Clinical Focus

  • Adolescent Medicine

Academic Appointments

Professional Education

  • Board Certification: Pediatrics, American Board of Pediatrics (1990)
  • Medical Education:Yale University School of Medicine (1987) CT
  • Board Certification: Adolescent Medicine, American Board of Pediatrics (1994)
  • Fellowship:UCSF Medical Center (1993) CA
  • Residency:Johns Hopkins University (1990) MD
  • MPH, Johns Hopkins, Health Care Policy & Management (1991)
  • MD, Yale School of Medicine, Medicine (1987)

Research & Scholarship

Current Research and Scholarly Interests

Access to health care services for adolescents.
Mental Health Financing.
Eating disorders.


2015-16 Courses


All Publications

  • Higher Caloric Intake in Hospitalized Adolescents With Anorexia Nervosa Is Associated With Reduced Length of Stay and No Increased Rate of Refeeding Syndrome JOURNAL OF ADOLESCENT HEALTH Golden, N. H., Keane-Miller, C., Sainani, K. L., Kapphahn, C. J. 2013; 53 (5): 573-578


    To determine the effect of higher caloric intake on weight gain, length of stay (LOS), and incidence of hypophosphatemia, hypomagnesemia, and hypokalemia in adolescents hospitalized with anorexia nervosa.Electronic medical records of all subjects 10-21 years of age with anorexia nervosa, first admitted to a tertiary children's hospital from Jan 2007 to Dec 2011, were retrospectively reviewed. Demographic factors, anthropometric measures, incidence of hypophosphatemia (?3.0 mg/dL), hypomagnesemia (?1.7 mg/dL), and hypokalemia (?3.5 mEq/L), and daily change in percent median body mass index (BMI) (%mBMI) from baseline were recorded. Subjects started on higher-calorie diets (?1,400 kcal/d) were compared with those started on lower-calorie diets (<1,400 kcal/d).A total of 310 subjects met eligibility criteria (age, 16.1 2.3 years; 88.4% female, 78.5 8.3 %mBMI), including 88 in the lower-calorie group (1,163 107 kcal/d; range, 720-1,320 kcal/d) and 222 in the higher-calorie group (1,557 265 kcal/d; range, 1,400-2,800 kcal/d). Neither group had initial weight loss. The %mBMI increased significantly (p < .001) from baseline by day 1 in the higher-calorie group and day 2 in the lower-calorie group. Compared with the lower-calorie group, the higher-calorie group had reduced LOS (13.0 7.3 days versus 16.6 9.0 days; p < .0001), but the groups did not differ in rate of change in %mBMI (p= .50) or rates of hypophosphatemia (p=.49), hypomagnesemia (p= 1.0), or hypokalemia (p= .35). Hypophosphatemia was associated with %mBMI on admission (p= .004) but not caloric intake (p= .14).A higher caloric diet on admission is associated with reduced LOS, but not increased rate of weight gain or rates of hypophosphatemia, hypomagnesemia, or hypokalemia. Refeeding hypophosphatemia depends on the degree of malnutrition but not prescribed caloric intake, within the range studied.

    View details for DOI 10.1016/j.jadohealth.2013.05.014

    View details for Web of Science ID 000325751800005

    View details for PubMedID 23830088

  • A Self-Defense Program Reduces the Incidence of Sexual Assault in Kenyan Adolescent Girls JOURNAL OF ADOLESCENT HEALTH Sinclair, J., Sinclair, L., Otieno, E., Mulinge, M., Kapphahn, C., Golden, N. H. 2013; 53 (3): 374-380


    PURPOSE: To determine the effect of a standardized 6-week self-defense program on the incidence of sexual assault in adolescent high school girls in an urban slum in Nairobi, Kenya. METHODS: Population-based survey of 522 high school girls in the Korogocho-Kariobangi locations in Nairobi, Kenya, at baseline and 10 months later. Subjects were assigned by school attended to either a "No Means No Worldwide" self-defense course (eight schools; N= 402) or to a life-skills class (two schools; N= 120). Both the intervention and the life-skills classes were taught in the schools by trained instructors. Participants were administered the same survey at baseline and follow-up. RESULTS: A total of 522 girls (mean age, 16.7 1.5 years; range, 14-21 years) completed surveys at baseline, and 489 at 10-month follow-up. At baseline, 24.5% reported sexual assault in the prior year, with the majority (90%) reporting assault by someone known to them (boyfriend, 52%; relative, 17%; neighbor, 15%; teacher or pastor, 6%). In the self-defense intervention group, the incidence of sexual assault decreased from 24.6% at baseline to 9.2% at follow-up (p < .001), in contrast to the control group, in which the incidence remained unchanged (24.2% at baseline and 23.1% at follow-up; p= .10). Over half the girls in the intervention group reported having used the self-defense skills to avert sexual assault in the year after the training. Rates of disclosure increased in the intervention group, but not in controls. CONCLUSIONS: A standardized 6-week self-defense program is effective in reducing the incidence of sexual assault in slum-dwelling high school girls in Nairobi, Kenya.

    View details for DOI 10.1016/j.jadohealth.2013.04.008

    View details for Web of Science ID 000323602900012

    View details for PubMedID 23727500

  • An Eleven Site National Quality Improvement Evaluation of Adolescent Medicine-Based Eating Disorder Programs: Predictors of Weight Outcomes at One Year and Risk Adjustment Analyses JOURNAL OF ADOLESCENT HEALTH Forman, S. F., Grodin, L. F., Graham, D. A., Sylvester, C. J., Rosen, D. S., Kapphahn, C. J., Callahan, S. T., Sigel, E. J., Bravender, T., Peebles, R., Romano, M., Rome, E. S., Fisher, M., Malizio, J. B., Mammel, K. A., Hergenroeder, A. C., Buckelew, S. M., Golden, N. H., Woods, E. R. 2011; 49 (6): 594-600


    This quality improvement project collected and analyzed short-term weight gain data for patients with restrictive eating disorders (EDs) treated in outpatient adolescent medicine-based ED programs nationally.Data on presentation and treatment of low-weight ED patients aged 9-21 years presenting in 2006 were retrospectively collected from 11 independent ED programs at intake and at 1-year follow-up. Low-weight was defined as < 90% median body weight (MBW) which is specific to age. Treatment components at each program were analyzed. Risk adjustment was performed for weight gain at 1 year for each site, accounting for clinical variables identified as significant in bivariate analyses.The sites contained 6-51 patients per site (total N = 267); the mean age was 14.1-17.1 years; duration of illness before intake was 5.7-18.6 months; % MBW at intake was 77.5-83.0; and % MBW at follow-up was 88.8-93.8. In general, 40%-63% of low weight ED subjects reached ?90% MBW at 1-year follow-up. At intake, patients with higher % MBW (p = .0002) and shorter duration of illness (p = .01) were more likely to be ?90% MBW at follow-up. Risk-adjusted odds ratios controlled for % MBW and duration of illness were .8 (.5, 1.4)-1.3 (.3, 3.8), with no significant differences among sites.A total of 11 ED programs successfully compared quality improvement data. Shorter duration of illness before intake and higher % MBW predicted improved weight outcomes at 1 year. After adjusting for risk factors, program outcomes did not differ significantly. All adolescent medicine-based ED programs were effective in assisting patients to gain weight.

    View details for DOI 10.1016/j.jadohealth.2011.04.023

    View details for Web of Science ID 000297261000005

    View details for PubMedID 22098769

  • Financing mental health services for adolescents: A position paper of the Society for Adolescent Medicine JOURNAL OF ADOLESCENT HEALTH Kapphahn, C. J., Morreale, M. C., Rickert, V. I., Walker, L. R. 2006; 39 (3): 456-458
  • Financing mental health services for adolescents: A background paper JOURNAL OF ADOLESCENT HEALTH Kapphahn, C., Morreale, M., Rickert, V. I., Walker, L. 2006; 39 (3): 318-327


    Good mental health provides an essential foundation for normal growth and development through adolescence and into adulthood. Many adolescents, however, experience mental health problems that significantly impede the attainment of their full potential. The majority of these adolescents do not receive needed mental health services, in part because of financial obstacles to care. This article reviews the magnitude and impact of mental health problems during adolescence and highlights the importance of insurance coverage in assuring access to mental health services for adolescents. Significant limitations in private health insurance coverage of mental health services are outlined. Recent federal and state efforts to move toward parity in private insurance coverage between mental and physical health services are discussed, including an explanation of the role of Medicaid and the State Children's Health Insurance Program (SCHIP) in providing access to mental health services for adolescents. Finally, other elements that would facilitate financial access to essential mental health services for adolescents are presented.

    View details for DOI 10.1016/j.jadohealth.2006.06.002

    View details for Web of Science ID 000240324100003

    View details for PubMedID 16919792

  • Adolescent girls' and boys' preferences for provider gender and confidentiality in their health care JOURNAL OF ADOLESCENT HEALTH Kapphahn, C. J., Wilson, K. M., Klein, J. D. 1999; 25 (2): 131-142


    To assess the influence of demographic variables and health risk status on adolescents' preferences and actual receipt of services regarding provider gender, sharing a physician with parents, and private examinations.Data from students participating in the Commonwealth Fund 1997 Survey of the Health of Adolescent Girls were analyzed. The weighted sample included 6748 students from grades 5-12. The influence of demographic variables and health risk status on preferences regarding physician gender, sharing a physician with parents, and parental presence during examinations and on actual physician gender, sharing a physician with parents, and receipt of confidential care was assessed for the 5067 students who indicated that they had a health check-up or physical examination within the past 2 years. Associations were examined using SAS to determine preliminary estimates of significance and correlation coefficients, and SUDAAN to generate proportions and Cochran Mantel-Haenszel Chi-squared values. A multiple logistic regression procedure in SUDAAN was used to assess interaction among demographic variables.Gender, race/ethnicity, grade level, and risk status were associated with preferences regarding provider gender and sharing a physician with parents. 50% of girls preferred a female provider; 48% had no preference. 23% of boys preferred a male provider; 65% had no preference. Most adolescents had no preference regarding whether they shared a physician with parents. Gender, race/ethnicity, grade level, and risk status were associated with preference regarding parental presence during examinations. Most younger girls preferred to have a parent present; most younger boys had no preference. Most older girls and boys preferred private examinations. For actual care situation, most adolescents were cared for by male health providers and did not share a physician with parents. 57% of girls and 66% of boys spoke privately with their health provider. Girls who had a female physician were more likely to have private time than were girls receiving care from a male physician. Gender, grade level, and risk status were associated with having private time with a physician.Gender was a significant variable in adolescents' preferences regarding health care. Preferences were also influenced by race/ethnicity, grade level, and risk status. A substantial proportion of adolescents, including those involved in health risk activities, report not having private time with their health provider.

    View details for Web of Science ID 000081723700007

    View details for PubMedID 10447040

  • Access to medical care for adolescents: Results from the 1997 Commonwealth Fund Survey of the Health of Adolescent Girls JOURNAL OF ADOLESCENT HEALTH Klein, J. D., Wilson, K. M., McNulty, M., Kapphahn, C., Collins, K. S. 1999; 25 (2): 120-130


    This study examined the factors associated with access to care among adolescents, including gender, insurance coverage, and having a regular source of health care.Analyses were done on the 1997 Commonwealth Fund Survey of the Health of Adolescent Girls, a nationally representative sample of in-school adolescents in 5th through 12th grade. Access to health care, missing needed care, and whether the adolescent had private time with their provider were assessed. Cochran-Mantel-Haenszel chi-square statistics were computed using SUDAAN.Nearly a third of the 6748 adolescents surveyed had missed needed care. The most common reason for missing care was not wanting a parent to know (35%). Girls were more likely than boys to miss care (29% vs. 24%). Most adolescents reported using a source of primary health care (92%); girls were more likely than boys to use a physician's office rather than another site (65% vs. 60%). Eleven percent of adolescents reported having no health insurance. Uninsured adolescents were more likely to have missed needed care (46% vs. 25%) [corrected].Certain groups of adolescents have less access to health care. Girls have more emotional barriers, such as not wanting parents to know about care, and embarrassment. Adolescents without health insurance are at high risk for missing care because of financial strain. States, insurers, and advocates can influence policies around confidentiality and insurance coverage to address these issues.

    View details for Web of Science ID 000081723700006

    View details for PubMedID 10447039

  • Meeting the health care needs of adolescents in managed care: A background paper JOURNAL OF ADOLESCENT HEALTH Engligh, A., Kapphahn, C., Perkins, J., Wibbelsman, C. J. 1998; 22 (4): 278-292

    View details for Web of Science ID 000072891400002

    View details for PubMedID 9561460

  • Schools sites for research: Land of opportunity - And dilemma JOURNAL OF ADOLESCENT HEALTH Kapphahn, C. J. 1996; 18 (3): 165-165

    View details for Web of Science ID A1996UC63400001

    View details for PubMedID 8777190



    1) To examine variations among students with different health insurance coverage in their use of school-based clinics (SBCs), reasons for not receiving health care when needed, and reasons for using or not using SBCs, and 2) to determine if insurance status is a significant factor in predicting SBC use, after controlling for demographic variables and health status.Confidential questionnaires were administered to 2,860 adolescents attending 3 urban high schools with on-site SBCs. Chi-square and multiple logistic regression analyses were used to assess differences among insurance groups in patterns of SBC use and reasons for clinic use/nonuse.Students with private insurance or HMO coverage had the highest rates of SBC utilization (67% & 66%) and students without health insurance and with Medicaid had the lowest (57% & 59%) (p < 0.01). While there was no difference among adolescents according to insurance group membership in their use of SBC medical services, a significantly higher proportion of students with Medicaid coverage used SBC mental health services. Students without health insurance were less likely to receive health care from any source when it was needed. After controlling for demographic variables and health status, no insurance factors remained significant.SBC users represent a variety of insurance groups. Health care reform efforts need to take into account the special needs of adolescents and the challenges they face in accessing care that go beyond financial barriers to care. SBC have been shown to provide a convenient and acceptable source of care, as well as offering the opportunity to provide preventive and primary care services to at-risk youth. As the country moves to a managed care environment potential partnerships with SBCs represent a unique opportunity to improve the delivery of care to adolescents, assuring increased access to a package of health services that they need.

    View details for Web of Science ID A1995QE91700004

    View details for PubMedID 7742332

Footer Links:

Stanford Medicine Resources: