147. does health literacy predict medication adherence in adolescents? exploring teens and the...

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Results: 713 children were enrolled; 54.8% male; 45.6% African American, 46.8% Latino; 70.9% have Medicaid; 65.3% have household income $25,000. Adolescents made up 17.8% (n127) of the CAI population. Adolescents showed similar positive outcomes to chil- dren at 12 months post-enrollment: reductions in hospitalizations (73.7% in adolescents vs. 80.8% in children; both p0.001), ED visits (65.5% vs. 64%; both p0.001), missed school days (40.6% vs. 41.4%; both p0.001), and missed work days (48% vs. 45%; both p0.001). These reductions were not statistically significantly different be- tween the two age groups. The reduction in limitation of physical activity (45.8% vs. 27.6%; p0.099 vs. p0.003) was greater for chil- dren. The risk of limitation of physical activity was two times greater (OR 1.95; 95% CI 1.03 to 3.69) for children compared to adolescents at 12 months post-enrollment. GIS mapping showed the majority of patients live in the poorest neighborhoods of Boston, and the dis- tance from the hospital was not significantly different for the two groups (2.46 miles 2.82 for adolescents, 2.21 miles 1.51 for children; p0.16). The ROI was 1.46 (benefits/program cost) and the SROI is 1.73 including Quality of Life (QOL) measures. Conclusions: CAI reductions in hospitalizations, ED visits, and QOL indicators were similar for adolescents and children. GIS Mapping shows overlap with areas of greatest poverty and no significant differences for adolescents and children. This model of asthma care has generated information to develop policy advocacy efforts to improve services and financing of enhanced asthma care. Sources of Support: This program is supported in part by CDC REACH US #1U58DP001055-01, Healthy Tomorrows #H17MC06705 and #H17MC21564, and LEAH #T71MC00009, MCHB, and HRSA. 147. DOES HEALTH LITERACY PREDICT MEDICATION ADHERENCE IN ADOLESCENTS? EXPLORING TEENS AND THE MEASURES Sadhana Dharmapuri, MD 1 , Dana Best, MD, MPH 2 , Terry Kind, MD, MPH 1 , Lawrence D’Angelo, MD, MPH, FSAHM 1 , Tomas J. Silber, MD, FSAHM 1 . 1 Children’s National Medical Center 2 George Washington University Purpose: There have been few studies of health literacy in adoles- cents; only one, of adolescents with HIV, investigated the association of health literacy with medication adherence. We compared health literacy levels to self-reported medication adherence of adolescent patients of an urban health center. Methods: A convenience sample of adolescents aged 12-21 years was recruited between April-June 2011 at an urban adolescent health center. Adolescents 18 were required to have guardian consent for participation. Health literacy was measured using REALM-TEEN (Da- vis, 2006; validated in 10-19 year olds recruited from schools and pediatric clinics),and medication adherence measured using the Ad- herence to Medications and Refill Scale (ARMS; Kripalani, 2008), a scale validated in low-literacy adults with chronic disease. Persons with ARMS score 21 are designated to have “poor adherence”. STATA 10 was used to analyze the data. The study was IRB-approved. Results: 106 persons completed the study; 80 (75%) had taken at least one medication and completed all ARMS questions; these sub- jects served as the ultimate study population from whom data were analyzed. Mean participant age was 16.3 years (range 12-21, SD 2.59). 90% of participants were African American and 69% female. Mean grade level was 11th grade (range 7-some college, SD 2.38). The mean REALM-TEEN score was 58 (SD 6.9), corresponding to 6th-7th grade health literacy. The mean ARMS score, 21 (SD 4.3), indicated overall poor medication adherence in this sample population.No statistically significant difference was demonstrable in REALM-TEEN scores by gender (p0.19), the presence or absence of chronic illness (p0.87), or having a self reported learning disability (p0.14). Sim- ilarly, there were no differences between ARMS scores by gender (p0.630), age (p0.528), health rating (p0.07) or being chroni- cally ill (p0.07). In addition to these, no correlation was found between ARMS and REALM-TEEN scores (p0.37).Using linear re- gression analysis, higher health rating (p0.045) and older age (p0.001) predicted a 2 point and 1 point improvement, respec- tively, in REALM-TEEN scores, with R20.192. Learning disabilities (p0.006) and better self health ratings (p0.036) predicted a 4 point and 1 point increase in ARMS scores, respectively (R20.132), indicating poorer medication adherence in these subgroups. Conclusions: Overall, adolescents had poor medication adherence as indicated by ARMS scores, independent of health literacy. Health literacy improved with age, better self health ratings, and grade level. Independent of health literacy scores, adolescents with learning dis- abilities had worse medication adherence and health ratings com- pared to those without such limitations. The absence of a correlation between health literacy and medication adherence, while unex- pected, shows that adherence to medication regimens is a complex process that may be explainable on multiple levels. Exploration of this issue should include further validation of medication adherence scales in adolescents as well as examination of other factors effecting medication adherence. Sources of Support: Supported by a Research Discovery Fund Grant, Children’s National Medical Center, Washington, DC. 148. ADOLESCENTS’ PREFERENCES FOR THE USE OF CHAPERONES DURING GENITAL AND BREAST EXAMS Molly Uhlenhake DO 1 , Ashley K. Sherman, MA 2 , Laurie L. Hornberger, MD, MPH 1 . 1 Children’s Mercy Hospital, University of Missouri - Kansas City 2 Children’s Mercy Hospital Purpose: Genital and breast exams are routine components of ado- lescent health care. Chaperoning during exams may help put patients at ease and protect the examiner from accusations of impropriety. Conversely, the presence of a chaperone may add to patient discom- fort by bringing an observer into the room at a sensitive time, or interrupt the flow of the provider’s examination. At the time of study, neither our institution nor most professional organizations had de- finitive guidelines for chaperoning adolescent exams. The purpose of this project was to determine adolescent preferences on the use of chaperones during genital and breast exams. Methods: An anonymous survey was administered to adolescents ages 12-17 presenting to an urban, Midwestern hospital-based ado- lescent clinic. The clinic provides primary care as well as consultation services. Survey questions included demographics and preferences for chaperones given several clinical scenarios. The data was ana- lyzed with simple frequencies and chi-square using SPSS software. The project was IRB approved; parental permission was waived. Results: Surveys were distributed to 200 girls (mean age 16.1 years) and 194 boys (mean age 15.4 years). Most (69%) were African-American, 13% were Caucasian, and 12% were Hispanic. Most (78%) had had previous visits to the clinic. Most girls (62%) had had a previous breast exam and 74% had had a genital exam. Two thirds of boys had had a previous genital exam. Girls consistently preferred a chaperone more frequently than boys. Only 1/3 of boys preferred a chaperone with any given scenario; girls were usually equally split between those preferring and those declining a chaperone. Multiple factors were considered as possible influences on the preference for a S84 Poster Abstracts / 50 (2012) S16 –S95

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Page 1: 147. Does Health Literacy Predict Medication Adherence in Adolescents? Exploring Teens and the Measures

Results: 713 children were enrolled; 54.8% male; 45.6% AfricanAmerican, 46.8% Latino; 70.9% haveMedicaid; 65.3% have householdincome �$25,000. Adolescents made up 17.8% (n�127) of the CAIpopulation. Adolescents showed similar positive outcomes to chil-dren at 12 months post-enrollment: reductions in hospitalizations(73.7% in adolescents vs. 80.8% in children; both p�0.001), ED visits(65.5% vs. 64%; both p�0.001), missed school days (40.6% vs. 41.4%;both p�0.001), and missed work days (48% vs. 45%; both p�0.001).These reductions were not statistically significantly different be-tween the two age groups. The reduction in limitation of physicalactivity (45.8% vs. 27.6%; p�0.099 vs. p�0.003) was greater for chil-dren. The risk of limitation of physical activity was two times greater(OR 1.95; 95% CI 1.03 to 3.69) for children compared to adolescents at12 months post-enrollment. GIS mapping showed the majority ofpatients live in the poorest neighborhoods of Boston, and the dis-tance from the hospital was not significantly different for the twogroups (2.46 miles � 2.82 for adolescents, 2.21 miles � 1.51 forchildren; p�0.16). The ROI was 1.46 (benefits/program cost) and theSROI is 1.73 including Quality of Life (QOL) measures.Conclusions: CAI reductions in hospitalizations, ED visits, and QOLindicators were similar for adolescents and children. GIS Mappingshows overlap with areas of greatest poverty and no significantdifferences for adolescents and children. This model of asthma carehas generated information to develop policy advocacy efforts toimprove services and financing of enhanced asthma care.Sources of Support: This program is supported in part by CDCREACH US #1U58DP001055-01, Healthy Tomorrows #H17MC06705and #H17MC21564, and LEAH #T71MC00009, MCHB, and HRSA.

147.

DOES HEALTH LITERACY PREDICT MEDICATION ADHERENCE INADOLESCENTS? EXPLORING TEENS AND THE MEASURESSadhana Dharmapuri, MD1, Dana Best, MD, MPH2, Terry Kind, MD,MPH1, Lawrence D’Angelo, MD, MPH, FSAHM1, Tomas J. Silber, MD,FSAHM1.1Children’s National Medical Center 2George Washington University

Purpose: There have been few studies of health literacy in adoles-cents; only one, of adolescents with HIV, investigated the associationof health literacy with medication adherence. We compared healthliteracy levels to self-reported medication adherence of adolescentpatients of an urban health center.Methods: A convenience sample of adolescents aged 12-21 yearswas recruited betweenApril-June 2011 at anurban adolescent healthcenter. Adolescents �18 were required to have guardian consent forparticipation. Health literacy wasmeasured using REALM-TEEN (Da-vis, 2006; validated in 10-19 year olds recruited from schools andpediatric clinics),and medication adherence measured using the Ad-herence to Medications and Refill Scale (ARMS; Kripalani, 2008), ascale validated in low-literacy adults with chronic disease. Personswith ARMS score � 21 are designated to have “poor adherence”.STATA 10was used to analyze the data. The studywas IRB-approved.Results: 106 persons completed the study; 80 (75%) had taken atleast one medication and completed all ARMS questions; these sub-jects served as the ultimate study population from whom data wereanalyzed. Mean participant age was 16.3 years (range 12-21, SD2.59). 90% of participants were African American and 69% female.Mean grade levelwas 11th grade (range 7-some college, SD2.38). Themean REALM-TEEN score was 58 (SD 6.9), corresponding to 6th-7thgrade health literacy. The mean ARMS score, 21 (SD 4.3), indicatedoverall poor medication adherence in this sample population.Nostatistically significant difference was demonstrable in REALM-TEEN

scores by gender (p�0.19), the presence or absence of chronic illness(p�0.87), or having a self reported learning disability (p�0.14). Sim-ilarly, there were no differences between ARMS scores by gender(p�0.630), age (p�0.528), health rating (p�0.07) or being chroni-cally ill (p�0.07). In addition to these, no correlation was foundbetween ARMS and REALM-TEEN scores (p�0.37).Using linear re-gression analysis, higher health rating (p�0.045) and older age(p�0.001) predicted a 2 point and 1 point improvement, respec-tively, in REALM-TEEN scores, with R2�0.192. Learning disabilities(p�0.006) and better self health ratings (p�0.036) predicted a 4point and 1 point increase in ARMS scores, respectively (R2�0.132),indicating poorer medication adherence in these subgroups.Conclusions: Overall, adolescents had poor medication adherenceas indicated by ARMS scores, independent of health literacy. Healthliteracy improvedwith age, better self health ratings, and grade level.Independent of health literacy scores, adolescents with learning dis-abilities had worse medication adherence and health ratings com-pared to those without such limitations. The absence of a correlationbetween health literacy and medication adherence, while unex-pected, shows that adherence to medication regimens is a complexprocess that may be explainable on multiple levels. Exploration ofthis issue should include further validation of medication adherencescales in adolescents aswell as examination of other factors effectingmedication adherence.Sources of Support: Supported by a Research Discovery FundGrant, Children’s National Medical Center, Washington, DC.

148.

ADOLESCENTS’ PREFERENCES FOR THE USE OF CHAPERONESDURING GENITAL AND BREAST EXAMSMolly Uhlenhake DO1, Ashley K. Sherman, MA2, Laurie L. Hornberger,MD, MPH1.1Children’s Mercy Hospital, University of Missouri - Kansas City2Children’s Mercy Hospital

Purpose: Genital and breast exams are routine components of ado-lescent health care. Chaperoning during examsmay help put patientsat ease and protect the examiner from accusations of impropriety.Conversely, the presence of a chaperone may add to patient discom-fort by bringing an observer into the room at a sensitive time, orinterrupt the flowof the provider’s examination. At the time of study,neither our institution nor most professional organizations had de-finitive guidelines for chaperoning adolescent exams. The purpose ofthis project was to determine adolescent preferences on the use ofchaperones during genital and breast exams.Methods: An anonymous survey was administered to adolescentsages 12-17 presenting to an urban, Midwestern hospital-based ado-lescent clinic. The clinic provides primary care aswell as consultationservices. Survey questions included demographics and preferencesfor chaperones given several clinical scenarios. The data was ana-lyzed with simple frequencies and chi-square using SPSS software.The project was IRB approved; parental permission was waived.Results: Surveys were distributed to 200 girls (mean age 16.1years) and 194 boys (mean age 15.4 years). Most (69%) wereAfrican-American, 13%were Caucasian, and 12%were Hispanic. Most(78%) had had previous visits to the clinic. Most girls (62%) had had aprevious breast exam and 74% had had a genital exam. Two thirds ofboys had had a previous genital exam. Girls consistently preferred achaperone more frequently than boys. Only 1/3 of boys preferred achaperone with any given scenario; girls were usually equally splitbetween those preferring and those declining a chaperone. Multiplefactorswere considered as possible influences on the preference for a

S84 Poster Abstracts / 50 (2012) S16–S95