Mary A. Ott

Contraception for adolescents.

A working knowledge of contraception will assist the pediatrician in both sexual health promotion as well as treatment of common adolescent gynecologic problems. Best practices in adolescent anticipatory guidance and screening include a sexual health history, screening for pregnancy and sexually transmitted infections, counseling, and if indicated, providing access to contraceptives. Pediatricians’ long-term relationships with adolescents and families allow them to help promote healthy sexual decision-making, including abstinence and contraceptive use. Additionally, medical indications for contraception, such as acne, dysmenorrhea, and heavy menstrual bleeding, are frequently uncovered during adolescent visits. This technical report provides an evidence base for the accompanying policy statement and addresses key aspects of adolescent contraceptive use, including the following: (1) sexual history taking, confidentiality, and counseling; (2) adolescent data on the use and side effects of newer contraceptive methods; (3) new data on older contraceptive methods; and (4) evidence supporting the use of contraceptives in adolescent patients with complex medical conditions.

Abstinence and abstinence-only education.

Purpose of review To review recent literature on medical accuracy, program effectiveness, and ethical concerns related to abstinence-only policies for adolescent sexuality education. Recent findings The federal government invests over 175 million dollars annually in ‘abstinence-only-until-marriage’ programs. These programs are required to withhold information on contraception and condom use, except for information on failure rates. Abstinence-only curricula have been found to contain scientifically inaccurate information, distorting data on topics such as condom efficacy, and promote gender stereotypes. An independent evaluation of the federal program, several systematic reviews, and cohort data from population-based surveys find little evidence of efficacy and evidence of possible harm. In contrast, comprehensive sexuality education programs have been found to help teens delay initiation of intercourse and reduce sexual risk behaviors. Abstinence-only polices violate the human rights of adolescents because they withhold potentially life-saving information on HIV and other sexually transmitted infections. Summary Federal support of abstinence-only as an approach to adolescent sexuality education is of much concern due to medical inaccuracies, lack of effectiveness, and the withholding and distorting of health information.

Parent-son decision-making about human papillomavirus vaccination: a qualitative analysis

BackgroundLicensed for use in males in 2009, Human Papillomavirus (HPV) vaccination rates in adolescent males are extremely low. Literature on HPV vaccination focuses on females, adult males, or parents of adolescent males, without including adolescent males or the dynamics of the parent-son interaction that may influence vaccine decision-making. The purpose of this paper is to examine the decision-making process of parent-son dyads when deciding whether or not to get vaccinated against HPV.MethodsTwenty-one adolescent males (ages 13–17), with no previous HPV vaccination, and their parents/guardians were recruited from adolescent primary care clinics serving low to middle income families in a large Midwestern city. Dyad members participated in separate semi-structured interviews assessing the relative role of the parent and son in the decision regarding HPV vaccination. Interviews were recorded, transcribed, and coded using inductive content analysis.ResultsParents and sons focused on protection as a reason for vaccination; parents felt a need to protect their child, while sons wanted to protect their own health. Parents and sons commonly misinterpreted the information about the vaccine. Sons were concerned about an injection in the penis, while some parents and sons thought the vaccine would protect them against other sexually transmitted infections including Herpes, Gonorrhea, and HIV. Parents and sons recalled that the vaccine prevented genital warts rather than cancer. The vaccine decision-making process was rapid and dynamic, including an initial reaction to the recommendation for HPV vaccine, discussion between parent and son, and the final vaccine decision. Provider input was weighed in instances of initial disagreement. Many boys felt that this was the first health care decision that they had been involved in. Dyads which reported shared decision-making were more likely to openly communicate about sexual issues than those that agreed the son made the decision.ConclusionParents and sons play an active role in the decision-making process, with an individual’s role being influenced by many factors. The results of this study may be used to guide the messages presented by clinicians when recommending the HPV vaccine, and future vaccine uptake interventions.

Adolescent and Young Adult Male Health: A Review

Adolescent and young adult male health receives little attention, despite the potential for positive effects on adult quality and length of life and reduction of health disparities and social inequalities. Pediatric providers, as the medical home for adolescents, are well positioned to address young men’s health needs. This review has 2 primary objectives. The first is to review the literature on young men’s health, focusing on morbidity and mortality in key areas of health and well-being. The second is to provide a clinically relevant review of the best practices in young men’s health. This review covers male health issues related to health care access and the Centers for Disease Control and Prevention’s Healthy 2020 objectives for adolescents and young adults, focusing on the objectives for chronic illness, mortality, unintentional injury and violence, mental health and substance use, and reproductive and sexual health. We focus, in particular, on gender-specific issues, particularly in reproductive and sexual health. The review provides recommendations for the overall care of adolescent and young adult males.

Longitudinal associations among relationship factors, partner change, and sexually transmitted infection acquisition in adolescent women.

Objectives: New sex partners put adolescents at increased risk for sexually transmitted infections (STIs), even when these sex partners are nonoverlapping. Although the risk of partner change is well described, little is known about its antecedents. We prospectively examined associations between relationship characteristics, partner change, and subsequent STI during intervals of “serial monogamy.” Methods: As part of a longitudinal study, 332 adolescent women were interviewed and tested for gonorrhea, chlamydia, and trichomonas every 3 months for up to just over 6 years. Interviews covered partner-specific relationship characteristics and sexual behaviors. The quarterly interval, a 3-month period bracketed by interviews and STI testing, was the unit of analysis. We examined associations among relationship factors, partner change, and subsequent STI using a series of mixed regression models, controlling for age, STI at Time 1, and condom nonuse. Results: Age, lower relationship quality, and lower levels of partner closeness to friends and family predicted partner change from Time 1 to Time 2. In turn, partner change was associated with acquisition of a new STI at Time 2. Although relationship factors did not exert a direct effect on STI at Time 2, they improved partner change—STI model fit. Similar patterns were seen with each organism. Conclusion: Relationship factors drive partner change, which in turn contributes to STI acquisition. STI prevention research may need to focus on the relationship antecedents to partner change, in addition to the partner change itself.

Community-Level Successes and Challenges to Implementing Adolescent Sex Education Programs

Best practices for adolescent sex education recommend science-based approaches. However, little is known about the capacity and needs of organizations who implement sex education programs on the local level. The purpose of this research was to describe successes and challenges of community organizations in implementing science-based sex education. Using qualitative methods, we interviewed program directors and educators in 17 state-funded adolescent pregnancy prevention/sex education programs as part of a larger mixed methods evaluation. Semi-structured interviews focused on success and challenges faced in implementing science-based approaches to program design, implementation and evaluation. Interviews were audio-recorded, transcribed and analyzed using a thematic approach. Grantees included a range of programs, from short programs on puberty and HIV for late elementary students, to skills-based curricular sex education programs for high schools, to year-long youth development programs. Key aspects of curricular choice included meeting the needs of the population, and working within time constraints of schools and other community partners. Populations presenting specific challenges included rural youth, youth in juvenile justice facilities, and working with Indiana’s growing Latino population. Programs self-developing curricula described challenges related to assessment and evaluation of impact. Programs using commercial curricula described challenges related to curricular selection and adaptation, in particularly shortening curricula, and adapting to different cultural or social groups. A remarkable degree of innovation was observed. The use of qualitative methods permitted the identification of key challenges and successes in a state-sponsored small grants program. Information can be used to enhance program capacity and quality.

Coping with physical and psychological symptoms: a qualitative study of advanced lung cancer patients and their family caregivers

PurposeAdvanced lung cancer patients have high rates of multiple physical and psychological symptoms, and many of their family caregivers experience significant distress. However, little is known about strategies that these patients and their family caregivers employ to cope with physical and psychological symptoms. This study aimed to identify strategies for coping with various physical and psychological symptoms among advanced, symptomatic lung cancer patients and their primary family caregivers.MethodsPatients identified their primary family caregiver. Individual semi-structured qualitative interviews were conducted with 21 advanced, symptomatic lung cancer patients and primary family caregivers. Thematic analysis of interview data was framed by stress and coping theory.ResultsPatients and caregivers reported maintaining a normal routine and turning to family and friends for support with symptom management, which often varied in its effectiveness. Whereas support from health-care professionals and complementary and alternative medicine were viewed favorably, reactions to Internet and in-person support groups were mixed due to the tragic nature of participants’ stories. Several cognitive coping strategies were frequently reported (i.e., changing expectations, maintaining positivity, and avoiding illness-related thoughts) as well as religious coping strategies.ConclusionsResults suggest that advanced lung cancer patients and caregivers may be more receptive to cognitive and religious approaches to symptom management and less receptive to peer support. Interventions should address the perceived effectiveness of support from family and friends.

The Experiences of Parents Who Report Youth Bullying Victimization to School Officials

Current research offers a limited understanding of parental experiences when reporting bullying to school officials. This research examines the experiences of middle-school parents as they took steps to protect their bullied youth. The qualitative tradition of interpretive phenomenology was used to provide in-depth analysis of the phenomena. A criterion-based, purposeful sample of 11 parents was interviewed face-to-face with subsequent phone call follow-ups. Interviews were taped, transcribed, and coded. MAX qda software was used for data coding. In analyzing the interviews, paradigm cases, themes, and patterns were identified. Three parent stages were found: discovering, reporting, and living with the aftermath. In the discovery stage, parents reported using advice-giving in hopes of protecting their youth. As parents noticed negative psychosocial symptoms in their youth escalate, they shifted their focus to reporting the bullying to school officials. All but one parent experienced ongoing resistance from school officials in fully engaging the bullying problem. In the aftermath, 10 of the 11 parents were left with two choices: remove their youth from the school or let the victimization continue. One paradigm case illustrates how a school official met parental expectations of protection. This study highlights a parental sense of ambiguity of school officials’ roles and procedures related to school reporting and intervention. The results of this study have implications in the development and use of school-wide bullying protocols and parental advocacy.

Preventive misconception and adolescents’ knowledge about HIV vaccine trials

Objective Adolescents have had very limited access to research on biomedical prevention interventions despite high rates of HIV acquisition. One concern is that adolescents are a vulnerable population, and trials carry a possibility of harm, requiring investigators to take additional precautions. Of particular concern is preventive misconception, or the overestimation of personal protection that is afforded by enrolment in a prevention intervention trial. Methods As part of a larger study of preventive misconception in adolescent HIV vaccine trials, we interviewed 33 male and female 16–19-year-olds who have sex with men. Participants underwent a simulated HIV vaccine trial consent process, and then completed a semistructured interview about their understanding and opinions related to enrolment in a HIV vaccine trial. A grounded theory analysis looked for shared concepts, and focused on the content and process of adolescent participants’ understanding of HIV vaccination and the components of preventive misconception, including experiment, placebo and randomisation. Results Across interviews, adolescents demonstrated active processing of information, in which they questioned the interviewer, verbally worked out their answers based upon information provided, and corrected themselves. We observed a wide variety of understanding of research concepts. While most understood experiment and placebo, fewer understood randomisation. All understood the need for safer sex even if they did not understand the more basic concepts. Conclusions Education about basic concepts related to clinical trials, time to absorb materials and assessment of understanding may be necessary in future biomedical prevention trials.

What parents and their adolescent sons suggest for male HPV vaccine messaging.

OBJECTIVE The purpose of this article was to identify the information parents and their adolescent sons deem important when making the decision to get vaccinated against human papillomavirus (HPV). METHOD Twenty-one adolescent males (ages 13 to 17), with no previous HPV vaccination, and their parents were recruited from adolescent primary care clinics serving low- to middle-income families in a large Midwestern city. Dyad members participated in separate semistructured interviews eliciting the information participants felt would increase vaccine uptake and series completion via media and clinic-based sources. Interviews were recorded, transcribed, and coded using inductive content analysis. RESULTS Overall, participants felt fear-based messages would be most effective for increasing vaccination uptake through commercials. When describing clinic messages, parents and sons felt the most important component was a recommendation for vaccination from the health care provider (HCP). Additionally, parents desired more information about the vaccine from the HCP than the sons, including cost, number of shots, and time since the approval of the vaccine for males. Compared with the clinic message, the commercial message was a vector for vaccine awareness, whereas the clinic message was a source of vaccine information. Vaccine initiation messages should provide vaccine information and come from an HCP, whereas completion messages should remind the patient why they initiated the vaccine and can come from any medical staff. CONCLUSIONS Family/individual-focused interventions should be tailored to message source, timing, and target audience. This information can be used to guide public health professionals in the development of interventions to increase vaccine uptake.