Division of Adolescent Medicine Investigators and Current Research Projects
Interim Division Chief: Amy DiVasta, MD, MMSc
Emeritus Chief: S. Jean Emans, MD
Associate Chief, Clinical Chief: Sara Forman, MD
Director of Research: Lydia Shrier, MD, MPH
S. Bryn Austin, ScD
- Sexual and gender minority (lesbian, gay, bisexual, and transgender youth) health. With a series of studies, Dr. Austin is examining the causes and consequences of disparities in health outcomes such as eating disorders, obesity, alcohol use, and smoking adversely affecting sexual and gender minority youth and adults. Her projects range from biological studies of stress response to abuse and discrimination to policy studies of the effects of discrimination on economic outcomes and quality adjusted life years. www.hsph.harvard.edu/sogie
David S. Bickham, PhD,
LEAH Director of Research Training
- Media and depression. Dr. Bickham studies links between media use and mental health including work that showed that young adolescents’ cell phone use predicted increases in symptoms of depression. Results from his study using Ecological Momentary Assessment have identified how characteristics of the individual and the communication moment contribute to the impact of social media use on adolescents’ affect.
- Problematic Interactive Media Use (PIMU). In collaboration with other members of the CIMAID (Clinic for Interactive Media and Internet Disorders) team, Dr. Bickham is conducting research to identify key risk factors of PIMU by investigating common characteristics among CIMAID patients. He and the team are currently developing research questions and protocols to examine the effectiveness of newly designed manualized treatment for treating young people suffering from PIMU.
- Children’s play and media use. Dr. Bickham directed a longitudinal study in the US and Mexico that examined how children’s play is linked to their media use and their healthy development. This work used Ecological Momentary Sampling and other techniques to assess play in children’s real life to help determine if media use is replacing play and how children’s health and development might be impacted.
- Media and obesity. Dr. Bickham studies the different pathways linking electronic media use to obesity among children and adolescents. His work examines how digital advertising can influence children’s food choice, how attending to television is linked to obesity, and how reducing media use can enhance physical activity and sleep.
- Longitudinal impact of media use on health. Using various existing databases, Dr. Bickham investigates various adolescent health consequences of early media use including aggression and risky sexual behaviors.
- Dating apps and sexual risk behaviors. Dr. Bickham is currently fielding a study examining links between dating app use, depression, and sexual risk behaviors among emerging adults. This work will help answer whether mental health issues increase the risk of dating app use contributing to sexual risk behaviors.
Joshua Borus, MD, MPH
- Educational Research Opportunities: There are many opportunities to participate in projects related to adolescent education and evaluation of residents. Some projects are ready to go and need person-power to convert a good idea into reality, also excited to hear about what might be exciting to you.
- Quality Improvement: Quality Improvement efforts generate lots of data and opportunities to reflect on the care we provide. Recent projects have looked at potential disparities in the patient experience amongst different groups within our clinic, asthma care, STI testing rates, Depression follow up and many others. There are exciting projects which have data and need person-power to explore further–what happens to patients if they get sectioned? How often do patients follow up once starting ADHD medications? many others!– which could be easily turned into academic products.
Pam Burke, PhD, RN
Pam is currently a Co-Investigator on two federally funded intervention studies, both of which incorporate motivational interviewing. Her primary responsibilities are around training and fidelity monitoring.
- Rigorous Evaluation of a Teen Pregnancy Prevention Program, Momentary Affect Regulation – Safer Sex Intervention (MARSSI).
PI – Lydia Shrier, MD, MPH.
- This study is in collaboration with PRG (Policy Research Group) – Independent Evaluator and two Planned Parenthood Affiliates (PP Great Northwest, Hawaii, Alaska, Indiana, Kentucky; and PP of Wisconsin). Funding is for 3 years (2020-2023) from the U.S. DHHS Office of Population Affairs, Teen Pregnancy Prevention (TPP), Tier 2, Phase II.
- Computer-facilitated Screening and Brief Intervention in Pediatric Primary Care to Reduce Underage Drinking: A Large Multi-Site Randomized trial.
PIs – Sion Kim Harris, PhD and Lydia Shrier, MD, MPH
- This R01 study is in collaboration the AAP PROS Network (American Academy of Pediatrics – Pediatric Research in Office Settings). Funding is for five years (2020-2025) from NIAAA (National Institutes of Health, National Institute on Alcohol Abuse & Alcoholism).
Amy DiVasta, MD, MMSc
- Boston Center for Endometriosis: Working together with researchers from Brigham and Women’s Hospital, our team is compiling the largest database and biorepository of adolescents and young adults with endometriosis in the United States. We will utilize these data to learn more about the etiology of endometriosis, appropriate therapies, and prognostic information for the future. Dr. DiVasta is also conducting clinical trials investigating new therapies for endometriosis.
- Bone health in girls. Dr. DiVasta is studying skeletal health in girls with anorexia nervosa and completed a clinical trial using mechanical stimulation delivered via a vibrating platform to try to prevent the bone loss so commonly seen in patients with malnutrition. Data analyses are underway.
- Reproductive Endocrine: Drs. DiVasta and Pitts would like to begin a project exploring future health outcomes of our AYA with PCOS, and to determine what treatments utilized during adolescence may impact these outcomes.
- LARC: Drs. DiVasta and Pitts are leading a national LARC QI collaborative to benchmark the adolescent LARC experience.
Shannon Fitzgerald MD, MPH
- MICON/adolescent pregnancy QI – part of a team in the adolescent clinic providing outreach and coordination for our patients with positive pregnancy tests. We also collect data as a part of a QI effort to ensure appropriate and timely follow up. We are currently looking into how the COVID pandemic affected pregnancy rates in our clinic as well.
Sara Forman, MD
- National Eating Disorders Quality Improvement Collaborative: An 18-site collaborative that looks at outcomes for teens with restrictive and other types of eating disorders via retrospective chart review. The NEDQIC is in the process of establishing a prospective registry for patients with eating disorders with the aim of improving outcomes and defining standards of best practice for teens with eating disorders. The registry is being launched in Boston and we are awaiting funding to launch it nationally at all sites.
- Accountable Care Organization: Sara Forman also directs the ACO for BCH for the Division of Adolescent/Young Adult Medicine. The ACO has supported efforts for Care coordination in Complex care, behavioral health and social determinants of health. Quality data within our division have been collected on our priority areas, and is available for individuals to review.
Carly Guss, MD, MPH
- Bone density and transgender youth: Dr Guss is working with Dr. Catherine Gordon on a NIH-funded study to evaluate changes in bone density and bone marrow composition in transgender youth who use GnRH analogues in order to block puberty as part of their gender affirming care.
Sion Kim Harris, PhD, CPH
- Teen substance abuse screening, prevention, and brief intervention research: Dr. Harris recently completed two NIH-funded trials testing a computer-assisted adolescent substance use screening and brief intervention system implemented on tablet computers in primary care offices. Prior projects included the first large international multi-site evaluation of the effects of computer-facilitated screening and clinician brief advice to address adolescent substance use in primary care settings, evaluation of a pediatric SBIRT residency training program, and evaluation of student and parent perspectives on SBIRT implementation in a school setting.
- Risks for, and effects of, problematic substance use on adolescent brain development: Dr. Harris collaborates with developmental neuroscientists at the McLean Imaging Center on longitudinal brain imaging studies of adolescent brain development and the effects of alcohol and drug use.
- Building character strengths/resilience among youth in Zambia to prevent problematic substance use: Dr. Harris is collaborating with a multi-national team to conduct a pilot trial of a positive youth development curriculum for youth ages 10-13 years old in Zambia, a country with early initiation of alcohol and drug use among youth and high HIV prevalence.
Sabra L. Katz-Wise, PhD
- Dr. Katz-Wise co-directs the Harvard SOGIE (Sexual Orientation and Gender Identity and Expression) Health Equity Research Collaborative: https://www.hsph.harvard.edu/sogie/.
- Psychosocial functioning of families with transgender youth. Dr. Katz-Wise is the Principal Investigator of a NIH-funded study, which uses a community-based longitudinal mixed methods approach to understand how the family environment affects transgender and nonbinary (TNB) youth’s health and well-being and to develop a family-level intervention to support families with TNB youth. Opportunities are available to be involved with quantitative or qualitative data analysis for this project. Dr. Katz-Wise is also working on a study to develop parenting guidelines for parents of gender diverse children.
- Sexual and gender minority (lesbian, gay, bisexual, transgender, queer) health. Dr. Katz-Wise has led a series of secondary data analyses of health disparities related to sexual orientation and gender identity, including obesity, weight-related behaviors, pain, and mental health. Dr. Katz-Wise is also a co-investigator for an online study of bisexual adults to investigate links between prejudice and health.
- Sexual orientation and gender identity development and sexual fluidity. Dr. Katz-Wise uses mixed methods to study how sexual orientation and gender identity develop and change over time and how these developmental processes may be related to physical and mental health. Dr. Katz-Wise is the Principal Investigator of a NIH-funded study to understand measurement of sexual orientation fluidity over time among adolescents and young adults.
Pamela J Murray, MD, MHP
- Making Healthy Decisions: Integrated Group-Individual Curriculum to Prevent Teen Pregnancy with Julie Downs, PhD (CMU): Multisite randomized clinical trial of an integrated teen pregnancy prevention interactive video intervention and classroom curricular materials delivered to at risk teen girls in groups compared to control (healthy eating) interventions in geographically diverse communities. Effectiveness to decrease rates of teen pregnancy, increase contraceptive and condom use and improve self-efficacy around these behaviors are being evaluated. Data available to evaluate for secondary outcomes.
- Emergency Contraception Access on College Campuses: Mentor/Co-PI for Amie Ashcraft, WVU; Assessment of emergency contraception access at tertiary care institutions with patient-simulated phone calls, building on project assessing EC access in community pharmacies in West Virginia.
- Chronic Fatigue Syndrome and Orthostatic Intolerance: Anticipating developing a protocol to assess use of a passive standing test for patients with chronic fatigue, ‘brain fog’, POTS, orthostatic intolerance. long-haul COVID presentations.
Sarah Pitts, MD,
Medical Fellowship Program Director
- LARC: Drs. DiVasta and Pitts are leading a national LARC QI collaborative to benchmark the adolescent LARC experience.
- Medical Education. As part of a national endeavor to understand the validity and utility of Entrustable Professional Activities (EPAs) in fellowship training, Dr. Pitts is the Adolescent Medicine representative on a 3-year longitudinal project utilizing EPAs as a rubric for successful completion of fellowship.
Amanda Raffoul, PhD
- Eating- and weight-related policies among populations. Dr. Raffoul’s research explores the impact and feasibility of public health policies that aim to reduce disordered eating and weight control behaviors among populations. She currently holds a Canadian Institutes of Health Research (CIHR) Fellowship, in which she is leading policy analyses using microsimulation modeling and a Delphi study of leaders in the fields of eating disorders, weight studies, nutrition, and mental health to identify gaps in eating disorders prevention.
- Food & nutrition public health policies. In collaboration with colleagues in Canada, Dr. Raffoul also uses prospective cohort data from the Canada and International Food Policy Studies to explore the impact of food and nutrition policies on disordered eating risk, as well as weight stigma and diet quality. She leverages international food policy data to explore the unintended consequences of public health policies (e.g., calorie menu labelling) on disordered eating risk, particularly among youth and young adults.
- Complex systems approaches to public health. Dr. Raffoul also has interests in the application of complex systems science to “wicked” public health challenge, especially as they pertain to nutrition and weight.
Michael Rich, MD, MPH
is the Founder and Director of the Digital Wellness Lab, an evolution of the Center on Media and Child Health, at Boston Children’s Hospital, which brings together thought leaders from tech, entertainment, public health, and medicine to understand and promote wellness in the digital age.
Dr. Rich advises pediatricians, educators, and caregivers in strategies to optimize child and adolescent development in the digital age. He has developed innovative media-based research methodologies, including Video Intervention/Prevention Assessment (VIA) and Measurement of Youth Media Exposure (MYME), which engage young people as partners in studying their lived experience.
The Digital Wellness Lab pursues research, provides education to clinicians, educators, and parents, and innovates to improve the digital environment. Research on media effects on child development, physical, mental, and social health include Global Growing Up Digital (GUD). Global GUD uses MYME to follow several thousand children and adolescents over a decade in a prospective longitudinal study. With ongoing sites in Canada and Australia, and developing sites in India, Brazil, and Switzerland, Global GUD is collecting worldwide data on how the media children use and how they use them influence their long-term well-being.
A strong advocate of applying research findings to clinical care and evaluating the interventions that result, Dr. Rich is the founding director of the Clinic for Interactive Media and Internet Disorders at Boston Children’s Hospital (www.cimaid.org), the first evidence-based clinical program designed to address Problematic Interactive Media Use (PIMU) in children, adolescents, and young adults, helping them adopt and sustain healthy lifestyles and behaviors.
Tracy Richmond, MD, MPH
Dr. Richmond is interested in weight-related disorders as well as macrosocial influences on health.
- **The Registry of Eating disorders and their Co-morbidities OVER time in Youth (RECOVERY) RECOVERY is a longitudinal registry of patients with eating disorders. Participants complete web-based surveys semi-annually including validated measures of eating disordered cognitions and behaviors, depression and anxiety. Additionally, parents and clinicians provide assessments re: the patient’s recovery and treatment. 3 years’ worth of data has been collected and there is funding for 2 years’ more data collection.
- **Avoidant Restrictive Food Intake Disorder: Dr. Richmond is the Co-Director of the ARFID Program, a multi-disciplinary program that is a collaboration between the Divisions of Gastroenterology and Adolescent Medicine. The ARFID program collects detailed information regarding development as well as validated measures that capture ARFID-related behaviors. Dr. Richmond is also leading a study using the Pediatric Health Information System (PHIS) database to document national changes in ARFID hospital stays.
- **Weight stigma: Dr.Richmond, with Drs. Idia Thurston and Kendrin Sonneville, conduct studies examining the impact of weight perception, body satisfaction, and internalization of weight-related stigma on health-related outcomes in youth with overweight/obesity. They have used the National Longitudinal Study of Adolescent to Adult Health as well as the WRAP study, a primary data collection from a cohort of youth attending a MidSouth university.
- Dieting and social contexts: Examining the impact of multiple social contexts (schools and peer networks) on weight perception and dieting behaviors.
- **Weight trajectories: Determining sensitive periods in BMI trajectories in youth with severe v. non-severe obesity and their genetic predictors. Dr. Richmond will be applying similar techniques to a population with anorexia nervosa and ARFID.
**readily available data to be analyzed
Amy L. Shafrir, ScD
- Pelvic pain and endometriosis. Dr. Shafrir is an Epidemiologist within the Boston Center for Endometriosis, in which we have established a large cohort study to collect pelvic pain, reproductive and lifestyle characteristics among adolescents and women with and without endometriosis. Dr. Shafrir conducts research on biologic markers for endometriosis diagnosis as well as to predict which endometriosis patients will benefit the most from different endometriosis-related treatments (e.g. surgery, hormonal medication use).
- Pelvic pain and substance use (potential fellow project). Within the Boston Center for Endometriosis cohort study, we have a vast amount of information on pelvic pain (dysmenorrhea, non-cyclic pain, dyspareunia) that is asked on each questionnaire in addition to information on substance use (alcohol, smoking, marijuana, vaping). We are interested in looking at associations between substance use and pelvic pain among adolescents with and without endometriosis.
Lydia A. Shrier, MD, MPH,
Research Director for the Division of Adolescent/Young Adult Medicine and Co-Director (with Dr. Sion Harris) of the Center for Adolescent Behavioral Health Research.
- Risk behaviors, social context, and mental health. Dr. Shrier uses mobile technology and momentary sampling methodology to collect data and intervene on sexual and drug use behaviors and mental health states in youth in real-life contexts. Her current projects include
- evaluating the efficacy of MARSSI, a motivational interviewing and cognitive behavioral skill intervention to reduce sexual risk behaviors in high-risk young women with depressive symptoms, and
- developing a virtual form of the motivational enhancement counseling in MOMENT, an intervention to reduce cannabis use in youth who use frequently
- Substance use screening and brief intervention. Dr. Shrier is co-investigator with Dr. Harris on two NIH-funded studies,
- a randomized controlled trial of the computer-facilitated Screening and clinician Brief Intervention system for primary care, and
- a project to integrate the computerized Screening and provider Brief Advice system for adolescent substance use and the CHADIS online clinical process support system for pediatric primary care.
- Screening for early psychosis symptoms in primary care. Dr. Shrier is collaborating with Dr. Kristen Woodberry (Maine Medical Center) on research and education to improve early detection and treatment for psychosis in adolescents and young adults.
Gabriela Vargas, MD, MPH
- Young Men’s Health Site. Dr. Vargas is the director of the young men’s health site (youngmenshealthsite.org). It helps young men and their caregivers understand health and development, including specific diseases and conditions. The website aims to empower young men around the world to take an active role in their health and health care. As of Spring 2021, the young men’s health site has over 300,000 site visits per month. There are multiple opportunities to become involved, including the development of health guides and blog posts.
- Young Men’s Health Research. Dr. Vargas is working with Dr. Borus on a qualitative study of adolescent male’s views on healthy relationships. Data collection is occurring in Summer and Fall 2021. There is opportunity for data analysis in 2022. Dr. Vargas also has IRB approval for secondary YRBS data analysis of male high school students’ report of sexual/dating violence and sexual practices.
- Quality Improvement. Dr. Vargas is the associate director of Quality Improvement in the Division of Adolescent/Young Adult Medicine. There is an array of opportunities for quality improvement geared towards fellows’ specific area of interest.
Elissa Weitzman, ScD, MSc
- Health risk behaviors among chronically ill youth. Dr. Weitzman is investigating patterns of substance use and other health risk behaviors among chronically ill youth and their interrelationship with self-care and health status. She leads multiple large sample cohort studies of youth with type 1 diabetes, juvenile idiopathic arthritis/lupus, IBD, asthma/cystic fibrosis (supported by the NIAAA). She is also developing and evaluating using RCTs psycho-educational preventive interventions to delay onset/reduce use among multiple cohorts of youth, including teens with type 1 diabetes and rheumatic diseases (funding from the Conrad N Hilton Foundation). Time series data are being collected from approximately 500 youth for these trials. A comprehensive set of epidemiological investigations are underway to support trial development including national surveys of parents of youth with chronic illness, and national surveys of subspecialty providers to characterize clinical practices.
- Social networking, surveillance and safety. Dr. Weitzman is investigating the feasibility and utility of “mining” Twitter data to detect alcohol use related behaviors for comparison with national survey survey and to explore associations with other ambient factors including alcohol control policies. Dr. Weitzman is also leading a study (funded by NIH/NIAMS) to understand the feasibility and value of collecting social media data from a cohort of teens with a chronic rheumatic condition, to augment understanding of psychosocial risks associated with chronic illness and complement structured patient-reported and clinical metrics. Findings will inform the nationally prioritized research goal of enabling cohort engagement and data donation for health research, and development of patient-centered interventions vital to improve outcomes.
- Adding the patient voice to pediatric disease registries to support patient-centered outcomes research (PCOR) and comparative effectiveness research. Dr. Weitzman has pioneered models for engaging parents of patients with pediatric onset rheumatic diseases and their children in proving structured data into a national disease registry, to augment clinical data and to identify disease and treatment burden among children with rare diseases. As part of these studies (funded by NLM), she is testing models for return of aggregate/cohort research results to participants, and is quantifying effects of doing so on motivation to participate in research and the balance of harm/benefit.
- Clinical validation of patient reported outcome measures among diverse cohorts of chronically ill youth. In this NIAMS funded cohort study (Weitzman PI), study we are collecting time series patient reported outcome measures from children and teens with rheumatic disease, cancer, and IBD, using the PROMIS system. We are validating PROs against clinical measures to understand the meaning, patterning and clinical significance of physical, social and emotional aspects of disease. We are also investigating whether depression and anxiety predict disease flares/exacerbations and substance use behaviors among teens with rheumatic disease.
- Health care transitions: chronically ill youth. Dr. Weitzman directs multiple projects focused on supporting care transitions among chronically ill youth, including ones that employ patient facing health information technologies including social media apps.
- Evaluation of School-based Screening, Brief Intervention, and Referral to Treatment in Massachusetts Public Schools. Dr. Weitzman currently co-leads a state-wide policy evaluation examining the impact of school SBIRT on health and behavioral outcomes among adolescents.
Elizabeth R. Woods, MD, MPH
- Boston Children’s Hospital Community Asthma Initiative (CAI). The CAI provides outreach to patients with poorly controlled asthma from low income neighborhoods of Boston, and provides nurse case management and home visits, including an individualized asthma management plan, environmental assessment, and connection to community resources. The program is having remarkable results in reducing subsequent hospitalizations (81%), emergency department visits (57%) and missed school days, and has a positive return on investment. A 15-year data set has been accumulated with potential for evaluation projects.
- National Eating Disorder QI Collaborative: Drs. Woods and Forman have spearheaded two phases of the 18 site national eating disorder collaborative. With Tracy Richmond, MD, a prospective registry has collected patient and provider data with one year of follow-up. Data is available for analyses. Hopefully 20 national sites will join the registry with external funding.
- Quality Improvement Projects: Dr. Woods is the Senior Advisor, with Dr. Joshua Borus as the Director, for Adolescent Division’s QI initiatives and all fellows should have some involvement with a QI project, evidence-based guidelines, and many turn into scholarly projects for fellows.