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Objectives To compare 3 different treatment regimens for vitamin D deficiency in minority adolescents and to explore factors that impact treatment efficacy. Study design We conducted an 8-week, prospective, open-label, randomized clinical trial in an urban, academic, children’s hospital. 183 vitamin D-deficient adolescents [mean 25(OH)D 13.7±3.9 ng/mL; mean age 16.6±2.2 years] were randomized into 3 vitamin D3 (cholecalciferol) treatment arms: 50,000IU/week; 5,000IU/day; and 1,000IU/day. Serum 25(OH)D and vitamin D binding protein (VDBP) levels were measured pre-and post-treatment.122 (67%) participants completed post-treatment measures. Complete-case and multiple-imputation, intention-to-treat analyses were performed. Results Mean change in 25(OH)D level post-treatment was significantly different among the 3 arms, 24.9±15.1vs. 21.0±15.2 vs. 6.2±6.5 ng/mL, for 50,000IU, 5,000IU, and 1,000IU doses, respectively, p<0.001. Both high-dose treatments were effective in increasing the 25(OH)D level out of deficiency range (≥20ng/mL) in more than 80% of participants, and 60% remained deficient after low-dose treatment. Only 72%, 56%, and 2% achieved vitamin D sufficiency (>30ng/mL) with 50,000IU, 5,000IU, and 1,000IU doses, respectively, p<0.001. Obese participants had substantially less mean change in 25(OH)D level after treatment than normal-weight participants, 13.7±10.7 vs. 21.9±16.9 ng/mL, p<0.001. Mean baseline VDBP level was almost twice as high in Hispanic compared with black participants (p<0.001) and did not alter treatment response or change with treatment. Conclusions Adult-sized adolescents require 8-weeks of high-dose cholecalciferol, at least 5,000IU/day, to correct deficiency. Obese adolescents have poorer response to treatment and may need higher doses than non-obese youth. Hispanic and black adolescents have different VDBP levels but similar treatment responses.

Early identification of HIV by increasing testing is a national priority; however, little is known about HIV testing behaviors in high school age adolescents. We examined the association of individual, partner, and relationship factors with HIV testing using a computer-assisted survey administered from 2003 to 2006 in a community sample of 980 sexually active 14-to 17-year-olds (56% female, 55% Latino, 25% African American) living in a jurisdiction with a high AIDS burden. Twenty percent reported their first sexual encounter as having occurred when they were < 13 years of age, 33% had had four or more lifetime sexual partners, 21% reported high partner HIV-risk behavior, and 428 (44%) had been tested for HIV. In our final regression model, independent associations with HIV testing included being female (OR = High HIV/AIDS knowledge, high partner HIV risk behavior, and young age at first sexual encounter were not associated with testing. These findings suggest that, for high school aged adolescents, optimal strategies to promote HIV testing should look beyond increasing HIV/AIDS knowledge and identifying individual risk behaviors to also considering the role of partners and relationships and their influence on testing behavior.1

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Abortion is not uncommon among physicians, and maintaining access to abortion care is critical to support reproductive autonomy in the physician workforce.

Breaches in confidentiality for hospitalized adolescents are a common trainee experience. On PFCR, adolescents are less likely to have confidential time with the medical team than young adults. In trainees' experience, hospital systems such as PFCR and discharge procedures pose inherent challenges to confidentiality for minor adolescent patients, as do lack of knowledge of minor consent laws by both clinicians and families.

This is a prepublication version of an article that has undergone peer review and been accepted for publication but is not the final version of record. This paper may be cited using the DOI and date of access. This paper may contain information that has errors in facts, figures, and statements, and will be corrected in the final published version. The journal is providing an early version of this article to expedite access to this information. The American Academy of Pediatrics, the editors, and authors are not responsible for inaccurate information and data described in this version.