e80 • CID 2010:51 (15 November) • Stadler et al
CMV infection [1, 33–36]. In our study, we examined group
living exposure without a precise assessment of how much close
contact that involved. After evaluating various types of group
living situations and varied durations of exposure to those set-
tings individually, this variable was not signiﬁcant. Therefore,
the speciﬁc types and durations were combined as a group living
variable; however, it still was not statistically signiﬁcant.
One of the possible sources of transmission is saliva, and
saliva-sharing behaviors increase during adolescence. These be-
haviors are common, with 57% of adolescents having shared
items and 74% having a history of kissing. When evaluated
collectively, the relationship was not signiﬁcant; however, this
could have been a sample size issue, because the relationship
approached signiﬁcance. It may be that kissing is a key behavior,
but the cross-sectional design, older age of our subjects (mean
age, 14.4 years), and limited assessment of the amount and
type of kissing did not allow us to capture the impact of this
behavior. Lastly, when placed in a multivariate analysis, African
American race and age remained in the model, and exposure
to young children did not. Furthermore, there appeared to be
an additive effect of various risk factors, such that seropositivity
increased with the number of risk factors that were present.
There are a number of limitations to this study, including a
sample size that may have been unable to detect small differ-
ences between groups and to evaluate differences in frequency
and amount of speciﬁc behaviors. Given that only 262 of 397
participants were ⭓14 years of age and thus eligible to answer
questions regarding sexual activity, our ability to fully assess
sexual activity was limited. Factors related to the postinfancy
years and early childhood (such as country of origin, breast-
feeding, and day care) were not evaluated, because we wanted
to focus on issues pertinent to adolescents. Lastly, the cross-
sectional design of this study limits the analysis to associations
and does not allow us to pair the timing of increases in risk
behavior in adolescence with new infections. Future studies
should examine these relationships in a longitudinal design of
sufﬁcient sample size to evaluate these exposures and individual
behaviors in adolescent males in preparation for a CMV vaccine
targeted at adolescents.
We thank Dick Ward and Jesse LePage, for performing the CMV antibody
assays; study coordinators Tara Foltz, Danielle Shoreman (CCHMC), and
Heather Meza (UTMB), as well as Lisa Sherden, Matt Urmy, and Mary
Vozar (VUMC), for their efforts in recruitment and sound advice; Jennifer
Kissner and Emily Foster (VUMC), for their involvement in the study; and
Heather Hill (Emmes), for help in developing the CASI.
Financial support. National Institute of Allergy and Infectious Diseases
(grants N01-AI-25459, AI-80006 to Cincinnati Children’s Hospital, and
N01-AI-8007 to Vanderbilt University); Molecular Epidemiology Child En-
vironmental Health–National Institute of Environmental Health Sciences
(training grant 5-T32-ES010957-08 to L.P.S.); National Institutes of Health
(loan repayment extramural grant funding 2L30AI066732-02 for clinical
research from October 2005 through July 2008 to L.P.S.).
Potential conﬂicts of interest. K.M.E. participates in research with
Novartis for meningococcal vaccines and with Sanoﬁ Pasteur for serologic
studies for pertussis, serves as a consultant to NexBio, and receives contract
support from National Institutes of Health and Centers for Disease Control
and Prevention. All other authors: no conﬂicts.
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