Elise D. Berlan

Sexual Orientation and Bullying Among Adolescents in the Growing Up Today Study

PURPOSE To examine the relationship between sexual orientation and past-year reports of bullying victimization and perpetration in a large sample of American youth. METHODS Survey data from 7,559 adolescents aged 14-22 who responded to the 2001 wave questionnaire of the Growing Up Today Study were examined cross-sectionally. Multivariable generalized estimating equations regression was performed using the modified Poisson method. We examined associations between sexual orientation and past-year bully victimization and perpetration with heterosexuals as the referent group, stratifying by gender and controlling for age, race/ethnicity, and weight status. RESULTS Compared to heterosexual males, mostly heterosexual males (risk ratio [RR]: 1.45; 95% confidence interval [CI]: 1.13, 1.86) and gay males (RR 1.98; CI: 1.39, 2.82) were more likely to report being bullied. Similarly, mostly heterosexual females (RR: 1.72, 95% CI: 1.45, 2.03), bisexual females (RR: 1.63, 95% CI: 1.14, 2.31), and lesbians (RR: 3.36, 95% CI: 1.76, 6.41) were more likely to report being bullied than were heterosexual females. Gay males (RR: 0.34, 95% CI: 0.14, 0.84) were much less likely to report bullying others than were heterosexual males. Mostly heterosexual females (RR: 1.70, 95% CI: 1.42, 2.04) and bisexual females (RR: 2.41, 95% CI: 1.80, 3.24) were more likely to report bullying others than heterosexual females. No lesbian participants reported bullying others. CONCLUSIONS There are significant differences in reports of bullying victimization and perpetration between heterosexual and sexual minority youth. Clinicians should inquire about sexual orientation and bullying, and coordinate care for youth who may need additional support.

Barriers and Facilitators to Adolescents' Use of Long-Acting Reversible Contraceptives.

Most pregnancies among teenagers are unintended and many can be attributed to contraception misuse or nonuse. The etonogestrel implant and intrauterine devices, referred to as long-acting reversible contraceptives, or LARCs, are the most effective reversible contraceptive methods. These methods are safe for use by adolescents, yet the number of LARC users remains low among adolescents in the United States. In this review we examine recent literature about barriers and facilitators to LARC use among adolescent women. Factors that influence decision-making and provision are organized into 4 categories: (1) cost and clinical operations; (2) adolescent awareness and attitudes; (3) confidentiality, consent, and parental attitudes; and (4) health care provider knowledge, attitudes, and counseling. Knowledge deficits and misconceptions among adolescents and their health care providers are key barriers to adolescent LARC use.

Twelve-month discontinuation of etonogestrel implant in an outpatient pediatric setting ☆

OBJECTIVE The etonogestrel (ENG) contraceptive implant is the most effective reversible contraceptive method. Uptake remains limited in adolescents, a population at high risk for unintended pregnancy. The objectives of this study were to determine the 12-month discontinuation rate of the ENG implant among adolescents in an outpatient setting and to characterize risk factors for discontinuation. STUDY DESIGN A retrospective chart review identified adolescent females aged 12 to 22years who received the ENG implant in one pediatric institution between January 1, 2011, and April 15, 2014. Patients were categorized into ENG discontinuers (removed prior to 12months) and ENG continuers (continued for ≥12months). Associations between demographic, clinical and postplacement characteristics with ENG discontinuation category were assessed with t tests, χ(2)/Fishers Exact Tests and backwards stepwise logistic regression. RESULTS Of the 750 patients who had an ENG implant inserted, 77 (10.3%) had the device removed prior to 12months of use. The mean length of implant use for those who discontinued was 7.5months. Problematic bleeding was the most commonly cited reason for discontinuation. Older age at time of insertion, history of pregnancy and ≥1 medical visit for implant concerns (not including removal) were independently predictive (p<.01) of method discontinuation. CONCLUSION The vast majority of adolescents continued the ENG implant at 12months, making it an excellent contraceptive choice for adolescents within the outpatient pediatric setting. Greater efforts should be made to increase its use by pediatric providers. IMPLICATIONS The ENG implant is an excellent contraceptive option for adolescents in the outpatient pediatric setting.

Applying Principles from Behavioral Economics To Promote Long-Acting Reversible Contraceptive (LARC) Methods

encourage LARC use at a later date for clients who currently decline LARC methods? These questions are based upon three steps from the confl ict theory of decision making that Chambers and Rew hypothesized are relevant for contraception: initially examining numerous options, obtaining new information on those options and reconsidering those options over time. Most of the behavioral economic principles highlighted below were selected because they were featured prominently in a leading academic textbook on behavioral economics, The Behavioral Foundations of Public Policy.

Variations in Measurement of Sexual Activity Based on EHR Definitions

OBJECTIVE: The goal of this study was to compare the performance of 4 operational definitions of sexual activity by using data electronically abstracted from electronic health records (EHRs) and examine how documentation of Chlamydia screening and positivity vary according to definition of sexual activity. METHODS: Extracts were created from EHRs of adolescent females 12 to 19 years old who had ≥1 visit to a primary care practice during 2011 at 4 US pediatric health care organizations. We created 4 definitions of sexual activity derived from electronically abstracted indicator variables. Percent sexually active, documentation of Chlamydia screening, and rate of positive Chlamydia test results per 1000 adolescent females according to the sexual activity definition were calculated. RESULTS: The most commonly documented individual indicator of sexual activity was “patient report of being sexually active” (mean across 4 sites: 19.2%). The percentage of adolescent females classified as sexually active varied by site and increased as more indicator variables were included. As the definition of sexual activity expanded, the percentage of sexually active females who received at least 1 Chlamydia test decreased. Using a broader definition of sexual activity resulted in improved identification of adolescent females with Chlamydia infection. For each sexual activity definition and performance item, the difference was statistically significant (P < .0001). CONCLUSIONS: Information about sexual activity may be gathered from a variety of data sources, and changing the configurations of these indicators results in differences in the percentage of adolescent females classified as sexually active, screened for Chlamydia infection, and Chlamydia infection rates.

How Can We Best Communicate with Adolescents

Pediatric patients with normal development require a transition in care from a parent-focused model of care to an adolescent-focused model at some point during their teenage years and beyond that to an adult model of care around age 18 years. There are two major challenges to the physician-patient relationship during this period of time: one, how to effectively communicate with the adolescent patient, and two, how to transition them to the adult provider who will ultimately provide care when the teen has reached adulthood. In this chapter we will explore effective communication strategies for talking with adolescents and their families, as well as the elements of an effective transition to an adult-style model of care.

Can pediatricians provide long acting reversible contraception

STUDY OBJECTIVE In the United States, 40% of high-school students have sex; few use highly effective and safe long-acting reversible contraceptives (LARCs): intrauterine devices and implants. Pediatricians are key health providers for many adolescents, yet few provide LARCs. Our objective was to understand the pragmatics of provision of LARCs (rather than beliefs or attitudes) and identify barriers to and opportunities for LARC provision by community-practicing pediatricians. DESIGN We conducted a qualitative descriptive study using semistructured interviews. Qualitative methods are valuable for generating conceptual models of complex phenomena. SETTING Set in a midsized Midwestern city, our study was community-based. PARTICIPANTS, INTERVENTIONS, AND MAIN OUTCOME MEASURES We interviewed 23 pediatricians to understand their views about providing contraception (including LARCs) to adolescents. For analysis, we developed a coding schema and applied it using a priori and open coding. RESULTS Several inter-related themes regarding challenges to provision of LARC emerged: limited motivation for on-site LARC provision or referral streams, low pediatric patient interest in LARC, lack of pediatrician training about LARC provision, and inadequate structural elements for on-site placement of LARCs in pediatric offices. Each challenge could be remedied, because pediatricians were motivated to provide adolescent patients with high-quality care. Improvements in these inter-related conditions could facilitate pediatrician provision of LARC. CONCLUSION Pediatricians and their patients want to prevent pregnancy, but current practice norms limit LARC provision by pediatricians. To increase LARC access in pediatrician offices, we suggest training in LARC provision and patient education for medical students, residents, and pediatricians; communicating about LARC methods with adolescents to increase patient demand; and systemic changes to improve referral processes and/or allow on-site LARC placements.

Adolescent medicine today : a guide to caring for the adolescent patient

Routine Health Maintenance Normal Growth and Development Precocious Puberty Delayed Puberty Dysmenorrhea and Pelvic Pain Irregular Vaginal Bleeding Amenorrhea Polycystic Ovary Syndrome Vulvovaginitis Pelvic Inflammatory Disease HIV/AIDS Contraception Pregnancy Abdominal Pain Eating Disorders Alcohol and Substance Abuse Tobacco Cessation Obesity Depression Anxiety Disorders Suicide ADHD Common Musculoskeletal Concerns Common Cardiac Concerns Common Rheumatologic Concerns Headache Acne Male Health College Health Lesbian/Gay/Bisexual/Transgender Health Institutionalized Adolescent Health Adolescents with Special Health Care Needs Confidentiality and Consent.