Papers by Melanie A. Gold, DO, FAAP
Journal of Technology in Behavioral Science, 2020
Motivational interviewing (MI), an effective communication style for facilitating behavior change... more Motivational interviewing (MI), an effective communication style for facilitating behavior change, paired with a smartphone app is a unique approach to engage young men in health promotion. We assessed young men's experiences with a pilot intervention using a smartphone app paired with phone-based MI coaching by trained community health coaches. App activities included goal setting, health behavior tracking, and educational materials. The app and coaching addressed sexual health or fitness. Fourteen black and/or Hispanic men, ages 15-19 years, were interviewed about their experiences. Interviews were transcribed and coded using framework analysis. Participants found the app activities and coaching acceptable and felt comfortable discussing health behaviors. They reported gaining knowledge about sexual health and fitness, which some shared with others. Most preferred phone rather than in-person or video coaching due to it feeling "safer," travel barriers, ease of rescheduling sessions, and increased privacy regarding sensitive subjects. Some found phone coaching preferable to a healthcare visit. Obstacles to participation included phone replacement, parental monitoring, and restriction of phone privileges. Over time, participants felt positively about their relationship with their coach but sometimes viewed them as having medical expertise beyond their training. Smartphone app-based MI with community health coaches has great potential for use with young men for a variety of health issues. However, it has unique obstacles: phone accessibility may restrict participant's ability to engage fully and perceptions of a coach's expertise should be regularly clarified. Future studies should continue assessing acceptability and rigorously evaluate effectiveness and scalability.
Poster Presentations, 2019
better sexual health outcomes. There is a need for strategies to raise uptake of such edu-dramas,... more better sexual health outcomes. There is a need for strategies to raise uptake of such edu-dramas, and to evaluate whether wider coverage leads to population impact. Disclosure No significant relationships.
Military Medicine, 2000
Cadet basic training (CBT) at the U.S. Military Academy at West Point is an initial cadet experie... more Cadet basic training (CBT) at the U.S. Military Academy at West Point is an initial cadet experience designed to transition freshmen (new cadets) into the military. Challenge is an inherent component of CBT,and some challenging activities may be stressful. However, the nature and the impact of stress on health status have not been systematically investigated. An ethnographic technique, participant observation, was used to identify stressors and coping strategies among cadets aged 18 to 21 years participating in CBT. A company of 183 cadets, consisting of 123 new cadets and 60 supervising upperclass cadets from the U.S. Military Academy, was followed throughout the 6-week CBT in the summer of 1993. The investigator observed daily activities and participated in select field training experiences. Daily field observations were taped, and field notes were generated chronicling the experience. After CBT, 10 of the 60 upperclass cadets participated in a 20-minute structured interview. Field and interview notes were systematically reviewed to identify and categorize stressors and coping techniques. Stressors included anticipatory stress, time management pressures, sleep deprivation, perfo~ance eV~lu ations, conflicts between teamwork and competitive grading, and inexperience in the leadership role. Coping techniques identified included perceiving social support, humor, and rationalization. Three new hypotheses were generated from the observations,
Journal of American College Health, 2019
Objective: To evaluate feasibility of integrating Bedsider.org, a web-based contraceptive decisio... more Objective: To evaluate feasibility of integrating Bedsider.org, a web-based contraceptive decision support tool, at a university health clinic (UHC). Participants: Female students (ages 18-29) seeking contraceptive care at the UHC were enrolled in September 2015 (n ¼ 46). Methods: Providers recruited eligible patients during reproductive healthcare visits and introduced Bedsider. Surveys were administered immediately following the visit and a follow-up 2-4 weeks later. Electronic health records through 6 weeks post-enrollment were extracted. Results: Most patients had positive views toward Bedsider and appreciated receiving information during their UHC encounters. None were using long-acting reversible contraceptives (LARC) at enrollment. At follow-up, two patients self-reported IUD use. Among those recently sexually active, use of more effective contraceptive methods increased from 65% to 74%; 11% had initiated or were scheduled to receive a LARC. Conclusion: Bedsider can be feasibly integrated into UHC visits and may support women's selection of more effective contraceptive methods, including LARCs.
Journal of pediatric and adolescent gynecology, Jan 30, 2017
Little is known about the information shared during family discussions about sexuality. From a pu... more Little is known about the information shared during family discussions about sexuality. From a public health perspective, abstinence is one of the most important sexuality topics parents can talk with adolescents about. We sought to characterize the messages mothers communicate to young adolescents regarding abstinence. Content analysis of dyadic discussions that occurred between June 2011-December 2012 between mothers and their 10-14 years old adolescent sons and daughters. Discussions were audio-recorded, transcribed, and a grounded theory approach to content analysis performed. Urban city in Western Pennsylvania INTERVENTIONS: None MAIN OUTCOME MEASURES: None PARTICIPANTS: 21 dyads - 15 mother-daughter dyads and 6 mother-son dyads RESULTS: Four key themes emerged reflecting the high priority mothers placed on abstinence, delaying their adolescent's sexual debut and nurturing sexual decision making skills. Theme 1 focused on ensuring that adolescents understand what abstinence...
Journal of Pediatric and Adolescent Gynecology, 2017
Pediatrics in Review, 1994
There are no data to suggest that children who have gay or lesbian parents are different in any a... more There are no data to suggest that children who have gay or lesbian parents are different in any aspects of psychological, social, and sexual development from children in heterosexual families. There has been fear that children raised in gay or lesbian households will grow up to be homosexual, develop improper sex-role behavior or sexual conflicts, and may be sexually abused. There has been concern that children raised by gay or lesbian parents will be stigmatized and have conflicts with their peer group, thus threatening their psychological health, self-esteem, and social relationships. These fears and concerns have not been substantiated by research. Pediatricians can facilitate the health care and development of these children by being aware of these and their own attitudes, by educating themselves about special concerns of gay or lesbian parents, and by being a resource and an advocate for children who have homosexual parents.
Motivational Interviewing, 2014
Journal of Pediatric and Adolescent Gynecology, 2000
Background: Female adolescents frequently practice unprotected vaginal intercourse leading to nea... more Background: Female adolescents frequently practice unprotected vaginal intercourse leading to nearly 1 million unintended pregnancies and 3 million sexually transmitted diseases (STDs) a year. Qualitative reasons for three contraceptive use patterns were explored. Contraceptive use patterns were quantified and correlated with gynecologic history.Methods: A total of 146 predominantly non-white (81%) sexually active female adolescents with a mean age of 17.2 +/- 1.9 years (13-21 years), completed a 45-minute self-administered, computerized questionnaire as part of a larger project. The questionnaire assessed sexual, contraceptive, gynecologic and obstetric history. Nearly a third (32%) had ever been pregnant and 32% had ever had a STD. Subjects were asked to describe their contraceptive use patterns for condoms, pills, and Depo-Provera as either "never used," "have used, but stopped," or "used before and am still using." Adolescents typed in their qualitative reasons for never using, stopping, or still using each of the three methods of contraception.Results:None of the three condom use patterns were significantly correlated with ever having a STD or being pregnant. Of those who had ever been pregnant, 70% had stopped using Depo-Provera as compared to 38% who were still using Depo-Provera, p < 0.02; 47% had stopped using pills as compared to 25% who were still using pills, p = 0.04; 47% had stopped using pills as compared to 22% who had never used pills, p < 0.01. "Using another contraceptive" was the reason why one-third of subjects never used condoms. The most common reasons for never using pills were "on Depo-Provera," "would forget," and not liking to take pills. Reasons for never using Depo-Provera included using another contraceptive, not liking shots and "might make me fat." The top four reasons for discontinuing condom use were being in a trusting, monogamous relationship, using another form of contraception, abstinence, and "don't like the way condoms feel." Two of the main reasons for stopping pills and Depo-Provera were weight gain and altered menses. However, those subjects who stopped taking the pill reported "kept forgetting" and "they made me sick" as other reasons for stopping. "Prevent pregnancy" was by far the most common reason for still using pills and Depo-Provera, while for condoms "prevent STDs" was cited with equal frequency to "prevent pregnancy." Having regular or no periods were frequent reasons for ongoing use of pills and Depo-Provera, respectively. Depo-Provera users also reported "don't have to worry about missing a pill" as a major reason for continuing use.Conclusions: Understanding the reasons why adolescents never use, stop using, or continue to use a particular method of contraception may provide a focus for more effective counseling.
Journal of Adolescent Health, 2008
Journal of Adolescent Health, 2005
accepting of tattoos and piercings respectively. For tattoos, being stylish or looking good (58%)... more accepting of tattoos and piercings respectively. For tattoos, being stylish or looking good (58%) would be the major reasons for getting a tattoo; 22% would get one to honor or remember someone. Seventy-four percent would get a piercing to be stylish or look good. Of those with body art, 63% with tattoos and 60% with piercings indicated that their parents knew that they were having it done. Fifty-six percent and 63% with tattoos and piercings respectively said that the person performing the procedure asked for parental consent. All but one person had received their tattoo or piercing at a professional shop or at a mall. Conclusions: Although relatively few subjects had body art, many wanted either a tattoo (44%) or a piercing (17%), usually to look good or to be stylish. Approximately one-third of those with a tattoo or piercing would not repeat the experience. Most states, including Texas, require parental consent prior to the age of 18 for tattoos and piercings; however, approximately 40% of the teenagers surveyed were not asked to provide consent. Because only 60% of parents knew that their teenagers planned to have body art, some probably would not have given their permission.
Journal of Adolescent Health, 2005
Preadmission patterns of physical activity were examined in a sample of 537 juvenile detainees an... more Preadmission patterns of physical activity were examined in a sample of 537 juvenile detainees and compared with the 2001 Youth Risk Behavior Survey (YRBS), a national sample of high school students. Overall, detained youth reported similar participation in physical activity, surpassing the student sample in some areas.
Current Problems in Pediatric and Adolescent Health Care, 2004
Adolescents are questioning and coming to understand their sexuality, and recognizing and disclos... more Adolescents are questioning and coming to understand their sexuality, and recognizing and disclosing their sexual orientation, at increasingly younger ages. At the same time pediatricians have begun to care for teenagers ...
Background Adolescent and young adult (AYA) women with sickle cell disease (SCD) have increased p... more Background Adolescent and young adult (AYA) women with sickle cell disease (SCD) have increased pregnancy-related health risks and are prescribed potentially teratogenic medications, yet little is known about pediatric SCD provider contraceptive practices. We aimed to assess pediatric hematology providers’ beliefs, practices, motivators, and barriers for providing contraceptive care to female AYA with SCD. Methods Guided by the Health Belief Model (HBM), we developed a 25-question, web-based survey to assess providers’ practices. Survey links were distributed nation-wide to pediatric SCD and/or general hematology providers through their publicly available emails and by request to directors of U.S. accredited Pediatric Hematology-Oncology fellowship programs for distribution to their SCD providers. Data analysis included descriptive statistics, chi-square analysis, logistic regression. Results Of 177 respondents, 160 surveys meeting inclusion criteria were analyzed. Most providers re...
Promoting Mental Health in Children and Adolescents: Primary Care Practice and Advocacy, 2018
Medical acupuncture, 2018
DR. SHIU-LIN TSAI: Thanks to each of you for joining this panel on acupuncture and integrative me... more DR. SHIU-LIN TSAI: Thanks to each of you for joining this panel on acupuncture and integrative medicine in pediatrics. We have a ''dream team'' of experts and leaders in the field of pediatric integrative medicine for this discussion from across the United States and as far away as Australia! What a privilege to have you all together to describe the many innovations that you are doing in your areas, and to discuss the state of acupuncture in pediatrics. I would like to start with Dr. Brown-would you please describe for us the integrative service clinic at the Children's Hospital and Clinics of Minnesota? How did that clinic get set up and who have you been seeing in terms of your patient base? DR. MELANIE BROWN: Our clinic has actually been in existence for more than 10 years, and we have a very busy practice. One unique thing is that we are part of the Department of Pain, Palliative Care and Integrative Medicine, and truly take a comprehensive approach to taking care of children with serious illnesses as well as typical healthy children. At Children's Minnesota, we have both an inpatient and an outpatient practice. Our outpatient clinic gets referrals from all areas of the hospital, as well as from the general region. We see children with many different diagnosesincluding vocal-cord dysfunction, pain, nausea, anxiety, postconcussion/headache, sickle-cell disease, and abdominal pain, and for general nutrition and health, and much more. One of the beautiful things about integrative medicine is that it is the kind of care that can benefit everyone. In our comprehensive approach, we look at what is most concerning for the patients and their families and focus our care on exactly what it is that they need. We are focused on strengthening the resources and the tools that our patients and families have innately, and a lot of our work is modeled around that. Some of the integrative techniques that we use involve clinical medical hypnosis. Other therapies include acupressure and acupuncture; biofeedback; and nutrition counseling, looking at vitamins and supplements, looking at sleep and exercise, Pediatric acupuncture is being used to treat many different symptoms in various healthcare settings-from the clinic to the emergency room to school-based health centers. Medical Acupuncture convened the following roundtable discussion with the physicians shaping the field through their clinical practices and their growing evidence bases.
The Clinical Teacher, 2016
Background : Motivational interviewing (MI) is a collaborative, evidence-based, personcentred cou... more Background : Motivational interviewing (MI) is a collaborative, evidence-based, personcentred counselling style for addressing ambivalence about behaviour change. Despite its proven effectiveness, there is little formal instruction of MI in paediatric training programmes. Methods : Second-year paediatric residents participated in a 4-hour MI workshop, followed by a 1-hour small group review course and hands-on supervision during their Adolescent Medicine rotation. After the MI workshop, and again after their refresher course, we assessed residents' attitudes and skill with written and online surveys, as well There is little formal instruction of MI in paediatric training programmes
Clinical Medicine Reviews in Women's Health, 2010
The levonorgestrel-releasing intrauterine system (LNG-IUS) is a highly effective method of pregna... more The levonorgestrel-releasing intrauterine system (LNG-IUS) is a highly effective method of pregnancy prevention used by women throughout the world. Until recently, intrauterine contraception has been underutilized by US women particularly adolescents. This is primarily because of persistent misconceptions and myths held by clinicians and patients surrounding the safety and efficacy of these devices. This article presents the latest research regarding the acceptability, safety, and efficacy of the LNG-IUS.
The Journal of the American Osteopathic Association, 2014
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Papers by Melanie A. Gold, DO, FAAP