frames. However, less reliable coefficients were obtained in a part-ner-specific context.Sources of Support: None.

56.

SURVEYING ADOLESCENTS ENROLLED IN

A REGIONAL HEALTH PLAN: MAIL & PHONE FOLLOW-

UP–WHAT WORKS AT WHAT COST?

Julie Richards, MPH, Kym Ahrens, MD, MPH, Paula Sandler, BA,

and Laura Richardson, MD, MPH. Group Health Center for Health

Studies, University of Washington Department of Pediatrics, Children’s

Hospital and Regional Medical Center, Seattle, WA

Purpose: To describe the differential completion rates and associ-ated costs with varying methods for a mailed self-administeredhealth survey and telephone follow-up among adolescents enrolledin a regional managed care organization.Methods: A random sample of 4,000 adolescent health plan enroll-ees (ages 13-17 years) were invited to participate in a 10-item surveyexamining exercise, sedentary behaviors, and depressive symp-toms. Mailings were directed at parents and included an invitationletter, a consent form, survey, and a $2 pre-incentive for the youth.Parents were instructed to complete the consent form and give thesurvey to their child to complete and return. Several techniqueswere used in order to boost response rates: (1) a follow-up mailing(2) varying the appearance of the survey (color tri-fold or black &white single sheet), (3) reminder phone calls to parents to requestsurvey return, and (4) phone calls to obtain parent and child consentand administer the survey. We evaluated the impact and associatedcosts with these techniques.Results: Seven hundred eighty-three (20%) of invited subjects com-pleted the first mailed survey and 2% refused. A total of 521 (17%)completed the second mailed survey increasing the overall re-sponse rate to 33%. Survey formatting was varied among partici-pants: 28% received the color tri-fold for both mailings, 35%received the tri-fold followed by the plain black & white, and38% received the plain black & white for both mailings. The com-pletion rate was significantly higher (p ¼ 0.007) for respondentswho received only the plain survey (38%) than those receivingonly the color (29%). After the mailed surveys were sent, 65% ofnon-responders (n ¼ 1,600) received reminder calls increasingoverall response to 41%. Although 68% who received a remindercall agreed to participate, only 18% returned a completed survey.Study methods were changed to obtain consent and survey re-sponses via phone from the remaining 848 youth who had notyet received a reminder call, and 493 youth whose parents statedintent to participate during reminder calls but did not. Of these,52% consented and completed the survey via phone, boosting thefinal overall completion rate to 61%. The cost of survey administra-tion (presented per returned completed survey) was $24 for the firstmailing, $16 for the second mailing, $34 for reminder calls, and $60per phone survey.Conclusions: In this general population sample of adolescents,the overall response rate to mailings combined with remindercalls was low and incremental costs were high with decreasingyield at each step although some low cost techniques such asthe use of plain survey formatting may be helpful. Althoughthe sequential nature of survey methods used in this study con-found direct cost comparison, given the additional costs and com-plexity of incremental efforts to boost response to mail surveys, itmay be more cost-effective to conduct phone surveys among com-munity samples of adolescents.Sources of Support: NIH/NIMH 1 K23MH069814, UW RoyaltyResearch Fund, Children’s Hospital Steering Committee Award,and Group Health Community Foundation.

SESSION II (THURSDAY): OBESITY

57.

ISOLATED LOW HDL CHOLESTEROL EMERGES AS THE

MOST COMMON LIPID ABNORMALITY AMONG OBESE

ADOLESCENTS

Zeev Harel, MD, Suzanne Riggs, MD, Rosalind Vaz, MD,

Patricia Flanagan, MD, and Dalia Harel, MSc. Division of Adolescent

Medicine, Hasbro Children’s Hospital and Brown University,

Providence, RI

Background: While until recently, selective screening for lipid dis-orders in adolescents has been based mainly on family history (pa-rental hypercholesterolemia or a positive family history ofpremature cardiovascular disease) many adolescents are currentlybeing screened because of obesity. However, little is known aboutthe prevalence and the different types of lipid abnormalities amongobese adolescents.Methods: To screen for lipid abnormalities, a 12-hour fasting lipidprofile was obtained from otherwise healthy obese adolescents(10 – 25 years, BMI> 95th percentile) attending an urban adolescentclinic. A retrospective chart review of these obese adolescents wasconducted.Results: Sixty-seven adolescents (47 boys, 20 girls, 56% Hispanic,27% African-American, 17% White) have been screened. The fol-lowing table delineates the results of this screen.

Conclusions: About 90% of obese adolescents have lipid abnormal-ities. Isolated low HDL cholesterol emerges as the most commonlipid abnormality among this group. Screening for total cholesterolonly would not detect this abnormality.Sources of Support: None.

Lipid

Profile

N (%) Age

(Years ±

SD)

BMI

(Kg/m2)

(M ± SD)

Total

Chol

(MG/DL)

(M ± SD)

HDL

(MG/DL)

(M ± SD)

LDL

(MG/DL)

(M ± SD)

TRIG

(MG/DL)

(M ± SD)

Normal 7 (10) 17 6 2 39 6 7 145 6 25 52 6 13 81 6 16 58 6 26

(Y) HDL 31 (46) 16 6 3 35 6 6 136 6 21 32 6 5 88 6 18 81 6 28

([) LDL 12 (18) 15 6 2 35 6 5 201 6 27 47 6 6 141 6 25 69 6 24

([) LDL,

(Y) HDL

6 (9) 16 6 1 35 6 6 183 6 15 34 6 6 128 6 14 105 6 28

([) TRIG,

(Y) HDL

4 (6) 16 6 1 43 6 9 173 6 17 29 6 4 98 6 8 229 6 63

([) TRIG 3 (5) 16 6 2 33 6 2 164 6 34 45 6 4 73 6 30 231 6 34

([) LDL, (Y)

HDL,

([) TRIG

4 (6) 18 6 3 37 6 10 206 6 12 30 6 2 133 6 7 215 6 26

BMI¼Body mass index; HDL¼High-density lipoprotein; LDL¼Low-density lipoprotein; Chol ¼ Cholesterol; TRIG ¼ Triglycer-ides; N ¼ number; M ¼ Mean; SD ¼ Standard deviation.

Abstracts / 44 (2009) S14–S47 S37

58.

ADOLESCENT OBESITY EDUCATION VIA A MOBILE

HEALTH PROGRAM

Denise Edwards, MD, Christy Anderson, MD,

Elizabeth Rommel, MD, Jeannette Fleischer, ARNP, and

Lynn Ringenberg, MD. University of South Florida, Tampa, FL

Purpose: A 2005 study on overweight adolescents in the UnitedStates reports that 1 in 7 children and adolescents are overweight(14.2%). During the 2005-2006 academic year, the HillsboroughCounty School District had 15.3% of students between 85-95%BMI measurements, while an additional 16.2% had BMIs greater

psychologist, and the exercise physiologist. The dietitian coveredportion control, stop light plan, high fiber diet, and label reading.The psychologist covered mindfulness, hunger scale; helpful dis-tractions, relapse prevention, and bully management. The exercisephysiologist covered aerobic exercise, strength training, and flexi-bility. The pediatrician attended one session to discuss the medicalcomplications of obesity. Outcome measures included changes inthe following parameters: BMI; chest, waist, hip and right thighgirth; length of sit and back scratch reach; number of squats,push-ups, and crunches. Change in these outcome measures was as-sessed using the Wilcoxon signed rank test, and age groups werecompared on these changes using the Wilcoxon rank sum test. Alltests were two-tailed and performed at a significance level of 0.05.SAS 9.1 software was used for all analyses.Results: A total of 10 pilot groups were conducted. Completion ofthe program was defined as a visit between 9-11 weeks after the firstvisit. A total of 83 participants were enrolled in the program and 64completed the program. BMI, weight, chest girth, waist girth, hipgirth, and right thigh girth were significantly lower at the end ofthe program. Height, sit reach, right back scratch reach, squats,push-ups, and crunches were significantly higher. The medianchanges in BMI and weight were -1.0 units and -4.0 pounds, respec-tively (p< 0.001 for both). Children and teenagers did not differ sig-nificantly on the change in these outcomes.Conclusions: The program had a significantly positive effect onBMI, weight, and almost all other physical measurements of fitnessfrom baseline to the end of the program. There was no evidence thatthis effect differed between age groups. Further study is indicated todetermine if these results are sustainable over time.Sources of Support: None.

60.

WAIST CIRCUMFERENCE TO SCREEN FOR

CARDIOVASCULAR DISEASE RISK FACTORS IN A

RACIALLY DIVERSE ADOLESCENT POPULATION

Sharonda Alston Taylor, MD, and Albert C. Hergenroeder, MD.

Department of Pediatrics, Baylor College of Medicine, Houston, TX

Purpose: To isolate waist circumference (WC) measurement cut-offs that will identify male and female adolescents with central ad-iposity who are at risk for atherosclerotic cardiovascular disease

Abstracts / 44 (2009) S14–S47S38

than 95%. The Healthy Weight Program was designed to screen,monitor, and educate students about obesity in the school environ-ment by means of a mobile health program.Methods: The USF Pediatric Mobile Health Program/RonaldMcDonald Care Mobile (RMCM), a mobile medical office, visited11 underserved (Title I) schools in Hillsborough County monthlyfor the 5 months of this study. School nurses and teachers referredprospective students identified as overweight, obese, or in need ofhealthy lifestyle counseling to the Healthy Weight Program on theRMCM. Each student completed a health and nutrition surveyand received an initial comprehensive physical examination. Theirheight, weight, body mass index (BMI), and blood pressure were re-corded each month during school visits. Intervention consisted ofa pedometer and nutritional information provided on the initial stu-dent visit, with written nutritional and exercise information fur-nished on subsequent visits. During each follow-up visit, studentsprovided feedback on their individual diet and exercise habits.Students with complications were referred to a multidisciplinaryobesity clinic for further evaluation and treatment.Results: One hundred nine students enrolled in the program, withan average of 14.1 years of age. African American students madeup 49% of the students, followed by 29% Hispanic, and 19% White.The average BMI was 35.5, with 96% of students being > 95th per-centile and 30% of students with a systolic blood pressure > 95th

percentile. Eighty-eight students had voluntary follow-up visitsduring the study. The average follow-up was 3 months (range, 1-5). Of the students with multiple visits, the BMI increased in 54 stu-dents, remained the same in 1 student, and decreased in 33 stu-dents. Overall, the BMI increased by an average 0.39 kg/m2.Survey information found an impressive discrepancy betweenknowledge of recommended daily activity and actual exercisehabits. Students had poor nutritional knowledge and had actualdeficits in consumption of the recommended fruits, vegetables,and calcium containing foods.Conclusions: A mobile health program presents an additionalmethod of access to care for underserved students in need of healthintervention and education. Robust community collaboration withteachers and nurses provide the needed push to get students themedical care, health information, and follow-up to emphasize health-ier lifestyle changes. Efforts to increase program retention may showimprovement in knowledge, behavior, and healthier lifestyles.Sources of Support: None.

59.

EFFICACY OF A MULTIDISCIPLINARY WEIGHT LOSS

PROGRAM FOR CHILDREN AND TEENS

Karen S. Vargo, MD, Jill Fisher, RD, LD, Eileen Kennedy, PhD, and

Elizabeth Sprogis, MA. Dept. of Pediatrics, Cleveland Clinic

Foundation, Cleveland, OH

Purpose: Childhood obesity has reached epidemic proportions andit is clearly linked to an increase risk of adult obesity and obesityrelated morbidity. The goal of this study was to assess the changesin BMI and other physical measures of fitness at the end of a 10week multidisciplinary weight loss program for children and teen-agers.Methods: This was a retrospective study that took place betweenJanuary 2005 and March 2008. The program was conducted at a fam-ily health center and participants were referred to the program bylocal practitioners. Participants were required to have a BMI greaterthan the 95% to enroll and at least one parent was required to attendeach of the 10 week sessions. Separate programs were conducted forchildren ages 6-12 years and teenagers’ ages 13-18 years. Eachsession consisted of an interactive presentation by the dietician,

(ASCVD). It builds on a previous study that focused on African-American male adolescents by examining cut-offs for gender andrace subgroups.Methods: This is a secondary data analysis using data from theCDC Third National Health and Nutrition Examination Survey(NHANES III, 1988-1994). The participants consisted of a sub-population of adolescents, ages 12 to 19 years with records con-taining data on WC and at least 3 of the following variables:fasting glucose (GLU), high density lipoprotein (HDL), serumtriglyceride (TG), systolic blood pressure (SBP), and diastolicblood pressure (DBP). The participants were scored andgrouped based on ASCVD risk factors as defined by the Amer-ican Heart Association, National Cholesterol Education Program(NCEP) Adult Treatment Panel III as modified by Cook, et al.These include: fasting glucose � 110 mg/dL, HDL � 40 mg/dL, TG � 110 mg/dL, SBP and DBP > 95% for age and gender.Individuals were categorized as low risk (< 3 risk factors) orhigh risk (� 3 risk factors) for ASCVD. The statistical analysiswas reached by using WC and BMI as independent variables,linear and logistic regressions, and receiver-operating character-istics curve (ROC) analysis to identify the optimal WC measure-ments that identify risk factors for ASCVD and to determine ifWC adds additional information beyond that provided by