The
n e w e ng l a n d j o u r na l
of
m e dic i n e
Measuring macrophage-specific cholesterol Anand Rohatgi, M.D. efflux involves three key aspects: the cholesterol James A. de Lemos, M.D. donor (i.e., the macrophage), the cholesterol Philip W. Shaul, M.D. labeling and transport out of the macrophage, University of Texas Southwestern Medical Center and the cholesterol acceptor. We agree with Dallas, TX [email protected] Kane et al. regarding the importance of assessSince publication of their article, the authors report no furing variation in the cholesterol-donor aspect of ther potential conflict of interest. efflux to fully characterize this process, but we 1. Li XM, Tang WH, Mosior MK, et al. Paradoxical association and others have focused on measuring the po- of enhanced cholesterol efflux with increased incident cardiotential of human plasma or serum to accept vascular risks. Arterioscler Thromb Vasc Biol 2013;33:1696-705. cholesterol, because this is more amenable to 2. Khera AV, Cuchel M, de la Llera-Moya M, et al. Cholesterol efflux capacity, high-density lipoprotein function, and atherohigh-throughput measurement in large num- sclerosis. N Engl J Med 2011;364:127-35. bers of samples. We also agree that there re- 3. Mackey RH, Greenland P, Goff DC Jr, Lloyd-Jones D, Sibley main many unanswered questions about how CT, Mora S. High-density lipoprotein cholesterol and particle concentrations, carotid atherosclerosis, and coronary events: the marked heterogeneity and complexity of MESA (Multi-Ethnic Study of Atherosclerosis). J Am Coll Cardiol HDL particles may affect the selection of thera- 2012;60:508-16. peutic targets. DOI: 10.1056/NEJMc1503139
A Longitudinal Study of Bullying of Sexual-Minority Youth To the Editor: Lesbian, gay, and bisexual youth, also termed sexual-minority youth, are at high risk for being bullied.1 However, studies of bullying experiences of sexual-minority youth in the United States often rely on retrospective reports, rarely include children in elementary school, and provide little longitudinal information on changes in the prevalence of bullying with age. We used three waves of data from the Healthy Passages longitudinal study2,3 of public-school students in and around Birmingham, Alabama; Houston; and Los Angeles County. Data collection started when students were in the 5th grade (mean [±SD] age, 11.1±0.5 years) in August 2004 through September 2006 and continued in the 7th and 10th grades. At baseline, 5147 of 6663 children (77%) with permission to be contacted in randomly sampled schools participated; 4268 children completed interviews at all three waves and answered key items for this analysis. The items in this analysis were collected from children with the use of audio computer-assisted self-administered interviews in English or Spanish. Sexual-minority status was derived from the combined responses to two items in the 10thgrade survey — one on self-identified sexual orientation and one on sexual attraction (21% of girls and 8% of boys reported that they were not 100% heterosexual or straight or not attracted
1872
only to the opposite sex). The survey did not ask whether respondents were transgender. We examined two outcomes: a single-item bullying measure and a six-item peer-victimization scale covering a range of behaviors spanning social exclusion and physical harm.2 Children were classified as having been bullied or victimized if they had these experiences at least once a week. Relevant institutional review boards approved the study. As early as 5th grade, before most youth are likely to be aware of or to disclose their sexual orientation, girls and boys who 5 years later were considered to be sexual minorities on the basis of self-reported information were more likely than other children to report that they had been bullied and victimized (Fig. 1). Although bullying and victimization in the two groups declined with age, a finding that is consistent with prior research,4 sexual-minority youth experienced higher levels across grades than other children did. Our findings underscore the importance of clinicians routinely screening youth for bullying experiences, remaining vigilant about indicators of possible bullying (e.g., unexplained trauma and school avoidance), and creating a safe environment in which youth feel comfortable discussing their sexuality.5 Further re-
n engl j med 372;19 nejm.org may 7, 2015
The New England Journal of Medicine Downloaded from nejm.org at EMORY UNIVERSITY on August 10, 2015. For personal use only. No other uses without permission. Copyright © 2015 Massachusetts Medical Society. All rights reserved.
correspondence
Heterosexual
Sexual minority
A Bullying 40.0
Odds ratio, 2.13 (1.57–2.89)
Odds ratio, 1.77 (1.12–2.78)
Odds ratio, 1.99 (1.56–2.55)
P
n e w e ng l a n d j o u r na l
of
m e dic i n e
Measuring macrophage-specific cholesterol Anand Rohatgi, M.D. efflux involves three key aspects: the cholesterol James A. de Lemos, M.D. donor (i.e., the macrophage), the cholesterol Philip W. Shaul, M.D. labeling and transport out of the macrophage, University of Texas Southwestern Medical Center and the cholesterol acceptor. We agree with Dallas, TX [email protected] Kane et al. regarding the importance of assessSince publication of their article, the authors report no furing variation in the cholesterol-donor aspect of ther potential conflict of interest. efflux to fully characterize this process, but we 1. Li XM, Tang WH, Mosior MK, et al. Paradoxical association and others have focused on measuring the po- of enhanced cholesterol efflux with increased incident cardiotential of human plasma or serum to accept vascular risks. Arterioscler Thromb Vasc Biol 2013;33:1696-705. cholesterol, because this is more amenable to 2. Khera AV, Cuchel M, de la Llera-Moya M, et al. Cholesterol efflux capacity, high-density lipoprotein function, and atherohigh-throughput measurement in large num- sclerosis. N Engl J Med 2011;364:127-35. bers of samples. We also agree that there re- 3. Mackey RH, Greenland P, Goff DC Jr, Lloyd-Jones D, Sibley main many unanswered questions about how CT, Mora S. High-density lipoprotein cholesterol and particle concentrations, carotid atherosclerosis, and coronary events: the marked heterogeneity and complexity of MESA (Multi-Ethnic Study of Atherosclerosis). J Am Coll Cardiol HDL particles may affect the selection of thera- 2012;60:508-16. peutic targets. DOI: 10.1056/NEJMc1503139
A Longitudinal Study of Bullying of Sexual-Minority Youth To the Editor: Lesbian, gay, and bisexual youth, also termed sexual-minority youth, are at high risk for being bullied.1 However, studies of bullying experiences of sexual-minority youth in the United States often rely on retrospective reports, rarely include children in elementary school, and provide little longitudinal information on changes in the prevalence of bullying with age. We used three waves of data from the Healthy Passages longitudinal study2,3 of public-school students in and around Birmingham, Alabama; Houston; and Los Angeles County. Data collection started when students were in the 5th grade (mean [±SD] age, 11.1±0.5 years) in August 2004 through September 2006 and continued in the 7th and 10th grades. At baseline, 5147 of 6663 children (77%) with permission to be contacted in randomly sampled schools participated; 4268 children completed interviews at all three waves and answered key items for this analysis. The items in this analysis were collected from children with the use of audio computer-assisted self-administered interviews in English or Spanish. Sexual-minority status was derived from the combined responses to two items in the 10thgrade survey — one on self-identified sexual orientation and one on sexual attraction (21% of girls and 8% of boys reported that they were not 100% heterosexual or straight or not attracted
1872
only to the opposite sex). The survey did not ask whether respondents were transgender. We examined two outcomes: a single-item bullying measure and a six-item peer-victimization scale covering a range of behaviors spanning social exclusion and physical harm.2 Children were classified as having been bullied or victimized if they had these experiences at least once a week. Relevant institutional review boards approved the study. As early as 5th grade, before most youth are likely to be aware of or to disclose their sexual orientation, girls and boys who 5 years later were considered to be sexual minorities on the basis of self-reported information were more likely than other children to report that they had been bullied and victimized (Fig. 1). Although bullying and victimization in the two groups declined with age, a finding that is consistent with prior research,4 sexual-minority youth experienced higher levels across grades than other children did. Our findings underscore the importance of clinicians routinely screening youth for bullying experiences, remaining vigilant about indicators of possible bullying (e.g., unexplained trauma and school avoidance), and creating a safe environment in which youth feel comfortable discussing their sexuality.5 Further re-
n engl j med 372;19 nejm.org may 7, 2015
The New England Journal of Medicine Downloaded from nejm.org at EMORY UNIVERSITY on August 10, 2015. For personal use only. No other uses without permission. Copyright © 2015 Massachusetts Medical Society. All rights reserved.
correspondence
Heterosexual
Sexual minority
A Bullying 40.0
Odds ratio, 2.13 (1.57–2.89)
Odds ratio, 1.77 (1.12–2.78)
Odds ratio, 1.99 (1.56–2.55)
P
