Jennifer Carlson

All Publications

• Contraception for Adolescents and Young Adults in the Inpatient Setting: The Providers' Perspective. Hospital pediatrics Goldstein, R. L., Carlson, J. L., Halpern-Felsher, B. 2018

  Abstract

  To assess pediatric providers' attitudes and barriers to initiating a contraceptive method in the inpatient setting.Pediatric attending physicians and trainees from 5 academic institutions were surveyed about contraceptive prescribing practices, attitudes, and potential barriers to initiating contraception in the inpatient setting.In 2016, 271 pediatric providers (34.0% were attending physicians, 18.1% fellows, and 47.9% residents) completed the survey; the response rate was 19.2%. Most participants practiced in both inpatient and outpatient settings (95.7% and 85.0%, respectively). More providers felt confident screening for sexual activity among young adults as compared with adolescents (71.9% vs 65.6%). The same was true for discussing contraceptive options (44.0% vs 38.8%, respectively). Inpatient providers reported seeing adolescents and young adults privately, discussing confidentiality, and asking about sex less than half of the time. More than 80% of providers agreed that it would be appropriate to initiate a contraceptive method for inpatients; 35.8% had done so, and 85.2% indicated that having additional consultation would increase initiation of a contraceptive method in the hospital (88.1% felt similarly for long-active reversible contraception methods). General barriers to initiating contraception included insufficient training, insufficient exposure to adolescents and young adults to maintain skills, and lack of time. Barriers specific to the inpatient setting included concerns about follow-up, confidentiality, and interference with the treatment plan.Initiation of a contraceptive method in the inpatient setting is acceptable to providers. In our findings, it is suggested that strategies are needed to enhance provision of these services by addressing confidentiality concerns and educating providers.

  View details for DOI 10.1542/hpeds.2017-0167

  View details for PubMedID 29496729

• Characterization and correlates of exercise among adolescents with anorexia nervosa and bulimia nervosa INTERNATIONAL JOURNAL OF EATING DISORDERS Nagata, J. M., Carlson, J. L., Kao, J. M., Golden, N. H., Murray, S. B., Peebles, R. 2017; 50 (12): 1394–1403

  Abstract

  To characterize exercise behaviors among adolescents with anorexia nervosa (AN), atypical AN, or bulimia nervosa (BN), and determine associations between exercise and medical risk.Cross-sectional electronic medical records of all patients evaluated by the Eating Disorder Program at Stanford between January 1997 and February 2011 were retrospectively reviewed.1,083 subjects (961 females, 122 males; mean age 15.6) met eligibility criteria. Most patients (89.7%) reported exercise (mean 7.0 h per week over mean 5.4 days per week) prior to presentation. Running (49.9%), calisthenics (40.7%), walking (23.4%), soccer (20.9%), and swimming (18.2%) were the most common exercises; a majority (60.6%) reported team sport participation. Males were less likely to report team exercise (p = .005). Bradycardia (heart rate <50) at presentation was associated with team sport participation (adjusted odds ratio [AOR] 1.66, 95% confidence interval [CI] 1.02-2.72) and hours of exercise per week (AOR 1.05, 95% CI 1.02-1.09), controlling for diagnosis, sex, age, duration of illness, rate of weight loss, and percent median body mass index (%mBMI).Adolescents with AN, atypical AN, and BN reported high levels of exercise. Females reported more team sport participation. Greater exercise frequency and team sport participation were associated with bradycardia. Further studies assessing the relationship between exercise and bradycardia may help inform the medical management of adolescents with these eating disorders who are more physically active.

  View details for DOI 10.1002/eat.22796

  View details for Web of Science ID 000417166300007

  View details for PubMedID 29112280

  View details for PubMedCentralID PMC5761671

• Type of Sports Participation Modulates Risk For Low BMD in Athletes With Female Athlete Triad Tenforde, A., Sainani, K., Carlson, J., Golden, N., Fredericson, M. WILEY. 2017: S102

  View details for Web of Science ID 000418869201110

• Effect of a Prior History of Overweight on Return of Menses in Adolescents With Eating Disorders. journal of adolescent health Seetharaman, S., Golden, N. H., Halpern-Felsher, B., Peebles, R., Payne, A., Carlson, J. L. 2017; 60 (4): 469-471

  Abstract

  The purpose of this study was to determine whether a history of overweight, weight suppression, and weight gain during treatment have an effect on return of menses (ROM) in adolescents with eating disorders (EDs).Retrospective chart review of female adolescents presenting to an ED program from January 2007 to June 2009.One hundred sixty-three participants (mean age, 16.6 ± 2.1 years) met eligibility criteria. The mean median body mass index percent at ROM for those previously overweight was 106.1 ± 11.7 versus 94.2 ± 8.9 for those not previously overweight (p < .001). Both groups needed to gain weight for ROM. Greater weight suppression (odds ratio, 0.90; 95% confidence interval, 0.84-0.98; p = .013) was associated with lower likelihood of ROM, and greater weight gain during treatment (odds ratio, 1.20; 95% confidence interval, 1.07-1.36; p = .002) was associated with higher likelihood of ROM in those not previously overweight.Previously overweight amenorrheic patients with EDs needed to be at a higher median body mass index percent for ROM compared to those who were not previously overweight.

  View details for DOI 10.1016/j.jadohealth.2016.10.019

  View details for PubMedID 27998699

• Assessment of sex differences in bone deficits among adolescents with anorexia nervosa INTERNATIONAL JOURNAL OF EATING DISORDERS Nagata, J. M., Golden, N. H., Peebles, R., Long, J., Leonard, M. B., Chang, A. O., Carlson, J. L. 2017; 50 (4): 352-358

  Abstract

  The objective of this study was to compare sex differences in bone deficits among adolescents with anorexia nervosa (AN) and to identify other correlates of bone health.Electronic medical records of all patients 9-20 years of age with a DSM-5 diagnosis of AN who were evaluated by the eating disorders program at Stanford with dual-energy X-ray absorptiometry (DXA) between March 1997 and February 2011 were retrospectively reviewed. Whole body bone mineral content Z-scores and bone mineral density (BMD) Z-scores at multiple sites were recorded using the Bone Mineral Density in Childhood Study (BMDCS) reference data.A total of 25 males and 253 females with AN were included, with median age 15 years (interquartile range [IQR] 14-17) and median duration of illness 9 months (IQR 5-13). Using linear regression analyses, no significant sex differences in bone deficits were found at the lumbar spine, total hip, femoral neck, or whole body when controlling for age, %mBMI, and duration of illness. Lower %mBMI was significantly associated with bone deficits at all sites in adjusted models.This is the first study to evaluate sex differences in bone health among adolescents with AN, using novel DSM-5 criteria for AN and robust BMDCS reference data. We find no significant sex differences in bone deficits among adolescents with AN except for a higher proportion of females with femoral neck BMD Z-scores <-1. Degree of malnutrition was correlated with bone deficits at all sites. © 2016 Wiley Periodicals, Inc. (Int J Eat Disord 2016).

  View details for DOI 10.1002/eat.22626

  View details for Web of Science ID 000398841500004

• Effect of a Prior History of Overweight on Return of Menses in Adolescents With Eating Disorders JOURNAL OF ADOLESCENT HEALTH Seetharaman, S., Golden, N. H., Halpern-Felsher, B., Peebles, R., Payne, A., Carlson, J. L. 2017; 60 (4): 469-471

  Abstract

  The purpose of this study was to determine whether a history of overweight, weight suppression, and weight gain during treatment have an effect on return of menses (ROM) in adolescents with eating disorders (EDs).Retrospective chart review of female adolescents presenting to an ED program from January 2007 to June 2009.One hundred sixty-three participants (mean age, 16.6 ± 2.1 years) met eligibility criteria. The mean median body mass index percent at ROM for those previously overweight was 106.1 ± 11.7 versus 94.2 ± 8.9 for those not previously overweight (p < .001). Both groups needed to gain weight for ROM. Greater weight suppression (odds ratio, 0.90; 95% confidence interval, 0.84-0.98; p = .013) was associated with lower likelihood of ROM, and greater weight gain during treatment (odds ratio, 1.20; 95% confidence interval, 1.07-1.36; p = .002) was associated with higher likelihood of ROM in those not previously overweight.Previously overweight amenorrheic patients with EDs needed to be at a higher median body mass index percent for ROM compared to those who were not previously overweight.

  View details for DOI 10.1016/j.jadohealth.2016.10.019

  View details for Web of Science ID 000401108300017

• Association of the Female Athlete Triad Risk Assessment Stratification to the Development of Bone Stress Injuries in Collegiate Athletes. American journal of sports medicine Tenforde, A. S., Carlson, J. L., Chang, A., Sainani, K. L., Shultz, R., Kim, J. H., Cutti, P., Golden, N. H., Fredericson, M. 2017; 45 (2): 302-310

  Abstract

  The female athlete triad (referred to as the triad) contributes to adverse health outcomes, including bone stress injuries (BSIs), in female athletes. Guidelines were published in 2014 for clinical management of athletes affected by the triad.This study aimed to (1) classify athletes from a collegiate population of 16 sports into low-, moderate-, and high-risk categories using the Female Athlete Triad Cumulative Risk Assessment score and (2) evaluate the predictive value of the risk categories for subsequent BSIs.Cohort study; Level of evidence, 3.A total of 323 athletes completed both electronic preparticipation physical examination and dual-energy x-ray absorptiometry scans. Of these, 239 athletes with known oligomenorrhea/amenorrhea status were assigned to a low-, moderate-, or high-risk category. Chart review was used to identify athletes who sustained a subsequent BSI during collegiate sports participation; the injury required a physician diagnosis and imaging confirmation.Of 239 athletes, 61 (25.5%) were classified into moderate-risk and 9 (3.8%) into high-risk categories. Sports with the highest proportion of athletes assigned to the moderate- and high-risk categories included gymnastics (56.3%), lacrosse (50%), cross-country (48.9%), swimming/diving (42.9%), sailing (33%), and volleyball (33%). Twenty-five athletes (10.5%) assigned to risk categories sustained ≥1 BSI. Cross-country runners contributed the majority of BSIs (16; 64%). After adjusting for age and participation in cross-country, we found that moderate-risk athletes were twice as likely as low-risk athletes to sustain a BSI (risk ratio [RR], 2.6; 95% confidence interval [95% CI], 1.3-5.5) and high-risk athletes were nearly 4 times as likely (RR, 3.8; 95% CI, 1.8-8.0). When examining the 6 individual components of the triad risk assessment score, both the oligomenorrhea/amenorrhea score ( P = .0069) and the prior stress fracture/reaction score ( P = .0315) were identified as independent predictors for subsequent BSIs (after adjusting for cross-country participation and age).Using published guidelines, 29% of female collegiate athletes in this study were classified into moderate- or high-risk categories using the Female Athlete Triad Cumulative Risk Assessment Score. Moderate- and high-risk athletes were more likely to subsequently sustain a BSI; most BSIs were sustained by cross-country runners.

  View details for DOI 10.1177/0363546516676262

  View details for PubMedID 28038316

• Assessment of Sex Differences in Body Composition Among Adolescents With Anorexia Nervosa. journal of adolescent health Nagata, J. M., Golden, N. H., Peebles, R., Long, J., Murray, S. B., Leonard, M. B., Carlson, J. L. 2017

  Abstract

  To compare deficits in fat mass (FM) and lean body mass (LM) among male and female adolescents with anorexia nervosa (AN) and to identify other covariates associated with body composition.We retrospectively reviewed electronic medical records of all subjects aged 9-20 years with a Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition diagnosis of AN and dual-energy x-ray absorptiometry scans after initial evaluation at Stanford between March 1997 and February 2011. From the dual-energy x-ray absorptiometry scans, LM and FM results were converted to age-, height-, sex-, and race-specific Z-scores for age using the National Health and Nutrition Examination Survey reference data.A total of 16 boys and 119 girls with AN met eligibility criteria. The FM Z-score in girls with AN (-3.24 ± 1.50) was significantly lower than that in boys with AN (-2.41 ± .96) in unadjusted models (p = .007). LM was reduced in both girls and boys with AN, but there was no significant sex difference in LM Z-scores. In multivariate models, lower percentage median body mass index was significantly associated with lower FM Z-scores (β = .08, p < .0001) and lower LM Z-score (β = .03, p = .0002), whereas lower whole body bone mineral content Z-score was significantly associated with lower LM Z-score (β = .21, p = .0006).FM deficits in girls were significantly greater than those in boys with AN in unadjusted models; however, the degree of malnutrition appeared to be the primary factor accounting for this difference. There were no significant sex differences in FM or LM in adjusted models.

  View details for DOI 10.1016/j.jadohealth.2016.11.005

  View details for PubMedID 28087266

• Assessment of sex differences in bone deficits among adolescents with anorexia nervosa. International journal of eating disorders Nagata, J. M., Golden, N. H., Peebles, R., Long, J., Leonard, M. B., Chang, A. O., Carlson, J. L. 2016

  Abstract

  The objective of this study was to compare sex differences in bone deficits among adolescents with anorexia nervosa (AN) and to identify other correlates of bone health.Electronic medical records of all patients 9-20 years of age with a DSM-5 diagnosis of AN who were evaluated by the eating disorders program at Stanford with dual-energy X-ray absorptiometry (DXA) between March 1997 and February 2011 were retrospectively reviewed. Whole body bone mineral content Z-scores and bone mineral density (BMD) Z-scores at multiple sites were recorded using the Bone Mineral Density in Childhood Study (BMDCS) reference data.A total of 25 males and 253 females with AN were included, with median age 15 years (interquartile range [IQR] 14-17) and median duration of illness 9 months (IQR 5-13). Using linear regression analyses, no significant sex differences in bone deficits were found at the lumbar spine, total hip, femoral neck, or whole body when controlling for age, %mBMI, and duration of illness. Lower %mBMI was significantly associated with bone deficits at all sites in adjusted models.This is the first study to evaluate sex differences in bone health among adolescents with AN, using novel DSM-5 criteria for AN and robust BMDCS reference data. We find no significant sex differences in bone deficits among adolescents with AN except for a higher proportion of females with femoral neck BMD Z-scores <-1. Degree of malnutrition was correlated with bone deficits at all sites. © 2016 Wiley Periodicals, Inc. (Int J Eat Disord 2016).

  View details for DOI 10.1002/eat.22626

  View details for PubMedID 27611361

• Use of Psychopharmacologic Medications in Adolescents With Restrictive Eating Disorders: Analysis of Data From the National Eating Disorder Quality Improvement Collaborative. journal of adolescent health Monge, M. C., Forman, S. F., McKenzie, N. M., Rosen, D. S., Mammel, K. A., Callahan, S. T., Hehn, R., Rome, E. S., Kapphahn, C. J., Carlson, J. L., Romano, M. E., Malizio, J. B., Bravender, T. D., Sigel, E. J., Rouse, M. R., Graham, D. A., Jay, M. S., Hergenroeder, A. C., Fisher, M. M., Golden, N. H., Woods, E. R. 2015; 57 (1): 66-72

  Abstract

  Psychopharmacologic medications are often prescribed to patients with restrictive eating disorders (EDs), and little is known about the frequency of use in adolescents. We examined the use of psychopharmacologic medications in adolescents referred for treatment of restrictive ED, potential factors associated with their use, and reported psychiatric comorbidities.Retrospective data from the initial and 1-year visits were collected for patients referred for evaluation of restrictive ED at 12 adolescent-based ED programs during 2010 (Group 1), including diagnosis, demographic information, body mass index, prior treatment modalities, and psychopharmacologic medications. Additional data regarding patients' comorbid psychiatric conditions and classes of psychopharmacologic medications were obtained from six sites (Group 2).Overall, 635 patients met inclusion criteria and 359 had 1-year follow-up (Group 1). At intake, 20.4% of Group 1 was taking psychopharmacologic medication and 58.7% at 1 year (p ≤ .0001). White, non-Hispanic race (p = .020), and prior higher level of care (p < .0001) were positively associated with medication use at 1 year. Among Group 2 (n = 256), serotonin reuptake inhibitors/serotonin-norepinephrine reuptake inhibitors use was most common, and 62.6% had a reported psychiatric comorbidity. Presence of any psychiatric comorbidity was highly associated with medication use; odds ratio, 10.0 (5.6, 18.0).Adolescents with restrictive ED treated at referral centers have high rates of reported psychopharmacologic medication use and psychiatric comorbidity. As more than half of this referral population were reported to be taking medication, continued investigation is warranted to ensure the desired outcomes of the medications are being met.

  View details for DOI 10.1016/j.jadohealth.2015.03.021

  View details for PubMedID 26095410

• The Female Athlete Triad The Female Patient Carlson JL, Golden NH 2012; 37 (6): 16-24
• Obstacles in the Optimization of Bone Health Outcomes in the Female Athlete Triad SPORTS MEDICINE Ducher, G., Turner, A. I., Kukuljan, S., Pantano, K. J., Carlson, J. L., Williams, N. L., De Souza, M. J. 2011; 41 (7): 587-607

  Abstract

  Maintaining low body weight for the sake of performance and aesthetic purposes is a common feature among young girls and women who exercise on a regular basis, including elite, college and high-school athletes, members of fitness centres, and recreational exercisers. High energy expenditure without adequate compensation in energy intake leads to an energy deficiency, which may ultimately affect reproductive function and bone health. The combination of low energy availability, menstrual disturbances and low bone mineral density is referred to as the 'female athlete triad'. Not all athletes seek medical assistance in response to the absence of menstruation for 3 or more months as some believe that long-term amenorrhoea is not harmful. Indeed, many women may not seek medical attention until they sustain a stress fracture. This review investigates current issues, controversies and strategies in the clinical management of bone health concerns related to the female athlete triad. Current recommendations focus on either increasing energy intake or decreasing energy expenditure, as this approach remains the most efficient strategy to prevent further bone health complications. However, convincing the athlete to increase energy availability can be extremely challenging. Oral contraceptive therapy seems to be a common strategy chosen by many physicians to address bone health issues in young women with amenorrhoea, although there is little evidence that this strategy improves bone mineral density in this population. Assessment of bone health itself is difficult due to the limitations of dual-energy X-ray absorptiometry (DXA) to estimate bone strength. Understanding how bone strength is affected by low energy availability, weight gain and resumption of menses requires further investigations using 3-dimensional bone imaging techniques in order to improve the clinical management of the female athlete triad.

  View details for Web of Science ID 000292941700004

  View details for PubMedID 21688870

• Using OCs in teen eating disorders: What are we treating? Contemporary OB/Gyn Carlson, J., Golden, NH 2009; 54 (2): 39-46
• The pathophysiology of amenorrhea in the adolescent. Ann N Y Acad Sci Golden, N., Carlson, JL 2008; 1135: 163-178
• Clinician practices for the management of amenorrhea in the adolescent and young adult athlete JOURNAL OF ADOLESCENT HEALTH Carlson, J. L., Curtis, M., Halpern-Felsher, B. 2007; 40 (4): 362-365

  Abstract

  This study sought to describe clinician practices for the management of amenorrhea in the adolescent and young adult athlete. Clinicians adhered to certain guidelines but did not have a uniform "standard of care" for amenorrheic athletes. Almost 80% of clinicians reported insufficient guidelines for the management of this population.

  View details for DOI 10.1016/j.jadohealth.2006.10.017

  View details for Web of Science ID 000245567900011

  View details for PubMedID 17367734

• Service utilization and the life cycle of youth homelessness JOURNAL OF ADOLESCENT HEALTH Carlson, J. L., Sugano, E., MILLSTEIN, S. G., Auerswald, C. L. 2006; 38 (5): 624-627

  Abstract

  The study sought to describe service utilization patterns of homeless youth based on their life cycle stage. Ninety-nine percent of participants accessed services. Medical service utilization was highest among youth who were attempting to leave the street. Drug-related service utilization was lowest among youth most entrenched in street life.

  View details for DOI 10.1016/j.jadohealth.2005.10.009

  View details for Web of Science ID 000237215500024

  View details for PubMedID 16635781

• Childhood and adolescent sexuality PEDIATRIC CLINICS OF NORTH AMERICA Duncan, P., Dixon, R. R., Carlson, J. 2003; 50 (4): 765-?

  Abstract

  Sexuality is an important aspect of the lives of all human beings, including children and adolescents. The clinician can provide important guidance to pediatric patients and their parents regarding the healthy development of sexuality. Counseling techniques are important, including the "helping skill" model, in which the clinician can state the problem, identify options for the patient, identify consequences of each option, help the patient make a plan, and develop a plan for check back and follow-up.

  View details for DOI 10.1016/S0031-3955(03)00068-3

  View details for Web of Science ID 000185077000003

  View details for PubMedID 12964693