 15% and 35%, respectively.

The patients bridged to retransplantation were significantly more likely than were their nonbridged counterparts to have primary graft failure or hyperacute rejection (54% vs. 11%) and significantly less likely to have chronic rejection (16% vs. 63%).

And the bridged patients by and large underwent retransplantation early, with 64% in the VAD group and 76% in the ECMO group retransplanted within 3 months of their primary transplantation, compared with just 12% of their nonbridged peers.

"Regardless of MCS, patients retransplanted for primary graft failure or hyperacute rejection do not do well," Dr. Morales commented. Specifically, in patients with these indications for retransplantation, the 1-year mortality rate was 83%, with essentially no difference according to whether they received bridging or the type.

In the entire study population, median overall survival after retransplantation was 6.1 years in nonbridged patients, significantly longer than the 1.5 years in VAD-bridged patients and the 30 days in ECMO-bridged patients.

But when analyses were restricted to patients who underwent retransplantation at least 1 year after primary transplantation, median survival was similar in nonbridged and VAD-bridged patients, at 7.0 and 6.9 years. Compared with those groups, however, survival was significantly shorter – just 6 months – in the ECMO group.

"Patients bridged to retransplant with ECMO have poor outcomes regardless of timing or indication," Dr. Morales concluded of the findings. "And all patients retransplanted for hyperacute rejection or primary graft failure do poorly, regardless of MCS," he said. "However, patients who are bridged with a VAD to retransplant that is done a year post–primary transplant do have similar outcomes as compared to retransplant patients without MCS."

As for study limitations, "it is very important to note that we do not know the number of patients placed on MCS as a bridge to transplant who died while on support," he pointed out.

Despite the more favorable findings for VAD bridging, his pediatric patients needing retransplantation in adolescence often have chronic vasculopathy in their graft, Dr. Morales said. "They are a very, very difficult group to support with mechanical support with LVADs because we have to continue the immunosuppression," and the patients often die from infections as a result.

"It’s one of the reasons I’m interested in the total artificial heart, because the ability to take the heart out completely and stop immunosuppression I think will help bridge those patients," he commented. "The total artificial heart has lasted in patients for quite a long period of time, and I think eventually will start to be used maybe as a bridge to destination, as it was originally intended."

Dr. Morales disclosed having relationships with Berlin Heart Inc., Syncardia Systems Inc., and CircuLite Inc. as an investigator and/or consultant.

SAN DIEGO – Ventricular assist devices appear to be a "reasonable strategy" for supporting certain patients who have failing cardiac grafts and are waiting for a new heart, concludes a retrospective review of more than 1,500 patients who had a second transplant.

In the group who had retransplantation at least 1 year after their first transplantation, median survival was about 7 years. There was no difference between patients bridged with a ventricular assist device (VAD) and those who did not have bridging with any type of mechanical circulatory support (MCS), according to results reported at the annual meeting of the International Society for Heart and Lung Transplantation.

But survival was poor for those who were bridged after any interval with extracorporeal membrane oxygenation (ECMO) and for those who underwent retransplantation because they had primary graft failure or a hyperacute rejection, regardless of whether they were mechanically supported.

"The use of ECMO to bridge any patient to retransplantation does not appear judicious, nor does the use of MCS to bridge patients with primary graft failure or hyperacute rejection to retransplantation," said coinvestigator Dr. David L.S. Morales of the departments of surgery and pediatrics at the Texas Children’s Hospital in Houston. "However, the use of VADs to bridge patients to transplant after a year could be a reasonable strategy."

Although MCS is widely accepted for bridging patients to initial heart transplantation, its use for bridging to retransplantation has not been well studied. The investigators therefore took a closer look at this issue, analyzing data from the United Network for Organ Sharing (UNOS) database for 1,535 patients who underwent cardiac retransplantation during 1982-2009.

Results showed that just 8% of the patients were bridged to retransplantation, with a VAD in about two-thirds of cases and ECMO in the other third. The mean age was 41 years in the former and 35 years in the latter, with children (younger than age 18) comprising 15% and 35%, respectively.

The patients bridged to retransplantation were significantly more likely than were their nonbridged counterparts to have primary graft failure or hyperacute rejection (54% vs. 11%) and significantly less likely to have chronic rejection (16% vs. 63%).

And the bridged patients by and large underwent retransplantation early, with 64% in the VAD group and 76% in the ECMO group retransplanted within 3 months of their primary transplantation, compared with just 12% of their nonbridged peers.

"Regardless of MCS, patients retransplanted for primary graft failure or hyperacute rejection do not do well," Dr. Morales commented. Specifically, in patients with these indications for retransplantation, the 1-year mortality rate was 83%, with essentially no difference according to whether they received bridging or the type.

In the entire study population, median overall survival after retransplantation was 6.1 years in nonbridged patients, significantly longer than the 1.5 years in VAD-bridged patients and the 30 days in ECMO-bridged patients.

But when analyses were restricted to patients who underwent retransplantation at least 1 year after primary transplantation, median survival was similar in nonbridged and VAD-bridged patients, at 7.0 and 6.9 years. Compared with those groups, however, survival was significantly shorter – just 6 months – in the ECMO group.

"Patients bridged to retransplant with ECMO have poor outcomes regardless of timing or indication," Dr. Morales concluded of the findings. "And all patients retransplanted for hyperacute rejection or primary graft failure do poorly, regardless of MCS," he said. "However, patients who are bridged with a VAD to retransplant that is done a year post–primary transplant do have similar outcomes as compared to retransplant patients without MCS."

As for study limitations, "it is very important to note that we do not know the number of patients placed on MCS as a bridge to transplant who died while on support," he pointed out.

Despite the more favorable findings for VAD bridging, his pediatric patients needing retransplantation in adolescence often have chronic vasculopathy in their graft, Dr. Morales said. "They are a very, very difficult group to support with mechanical support with LVADs because we have to continue the immunosuppression," and the patients often die from infections as a result.

"It’s one of the reasons I’m interested in the total artificial heart, because the ability to take the heart out completely and stop immunosuppression I think will help bridge those patients," he commented. "The total artificial heart has lasted in patients for quite a long period of time, and I think eventually will start to be used maybe as a bridge to destination, as it was originally intended."

Dr. Morales disclosed having relationships with Berlin Heart Inc., Syncardia Systems Inc., and CircuLite Inc. as an investigator and/or consultant.

SEATTLE – Third-year medical students often have negative experiences related to the specialty they are interested in when they rotate through clerkships in other specialties, according to a survey presented at the annual meeting of the North American Primary Care Research Group.

In the survey of 603 students, students reported negative experiences during their clinical clerkships whether they were interested in primary care (family medicine, internal medicine, or pediatrics) or in a subspecialty (for example, otolaryngology or orthopedics).

These negative experiences included being discouraged from pursuing their specialty interest, being called offensive names because of it, or receiving poorer grades as a result.

"This study ... confirmed that there is a lot of bashing about student career choices," said investigator Dr. Shou Ling Leong, who is associate vice chair for education, and professor of family and community medicine, at Pennsylvania State University, Hershey. But the widespread nature of the problem was surprising.

"This behavior is worrisome. If we are truly putting down each other’s specialty, what does that say about professionalism?" she commented in an interview. "As physicians, we are held to a high level of professional standards, and if we mistreat each other, we are not serving as good role models for our students."

The findings are especially worrisome when it comes to primary care, given the severe shortage of these physicians nationally and the fact that negative experiences during training likely discourage some students from pursuing careers in the field, according to Dr. Leong.

"Now, this is not the only reason that students may not go into the field. Lifestyles and the amount of debt they owe and a multitude of factors may contribute to career selection," she acknowledged. But "if their supervisors – their professors and their residents – are telling them, ‘Don’t do it, this is not a good field,’ that’s going to have an impact on whether they are going to continue to pursue primary care."

Interspecialty friction can also undermine the medical home approach to care, which is built on collaboration among a team of physicians and other health care professionals, she further noted. "Negativity is going to erode the efficiency and the effectiveness of a team."

For the survey, conducted between 2004 and 2009, Dr. Leong distributed questionnaires to medical students at her college on the last day of their third-year clerkships.

They were asked to rate how frequent and how bothersome various negative experiences were on Likert scales. To determine whether experiences differed by specialty interest, Dr. Leong split the students into groups based on their reported specialty interest at the beginning and end of the year.

All of these groups reported at least some negative experiences related to their specialty interest during each of their clerkships in other specialties, according to results presented in a poster session.

"No matter what field you are going into, if you are on a rotation of a specialty that is different from what you are interested in, someone will tell you that it’s the wrong field," Dr. Leong commented.

The study was not designed to determine whether the negative experiences actually discouraged any students from pursuing primary care, according to Dr. Leong. But given that the students found these events troubling, they may have been a contributing or deciding factor for some.

Comments made in focus groups suggested there may be two subsets of students in this regard. "Those who truly believe in primary care will still go into primary care," she explained. "But those who are still sort of on the fence – ‘I like this, but I’m not completely passionate about it’ – I think that’s the vulnerable group that it probably had an effect on."

Discussing the study’s results, Dr. Leong said that "somehow we need to fix this problem so that, first, our students who are truly interested in primary care should be supported and feel comfortable pursuing the field, and second, if we truly are going to work together, we need to be more respectful of each other."

She noted that sharing the study’s results with faculty, residents, and others involved in medical students’ training could go a long way toward eliminating specialty-related negative experiences during clerkships.

"When people are conscious of what they are doing, perhaps they will then correct their behavior," she said. "By calling awareness to these issues, hopefully we can create a nurturing and respectful learning environment."

Dr. Leong reported that she had no conflicts of interest related to the study.

SEATTLE – Third-year medical students often have negative experiences related to the specialty they are interested in when they rotate through clerkships in other specialties, according to a survey presented at the annual meeting of the North American Primary Care Research Group.

In the survey of 603 students, students reported negative experiences during their clinical clerkships whether they were interested in primary care (family medicine, internal medicine, or pediatrics) or in a subspecialty (for example, otolaryngology or orthopedics).

These negative experiences included being discouraged from pursuing their specialty interest, being called offensive names because of it, or receiving poorer grades as a result.

"This study ... confirmed that there is a lot of bashing about student career choices," said investigator Dr. Shou Ling Leong, who is associate vice chair for education, and professor of family and community medicine, at Pennsylvania State University, Hershey. But the widespread nature of the problem was surprising.

"This behavior is worrisome. If we are truly putting down each other’s specialty, what does that say about professionalism?" she commented in an interview. "As physicians, we are held to a high level of professional standards, and if we mistreat each other, we are not serving as good role models for our students."

The findings are especially worrisome when it comes to primary care, given the severe shortage of these physicians nationally and the fact that negative experiences during training likely discourage some students from pursuing careers in the field, according to Dr. Leong.

"Now, this is not the only reason that students may not go into the field. Lifestyles and the amount of debt they owe and a multitude of factors may contribute to career selection," she acknowledged. But "if their supervisors – their professors and their residents – are telling them, ‘Don’t do it, this is not a good field,’ that’s going to have an impact on whether they are going to continue to pursue primary care."

Interspecialty friction can also undermine the medical home approach to care, which is built on collaboration among a team of physicians and other health care professionals, she further noted. "Negativity is going to erode the efficiency and the effectiveness of a team."

For the survey, conducted between 2004 and 2009, Dr. Leong distributed questionnaires to medical students at her college on the last day of their third-year clerkships.

They were asked to rate how frequent and how bothersome various negative experiences were on Likert scales. To determine whether experiences differed by specialty interest, Dr. Leong split the students into groups based on their reported specialty interest at the beginning and end of the year.

All of these groups reported at least some negative experiences related to their specialty interest during each of their clerkships in other specialties, according to results presented in a poster session.

"No matter what field you are going into, if you are on a rotation of a specialty that is different from what you are interested in, someone will tell you that it’s the wrong field," Dr. Leong commented.

The study was not designed to determine whether the negative experiences actually discouraged any students from pursuing primary care, according to Dr. Leong. But given that the students found these events troubling, they may have been a contributing or deciding factor for some.

Comments made in focus groups suggested there may be two subsets of students in this regard. "Those who truly believe in primary care will still go into primary care," she explained. "But those who are still sort of on the fence – ‘I like this, but I’m not completely passionate about it’ – I think that’s the vulnerable group that it probably had an effect on."

Discussing the study’s results, Dr. Leong said that "somehow we need to fix this problem so that, first, our students who are truly interested in primary care should be supported and feel comfortable pursuing the field, and second, if we truly are going to work together, we need to be more respectful of each other."

She noted that sharing the study’s results with faculty, residents, and others involved in medical students’ training could go a long way toward eliminating specialty-related negative experiences during clerkships.

"When people are conscious of what they are doing, perhaps they will then correct their behavior," she said. "By calling awareness to these issues, hopefully we can create a nurturing and respectful learning environment."

Dr. Leong reported that she had no conflicts of interest related to the study.

SEATTLE – Third-year medical students often have negative experiences related to the specialty they are interested in when they rotate through clerkships in other specialties, according to a survey presented at the annual meeting of the North American Primary Care Research Group.

In the survey of 603 students, students reported negative experiences during their clinical clerkships whether they were interested in primary care (family medicine, internal medicine, or pediatrics) or in a subspecialty (for example, otolaryngology or orthopedics).

These negative experiences included being discouraged from pursuing their specialty interest, being called offensive names because of it, or receiving poorer grades as a result.

"This study ... confirmed that there is a lot of bashing about student career choices," said investigator Dr. Shou Ling Leong, who is associate vice chair for education, and professor of family and community medicine, at Pennsylvania State University, Hershey. But the widespread nature of the problem was surprising.

"This behavior is worrisome. If we are truly putting down each other’s specialty, what does that say about professionalism?" she commented in an interview. "As physicians, we are held to a high level of professional standards, and if we mistreat each other, we are not serving as good role models for our students."

The findings are especially worrisome when it comes to primary care, given the severe shortage of these physicians nationally and the fact that negative experiences during training likely discourage some students from pursuing careers in the field, according to Dr. Leong.

"Now, this is not the only reason that students may not go into the field. Lifestyles and the amount of debt they owe and a multitude of factors may contribute to career selection," she acknowledged. But "if their supervisors – their professors and their residents – are telling them, ‘Don’t do it, this is not a good field,’ that’s going to have an impact on whether they are going to continue to pursue primary care."

Interspecialty friction can also undermine the medical home approach to care, which is built on collaboration among a team of physicians and other health care professionals, she further noted. "Negativity is going to erode the efficiency and the effectiveness of a team."

For the survey, conducted between 2004 and 2009, Dr. Leong distributed questionnaires to medical students at her college on the last day of their third-year clerkships.

They were asked to rate how frequent and how bothersome various negative experiences were on Likert scales. To determine whether experiences differed by specialty interest, Dr. Leong split the students into groups based on their reported specialty interest at the beginning and end of the year.

All of these groups reported at least some negative experiences related to their specialty interest during each of their clerkships in other specialties, according to results presented in a poster session.

"No matter what field you are going into, if you are on a rotation of a specialty that is different from what you are interested in, someone will tell you that it’s the wrong field," Dr. Leong commented.

The study was not designed to determine whether the negative experiences actually discouraged any students from pursuing primary care, according to Dr. Leong. But given that the students found these events troubling, they may have been a contributing or deciding factor for some.

Comments made in focus groups suggested there may be two subsets of students in this regard. "Those who truly believe in primary care will still go into primary care," she explained. "But those who are still sort of on the fence – ‘I like this, but I’m not completely passionate about it’ – I think that’s the vulnerable group that it probably had an effect on."

Discussing the study’s results, Dr. Leong said that "somehow we need to fix this problem so that, first, our students who are truly interested in primary care should be supported and feel comfortable pursuing the field, and second, if we truly are going to work together, we need to be more respectful of each other."

She noted that sharing the study’s results with faculty, residents, and others involved in medical students’ training could go a long way toward eliminating specialty-related negative experiences during clerkships.

"When people are conscious of what they are doing, perhaps they will then correct their behavior," she said. "By calling awareness to these issues, hopefully we can create a nurturing and respectful learning environment."

Dr. Leong reported that she had no conflicts of interest related to the study.

SEATTLE – Third-year medical students often have negative experiences related to the specialty they are interested in when they rotate through clerkships in other specialties, according to a survey presented at the annual meeting of the North American Primary Care Research Group.

In the survey of 603 students, students reported negative experiences during their clinical clerkships whether they were interested in primary care (family medicine, internal medicine, or pediatrics) or in a subspecialty (for example, otolaryngology or orthopedics).

These negative experiences included being discouraged from pursuing their specialty interest, being called offensive names because of it, or receiving poorer grades as a result.

"This study ... confirmed that there is a lot of bashing about student career choices," said investigator Dr. Shou Ling Leong, who is associate vice chair for education, and professor of family and community medicine, at Pennsylvania State University, Hershey. But the widespread nature of the problem was surprising.

"This behavior is worrisome. If we are truly putting down each other’s specialty, what does that say about professionalism?" she commented in an interview. "As physicians, we are held to a high level of professional standards, and if we mistreat each other, we are not serving as good role models for our students."

The findings are especially worrisome when it comes to primary care, given the severe shortage of these physicians nationally and the fact that negative experiences during training likely discourage some students from pursuing careers in the field, according to Dr. Leong.

"Now, this is not the only reason that students may not go into the field. Lifestyles and the amount of debt they owe and a multitude of factors may contribute to career selection," she acknowledged. But "if their supervisors – their professors and their residents – are telling them, ‘Don’t do it, this is not a good field,’ that’s going to have an impact on whether they are going to continue to pursue primary care."

Interspecialty friction can also undermine the medical home approach to care, which is built on collaboration among a team of physicians and other health care professionals, she further noted. "Negativity is going to erode the efficiency and the effectiveness of a team."

For the survey, conducted between 2004 and 2009, Dr. Leong distributed questionnaires to medical students at her college on the last day of their third-year clerkships.

They were asked to rate how frequent and how bothersome various negative experiences were on Likert scales. To determine whether experiences differed by specialty interest, Dr. Leong split the students into groups based on their reported specialty interest at the beginning and end of the year.

All of these groups reported at least some negative experiences related to their specialty interest during each of their clerkships in other specialties, according to results presented in a poster session.

"No matter what field you are going into, if you are on a rotation of a specialty that is different from what you are interested in, someone will tell you that it’s the wrong field," Dr. Leong commented.

The study was not designed to determine whether the negative experiences actually discouraged any students from pursuing primary care, according to Dr. Leong. But given that the students found these events troubling, they may have been a contributing or deciding factor for some.

Comments made in focus groups suggested there may be two subsets of students in this regard. "Those who truly believe in primary care will still go into primary care," she explained. "But those who are still sort of on the fence – ‘I like this, but I’m not completely passionate about it’ – I think that’s the vulnerable group that it probably had an effect on."

Discussing the study’s results, Dr. Leong said that "somehow we need to fix this problem so that, first, our students who are truly interested in primary care should be supported and feel comfortable pursuing the field, and second, if we truly are going to work together, we need to be more respectful of each other."

She noted that sharing the study’s results with faculty, residents, and others involved in medical students’ training could go a long way toward eliminating specialty-related negative experiences during clerkships.

"When people are conscious of what they are doing, perhaps they will then correct their behavior," she said. "By calling awareness to these issues, hopefully we can create a nurturing and respectful learning environment."

Dr. Leong reported that she had no conflicts of interest related to the study.

SEATTLE – Third-year medical students often have negative experiences related to the specialty they are interested in when they rotate through clerkships in other specialties, according to a survey presented at the annual meeting of the North American Primary Care Research Group.

In the survey of 603 students, students reported negative experiences during their clinical clerkships whether they were interested in primary care (family medicine, internal medicine, or pediatrics) or in a subspecialty (for example, otolaryngology or orthopedics).

These negative experiences included being discouraged from pursuing their specialty interest, being called offensive names because of it, or receiving poorer grades as a result.

"This study ... confirmed that there is a lot of bashing about student career choices," said investigator Dr. Shou Ling Leong, who is associate vice chair for education, and professor of family and community medicine, at Pennsylvania State University, Hershey. But the widespread nature of the problem was surprising.

"This behavior is worrisome. If we are truly putting down each other’s specialty, what does that say about professionalism?" she commented in an interview. "As physicians, we are held to a high level of professional standards, and if we mistreat each other, we are not serving as good role models for our students."

The findings are especially worrisome when it comes to primary care, given the severe shortage of these physicians nationally and the fact that negative experiences during training likely discourage some students from pursuing careers in the field, according to Dr. Leong.

"Now, this is not the only reason that students may not go into the field. Lifestyles and the amount of debt they owe and a multitude of factors may contribute to career selection," she acknowledged. But "if their supervisors – their professors and their residents – are telling them, ‘Don’t do it, this is not a good field,’ that’s going to have an impact on whether they are going to continue to pursue primary care."

Interspecialty friction can also undermine the medical home approach to care, which is built on collaboration among a team of physicians and other health care professionals, she further noted. "Negativity is going to erode the efficiency and the effectiveness of a team."

For the survey, conducted between 2004 and 2009, Dr. Leong distributed questionnaires to medical students at her college on the last day of their third-year clerkships.

They were asked to rate how frequent and how bothersome various negative experiences were on Likert scales. To determine whether experiences differed by specialty interest, Dr. Leong split the students into groups based on their reported specialty interest at the beginning and end of the year.

All of these groups reported at least some negative experiences related to their specialty interest during each of their clerkships in other specialties, according to results presented in a poster session.

"No matter what field you are going into, if you are on a rotation of a specialty that is different from what you are interested in, someone will tell you that it’s the wrong field," Dr. Leong commented.

The study was not designed to determine whether the negative experiences actually discouraged any students from pursuing primary care, according to Dr. Leong. But given that the students found these events troubling, they may have been a contributing or deciding factor for some.

Comments made in focus groups suggested there may be two subsets of students in this regard. "Those who truly believe in primary care will still go into primary care," she explained. "But those who are still sort of on the fence – ‘I like this, but I’m not completely passionate about it’ – I think that’s the vulnerable group that it probably had an effect on."

Discussing the study’s results, Dr. Leong said that "somehow we need to fix this problem so that, first, our students who are truly interested in primary care should be supported and feel comfortable pursuing the field, and second, if we truly are going to work together, we need to be more respectful of each other."

She noted that sharing the study’s results with faculty, residents, and others involved in medical students’ training could go a long way toward eliminating specialty-related negative experiences during clerkships.

"When people are conscious of what they are doing, perhaps they will then correct their behavior," she said. "By calling awareness to these issues, hopefully we can create a nurturing and respectful learning environment."

Dr. Leong reported that she had no conflicts of interest related to the study.

SEATTLE – Third-year medical students often have negative experiences related to the specialty they are interested in when they rotate through clerkships in other specialties, according to a survey presented at the annual meeting of the North American Primary Care Research Group.

In the survey of 603 students, students reported negative experiences during their clinical clerkships whether they were interested in primary care (family medicine, internal medicine, or pediatrics) or in a subspecialty (for example, otolaryngology or orthopedics).

These negative experiences included being discouraged from pursuing their specialty interest, being called offensive names because of it, or receiving poorer grades as a result.

"This study ... confirmed that there is a lot of bashing about student career choices," said investigator Dr. Shou Ling Leong, who is associate vice chair for education, and professor of family and community medicine, at Pennsylvania State University, Hershey. But the widespread nature of the problem was surprising.

"This behavior is worrisome. If we are truly putting down each other’s specialty, what does that say about professionalism?" she commented in an interview. "As physicians, we are held to a high level of professional standards, and if we mistreat each other, we are not serving as good role models for our students."

The findings are especially worrisome when it comes to primary care, given the severe shortage of these physicians nationally and the fact that negative experiences during training likely discourage some students from pursuing careers in the field, according to Dr. Leong.

"Now, this is not the only reason that students may not go into the field. Lifestyles and the amount of debt they owe and a multitude of factors may contribute to career selection," she acknowledged. But "if their supervisors – their professors and their residents – are telling them, ‘Don’t do it, this is not a good field,’ that’s going to have an impact on whether they are going to continue to pursue primary care."

Interspecialty friction can also undermine the medical home approach to care, which is built on collaboration among a team of physicians and other health care professionals, she further noted. "Negativity is going to erode the efficiency and the effectiveness of a team."

For the survey, conducted between 2004 and 2009, Dr. Leong distributed questionnaires to medical students at her college on the last day of their third-year clerkships.

They were asked to rate how frequent and how bothersome various negative experiences were on Likert scales. To determine whether experiences differed by specialty interest, Dr. Leong split the students into groups based on their reported specialty interest at the beginning and end of the year.

All of these groups reported at least some negative experiences related to their specialty interest during each of their clerkships in other specialties, according to results presented in a poster session.

"No matter what field you are going into, if you are on a rotation of a specialty that is different from what you are interested in, someone will tell you that it’s the wrong field," Dr. Leong commented.

The study was not designed to determine whether the negative experiences actually discouraged any students from pursuing primary care, according to Dr. Leong. But given that the students found these events troubling, they may have been a contributing or deciding factor for some.

Comments made in focus groups suggested there may be two subsets of students in this regard. "Those who truly believe in primary care will still go into primary care," she explained. "But those who are still sort of on the fence – ‘I like this, but I’m not completely passionate about it’ – I think that’s the vulnerable group that it probably had an effect on."

Discussing the study’s results, Dr. Leong said that "somehow we need to fix this problem so that, first, our students who are truly interested in primary care should be supported and feel comfortable pursuing the field, and second, if we truly are going to work together, we need to be more respectful of each other."

She noted that sharing the study’s results with faculty, residents, and others involved in medical students’ training could go a long way toward eliminating specialty-related negative experiences during clerkships.

"When people are conscious of what they are doing, perhaps they will then correct their behavior," she said. "By calling awareness to these issues, hopefully we can create a nurturing and respectful learning environment."

Dr. Leong reported that she had no conflicts of interest related to the study.