Jennifer Carlson

All Publications

• Lower Trabecular Bone Score and Spine Bone Mineral Density Are Associated with Bone Stress Injuries and Triad Risk Factors in Collegiate Athletes. PM & R : the journal of injury, function, and rehabilitation Tenforde, A. S., Carlson, J. L., Sainani, K. L., Chang, A. O., Kim, J. H., Diaz, R., Golden, N. H., Fredericson, M. 2020

  Abstract

  INTRODUCTION: Determinants of bone health and injury are important to identify in athletes. Bone mineral density (BMD) is commonly measured in athletes with Female Athlete Triad (Triad) risk factors; Trabecular Bone Score (TBS) has been proposed to predict fracture risk independent of BMD. Evaluation of TBS and spine BMD to bone stress injury (BSI) risk has not been studied in female collegiate athletes.OBJECTIVE: We hypothesized that spine BMD and TBS would each independently predict BSI and the combined measures would improve injury prediction in female collegiate athletes. We also hypothesized each measure would be correlated with Triad risk factors.DESIGN: Retrospective cohort SETTING: Academic Institution METHODS: Dual energy x-ray absorptiometry (DXA) of lumbar spine was used to calculate BMD and TBS values. Chart review was used to identify BSI that occurred after the DXA measurement and to obtain Triad risk factors. We used logistic regression to examine the ability of TBS and BMD alone or in combination to predict prospective BSI.RESULTS: Within 321 athletes, 29 (9.0%) sustained a BSI after DXA. BMD and TBS were highly correlated (Pearson's correlation r=0.62, P<0.0001). Spine BMD and TBS had similar ability to predict BSI; the C-statistic and 95% confidence intervals were: 0.69 (0.58, 0.81) for spine BMD versus 0.68 (0.57, 0.79) for TBS. No improvement in discrimination was observed with combined BMD+TBS (C-statistic 0.70 [0.59, 0.81]). Both TBS and BMD predicted trabecular-rich BSI (defined as pelvis, femoral neck and calcaneus) better than cortical-rich BSI. Both measures had similar correlations with Triad risk factors.CONCLUSION: Lower BMD and TBS values are associated with elevated risk for BSI and similar correlation to Triad risk factors. TBS does not improve prediction of BSI. Collectively, our findings suggest BMD may be a sufficient measure of skeletal integrity from DXA in female collegiate athletes. This article is protected by copyright. All rights reserved.

  View details for DOI 10.1002/pmrj.12510

  View details for PubMedID 33037847

• EVIDENCE-BASED RECOMMENDATIONS FOR MEDICAL MONITORING AND MANAGEMENT Carlson, J. ELSEVIER SCIENCE INC. 2020: S73

  View details for DOI 10.1016/j.jaac.2020.07.303

  View details for Web of Science ID 000579844100237

• Using the Electronic Health Record to Conduct Adolescent Telehealth Visits in the Time of COVID-19. The Journal of adolescent health : official publication of the Society for Adolescent Medicine Carlson, J. L., Goldstein, R. 2020

  View details for DOI 10.1016/j.jadohealth.2020.05.022

  View details for PubMedID 32517972

• IMPLEMENTATION OF AN INPATIENT REPRODUCTIVE HEALTH SCREENING CONSULT SERVICE Goldstein, R. L., Keppler, H., Pineda, N., Carlson, J. L. ELSEVIER SCIENCE INC. 2020: S56

  View details for Web of Science ID 000506637300107

• Teenager, Parent, and Clinician Perspectives on the Electronic Health Record. Pediatrics Carlson, J. L., Goldstein, R., Buhr, T., Buhr, N. 2020

  View details for DOI 10.1542/peds.2019-0193

  View details for PubMedID 32024749

• Associations between ergogenic supplement use and eating behaviors among university students. Eating disorders Nagata, J. M., Peebles, R., Hill, K. B., Gorrell, S., Carlson, J. L. 2020: 1–17

  Abstract

  Ergogenic supplements to improve athletic performance are commonly used among college athletes, but little is known about their association with eating disorder symptoms. The objective of this study was to examine associations between ergogenic supplement use and disordered eating attitudes and behaviors among university students, and to compare differences by sex. Undergraduate students from 10 top-ranked National College Athletics Association (NCAA) Division I colleges completed an online survey on supplement use, athletic activities, and eating attitudes and behaviors. Among 1633 university students, males (38.9%) reported higher rates of current supplement use than females (15.2%) (p < .001). In linear regression models adjusting for athletic status and body mass index, current supplement use was associated with higher Eating Disorders Examination-Questionnaire (EDE-Q) Global, Shape Concern, and Restraint scores in both males and females. Supplement use was associated with driven/compelled exercise (OR 2.00, 95% CI 1.33-2.99) in males and diuretic (OR 6.39, 95% CI 2.02-20.22) and diet pill use (OR 3.07, 95% CI 1.79-5.27) in females. Results suggest ergogenic supplement use is common in undergraduates and associated with disordered eating attitudes and behaviors. Clinicians should screen for disordered eating behaviors particularly in young adults who use ergogenic supplements.

  View details for DOI 10.1080/10640266.2020.1712637

  View details for PubMedID 32129729

• Providers' Perspectives on Adolescent Confidentiality and the Electronic Health Record: A State of Transition. The Journal of adolescent health : official publication of the Society for Adolescent Medicine Goldstein, R. L., Anoshiravani, A., Svetaz, M. V., Carlson, J. L. 2019

  Abstract

  PURPOSE: Electronic health records (EHRs) have led to more transparency and improvements in patient safety, yet electronic access to personal health information can pose significant threats to maintaining confidentiality for adolescents. To date, no studies have explored clinicians' perspectives on EHR functionality and institutional policies related to confidentiality and health information sharing for adolescents aged <18years.METHODS: A Web-based survey was sent out via the national listserv of the Society for Adolescent Health and Medicine. All English-speaking members practicing in the U.S. were eligible to participate. The survey included questions about demographics, EHR functionality, information sharing, and attitudes about confidentiality within the EHR.RESULTS: Participants included 212 clinicians who consented to the survey and used an EHR to document clinical visits with minors. Most participants were physicians and nurse practitioners (96.5%), and 60.0% had been on their institution's EHR for >5years. Positive findings included high levels of experience and comfort using the EHR and awareness of confidential features within their EHR. However, providers reported lack of training related to confidentiality within the EHR, low confidence in their EHR's ability to maintain confidentiality, and variation in approaches to portal access for adolescents and their adult proxies.CONCLUSIONS: Despite high comfort levels and robust EHR functionality at many institutions, significant concerns about adolescent confidentiality remain. Varying institutional approaches to protecting confidentiality underscores the need for a standardized and comprehensive framework to enable providers and institutions to take better care of adolescents in the age of EHRs.

  View details for DOI 10.1016/j.jadohealth.2019.09.020

  View details for PubMedID 31831320

• Associations between exercise, bone mineral density, and body composition in adolescents with anorexia nervosa EATING AND WEIGHT DISORDERS-STUDIES ON ANOREXIA BULIMIA AND OBESITY Nagata, J. M., Carlson, J. L., Golden, N. H., Murray, S. B., Long, J., Leonard, M. B., Peebles, R. 2019; 24 (5): 939–45

  View details for DOI 10.1007/s40519-018-0521-2

  View details for Web of Science ID 000496976600017

• AN OVERVIEW OF THE MEDICAL MANAGEMENT OF EATING DISORDERS Carlson, J. ELSEVIER SCIENCE INC. 2019: S110

  View details for DOI 10.1016/j.jaac.2019.07.571

  View details for Web of Science ID 000518857301129

• Comparisons of bone density and body composition among adolescents with anorexia nervosa and atypical anorexia nervosa INTERNATIONAL JOURNAL OF EATING DISORDERS Nagata, J. M., Carlson, J. L., Golden, N. H., Long, J., Murray, S. B., Peebles, R. 2019; 52 (5): 591–96

  View details for DOI 10.1002/eat.23048

  View details for Web of Science ID 000466815200013

• Comparisons of bone density and body composition among adolescents with anorexia nervosa and atypical anorexia nervosa. The International journal of eating disorders Nagata, J. M., Carlson, J. L., Golden, N. H., Long, J., Murray, S. B., Peebles, R. 2019

  Abstract

  OBJECTIVE: To compare bone mineral density (BMD) and body composition among adolescents: (a) with atypical anorexia nervosa (AAN) versus anorexia nervosa (AN) and (b) those with and without a prior history of overweight.METHOD: Electronic medical records of patients 9-20years with AN or AAN who underwent dual-energy x-ray absorptiometry scans were retrospectively reviewed and analyzed.RESULTS: A total of 286 adolescents with AN or AAN were included. In linear regression models, AAN was associated with greater Z-scores in whole body bone mineral content (BMC, B=0.88, p<0.001), lumbar spine BMD (B=0.79, p=0.002), femoral neck BMD (B=0.670, p=0.009); fat mass index (B=1.33, p=0.003), and lean body mass index (LBMI, B=1.10, p<0.001) compared to AN, adjusting for age, sex, and duration of illness. A prior overweight history was associated with greater Z-scores in whole body BMC; lumbar spine BMD, total hip BMD, femoral neck BMD, and LBMI.DISCUSSION: Adolescents with AAN had higher BMD Z-scores than adolescents with AN; adolescents with a prior overweight history had greater BMD Z-scores than adolescents without a prior overweight history. These findings may inform clinical guidelines for the medical management of AAN.

  View details for PubMedID 30771231

• Eating behavior and reasons for exercise among competitive collegiate male athletes. Eating and weight disorders : EWD Gorrell, S., Nagata, J. M., Hill, K. B., Carlson, J. L., Shain, A. F., Wilson, J., Alix Timko, C., Hardy, K. K., Lock, J., Peebles, R. 2019

  Abstract

  Research concerning eating disorders among adolescent and young adult male athletes is limited compared with female counterparts, but increasing evidence indicates that they may be at unique risk for unhealthy exercise and eating behavior. The current study aimed to characterize unhealthy exercise and eating behavior according to competitive athlete status, as well as per sport type.Collegiate male athletes (N = 611), each affiliated with one of the 10 National College Athletics Association (NCAA) Division I schools in the United States, completed an online survey, reporting on eating and extreme weight control behaviors, and reasons for exercise.Competitive athletes endorsed increased driven exercise and exercising when sick. Baseball players, cyclists, and wrestlers emerged as the sports with the most players reporting elevated Eating Disorder Examination-Questionnaire scores in a clinical range, and basketball players reported the highest rates of binge eating. overall, baseball players, cyclists, rowers, and wrestlers appeared to demonstrate the greatest vulnerability for unhealthy eating and exercise behavior.Findings revealed differences between competitive and non-competitive male athletes. Among competitive athletes, results identified unique risk for unhealthy eating and exercise behavior across a variety of sport categories and support continued examination of these attitudes and behaviors in a nuanced manner.Evidence obtained from well-designed controlled trials without randomization.

  View details for DOI 10.1007/s40519-019-00819-0

  View details for PubMedID 31782028

• Sport and Triad Risk Factors Influence Bone Mineral Density in Collegiate Athletes MEDICINE AND SCIENCE IN SPORTS AND EXERCISE Tenforde, A. S., Carlson, J. L., Sainani, K. L., Chang, A. O., Kim, J., Golden, N. H., Fredericson, M. 2018; 50 (12): 2536–43

  View details for DOI 10.1249/MSS.0000000000001711

  View details for Web of Science ID 000450086200019

• MEDICAL ASSESSMENT, MANAGEMENT, AND SAFE RENOURISHMENT IN ADOLESCENT EATING DISORDERS Carlson, J. ELSEVIER SCIENCE INC. 2018: S26–S28

  View details for DOI 10.1016/j.jaac.2018.07.113

  View details for Web of Science ID 000544087500091

• Sport and Triad Risk Factors Influence Bone Mineral Density in Collegiate Athletes. Medicine and science in sports and exercise Tenforde, A. S., Carlson, J. L., Sainani, K. L., Chang, A. O., Kim, J. H., Golden, N. H., Fredericson, M. 2018

  Abstract

  PURPOSE: Athletes in weight bearing sports may benefit from higher bone mineral density (BMD). However, some athletes are at risk for impaired BMD with Female Athlete Triad (Triad). The purpose of this study is to understand the influence of sports participation and Triad on BMD. We hypothesize that athletes in high-impact and multi-directional loading sports will have highest BMD, whereas non-impact and low-impact sports will have lowest BMD. Triad risk factors are expected to reduce BMD values independent of sports participation.METHODS: 239 female athletes participating in 16 collegiate sports completed dual energy x-ray absorptiometry (DXA) scans to measure BMD Z-scores of the lumbar spine(LS) and total body(TB). Height and weight were measured to calculate body mass index (BMI). Triad risk assessment variables were obtained from preparticipation examination. Mean BMD Z-scores were compared between sports and by sport category (high-impact, multi-directional, low-impact, and non-impact). Multivariable regression analyses were performed to identify differences of BMD Z-scores accounting for Triad and body size/composition.RESULTS: Athlete populations with lowest average BMD Z-scores included synchronized swimming (LS:-0.34,TB:0.21) swimming/diving (LS:0.34,TB:-0.06), crew/rowing (LS:0.27,TB:0.62), and cross-country (LS:0.29,TB:0.91). Highest values were in gymnastics (LS:1.96,TB:1.37), volleyball (LS:1.90,TB:1.74), basketball (LS:1.73,TB:1.99), and softball (LS:1.68,TB:1.78). All Triad risk factors were associated with lower BMD Z-scores in univariable analyses; only low BMI and oligomenorrhea/amenorrhea were associated in multivariable analyses (all P<0.05). Accounting for Triad risk factors and body size/composition, high-impact sports were associated with higher LS and TB BMD Z-scores and non-impact sports with lower LS and TB BMD Z-scores compared to low-impact sport (all P<0.05).CONCLUSION: Both sport type and Triad risk factors influence BMD. Athletes in low-impact and non-impact sports and athletes with low BMI and oligomenorrhea/amenorrhea are at highest risk for reduced BMD.

  View details for PubMedID 29975299

• Associations between exercise, bone mineral density, and body composition in adolescents with anorexia nervosa. Eating and weight disorders : EWD Nagata, J. M., Carlson, J. L., Golden, N. H., Murray, S. B., Long, J., Leonard, M. B., Peebles, R. 2018

  Abstract

  OBJECTIVE: To identify the effect of duration of weight-bearing exercise and team sports participation on bone mineral density (BMD) and body composition among adolescents with anorexia nervosa (AN).METHOD: We retrospectively reviewed electronic medical records of all patients 9-20years old with a DSM-5 diagnosis of AN evaluated by the Stanford Eating Disorders Program (1997-2011) who underwent dual-energy X-ray absorptiometry.RESULTS: A total of 188 adolescents with AN were included (178 females and 10 males). Using multivariate linear regression, duration of weight-bearing exercise (B=0.15, p=0.005) and participation in team sports (B=0.53, p=0.001) were associated with higher BMD at the hip and team sports (B=0.39, p=0.006) were associated with higher whole body BMC, controlling for covariates. Participation in team sports (B=-1.06, p=0.007) was associated with greater deficits in FMI Z-score. LBMI Z-score was positively associated with duration of weight-bearing exercise (B=0.10, p=0.018) and may explain the relationship between exercise and bone outcomes.CONCLUSION: Duration of weight-bearing exercise and team sports participation may be protective of BMD at the hip and whole body BMC, while participation in team sports was associated with greater FMI deficits among adolescents with AN.LEVEL OF EVIDENCE: Level V, descriptive retrospectivestudy.

  View details for PubMedID 29949128

• 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 PubMedID 29496729

• 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

• 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 PubMedID 29112280

• AVOIDANT RESTRICTIVE FOOD INTAKE DISORDER: MEDICAL ASSESSMENT, MANAGEMENT, AND SAFE RENOURISHMENT Carlson, J. ELSEVIER SCIENCE INC. 2017: S65

  View details for DOI 10.1016/j.jaac.2017.07.253

  View details for Web of Science ID 000544086200219

• 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

• PROVIDERS' ATTITUDES, BELIEFS, AND BARRIERS REGARDING INITIATION OF HORMONAL CONTRACEPTION FOR ADOLESCENT AND YOUNG ADULTS IN THE INPATIENT SETTING Goldstein, R. L., Carlson, J., Halpern-Felsher, B. ELSEVIER SCIENCE INC. 2017: S114–S115

  View details for DOI 10.1016/j.jadohealth.2016.10.405

  View details for Web of Science ID 000406846500214

• ASSESSMENT OF SEX DIFFERENCES IN BODY COMPOSITION AMONG ADOLESCENTS WITH ANOREXIA NERVOSA Nagata, J. M., Golden, N. H., Peebles, R., Long, J., Murray, S. B., Leonard, M. B., Carlson, J. L. ELSEVIER SCIENCE INC. 2017: S47

  View details for DOI 10.1016/j.jadohealth.2016.10.277

  View details for Web of Science ID 000397270700086

• ASSESSMENT OF SEX DIFFERENCES IN BODY COMPOSITION AMONG ADOLESCENTS WITH ANOREXIA NERVOSA Nagata, J. M., Golden, N. H., Peebles, R., Long, J., Murray, S. B., Leonard, M. B., Carlson, J. L. ELSEVIER SCIENCE INC. 2017: S47

  View details for Web of Science ID 000406846500086

• 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

• EFFECT OF PRIOR HISTORY OF OBESITY/OVERWEIGHT ON RETURN OF MENSES IN ADOLESCENTS WITH EATING DISORDERS Seetharaman, S., Carlson, J., Golden, N., Halpern-Felsher, B. L., Payne, A. E., Peebles, R. ELSEVIER SCIENCE INC. 2016: S25–S26

  View details for DOI 10.1016/j.jadohealth.2015.10.064

  View details for Web of Science ID 000373428800047

• HEALTHY RELATIONSHIPS AND PHYSICAL ACTIVITY: A QUALITATIVE ANALYSIS OF MIDDLE SCHOOL GIRLS AND THEIR PARENTS Ragavan, M. I., Halpern-Felsher, B., Chang, A., Carlson, J. ELSEVIER SCIENCE INC. 2016: S87

  View details for DOI 10.1016/j.jadohealth.2015.10.186

  View details for Web of Science ID 000373428800166

• ASSESSMENT OF SEX DIFFERENCES IN BONE DEFICITS AMONG ADOLESCENTS WITH ANOREXIA NERVOSA Nagata, J. M., Golden, N. H., Peebles, R., Bachrach, L. K., Long, J., Chang, A. O., Carlson, J. L. ELSEVIER SCIENCE INC. 2016: S11

  View details for DOI 10.1016/j.jadohealth.2015.10.037

  View details for Web of Science ID 000373428800021

• 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

• ASSOCIATIONS OF SUPPLEMENT USE AND EATING AND EXERCISE BEHAVIORS IN UNIVERSITY STUDENTS Carlson, J., Greer, A., Hill, K., Lock, J., Peebles, R. ELSEVIER SCIENCE INC. 2015: S87–S88

  View details for DOI 10.1016/j.jadohealth.2014.10.175

  View details for Web of Science ID 000375069900171

• MEDIA INFLUENCES BY GENDER AND SEXUAL ORIENTATION AMONG ADOLESCENTS WITH EATING DISORDERS Salas-Humara, C. L., McClain, Z., Dowshen, N., Carlson, J., Lock, J., Peebles, R. ELSEVIER SCIENCE INC. 2015: S87

  View details for DOI 10.1016/j.jadohealth.2014.10.174

  View details for Web of Science ID 000375069900170

• WEIGHT-RELATED COACHING PRESSURES, MENTAL HEALTH, SLEEP, AND QUALITY OF LIFE IN COMPETITIVE UNIVERSITY ATHLETES Cheek, C., Hill, K., Carlson, J., Lock, J., Peebles, R. ELSEVIER SCIENCE INC. 2015: S88

  View details for DOI 10.1016/j.jadohealth.2014.10.176

  View details for Web of Science ID 000375069900172

• DIFFERENCES IN PSYCHIATRIC COMORBIDITIES AMONG ADOLESCENTS WITH EATING DISORDERS BY SEXUAL ORIENTATION McClain, Z., Dowshen, N., Carlson, J., Lock, J., Peebles, R. ELSEVIER SCIENCE INC. 2014: S76

  View details for DOI 10.1016/j.jadohealth.2013.10.165

  View details for Web of Science ID 000330307800147

• REPORT FROM THE NATIONAL EATING DISORDER QUALITY IMPROVEMENT COLLABORATIVE OF TEN ADOLESCENT MEDICINE-BASED EATING DISORDER PROGRAMS: POPULATION DESCRIPTION AND PREDICTORS OF WEIGHT OUTCOME AT ONE YEAR Forman, S. F., McKenzie, N. M., Monge, M. C., Mammel, K. A., Kapphahn, C. J., Callahan, S. T., Rome, E. S., Rosen, D. S., Hehn, R. S., Carlson, J. L., Romano, M. E., Malizio, J. B., Rouse, M. R., Graham, D. A., Jay, M. S., Hergenroeder, A. C., Fisher, M. M., Golden, N. H., Woods, E. R. ELSEVIER SCIENCE INC. 2013: S37–S38

  View details for Web of Science ID 000314104000076

• DRIVERS OF DISORDERED EATING IN UNIVERSITY STUDENTS REPORTING VEGETARIAN DIETS Sieke, E., Carlson, J., Lock, J., Timko, C., Peebles, R. ELSEVIER SCIENCE INC. 2013: S38–S39

  View details for DOI 10.1016/j.jadohealth.2012.10.093

  View details for Web of Science ID 000314104000078

• EXERCISE LEVEL AND CLINICAL SEVERITY IN ADOLESCENTS WITH EATING DISORDERS Pih, J. M., Peebles, R., Carlson, J. ELSEVIER SCIENCE INC. 2013: S41

  View details for DOI 10.1016/j.jadohealth.2012.10.098

  View details for Web of Science ID 000314104000083

• RUNNING CLUB PARTICIPATION AFFECTS WEIGHT CONCERNS AND BMI IN MIDDLE SCHOOL GIRLS Carlson, J. L., Peebles, R., Golden, N. H. ELSEVIER SCIENCE INC. 2013: S104

  View details for DOI 10.1016/j.jadohealth.2012.10.260

  View details for Web of Science ID 000314104000215

• USE OF PSYCHOPHARMACOLOGIC MEDICATIONS IN ADOLESCENTS WITH RESTRICTIVE EATING DISORDERS: ANALYSIS OF DATA FROM THE NATIONAL EATING DISORDER QUALITY IMPROVEMENT COLLABORATIVE 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., Rouse, M. R., Graham, D. A., Jay, M. S., Hergenroeder, A. C., Fisher, M. M., Golden, N. H., Woods, E. R. ELSEVIER SCIENCE INC. 2013: S39–S39

  View details for Web of Science ID 000314104000079

• WEIGHT-RELATED TEASING IS ASSOCIATED WITH EATING DISORDER PATHOLOGY IN UNIVERSITY STUDENTS Sadler, C., Carlson, J., Lock, J., Peebles, R. ELSEVIER SCIENCE INC. 2012: S61–S62

  View details for DOI 10.1016/j.jadohealth.2011.10.166

  View details for Web of Science ID 000300243000130

• The Female Athlete Triad The Female Patient Carlson JL, Golden NH 2012; 37 (6): 16-24
• ATHLETIC PARTICIPATION AND SUBSTANCE USE IN UNIVERSITY STUDENTS Hsii, A., Carlson, J., Peebles, R. ELSEVIER SCIENCE INC. 2011: S69–S70

  View details for DOI 10.1016/j.jadohealth.2010.11.148

  View details for Web of Science ID 000286884700131

• 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

• COMPETITIVE SPORTS, EATING BEHAVIORS, AND MENSTRUAL HEALTH IN FEMALE COLLEGE ATHLETES Peebles, R., Bell, K., Carlson, J., Wilson, J., Allison, K., Lock, J., Jacobson, M., Hardy, K., Bachrach, L. ELSEVIER SCIENCE INC. 2009: S16–S16

  View details for Web of Science ID 000263270100036

• 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