title: Adolescent smoking, weight changes, and binge-purge behavior: associations with secondary amenorrhea.
abstract: BACKGROUND
  The association of secondary amenorrhea with extreme forms of substance use, weight control, and exercise in nonrepresentative samples raises questions as to whether adolescents in the general population who engage in these behaviors are at increased risk for secondary amenorrhea. We examined the prevalence and behavioral correlates of secondary amenorrhea in a county-wide high school population of 2544 girls aged 13 to 18.
  
  
  METHODS
  A survey questionnaire, which elicited menstrual history as well as weight history, weight control practices, level of exercise, and use of cigarettes, wine, and beer, was administered during school hours; absentees were also surveyed. The completion rate was 91%.
  
  
  RESULTS
  The 1-year prevalence of secondary amenorrhea was 8.5%. Secondary amenorrhea was associated with smoking one or more packs of cigarettes per day (adjusted relative risk [RRa] = 1.96, 1.21-3.10), with multiple binge-eating behaviors in combination with laxative use or self-induced vomiting (RRa = 4.17, 2.54-6.32), and with weight fluctuation due to weight control (RRa = 2.59, 1.33-4.79). There was no association between amenorrhea and alcohol consumption or exercise level.
  
  
  CONCLUSIONS
  Estimates of attributable risk are provided and indicate that bulimic behaviors and cigarette smoking may result in a considerable excess of cases of secondary amenorrhea in an adolescent population.
authors.affiliation: Clinical and Genetic Epidemiology Unit, Columbia University College of Physicians and Surgeons, New York, NY.
authors.forename: J
authors.initials: J
authors.lastname: Johnson
authors.forename: A H
authors.initials: AH
authors.lastname: Whitaker
mesh_terms: D000293:Adolescent; D000428:Alcohol Drinking / Q000009:adverse effects / Q000453:epidemiology; D000568:Amenorrhea / Q000145:classification / Q000453:epidemiology* / Q000209:etiology; D015992:Body Mass Index; D001835:Body Weight; D002032:Bulimia / Q000150:complications* / Q000453:epidemiology; D002400:Cathartics / Q000009:adverse effects; D003430:Cross-Sectional Studies; D015444:Exercise; D005260:Female; D006801:Humans; D015999:Multivariate Analysis; D015995:Prevalence; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects* / Q000453:epidemiology; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires / Q000592:standards; D015430:Weight Gain; D015431:Weight Loss
chemical_list: D002400:Cathartics