Browsing by Author "Donahue, Kelly L."

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    A Pediatric Provider’s Guide to Supporting the Family of a Gender-Expansive Child or Adolescent
    (Sage, 2022-06-22) Morgan, Lucas E.; Meininger, Eric T.; Donahue, Kelly L.; Pediatrics, School of Medicine
    Sexual and gender-minoritized youth, especially those who are gender-expansive (GE)*, are at increased risk for mental health complications including anxiety, depression, suicidality, and substance abuse. From a minority stress perspective, this increased risk may be attributable to external and internal stressors associated with minority status such as abuse/harassment, victimization at school, institutional discrimination, and fear of rejection. Medical curricula lack training on these disparities and how to care for LGBTQ+ (lesbian, gay, bisexual, transgender, queer/questioning, or other sexual/gender identities) patients, particularly those who are transgender. While pediatric providers must learn to provide competent care for all individuals who identify as LGBTQ+, this review focuses on the needs of GE youth and their families. *Gender expansive is an umbrella term that refers collectively to transgender, gender-questioning, non-binary, gender-diverse, or gender-variant individuals.
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    Human Papillomavirus Vaccine Initiation among 9-13-Year-Olds in the United States
    (Elsevier, 2015) Donahue, Kelly L.; Hendrix, Kristin S.; Sturm, Lynne A.; Zimet, Gregory D.; Department of Pediatrics, IU School of Medicine
    OBJECTIVE: The quadrivalent and 9-valent human papillomavirus (HPV) vaccines are licensed for administration among 9-26-year-old males and females, with routine vaccination recommended for 11-12-year-olds. Despite the availability of the vaccine at younger ages, few studies have explored vaccine uptake prior to age 13, and national HPV vaccination surveillance data is limited to 13-17-year-olds. Our objective was to examine rates and predictors of HPV vaccine initiation among 9-13-year-olds in the United States. METHODS: A national sample of mothers of 9-13-year-olds in the United States (N=2,446) completed a 2014 Web-based survey assessing socio-demographic characteristics, child's HPV vaccination history, provider communication regarding the vaccine, and other attitudes and behaviors pertaining to vaccination and healthcare utilization. The main outcome measure was child's initiation of the HPV vaccine (i.e., receipt of one or more doses). RESULTS: Approximately 35% of the full sample and 27.5% of the 9-10-year-olds had initiated HPV vaccination. Females were more likely than males to have initiated HPV vaccination by the age of 13 but not by younger ages. Strength of health provider recommendation regarding HPV vaccination was a particularly salient predictor of vaccine initiation. CONCLUSIONS: Approximately a third of children may be initiating the HPV vaccine series before or during the targeted age range for routine administration of the vaccine. Because coverage remains below national targets, further research aimed at increasing vaccination during early adolescence is needed. Improving providers' communication with parents about the HPV vaccine may be one potential mechanism for increasing vaccine coverage.
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    Nontraditional School Enrollment in Transgender and Gender-Diverse Youth
    (Elsevier, 2021) Gohil, Anisha; Donahue, Kelly L.; Eugster, Erica A.; Pediatrics, School of Medicine
    Purpose: This study aimed to investigate the prevalence of online and homeschool attendance in transgender and gender-diverse (TGD) youth. Methods: Caregivers of 12- to 17-year-olds participated in a phone survey about school attendance. Subjects included TGD youth receiving care in a gender health clinic and youth receiving care in a pediatric endocrinology/diabetes (PED) clinic. Results: Parents of 83 TGD and 83 PED youth participated in the study. Current/past enrollment in a nontraditional school setting was higher among TGD than PED youth (37.3% vs. 19.3%; p = .01). In addition, 14.5% of TGD and 7.2% of PED youth had transferred between traditional school settings (public, private, and charter) for psychosocial reasons. Conclusions: Approximately half of the TGD youth had either attended a nontraditional school setting or changed schools for psychosocial reasons, compared with approximately one fourth of PED youth (51.8% vs. 26.5%, p = .001). This suggests that traditional school environments present significant psychological difficulties for TGD adolescents.
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    Psychological assessment of mothers and their daughters at the time of diagnosis of precocious puberty
    (BioMed Central, 2015-03-16) Schoelwer, Melissa J.; Donahue, Kelly L.; Bryk, Kristina; Didrick, Paula; Berenbaum, Sheri A.; Eugster, Erica A.; Department of Pediatrics, IU School of Medicine
    BACKGROUND: Concerns about psychological distress are often used to justify treatment of girls with precocious puberty, but there is little evidence to support these concerns. The extent to which psychological problems are associated with central precocious puberty (CPP) compared with other forms of early puberty in girls has likewise not been established. METHODS: Girls presenting with untreated CPP, premature adrenarche (PA) or early normal puberty (ENP) were recruited from our pediatric endocrine clinic along with their mothers. Child psychological adjustment was assessed by child self-report and parent report. Parent self-reported personality, anxiety, and depression were also assessed. Differences between groups were explored using one-way ANOVA and Dunnett's T3 test. RESULTS: Sixty-two subjects (aged 7.5 ± 1.4 years, range 4.8-10.5) were enrolled, of whom 19 had CPP, 22 had PA, and 21 had ENP. Girls with ENP were significantly older (8.9 ± .9 years) than girls with CPP (6.9 ± 1.1 years, p < .001) and PA (6.6 ± 1.0 years, p < .001). Girls with PA had significantly higher BMI z-scores (1.7 ± .8) than girls with CPP (1.1 ± .6, p = .01) and ENP (1.2 ± .6, p = .04). More girls with PA and ENP were from racial minorities (47% and 50% respectively) than girls with CPP (32%). No group differences were found for any child measure of psychological adjustment. However, mothers of girls with PA scored significantly higher than mothers of girls with ENP on one measure of depression (p = .04) and stress (p = .01). CONCLUSIONS: While mothers of girls with PA report increased psychological distress on some measures, no differences in psychological adjustment were found at baseline amongst the girls themselves. Whether these results will change as puberty progresses in the PA and ENP groups or with treatment of CPP is unknown. Long-term prospective studies are needed in order to further investigate psychological correlates of early puberty in girls.
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    Supporting Caregivers and Families of Transgender and Nonbinary Youth
    (Routledge, 2020) Brandon-Friedman, Richard A.; Warden, Rand; Waletich, Rebecca; Donahue, Kelly L.
    A young person coming out as transgender or nonbinary (TNB) can affect their entire family system. Feelings of loss, confusion, self-doubt, fear, and anger are common during this time of transition as family members process the young person’s gender identity and the effects of the disclosure. With support, family members can successfully explore these thoughts and emotions and grow to not only accept but actively affirm and advocate for their loved ones. This chapter discusses the developmental processes that family members of TNB youth may experience after the young person comes out, reviews common concerns raised by family members, and provides strategies for supporting family members as they process a TNB young person’s coming out and what it means for the youth, the family, and their broader community. Three case scenarios provide further insight into how familial concerns may present in practice. Altogether, the chapter allows for an appreciation of the complexity and immense value of supporting caregivers and families as a means to enhance TNB youths’ lives.
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    Vaccinating sons against HPV: results from a U.S. national survey of parents
    (PLoS, 2014-12-26) Taylor, Jaime L.; Zimet, Greg D.; Donahue, Kelly L.; Alexander, Andreia B.; Shew, Marcia L.; Stupiansky, Nathan W.; Department of Pediatrics, IU School of Medicine
    PURPOSE: The quadrivalent HPV vaccination was approved for use in males ages 9 to 26 in 2009 and recommended for routine administration in 2011. The purpose of this study was to uncover predictable commonalities amongst parents who chose to vaccinate their 11-17 year old sons against HPV. METHODS: We compiled data from a U.S. national sample of 779 parents with sons 11-17 years old using a web-based survey to gather information about behavioral and sociodemographic factors which predicted receipt of 1 or more HPV vaccine doses based on parental report. Predictors were first modeled individually for univariable associations. Significant predictors (p<0.10) were combined in a multivariable model. RESULTS: In the adjusted model, independent predictors included receipt of flu vaccination, health insurance coverage and sexual health topic discussions with sons. Sons who had received a flu shot in the last two years more frequently received at least one dose of the vaccine (OR 1.82; 95% CI 1.45-2.26). Sons covered by private health insurance had decreased odds of HPV vaccination (OR 0.56 95% CI 0.37-0.83). Lastly, parents who had discussed sexual health topics with their sons were more likely to vaccinate (OR 1.61; 95% CI 1.37-1.89). CONCLUSIONS: Male vaccination rates in the U.S. have increased, but males continue to be under-immunized. Utilization of health care is an important factor in HPV vaccine uptake; therefore, health care providers should use every contact as an opportunity to vaccinate. Communication about sexual health topics may provide a forum for parents and health care providers to have conversations about HPV vaccination as those more comfortable discussing these topics may also be more comfortable discussing HPV vaccination.