Gastrointestinal transit of model mini-tablet controlled release oral dosage forms in fasted human volunteers

The aim of this study was to compare the gastrointestinal transit of multiple unit, small diameter (3.2 mm), non-disintegrating tablets of differing densities with results previously reported in the same volunteers in the fasted state for larger diameter (6.6 and 12.2 mm) tablets. The gastrointestinal transit was observed with gamma-scintigraphy at various intervals over a 9-h period to give an accurate assessment of the transit characteristics. The value for the median emptying time of the first light tablet was significantly shorter than that for the dense tablet, but the total emptying time and the time for the last tablet to empty for both sets of tablets were not statistically different. The value of the median time for initial and final emptying of the small tablets from the stomach was significantly longer than that for the larger diameter tablets. The 9-h time limit of the observations limited the estimation of the time taken to enter the caecum and consequently the small intestine transit times. There was clear evidence that for the dense tablets of all sizes, the value for the small intestine transit time was longer than the 3–4 h reported in the literature. The only tablet system to enter the caecum within the time limit of the study was the normal density 12.2-mm tablets.

The influence of non-disintegrating tablet dimensions and density on their gastric emptying in fasted volunteers

The aim of this work was to identify the influence of tablet density on their gastric emptying in fasted subjects and to compare the findings with those of a previous study using the same subjects with tablets of a larger diameter. Tablets of 6.6 mm diameter and densities of 1.41 and 2.85 g cm−3 were labelled with 99mTc and 111In. They were coated with ethyl cellulose to ensure that they remained intact within the gastrointestinal tract. Their position within the gastrointestinal tract of fasted healthy subjects was monitored with a double-headed gamma camera at 1-min time intervals. The median gastric emptying time and the interquartile range were derived from the Bernoulli random event distribution. It was found that the dense tablets had a significantly longer gastric emptying time than the light tablets. Comparison with the results from the previous study gave a clear indication that irrespective of tablet density, the 6.6-mm tablets had longer gastric emptying times than the 12.0-mm tablets.

Discussions of vaginal douching with family members

PURPOSE

This study examined women's personal douching history and the information they were given by others.

METHODS

Participants in the study (N=199; mean age=28.92) completed a 48-question survey on douching practices and attitudes.

RESULTS

Fifty-seven percent of participants had douched and 39% currently douche. The majority of women reported douching after menstruation, before or after sex, or as needed. Reasons for douching included maintaining cleanliness, feeling good and fresh, eliminating vaginal odor, and removing menstrual blood. Most women (69%) had at least one discussion about douching, with 49% having a discussion with their mother and 22% with a health care provider (HCP). Of the women who currently do not douche, 47% stopped after a HCP instructed them to quit; whereas, 100% of women whose HCP encouraged douching went on to douche. Furthermore, 66% of women planned to discuss douching with a younger girl, with 57% encouraging or being neutral and 43% discouraging it. Women who have previously douched were more likely to discuss and encourage douching than women who had never douched. Also, women who have received a discussion about douching or were encouraged to douche were more likely to douche than women who had not received a discussion or were discouraged.

CONCLUSIONS

Results from this study suggest that younger generations may be taught about or encouraged to douche by their mothers. By giving women accurate information and discouraging douching, women may be less likely to douche or encourage douching in their daughters.

Enrolment of young adolescents in a microbicide acceptability study

BACKGROUND

Clinical trials of microbicides should include adolescent participants. There may be unique challenges including obtaining informed consent, meeting eligibility criteria and adherence to study demands. We report on our experience enrolling young adolescents in a microbicide surrogate acceptability study and the implication of our experience for other types of clinical trials.

METHODS

Adolescent females were enrolled in a microbicide surrogate acceptability study for 6 months which required parental consent. They were asked to use the product every time they had coitus. They had face-to-face interviews at intake, 3 and 6 months, and completed weekly phone diaries.

RESULTS

Of the 208 enrolled, 95 participants were between 14 and 17 years. Ten were pregnant at intake, and 15 did not have sex during the study. Of the remaining 70 adolescents, 46 (66%) used the product at least once during the 6-month period, and all but seven attended a face-to-face interview after intake.

CONCLUSIONS

It will be possible to include young adolescents in clinical studies, even if parental consent is required. However, there will be challenges, and researchers need to anticipate those challenges and reduce barriers to enrolling young adolescents.

Research on adolescents and microbicides: a review

Adolescents are an important target for microbicide research, as they are disproportionately affected by sexually transmitted infections and currently are underrepresented in the microbicide research literature. Furthermore, adolescents are psychosocially and biologically different from adults, and findings from adult research cannot be assumed to apply universally to adolescents. Adolescents, to date have rarely been included in clinical trials and acceptability research for microbicides, in part because their participation requires attention to unique developmental issues, including parental consent and confidentiality. Despite these challenges, adolescents should be included in microbicide clinical research. If adolescents are ultimately expected to use microbicides, it is essential that we understand the developmental, contextual, and relationship variables that may influence use and acceptability. Accordingly, the goal of this paper was to examine the issues affecting the inclusion of adolescents in microbicide clinical research as well as review the existing adolescent-specific microbicide research, which highlights the various factors that may influence use and acceptability. It is hoped that this review can provide guidance for future work with this important, specialized population.

Relationship context associated with microbicide-like product use

STUDY OBJECTIVE

Topical microbicides are being developed to provide an alternative method of prevention of HIV and sexually transmitted infections. Although topical microbicides would be a female-controlled method of prevention, their use is likely to be disclosed to partners. Thus, the characteristics of the partner relationship may play a role in their use. We sought to examine whether qualities of the relationship and of the partner were associated with using a microbicide-like product.

DESIGN

We studied 166 females (14 to 21 years of age) who were participating in a 6-month study of microbicide-like products (vaginal lubricants). They described partner relationships and characteristics of the partners.

RESULTS

Of the 166 participants, 118 used the product. In bivariate analyses, those whose relationships were longer, monogamous, more mutual, and more satisfying were more likely to use the product. Further, when sex occurred in the young women's or couples' homes, use also was more likely. There was no relationship between product use and whether the partner had a job or was in school or between the partners' levels of substance use. In a multivariable logistic regression with backwards elimination, only relationship satisfaction remained significant in the model.

CONCLUSION

Topical microbicides will be used within the context of a relationship, and characteristics of the relationship most likely will influence use. These findings suggest that special attention may have to be given to supporting use in high-risk relationships and that all interventions to enhance uptake should consider the relationship context.

Participation of adolescent girls in a study of sexual behaviors: balancing autonomy and parental involvement

STUDY OBJECTIVE

The process of research with adolescents should balance parental involvement and adolescent autonomy. The attendance of parents and peers at research study visits of girls participating in a 6-month study of topical microbicide acceptability is described, as well as the participants' conversations with their parents.

METHODS

Girls, 14 through 21 years, were recruited from previous studies (3%), advertisements (14%), clinics (17%), and recommendations by friends (66%) to participate. Girls under 18 years were required to have parental consent, but parents could provide verbal phone consent as long as a signed consent form was returned before participation.

RESULTS

The 208 participants were 41% African-American, 30% Hispanic, and 29% Caucasian. Girls averaged 18 years of age, and 95 (46%) were under 18. Seventeen percent of parents attended the first visit; only 1 parent attended with a daughter older than 18 years of age. The mothers of older adolescents were less likely to attend the appointment with them. More Caucasian than African-American girls came with a mother. Parental attendance decreased at follow-up visits. Thirty-seven percent of girls brought a peer to the first visit; there were no age or race/ethnic differences. There was no relationship between attending with a parent or peer and talking to a parent about the study. Some adolescents obtained parental consent to participate in the study while keeping their sexual behaviors private.

CONCLUSIONS

Parental attendance at study visits may not be marker of parental involvement with the study. Creative ways for balancing concerns about confidentiality, promotion of autonomy, and adult involvement should be considered.

Racial/ethnic differences in patterns of sexual behavior and STI risk among sexually experienced adolescent girls

STUDY OBJECTIVE

Racial/ethnic differences in prevalence and patterns of oral and anal sex were analyzed among girls participating in a microbicide acceptability study.

DESIGN

Cross-sectional analysis

SETTING

Recruitment to participate in a 6-month study examining microbicide acceptability was conducted at a school-based health clinic and local colleges in Galveston, Texas and through snowball sampling.

PARTICIPANTS

Sexually experienced girls (n = 202) ages 14 to 21 years of age.

MAIN OUTCOME MEASURES

Girls reported on their demographic and sexual history at the intake interview.

RESULTS AND CONCLUSIONS

Their mean age was 18.2 years; 26% were white, 43% African-American, and 31% Hispanic. African-American girls were significantly less likely than whites and Hispanics to have had oral sex; no differences were found for anal sex. African-American girls were significantly older than whites and Hispanics when they initiated oral sex. African-American girls had a greater difference between ages of vaginal and oral sex initiation than whites and Hispanics. Oral sex history was associated with a 6-factor increase and anal sex history was associated with a 3-factor increase in the likelihood of a history of sexually transmitted infection. Future studies should explore these differences in greater depth in order to develop culturally specific STI prevention efforts.

Psychosocial development and puberty

The context of adolescent development in which puberty occurs is briefly reviewed, along with the psychosocial impact on timing of puberty, girls' perception of puberty, and the impact of puberty on relationships with parents and on psychological health. This information can be integrated into clinical practice in order to provide the best care for adolescents, but, first, access to confidential and comprehensive care must be available.

Uptake of HPV vaccine: demographics, sexual history and values, parenting style, and vaccine attitudes

PURPOSE

To examine the relationships of demographics, parenting, and vaccine attitudes with the acceptance of the human papillomavirus (HPV) vaccine or to the intent to vaccinate in the next 12 months.

METHODS

Mothers (n = 153) with daughters ages 11 to 17 years were recruited through the pediatric clinic waiting room/announcements to complete a questionnaire.

RESULTS

Eighteen percent of the daughters had not received the vaccine, although it had been offered; 34% had not been offered the vaccine and did not intend to get it in the next 12 months; 22% had not been offered the vaccine but intended to get it in the next 12 months; 26% had started vaccination or completed the series. In a multinomial, multivariable logistic regression model, those mothers who had less than a high school degree, had a history of a sexually transmitted infection, supervised their daughter more when she was with peers, and whose daughter would not mind three shots were more likely to be favorable about their daughter being vaccinated. The following variables were not related to their attitudes about getting the vaccine: mothers' and daughters' ages, race/ethnicity, mothers' self-reported history of HPV disease and age of sexual initiation, daughters' dating status and anticipated age of sexual initiation, the number of sexual topics discussed and level of comfort, mother's sexual values, and the family environment.

CONCLUSIONS

Mothers' decisions about the HPV vaccine were not related to their sexual values or their daughters' sexual behavior, but rather their parenting, sense of vulnerability, and vaccine attitudes. Mothers who were not planning to vaccinate did not appear to not feel an urgency given the newness of the vaccine, and many planned to vaccinate eventually.

Male partners of young women: assessing their attitudes toward topical microbicides

Male partners' attitudes toward microbicide use are important to understand; however, there are challenges in conducting research with adolescent couples. We describe the experience of recruiting male partners of adolescent females enrolled in a microbicide acceptability study. Creative solutions to enrolling partners of young women in studies need to be explored.

Adolescents' reasons for using a microbicide-like product over time

This study examined the reasons that adolescent girls used a product over time. Adolescent girls (n = 208; 14-21 years) participated in a six-month study in which they completed three face-to-face interviews and 24-weekly phone call interviews. Participants were given microbicide-like products (vaginal lubricants) and encouraged to use them with condoms when they had intercourse. Most of the reasons for use were endorsed by most of the adolescent girls, at some time during the study. Over time, the adolescents were significantly more likely to report the following reasons for use: did not think the product would leak out (z = 2.49; P < 0.01), the product felt comfortable (z = 2.41; P < 0.02) and the product was not messy to use (z = 3.11; P < 0.01). Although it appears that adolescents are interested in microbicides, they may worry about certain characteristics of the product. It will be important to develop anticipatory guidance that focuses on the experience of using the product, making sure adolescent girls continue to use over time.

Adolescent girls' communication with partners about microbicide use

BACKGROUND

Topical microbicides could be a female-controlled method of preventing sexually transmissible infections. Despite the possibility of surreptitious use, most women report that they would tell partners, and microbicides may be detectable. The purpose of the present study was to examine communication between adolescent girls and their partners regarding microbicides.

METHODS

Girls (aged 14-21 years) participated in a 6-month study in which they were given vaginal moisturisers to use when they had intercourse. Data was collected about their demographics, sexual histories and conversations with mothers and partners. Both quantitative and qualitative analyses were conducted.

RESULTS

Girls (n = 171) were asked about conversations with their partners. Talking with mothers and using the product were significantly related to talking with partners. Reasons for not talking were intrapersonal or interpersonal variables, the context of the relationship did not warrant an explanation and the lack of a decision to communicate. There seemed to be no difference in conversations for those who used or did not use. Girls had conversations with their partners when deciding to be in the study, when they were engaged in study activities or when deciding to use the product. Conversations about using the product focused on needing to use the product because of study demands, the lubricating properties or wanting to experience product use.

CONCLUSIONS

Most of the girls talked to their partners and had positive conversations. Girls may need help initiating conversations and managing reluctant partners.

Predictors of using a microbicide-like product among adolescent girls

PURPOSE

This study examined demographic, sexual history and weekly contextual variables, and perceptions about microbicides as predictors of microbicide-like product use.

METHODS

Adolescent girls (N = 208; 14-21 years) participated in a 6-month study in which they completed three face-to-face interviews and 24-weekly phone call interviews. Participants were given microbicide-like products (vaginal lubricants) and encouraged to use them with condoms when they had intercourse.

RESULTS

Of the girls, 75% had had a sexual opportunity to use the product. Using multi-variable logistic regression, the following variables independently predicted ever using the product: length of sexual experience, number of lifetime vaginal partners, and the Comparison to Condoms subscale on the Perceptions of Microbicides Scale. Using a mixed model repeated measure linear regression, the following variables independently predicted frequency of use: week of the study, age, condom frequency prior to the study, and three subscales on the Perceptions of Microbicide Scale: namely, the Comparison to Condoms subscale, the Negative Effects subscale, and the Pleasure subscale.

CONCLUSION

Most girls used the product, including those who were not protecting themselves with condoms. Girls' initial perceptions regarding the product predicted initial use and frequency of use. Further research should evaluate the best methods for supporting the use of these products by young or sexually less experienced girls.

Measurement of microbicide acceptability among U.S. adolescent girls

BACKGROUND AND OBJECTIVE

Topical microbicides will only be effective if they are acceptable to potential users. The purpose of this study is to develop a scale to evaluate characteristics and aspects of topical microbicides that are important to adolescent girls.

STUDY DESIGN

Girls (n = 207) completed a questionnaire on perceptions of microbicide-like products.

RESULTS

A principal components factor analysis with a varimax rotation produced a 6-factor solution. The mean factor scores suggested that girls saw the products positively. Age was positively correlated with "comparison to condoms" and "comfort while using" factor scores and inversely correlated with "negative impact on interpersonal relationships" factor score. Sexually transmitted infection (STI) history was related to higher scores on the "health benefits" and "pleasure" factors. Age, race/ethnicity, and STI history were not related to the other factor scores.

CONCLUSION

The current scale shows promise in assessment of microbicide acceptability, and in general, girls expressed positive views about microbicides.

Adolescents' descriptions of the physical characteristics of microbicide surrogates and experiences of use

PURPOSE

Our purpose was to describe adolescent girls' perceptions of microbicide surrogates and experiences of use, including impact on sexual pleasure.

METHODS

Sexually experienced girls, 14-21 years, were recruited for a study examining microbicide acceptability. The girls were given vaginal moisturizers (gel or suppository) to use as if they were microbicides. Girls (n = 175) discussed their perceptions and experiences of use of these products in response to semistructured interviews. Girls were asked at weekly phone interviews about the impact of product use on their and their partners' sexual pleasure. These answers were averaged, and girls were categorized into those for whom the product predominantely made sex feel worse, better less than half the time, or better half the time or more. The relationship of demographics and sexual history to the impact on pleasure was evaluated.

RESULTS

Overall, participants were positive about their experience with the products. More girls preferred the gel. Specific concerns about the suppository included the wait period, texture, and messiness of self-insertion. Many liked the lubricating quality of both of the surrogates. Girls discussed messiness, leakage, clumping, and the difficulties in communicating with partners. Over half reported an increase in pleasure most of the time for themselves and their partners. None of the demographic and sexual history predictors were significantly related to impact on pleasure.

CONCLUSIONS

Anticipatory guidance should help girls initiate and sustain use. Future research should examine the best way to accomplish counseling about microbicide use with adolescent girls.

Adolescent girls' communication with "mothers" about topical microbicides

STUDY OBJECTIVE

Topical microbicides, a female-initiated method to protect against sexually transmitted infections (STI) and pregnancy, will only be effective if found acceptable. Mothers may have an influence on acceptability and use among adolescent girls. The current study examined the communication between girls and mothers to understand the potential predictors and nature of conversations regarding surrogate microbicide products.

DESIGN

Sexually experienced girls, 14 to 21 years, were recruited for a 6-month study examining microbicide acceptability. During face-to-face interviews, qualitative data were collected regarding communication between girls and mothers. Two independent raters coded the responses, which were organized into themes. Themes were interpreted according to the conceptual understanding of mother-daughter communication.

RESULTS

Fifty percent of the 171 girls with codable responses had a conversation with their mother. Higher levels of indirect parental monitoring were related to being more likely to have a conversation. Concrete events related to the study (i.e. receiving phone call from the researcher, having an appointment, or seeing the product) or inquiries by mothers appeared to promote conversation. Barriers to conversation included the private nature of the information and relationship issues between the mother and daughter. Conversations often addressed issues related to girls' participation in the study, although some conversations included global issues related to sexuality.

CONCLUSIONS

Girls may talk to their mothers about new products for STI prevention, and such conversations may provide opportunities to promote use.

When adolescent girls say, "I don't know"

STUDY OBJECTIVE

To understand adolescent girls' use of "I don't know" within the context of discussing information related to sexual attitudes and behaviors.

DESIGN

Qualitative analysis of seven focus groups with adolescent girls.

SETTING

Urban primary care clinic.

PARTICIPANTS

Adolescent girls (n = 23) with a mean age of 16.4 years (range 14 to 18 years). Fifty-two percent were African-American, 26% were Caucasian, 17% were Hispanic/Latino, and 5% were Asian.

RESULTS

The use of "I don't know" served three functions: (1) place holder, (2) lack of commitment to an opinion; and (3) reduction of commitment to an opinion or belief.

CONCLUSIONS

These results suggest that girls use "I don't know" when asked about their thoughts and opinions related to sexual health, and that its use can have varying implications. Discriminating the intent may help providers respond appropriately. Responses should include providing a safe and nonjudgmental environment in which girls can express their feelings and opinions regarding their sexual health.

Intergenerational transfer of douching information

STUDY OBJECTIVE

To characterize the discussions on douching that female parents/guardians have with daughters.

DESIGN

A questionnaire assessing personal douching history, beliefs on the practice of douching, and what they had discussed or intended to discuss about douching with their daughters was administered to women who were parenting females 11-21 years of age.

PARTICIPANTS

Fifty-seven women who had douched or currently douche completed the questionnaire.

RESULTS

Fifty-six of the women had discussed or planned to discuss the subject with their daughters. The girls with whom they had had a discussion were significantly older (16.2 years) than those with whom they planned to have a discussion (14.1 years). Most (73%) of the women had encouraged or planned to encourage douching, while only 18% had or planned to discourage it. Mothers had or planned to have the conversation in the context of menses (76%), sexual activity (40%), or when their daughter instigated the conversation (44%). Over 40% of the mothers had not or did not intend to discuss any negatives about douching. Only ten of the women stated that a health care provider had spoken to them or their daughter about the subject.

CONCLUSION

Female parents/guardians are an important source of information about douching for their daughters. Health care providers need to educate girls as well as the women who parent them on the health risks associated with douching. Public campaigns aimed at decreasing douching should target this intergenerational transfer of information.

Parents and partners: enhancing participation in contraception use

When adolescent girls choose to have sexual intercourse, it is important for them to have the knowledge, resources, and communication skills necessary to avoid unintended pregnancies. There are many barriers to contraceptive use that are specific to adolescents, and it is possible that parents and partners could help to support consistent and correct use of contraception. This paper reviews the existing literature on the role of parents and partners, and discusses the implications of this knowledge base for clinical practice. The specific recommendations in this manuscript are designed to aid health care providers in supporting the involvement of parents and partners in the lives of adolescent girls in order to promote the positive emotional and physical growth of adolescent girls.

Parental acceptance of adolescent vaccines within school-based health centres

Parental acceptability of genital herpes (HV) and meningococcal (MV) vaccines within school-based health centres (SBHCs) was examined. A convenience sample of 85 parents completed a telephone survey. Eighty-five per cent of respondents supported offering the HV within SBHCs; 87% the MV. Sixty-two per cent of respondents would allow HV to be administered to their adolescent in the SBHC, 75% the MV. When location of vaccination was unspecified, 42% of parents would allow vaccination of their adolescent for HV, and 71% would permit MV vaccination. Parents supported offering HV via SBHCs; many would permit their adolescent to receive it. Predictors included SBHC perceptions and a belief that all adolescents should be vaccinated for genital herpes. Perceptions of stigma/shame associated with sexually transmitted infections were not related to herpes vaccine acceptability. Efforts to enhance vaccine uptake for adolescents should focus on promoting positive perceptions of the location of vaccination and universal recommendations.

Adolescent issues associated with knowledge of and access to topical microbicides

PURPOSE

Topical microbicides could be a female-controlled method for prevention of sexually transmitted diseases (STDs). Microbicides could offer girls a potential preventive option, if they are able to access them. The purpose of this investigation was to evaluate girls', mothers', experienced healthcare providers', and medical students' views on adolescent girls' obtaining information about and acquiring microbicides and where adolescent girls would keep or carry a microbicide.

METHODS

Focus groups were conducted and videotaped with each group of individuals. The videotapes were transcribed, and the transcriptions were coded for relevant themes.

RESULTS

Participants anticipated that adolescents would learn about microbicides from a variety of sources and that specific educational efforts for each of these sources (mothers, healthcare providers, and school-based sexuality education) would be needed. Healthcare providers stressed the importance of enhancing access by having both prescription and over-the-counter (OTC) options. For nonprescription products, the participants felt that the microbicide should be in stores and venues to which adolescents typically go by themselves. A microbicide that was girl-friendly and adolescent-friendly consistently was highlighted by the participants. Participants thought this would increase discretion and decrease embarrassment. The location of keeping and carrying the microbicide was anticipated to be dependent on parents' knowledge of their adolescent's sexuality and the likelihood that parents search their adolescent's belongings.

CONCLUSIONS

Consideration of the adolescent-specific issues in the design of microbicides and marketing strategies may be crucial for adolescent adoption of this female-controlled method.

Non-exclusivity in adolescent girls' romantic relationships

BACKGROUND AND OBJECTIVES

As adolescents develop intimate relationships skills, they might change romantic partners often. Little is known about this developmental phenomenon.

GOAL

The goal was to determine the frequency of non-exclusive romantic relationships in girls, the variables associated with non-exclusive relationships, and the variables associated with having sexual intercourse in a non-exclusive relationship.

STUDY DESIGN

Girls (12-15 years of age) participated in a longitudinal study (3 y, 7 visits) of romantic relationships.

RESULTS

Seventy-two of 160 girls had a non-exclusive relationship, and of these, 23 girls had intercourse in an outside relationship. Younger age, belief that the boyfriend had an outside relationship, and less parental indirect monitoring was associated with the girl having an outside relationship. A longer time being sexually experienced and less direct parental monitoring was associated with having intercourse in the outside relationship.

CONCLUSION

Non-exclusivity in adolescence is common but does not always include sexual intercourse. Healthcare providers can address non-exclusivity with adolescents directly.

Topical Microbicide Use by Adolescent Girls

BACKGROUND AND OBJECTIVES

Adolescent girls could benefit from topical microbicide use if the product is acceptable to them.

GOAL

The goal was to evaluate girls', mothers', experienced healthcare providers', and medical students' views on timing of use, efficacy, and safety of topical microbicide use by adolescents.

STUDY DESIGN

Focus groups were conducted with girls, mothers, healthcare providers, and medical students. All groups were videotaped, transcribed, and coded for relevant themes.

RESULTS

A delay between insertion and coitus presented a problem, and pre- and postcoital use had advantages depending on the group. Efficacy was evaluated by timing of use, smell, ability to feel the product, and confidence that it would spread sufficiently. There were concerns about physical side effects and the impact on normal vaginal flora.

CONCLUSION

This study demonstrated the importance of understanding the unique needs and perspectives of adolescent girls and the adults who have an influence on their use.