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Ketterer T, Sieke E, Min J, Quidgley-Martin M, Barral RL, Akers A, Adams A, Miller E, Miller MK, Mollen C. Contraception Initiation in the Emergency Department: Adolescent Perspectives. J Adolesc Health 2024:S1054-139X(24)00112-5. [PMID: 38493394 DOI: 10.1016/j.jadohealth.2024.02.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Revised: 01/26/2024] [Accepted: 02/14/2024] [Indexed: 03/18/2024]
Abstract
PURPOSE The purpose of this study was to identify factors affecting contraceptive intention and behavior among adolescent females in the pediatric Emergency Department. METHODS We conducted a qualitative interview study nested within a larger prospective cohort study examining adolescent contraceptive counseling for females ages 15-18 years at-risk of unintended pregnancy presenting to the pediatric Emergency Department. Interviews were conducted in a subset of participants. The ecologically expanded Theory of Planned Behavior, expert opinion, and literature review informed the interview guide. Interviews were recorded, transcribed, coded and monitored for thematic saturation. RESULTS Twenty-eight interviews were analyzed. Mean age was 17.1 years. Themes were mapped to ecologically expanded Theory of Planned Behavior constructs. Within health system influences, prior contraceptive experiences and patient-clinician interactions were described. Within community influences, contraceptive education, knowledge and misinformation, teen pregnancy norms, and social media impacts were described. Within attitudes influences, side-effect and safety concerns, contraceptive motivations and teen pregnancy beliefs were described. Within subjective norm influences, peer and family impacts were described. Within perceived behavioral control, Emergency Department (ED) counseling intervention impacts were described. DISCUSSION We identified factors affecting contraceptive initiation/behavior among an ED adolescent population that otherwise may not have received contraceptive education in similar detail as provided by study clinicians. Adolescents' prior contraceptive and clinician interactions, limited access to contraceptive education, knowledge and misinformation, and side-effect and safety concerns affected initiation. Peer/family sharing and social media were leading contraceptive information sources. Future studies should incorporate insights into adolescent ED intervention design to make optimal use of resources while maximizing potential benefit.
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Affiliation(s)
- Tara Ketterer
- Policylab, Children's Hospital of Philadelphia (CHOP), Roberts Center for Pediatric Research, Philadelphia, Pennsylvania.
| | - Erin Sieke
- Department of Pediatrics, CHOP, Philadelphia, Pennsylvania
| | - Jungwon Min
- Department of Biomedical and Health Informatics, CHOP, Roberts Center for Pediatric Research, Philadelphia, Pennsylvania
| | | | - Romina L Barral
- Division of Adolescent Medicine, Children's Mercy Hospital and Clinics, University of Missouri-Kansas City School of Medicine, University of Kansas School of Medicine, Children's Mercy at the University of Kansas Hospital, Kansas City, Kansas
| | - Aletha Akers
- Division of Adolescent Medicine, CHOP, Specialty Care Center, Philadelphia, Pennsylvania
| | - Amber Adams
- Department of Emergency Medicine, Children's Mercy Hospital (CMH), Kansas City, Missouri
| | - Elizabeth Miller
- Division of Adolescent and Young Adult Medicine, UPMC Children's Hospital of Pittsburgh, Public Health and Clinical and Translational Science, University of Pittsburgh School of Medicine, University Center, Pittsburgh, Pennsylvania
| | - Melissa K Miller
- Department of Emergency Medicine, CMH, University of Missouri-Kansas City School of Medicine, University of Kansas School of Medicine, Kansas City, Missouri
| | - Cynthia Mollen
- Department of Pediatrics, Department of Emergency Medicine, CHOP, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
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Mollen C, Ketterer T, Min J, Barral RL, Akers A, Adams A, Miller E, Miller MK. Expanding Contraceptive Access for Teens-Leveraging the Pediatric Emergency Department. J Adolesc Health 2023; 73:155-163. [PMID: 37330812 PMCID: PMC10287030 DOI: 10.1016/j.jadohealth.2023.02.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 02/15/2023] [Accepted: 02/17/2023] [Indexed: 06/19/2023]
Abstract
PURPOSE Adolescents have limited access to sexual healthcare services, and the emergency department (ED) may be the only place some will seek care. We implemented an ED-based contraception counseling intervention to assess intervention feasibility, and adolescent intention to initiate contraception, contraception initiation, and follow-up visit completion. METHODS This prospective cohort study trained advanced practice providers in the EDs of two pediatric urban academic medical centers to deliver brief contraception counseling. A convenience sample of patients enrolled from 2019 to 2021 included females aged 15-18 not pregnant/desiring pregnancy and/or using hormonal contraception/an intrauterine device. Participants completed surveys to assess demographics and intention to initiate contraception (yes/no). Sessions were audiotaped and reviewed for fidelity. We ascertained contraception initiation and follow-up visit completion via medical record review and participant survey at 8 weeks. RESULTS Twenty-seven advanced practice providers were trained, and 96 adolescents were counseled/responded to surveys (mean age 16.7 years; 19% non-Hispanic White, 56% non-Hispanic Black; 18% Hispanic). Mean counseling duration was 12 minutes and >90% of reviewed sessions maintained fidelity to content/style. Most participants (61%) reported intention to initiate contraception, and these participants were older and more likely to report prior contraceptive use, compared to those without intention. One-third (33%) initiated contraception in the ED or after the follow-up visit. DISCUSSION Contraceptive counseling was feasible to integrate in the ED visit. Intention to initiate contraception was common and many adolescents initiated contraception. Future work should increase the pool of trained providers and supports for same-day contraception initiation for those desiring in this novel setting.
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Affiliation(s)
- Cynthia Mollen
- Division of Emergency Medicine, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
| | - Tara Ketterer
- Roberts Center for Pediatric Research, Philadelphia, Pennsylvania
| | - Jungwon Min
- Roberts Center for Pediatric Research, Philadelphia, Pennsylvania
| | - Romina L Barral
- Division of Adolescent Medicine, Children's Mercy at the University of Kansas Hospital, Kansas City, Kansas
| | - Aletha Akers
- Division of Adolescent Medicine, Specialty Care Center, Philadelphia, Pennsylvania
| | - Amber Adams
- Division of Emergency Medicine, Department of Pediatrics, Children's Mercy at the University of Kansas Hospital, Kansas City, Kansas
| | | | - Melissa K Miller
- Division of Emergency Medicine, Department of Pediatrics, Children's Mercy at the University of Kansas Hospital, Kansas City, Kansas
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Kerolle S, Zuckerbraun N, Reed J, Pollack A, Lieberman J, Ruppert K, Hoehn E. Examining Parental Acceptance of Confidential Contraception Initiation in a Pediatric Emergency Department. Pediatr Emerg Care 2023; 39:125-129. [PMID: 35947074 DOI: 10.1097/pec.0000000000002818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The pediatric emergency department (PED) is a valuable site for contraceptive services among adolescents at risk for pregnancy. Studies have shown that adolescents are interested in such services; however, little is known about parental opinions on contraceptive care in the PED. We aimed to (1) assess parental acceptance of confidential provisions of contraception in the PED and (2) identify facilitators/barriers to parental acceptance of contraception in this setting. METHODS This study included parents/guardians of females aged 14 to 19 years who presented to the PED with any chief complaint. Participants completed a self-administered 25-question survey based on previously validated questions to assess their acceptance of contraception provisions, both confidentially and with parental involvement, for their adolescent in the PED. χ 2 or Fisher exact tests were used to examine variables associated with parental acceptance of confidential contraception. RESULTS Of the 102 parents/guardians surveyed, most parents (58/102, 57%) were accepting of confidential contraception for their adolescent. However, more parents (82/101, 81%) were accepting of contraception in the ED with their involvement, as opposed to confidentially without their involvement. Those accepting had an increased perceived risk of their adolescent having sex or becoming pregnant (mean [SD], 13 [20]; P = 0.02; odds ratio, 1.05; 95% confidence interval, 1.00-1.09), were aware of their adolescent's rights to confidential contraception (62%; P = 0.006; odds ratio, 3.18; 95% confidence interval, 1.39-7.28), and had slightly older teens (16 vs 15.5 years, P = 0.01). More parents accepted OCPs over IUDs in the PED (53/58, 91% vs 26/57, 46%). CONCLUSIONS Although most parents were accepting of the PED provider offering confidential contraception to their adolescent, more parents preferred to be involved with decisions regarding contraception, in a collaborative approach. Further research is necessary to better elucidate parental/adolescent preferences.
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Affiliation(s)
| | | | | | - Andrea Pollack
- From the UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA
| | - Julia Lieberman
- From the UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA
| | - Kristine Ruppert
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA
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Boutté AM, Thangavelu B, Anagli J. Opinion: The Potential Role of Amyloid Beta Peptides as Biomarkers of Subconcussion and Concussion. Front Neurol 2022; 13:941151. [PMID: 35903122 PMCID: PMC9315433 DOI: 10.3389/fneur.2022.941151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 06/10/2022] [Indexed: 11/24/2022] Open
Affiliation(s)
- Angela M. Boutté
- Aries Biotechnologies, Oakland, CA, United States
- *Correspondence: Angela M. Boutté
| | | | - John Anagli
- NeuroTheranostics, Inc., Detroit, MI, United States
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Rosen B, Dauria E, Shumway M, Smith JD, Koinis-Mitchell D, Tolou-Shams M. Association of pregnancy attitudes and intentions with sexual activity and psychiatric symptoms in justice-involved youth. CHILDREN AND YOUTH SERVICES REVIEW 2022; 138:106510. [PMID: 38107676 PMCID: PMC10723635 DOI: 10.1016/j.childyouth.2022.106510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2023]
Abstract
Context With over one-third of detained girls experiencing teenage pregnancy, it is critical that the juvenile justice system better addresses the sexual and reproductive health (SRH) needs of youth. Although pregnancy attitudes and intentions (PAI) are associated with pregnancy outcomes among the general adolescent population, this relationship has not been examined among justice-involved youth. Methods Participants were drawn from a longitudinal study characterizing trajectories of behavioral and reproductive health and recidivism among newly justice-involved youth in a Northeast family court. Baseline and four-month follow-up data from 288 justice-involved youth (JIY) were analyzed to characterize PAI; examine associations between pregnancy intentions and unprotected sexual activity (i.e., no hormonal, intrauterine, or barrier protection against pregnancy); and explore the relationship between pregnancy intentions and psychiatric symptoms. Results At baseline, 39% of JIY youth were sexually active, 44% of these youth reported inconsistent condom use and 14% had not used birth control at last sexual intercourse. Nearly half of sexually active youth reported some intent around pregnancy and those with any pregnancy intentions were more likely to report depression, low self-esteem, substance use, and trauma history. Pregnancy intentions at baseline predicted higher rates of unprotected sexual activity at four months (OR: 16.9, CI = 2.48-115.7). Conclusions This study highlights the importance of developing and implementing more comprehensive SRH assessments and brief interventions for youth entering the justice system.
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Affiliation(s)
- Brooke Rosen
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, 401 Parnassus Avenue, San Francisco, CA 94143, United States
- Department of Psychiatry and Behavioral Sciences, University of Washington, 1959 NE Pacific Street, Box 356560, Seattle, WA 98195, United States
| | - Emily Dauria
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, 401 Parnassus Avenue, San Francisco, CA 94143, United States
- Department of Community and Behavioral Health Sciences, Graduate School of Public Health, University of Pittsburgh, United States
- Department of Psychiatry and Behavioral Sciences, Department of Psychiatry and Behavioral Sciences, 1001 Potrero Avenue, Building 5, Room 7M18, San Francisco, CA, 94110, United States
| | - Martha Shumway
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, 401 Parnassus Avenue, San Francisco, CA 94143, United States
| | - Jaime Dumoit Smith
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, 401 Parnassus Avenue, San Francisco, CA 94143, United States
- Department of Psychiatry and Behavioral Sciences, 1001 Potrero Avenue, Building 20, Suite 2100, San Francisco, CA 94110, United States
| | - Daphne Koinis-Mitchell
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Rhode Island Hospital Department of Psychiatry, 1 Hoppin St. Coro West, 2nd Floor, Providence, RI 02903, United States
- Department of Pediatrics, Warren Alpert Medical School of Brown University, Providence, RI, United States
| | - Marina Tolou-Shams
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, 401 Parnassus Avenue, San Francisco, CA 94143, United States
- Department of Psychiatry and Behavioral Sciences, Department of Psychiatry and Behavioral Sciences, 1001 Potrero Avenue, Building 5, Room 7M18, San Francisco, CA, 94110, United States
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Miller MK, Catley D, Adams A, Staggs VS, Dowd MD, Stancil SL, Miller E, Satterwhite CL, Bauermeister J, Goggin K. Brief Motivational Intervention to Improve Adolescent Sexual Health Service Uptake: A Pilot Randomized Controlled Trial in the Emergency Department. J Pediatr 2021; 237:250-257.e2. [PMID: 34144031 DOI: 10.1016/j.jpeds.2021.06.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 06/01/2021] [Accepted: 06/09/2021] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To test the hypothesis that our motivational sexual health intervention (SexHealth) would increase health service uptake when compared with control. STUDY DESIGN In a randomized controlled trial at a pediatric emergency department, sexually active adolescents received either the SexHealth intervention or printed materials (control). SexHealth, delivered by a health educator, was a tablet-based, interactive intervention that included motivational techniques to promote sexual health, condom skills training, and tailored service recommendations. We assessed feasibility (eg, intervention completion, recommendations discussed, intervention duration), acceptability (ie, proportion enrolled and rating intervention as satisfactory), and efficacy; secondary outcomes were sexual and care-seeking behaviors at 6 months. The efficacy outcome was completion of ≥1 service at the index visit (ie, counseling, condoms, emergency contraception for immediate or future use, pregnancy/sexually transmitted infection/HIV testing, sexually transmitted infection treatment, and clinic referral). RESULTS We enrolled 91 participants (intervention = 44; control = 47). The intervention demonstrated high feasibility: 98% completed the intervention; 98% of recommendations were discussed; duration was 24.6 minutes, and acceptability: 87% of eligible adolescents enrolled and 93% rated the intervention as fairly to very satisfactory. Compared with controls, intervention participants were more likely to complete ≥1 service (98% vs 70%, P < .001) including HIV testing (33% vs 6%, P = .02) and emergency contraception (80% vs 0%, P = .01). There were no meaningful differences between arms in behaviors at follow-up. CONCLUSIONS SexHealth was feasible to implement, acceptable to youth, and resulted in increased uptake of health services during the emergency department visit. Additional strategies may be needed to extend intervention effects over time. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov; NCT03341975.
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Affiliation(s)
- Melissa K Miller
- Children's Mercy Kansas City, Kansas City, MO; University of Missouri-Kansas City School of Medicine, Kansas City, MO.
| | - Delwyn Catley
- Children's Mercy Kansas City, Kansas City, MO; University of Missouri-Kansas City School of Medicine, Kansas City, MO
| | - Amber Adams
- Children's Mercy Kansas City, Kansas City, MO
| | - Vincent S Staggs
- Children's Mercy Kansas City, Kansas City, MO; University of Missouri-Kansas City School of Medicine, Kansas City, MO
| | - M Denise Dowd
- Children's Mercy Kansas City, Kansas City, MO; University of Missouri-Kansas City School of Medicine, Kansas City, MO
| | - Stephani L Stancil
- Children's Mercy Kansas City, Kansas City, MO; University of Missouri-Kansas City School of Medicine, Kansas City, MO
| | - Elizabeth Miller
- University of Pittsburgh School of Medicine, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA
| | | | | | - Kathy Goggin
- Children's Mercy Kansas City, Kansas City, MO; University of Missouri-Kansas City School of Medicine, Kansas City, MO; University of Pittsburgh School of Medicine, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA; University of Missouri-Kansas City School of Pharmacy, Kansas City, MO
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Hunt JA, Randell KA, Mermelstein S, Miller MK, Sherman AK, Philipose S, Masonbrink AR. Sexual Health Behaviors and Pregnancy Risk Among Hospitalized Female Adolescents. Hosp Pediatr 2021; 11:1129-1136. [PMID: 34518336 DOI: 10.1542/hpeds.2021-005810] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVES To describe sexual health behaviors, contraceptive use, and pregnancy risk among hospitalized female adolescents. METHODS We conducted a cross-sectional survey of hospitalized female patients aged 14 to 21 years at 2 academic medical centers to assess sexual health behaviors, contraceptive use, contraceptive counseling receipt, and factors associated with pregnancy complications (eg, diabetes, teratogenic exposure). We calculated the validated Pregnancy Risk Index (PRI) (number per 100 who will become pregnant in the next year). RESULTS Among 177 participants (mean age 16 years, SD 1.5), 75 (43%) were sexually active. At last vaginal sex, 65% reported condom use; 49%, reversible contraception; and 12%, long-acting reversible contraception (LARC). Past-year contraceptive counseling was reported by 73% of sexually active female participants and was associated with increased use of reversible (P = .001) and dual contraception (P = .03) but not LARC (P = .24). The mean PRI among all participants was 4.75. Nearly three-quarters (73%) had a medical comorbidity or teratogenic exposure. Those with teratogenic medication use had the lowest PRI of 0.32 (P < .05), with 88% using reversible contraception and 31% using LARC. CONCLUSIONS Hospitalized female adolescents had a PRI similar to that of adolescents in the general population. However, nearly three-quarters had a medical comorbidity and/or teratogenic exposure, which increased risk for pregnancy complications. Contraceptive counseling was associated with increased reversible and dual contraception use but not LARC use. Efforts to improve comprehensive contraceptive counseling, highlighting LARC, are critically needed in this population.
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Affiliation(s)
- Jane Alyce Hunt
- Department of Pediatrics, Washington University in St Louis, St Louis, Missouri
| | - Kimberly A Randell
- School of Medicine, University of Missouri-Kansas City, Kansas City, Missouri.,Departments of Pediatrics
| | - Sarah Mermelstein
- Department of Pediatrics, Washington University in St Louis, St Louis, Missouri
| | - Melissa K Miller
- School of Medicine, University of Missouri-Kansas City, Kansas City, Missouri.,Departments of Pediatrics
| | - Ashley K Sherman
- Health Services and Outcomes Research, Children's Mercy Kansas City, Kansas City, Missouri
| | - Shirene Philipose
- Department of Internal Medicine, School of Medicine, University of Kansas, Kansas City, Kansas
| | - Abbey R Masonbrink
- School of Medicine, University of Missouri-Kansas City, Kansas City, Missouri.,Departments of Pediatrics
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Dubey VP, Randell KA, Masonbrink AR, Pickett ML, Sherman AK, Ramaswamy M, Miller MK. Justice System Involvement Among Adolescents in the Emergency Department. J Pediatr 2021; 236:284-290. [PMID: 33811870 PMCID: PMC8403109 DOI: 10.1016/j.jpeds.2021.03.048] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 03/04/2021] [Accepted: 03/25/2021] [Indexed: 01/26/2023]
Abstract
OBJECTIVE To assess justice system involvement among adolescents in the pediatric emergency department and identify associations with risk and protective factors. STUDY DESIGN We conducted a cross-sectional, computerized survey of adolescents to assess for personal, justice system involvement, and nonhousehold justice system involvement (ie, important people outside of household). We assessed sexual behaviors, violent behaviors, substance use, school suspension/expulsion, parental supportiveness, and participant mood (score <70 indicates psychological distress). We compared differences between groups using the χ2 tests, Fisher exact tests, t tests, and performed multivariable logistic regression analyses. RESULTS We enrolled 191 adolescents (mean age 16.1 years, 61% female). Most (68%) reported justice system involvement: personal (13%), household (42%), and nonhousehold (40%). Nearly one-half (47%) were sexually active and 50% reported school suspension/expulsion. The mean score for mood was 70.1 (SD 18); adolescents with justice system involvement had had lower mood scores (68 vs 74, P = .03) compared with those without justice system involvement. In a multivariable model, school expulsion/suspension was significantly associated with reporting any justice system involvement (OR 10.4; 95% CI 4.8-22.4). CONCLUSIONS We identified the pediatric emergency department as a novel location to reach adolescents at risk for poor health outcomes associated with justice system involvement. Future work should assess which health promotion interventions and supports are desired among these adolescents and families.
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Affiliation(s)
- Vivek P Dubey
- Pediatric Emergency Medicine, Children's Mercy Hospital, Kansas City, MO; The University of Missouri Kansas City, Kansas City, MO; The University of Kansas, School of Medicine, Kansas City, KS.
| | - Kimberly A Randell
- Pediatric Emergency Medicine, Children's Mercy Hospital, Kansas City, MO; The University of Missouri Kansas City, Kansas City, MO; The University of Kansas, School of Medicine, Kansas City, KS
| | - Abbey R Masonbrink
- Hospital Medicine, Children's Mercy Hospital, Kansas City, MO; The University of Missouri Kansas City, Kansas City, MO; The University of Kansas, School of Medicine, Kansas City, KS
| | - Michelle L Pickett
- Pediatric Emergency Medicine, Medical College of Wisconsin, Milwaukee, WI
| | | | - Megha Ramaswamy
- Population Health, University of Kansas School of Medicine, Kansas City, KS
| | - Melissa K Miller
- Pediatric Emergency Medicine, Children's Mercy Hospital, Kansas City, MO; The University of Missouri Kansas City, Kansas City, MO; The University of Kansas, School of Medicine, Kansas City, KS
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Chernick LS, Stockwell MS, Gonzalez A, Mitchell J, Ehrhardt A, Bakken S, Westhoff CL, Santelli J, Dayan PS. A User-Informed, Theory-Based Pregnancy Prevention Intervention for Adolescents in the Emergency Department: A Prospective Cohort Study. J Adolesc Health 2021; 68:705-712. [PMID: 32948403 PMCID: PMC8527994 DOI: 10.1016/j.jadohealth.2020.07.020] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2020] [Revised: 07/13/2020] [Accepted: 07/14/2020] [Indexed: 11/30/2022]
Abstract
PURPOSE Female adolescents seeking emergency department (ED) care are at high risk of unintended pregnancy, primarily because of contraceptive nonuse; yet, few ED patients follow up for reproductive care when referred. The objective of this cohort study was to determine the feasibility, acceptability, adoption, fidelity, and potential efficacy of a personalized and interactive ED-based pregnancy prevention mobile health intervention (Emergency Room Interventions to improve the Care of Adolescents [Dr. Erica]). METHODS We conducted a prospective cohort study with sexually active female ED patients aged 14-19 years who were not using highly effective contraceptives. Dr. Erica consists of a 10-week, automated, two-way texting intervention based on an evidence-based sexual health curriculum, the Social Cognitive Theory, and motivational interviewing techniques. At 12 weeks, we conducted follow-up via online survey and phone call to measure feasibility, acceptability, adoption, fidelity, and preliminary efficacy data (contraception initiation). RESULTS We screened 209 female ED patients to enroll 42. The average age was 17.5 years (standard deviation ± 1.4); the majority were Hispanic (n = 37, 88%) and had a primary provider (n = 40, 95%). One participant opted out (1/42, 2%), and a total of 35 participants (83%) completed follow-up. Although interactivity diminished with time, 83% of participants (35/42) replied to one or more text. Ninety-four percent of participants (29/31) liked the messages, and 83% (25/30) would recommend the program. Hormonal contraceptives were initiated by 46% of participants (16/35). CONCLUSIONS Dr. Erica was feasible and acceptable among female adolescent ED patients and demonstrated high fidelity and adoption. The intervention also showed potential to increase highly effective contraceptive use among high-risk females.
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Affiliation(s)
- Lauren S. Chernick
- Division of Pediatric Emergency Medicine, Department of Emergency Medicine, Columbia University Medical Center, New York, New York,Address correspondence to: Lauren S. Chernick, M.D., M.Sc., Department of Emergency Medicine, Columbia University Medical Center, 3959 Broadway, CHN 1-116, New York, NY 10032
| | - Melissa S. Stockwell
- Department of Child and Adolescent Health, Columbia University Medical Center, New York, New York,Department of Population and Family Health, Mailman School of Public Health, Columbia University Medical Center, New York, New York
| | - Ariana Gonzalez
- Division of Pediatric Emergency Medicine, Department of Emergency Medicine, Columbia University Medical Center, New York, New York
| | - Jameson Mitchell
- Division of Pediatric Emergency Medicine, Department of Emergency Medicine, Columbia University Medical Center, New York, New York
| | - Anke Ehrhardt
- Department of Psychology, Columbia University Medical Center, New York, New York
| | - Susanne Bakken
- Department of Nursing and Bioinformatics, Columbia University Medical Center, New York, New York
| | - Carolyn L. Westhoff
- Department of Population and Family Health, Mailman School of Public Health, Columbia University Medical Center, New York, New York,Department of Obstetrics-Gynecology, Columbia University Medical Center, New York, New York
| | - John Santelli
- Department of Child and Adolescent Health, Columbia University Medical Center, New York, New York,Department of Population and Family Health, Mailman School of Public Health, Columbia University Medical Center, New York, New York
| | - Peter S. Dayan
- Division of Pediatric Emergency Medicine, Department of Emergency Medicine, Columbia University Medical Center, New York, New York
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10
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Pfaff N, DaSilva A, Ozer E, Vemula Kaiser S. Adolescent Risk Behavior Screening and Interventions in Hospital Settings: A Scoping Review. Pediatrics 2021; 147:peds.2020-020610. [PMID: 33785635 DOI: 10.1542/peds.2020-020610] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/13/2021] [Indexed: 11/24/2022] Open
Abstract
CONTEXT Risky behaviors are the main threats to adolescents' health; consequently, evidence-based guidelines recommend annual comprehensive risk behavior screening. OBJECTIVE To review studies of adolescent risk behavior screening and interventions in urgent care, emergency department (ED), and hospital settings. DATA SOURCES Our data sources included PubMed (1965-2019) and Embase (1947-2019). STUDY SELECTION Studies were included on the basis of population (adolescents aged 10-25 years), topic (risk behavior screening or intervention), and setting (urgent care, ED, or hospital). Studies were excluded if they involved younger children or adults or only included previously identified high-risk adolescents. DATA EXTRACTION Data extracted were risk behavior screening rates, screening and intervention tools, and attitudes toward screening and intervention. RESULTS Forty-six studies were included; most (38 of 46) took place in the ED, and a single risk behavior domain was examined (sexual health [19 of 46], mood and suicidal ideation [12 of 46], substance use [7 of 46], and violence [2 of 46]). In 6 studies, authors examined comprehensive risk behavior screening, demonstrating low rates at baseline (∼10%) but significant increases with clinician reminder implementation. Adolescents and clinicians were highly accepting of risk behavior screening in all settings and preferred electronic screening over a face-to-face interview. Reported barriers were time constraints and limited resources. LIMITATIONS Only 1 included study was a randomized controlled trial, and there was large heterogeneity of included studies, potentially limiting generalizability. CONCLUSIONS Rates of adolescent risk behavior screening are low in urgent care, ED, and hospital settings. Our findings outline promising tools for improving screening and intervention, highlighting the critical need for continued development and testing of interventions in these settings to improve adolescent care.
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Affiliation(s)
| | | | - Elizabeth Ozer
- Division of Adolescent and Young Adult Medicine.,Office of Diversity and Outreach, and
| | - Sunitha Vemula Kaiser
- Departments of Pediatrics and.,Epidemiology and Biostatistics.,Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, San Francisco, California
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11
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Fischer K, Chernick LS. Contraception Provision in the Emergency Department: Are We Ready to Overcome the Obstacles? J Womens Health (Larchmt) 2020; 29:603-604. [DOI: 10.1089/jwh.2020.8294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Kayleigh Fischer
- Department of Pediatrics, Washington University in Saint Louis School of Medicine, Saint Louis, Missouri
| | - Lauren S. Chernick
- Department of Emergency Medicine, Columbia University Medical Center, New York, New York
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Vayngortin T, Bachrach L, Patel S, Tebb K. Adolescents' Acceptance of Long-Acting Reversible Contraception After an Educational Intervention in the Emergency Department: A Randomized Controlled Trial. West J Emerg Med 2020; 21:640-646. [PMID: 32421513 PMCID: PMC7234691 DOI: 10.5811/westjem.2020.2.45433] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Revised: 01/06/2020] [Accepted: 02/17/2020] [Indexed: 12/01/2022] Open
Abstract
INTRODUCTION Adolescents who seek care in the emergency department (ED) are a cohort at increased risk of unintended pregnancy. Although adolescents are interested in learning about pregnancy prevention in the ED, there is a lack of effective educational interventions in this setting. Long-acting reversible contraceptives (LARC) are highly effective and safe in teens, yet are underutilized. This study assessed contraception use among adolescents in the ED and evaluated the impact of an educational video on their interest in and uptake of LARCs. METHODS We conducted a two-arm randomized controlled trial on a convenience sample of sexually active females 14 to 21 years old in an urban pediatric ED. Participants were randomized to an educational video or standard care. All participants completed a survey and were given an informational card about affiliated teen clinics with the option to schedule an appointment. We assessed pre-post mean differences between control and intervention participants and pre-post differences among intervention participants. Participants were followed three months after their ED visit to examine use of contraception. RESULTS A total of 79 females were enrolled (42 control and 37 intervention). The mean age was 17 years, and most were youth of color. The proportion of participants with a prior pregnancy was 18%. Almost all participants reported wanting to avoid pregnancy, yet 18% reported not using contraception at last intercourse. At baseline, 17.7% of participants were somewhat or very interested in the intrauterine device (IUD) or implant. After watching the video, 42.3% were somewhat or very interested in the IUD and 35.7% in the implant. Among those who watched the video, there were significant increases in interest in using an IUD or implant (p<.001). Compared to controls, adolescents who watched the video were also significantly more likely to report wanting an IUD (p<0.001) or implant (p=0.002). A total of 46% were reached for follow-up. Of these, 16% had initiated a LARC method after their ED visit (p=NS). CONCLUSION Most adolescent females in the ED want to avoid pregnancy, but are using ineffective methods of contraception. A brief educational video on LARCs was acceptable to adolescents and feasible to implement in a busy urban ED setting. Adolescents who watched the video had significantly greater interest in using LARCs, but no demonstrated change in actual adoption of contraception.
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Affiliation(s)
- Tatyana Vayngortin
- Rady Children’s Hospital, University of California San Diego, Division of Emergency Medicine, San Diego, California
| | - Lela Bachrach
- University of California San Francisco Benioff Children’s Hospital Oakland, Department of Adolescent Medicine, Oakland, California
| | - Sima Patel
- University of California San Francisco Benioff Children’s Hospital Oakland, Department of Emergency Medicine, Oakland, California
| | - Kathleen Tebb
- University of California San Francisco, Department of Adolescent Medicine, San Francisco, California
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Chernick LS, Chun TH, Richards R, Bromberg JR, Ahmad FA, McAninch B, Mull C, Shenoi R, Suffoletto B, Casper C, Linakis J, Spirito A. Sex Without Contraceptives in a Multicenter Study of Adolescent Emergency Department Patients. Acad Emerg Med 2020; 27:283-290. [PMID: 31596987 DOI: 10.1111/acem.13867] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2019] [Revised: 09/15/2019] [Accepted: 10/06/2019] [Indexed: 12/28/2022]
Abstract
OBJECTIVES In the United States, rates of teenage pregnancy and sexually transmitted infections (STIs) remain exceptionally high, and racial and ethnic disparities persist. Emergency departments (EDs) care for over 19 million adolescents each year, the majority being minority and low socioeconomic status. Single-center studies demonstrate infrequent use of contraceptives among adolescent ED patients and an association between risky sex and behaviors such as alcohol and drug use; however, no multicenter ED data exist. The objectives of this study were to 1) determine the prevalence of sex without contraceptives in a large multicenter adolescent ED study and 2) assess patient demographic and risky behaviors associated with sex without contraceptives. METHODS Participants aged 14 to 17 years (n = 3,247) in 16 pediatric EDs across the United States completed an electronic survey. Questions focused on validated measures of risky sex; use of alcohol, tobacco, marijuana, and other drugs; and depression and violence. In this secondary analysis, we constructed univariable and multivariable models to identify demographic and behavioral factors associated with sex without contraceptives (our primary outcome), separately for adolescent males and females. RESULTS In the prior year, 17.4% (236/1,356) of males and 15.8% (299/1,891) of females had sex without contraceptives. In the multivariable model, sex without contraceptives for both genders was more likely among teens who were black, with conduct problems and participated in casual sex, binge drinking, or cannabis use. Sex without contraceptives was also more likely among Hispanic and cigarette-smoking males, as well as depressed females. CONCLUSIONS Adolescent ED patients across the United States are participating in risky sexual behaviors that increase their likelihood of pregnancy and STI acquisition. These adolescents report a number of problem behaviors, including substance use, which are strongly correlated with unprotected sex. The ED visit may be an opportunity to identify at-risk adolescent patients, address risky behaviors, and intervene to improve adolescent health.
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Affiliation(s)
- Lauren S. Chernick
- Division of Pediatric Emergency Medicine Department of Emergency Medicine Columbia University Medical Center New York NY
| | - Thomas H. Chun
- Department of Pediatrics and Emergency Medicine The Warren Alpert Medical School of Brown UniversityRhode Island Hospital ProvidenceRI
| | - Rachel Richards
- Division of Pediatric Critical Care Department of Pediatrics University of Utah Health Sciences Center Salt Lake City UT
| | - Julie R. Bromberg
- Department of Emergency Medicine The Warren Alpert Medical School of Brown UniversityRhode Island Hospital ProvidenceRI
| | - Fahd A. Ahmad
- Department of Pediatrics Washington University School of Medicine St. Louis MO
| | - Brett McAninch
- Division of Pediatric Emergency Medicine Department of Pediatrics University of Pittsburgh Medical Center Children’s Hospital of Pittsburgh PittsburghPA
| | - Colette Mull
- Division of Pediatric Emergency Medicine Department of Pediatrics Nemours/Alfred I. duPont Hospital for Children Wilmington DE
| | - Rohit Shenoi
- Section of Emergency Medicine Department of Pediatrics Baylor College of Medicine Houston TX
| | - Brian Suffoletto
- Department of Emergency Medicine University of Pittsburgh Pittsburgh PA
| | - Charlie Casper
- Division of Pediatric Critical Care Department of Pediatrics University of Utah Health Sciences Center Salt Lake City UT
| | - James Linakis
- Department of Pediatrics and Emergency Medicine The Warren Alpert Medical School of Brown UniversityRhode Island Hospital ProvidenceRI
| | - Anthony Spirito
- Department of Psychiatry and Human Behavior Alpert Medical School of Brown University Providence RI
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14
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Miller MK, Chernick LS, Goyal MK, Reed JL, Ahmad FA, Hoehn EF, Pickett MS, Stukus K, Mollen CJ. A Research Agenda for Emergency Medicine-based Adolescent Sexual and Reproductive Health. Acad Emerg Med 2019; 26:1357-1368. [PMID: 31148339 DOI: 10.1111/acem.13809] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Revised: 04/29/2019] [Accepted: 05/11/2019] [Indexed: 11/28/2022]
Abstract
OBJECTIVE The objective was to identify key questions for emergency medicine (EM)-based adolescent sexual and reproductive health and to develop an evidence-based research agenda. METHODS We recruited national content experts to serve as advisory group members and used a modified Delphi technique to develop consensus around actionable research questions related to EM-based adolescent reproductive and sexual health care. Author subgroups conducted literature reviews and developed the initial list of research questions, which were iteratively refined with advisory members. External stakeholders then independently rated each item for its importance in expanding the evidence base (1 = not important to 5 = very important) via electronic survey. RESULTS Our final list of 24 research questions included items that intersected all sexual and reproductive health topics as well as questions specific to human immunodeficiency virus/sexually transmitted infections (HIV/STIs), pregnancy prevention, confidentiality/consent, public health, and barriers and facilitators to care. External stakeholders rated items related to HIV/STI, cost-effectiveness, brief intervention for sexual risk reduction, and implementation and dissemination as most important. CONCLUSIONS We identified critical questions to inform EM-based adolescent sexual and reproductive health research. Because evidence-based care has potential to improve health outcomes while reducing costs associated with HIV/STI and unintended pregnancy, funders and researchers should consider increasing attention to these key questions.
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Affiliation(s)
- Melissa K. Miller
- Department of Pediatrics Division of Emergency Medical Services Children's Mercy Hospitals and Clinics Kansas City MO
| | - Lauren S. Chernick
- Department of Emergency Medicine and Pediatrics Columbia University New York NY
| | - Monika K. Goyal
- Department of Pediatrics Children's National Medical Center The George Washington University Washington DC
| | - Jennifer L. Reed
- Division of Emergency Medicine Cincinnati Children's Hospital Medical Center Cincinnati OH
- Department of Pediatrics University of Cincinnati College of Medicine Cincinnati OH
| | - Fahd A. Ahmad
- Department of Pediatrics Washington University School of Medicine St. Louis MO
| | - Erin F. Hoehn
- Division of Emergency Medicine Cincinnati Children's Hospital Medical Center Cincinnati OH
- Department of Pediatrics University of Cincinnati College of Medicine Cincinnati OH
| | | | - Kristin Stukus
- Department of Pediatrics Division of Emergency Medicine Nationwide Children's Hospital Columbus OH
| | - Cynthia J. Mollen
- Department of Pediatrics Division of Emergency Medicine Children's Hospital of Philadelphia Philadelphia PA
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15
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Hoehn EF, Hoefgen H, Chernick LS, Dyas J, Krantz L, Zhang N, Reed JL. A Pediatric Emergency Department Intervention to Increase Contraception Initiation Among Adolescents. Acad Emerg Med 2019; 26:761-769. [PMID: 30194791 DOI: 10.1111/acem.13565] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Revised: 08/18/2018] [Accepted: 09/04/2018] [Indexed: 01/08/2023]
Abstract
BACKGROUND The pediatric emergency department (PED) provides care for adolescents at high risk of unintended pregnancy, but little is known regarding the efficacy of PED-based pregnancy prevention interventions. The objectives of this PED-based pilot intervention study were to 1) assess the rate of contraception initiation after contraceptive counseling and appointment facilitation in the PED during the study period, 2) identify barriers to successful contraception initiation, and 3) determine adolescent acceptability of the intervention. METHODS This pilot intervention study included females 14 to 19 years of age at risk for unintended pregnancy. Participants received standardized contraceptive counseling and were offered an appointment with gynecology. Participants were followed via electronic medical record and phone to assess contraception initiation and barriers. Chi-square tests were used to examine the association between contraception initiation and participant characteristics. RESULTS A total of 144 patients were eligible, and 100 were enrolled. In the PED, 68% (68/100) expressed interest in initiating hormonal contraception, with 70% (48/68) of interested participants indicating that long-acting reversible contraception (LARC) was their preferred method. Twenty-five percent (25/100) of participants initiated contraception during the study period, with 19 participants starting LARC. Thirty-nine percent (22/57) of participants who accepted a gynecology appointment attended that appointment. Barriers to follow-up include transportation and inconvenient follow-up times. Participants were accepting of the intervention with 93% agreeing that the PED is an appropriate place for contraceptive counseling. CONCLUSIONS PED contraceptive counseling is acceptable among adolescents and led to successful contraception initiation in 25% of participants. The main barrier to contraception initiation was participant follow-up with the gynecology appointment.
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Affiliation(s)
- Erin F. Hoehn
- Division of Emergency Medicine Cincinnati Children's Hospital Medical Center Cincinnati OH
- Department of Pediatrics University of Cincinnati College of Medicine Cincinnati Ohio
| | - Holly Hoefgen
- Division of Pediatric and Adolescent Gynecology Cincinnati Children's Hospital Medical Center Cincinnati OH
| | - Lauren S. Chernick
- Department of Pediatrics Columbia University Medical Center New York New York
| | - Jenna Dyas
- Division of Emergency Medicine Cincinnati Children's Hospital Medical Center Cincinnati OH
| | - Landon Krantz
- Division of Emergency Medicine Cincinnati Children's Hospital Medical Center Cincinnati OH
| | - Nanhua Zhang
- Division of Biostatistics and Epidemiology Cincinnati Children's Hospital Medical Center Cincinnati OH
| | - Jennifer L. Reed
- Division of Emergency Medicine Cincinnati Children's Hospital Medical Center Cincinnati OH
- Department of Pediatrics University of Cincinnati College of Medicine Cincinnati Ohio
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Miller MK, Mollen C, Behr K, Dowd MD, Miller E, Satterwhite CL, Stancil S, Allen N, Michael J, Inboriboon PC, Park A, Goggin K. Development of a Novel Computerized Clinical Decision Support System to Improve Adolescent Sexual Health Care Provision. Acad Emerg Med 2019; 26:420-433. [PMID: 30240032 PMCID: PMC6625349 DOI: 10.1111/acem.13570] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Revised: 06/20/2018] [Accepted: 07/05/2018] [Indexed: 12/30/2022]
Abstract
OBJECTIVE The objective was to develop an acceptable clinical decision support (CDS) system to facilitate evidence-based sexual health care for adolescents in the emergency department (ED). METHODS In this multiphased iterative process, we engaged an expert group to synthesize evidence on a wide range of sexual health services (e.g., contraception, condoms, identification and treatment of previously diagnosed sexually transmitted infection). We created a computerized questionnaire and embedded our decision tree, utilizing patient-entered responses to create tailored, evidence-based recommendations, and embedded links to study-related resources such as the emergency contraception (EC) quick guide. We utilized mixed methodology to explore perspectives of adolescents aged 14 to 19 years and clinicians at two general and two pediatric EDs after they interacted with the system. Clinicians reported usefulness (Likert scale 1 = not at all, 4 = very); adolescents reported acceptability. We used the chi-square test to compare responses between subgroups. We collected adolescents' verbatim responses to open-ended questions; clinicians self-entered responses. Four authors independently generated themes from qualitative responses before compiling key findings and achieving consensus on final themes. RESULTS Among 57 clinicians (23 physicians, 23 nurses, 11 nurse practitioners; 54% female; 65% aged < 40 years), the mean system usefulness rating was 3.4 ± 0.7. Sex, age, clinician role, or ED type were not associated with rating the system "somewhat/very" useful. Clinicians identified barriers (e.g., time constraints) that could be overcome by implementation considerations (e.g., training) as well as benefits including improved care. For future assessments, providers preferred computer (65%) over face-to-face interview (26%). Among 57 adolescents (mean age = 16.2 years; 75% female; 56% sexually experienced), nearly all (95%) reported that it was "very/somewhat easy" to complete the computerized questionnaire and to understand the questions. Most adolescents understood the EC quick guide and correctly identified that ulipristal, compared to levonorgestrel, required a prescription and was more effective. For future assessments, adolescents preferred computer (69%) over face-to-face interviews (9%). CONCLUSIONS We developed a sexual health CDS system that is easy to use and can facilitate evidence-based care to reduce health outcome gaps. Evaluation of system impact on service delivery and, ultimately, health outcomes is needed.
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Affiliation(s)
- Melissa K. Miller
- Department of Pediatrics, Division of Emergency Medical Services, Children’s Mercy Hospitals and Clinics, Kansas City, MO
| | - Cynthia Mollen
- Department of Pediatrics, Division of Emergency Medical Services, Children’s Hospital of Philadelphia, Philadelphia, PA
| | - Kelli Behr
- Department of Pediatrics, Division of Emergency Medical Services, Children’s Mercy Hospitals and Clinics, Kansas City, MO
| | - M. Denise Dowd
- Department of Pediatrics, Division of Emergency Medical Services, Children’s Mercy Hospitals and Clinics, Kansas City, MO
| | - Elizabeth Miller
- Department of Pediatrics, Division of Adolescent Medicine, Children’s Hospital of Pittsburgh, Pittsburgh, PA
| | | | - Stephani Stancil
- Department of Pediatrics, Division of Adolescent Medicine, Children’s Mercy Hospitals and Clinics, Kansas City, MO
| | - Nancy Allen
- Department of Pediatrics, Office of Evidence-Based Practice, Children’s Mercy Hospitals and Clinics, Kansas City, MO
| | - Jeffery Michael
- Department of Pediatrics, Division of Emergency Medical Services, Children’s Mercy Hospitals and Clinics, Kansas City, MO
- Department of Pediatrics, Office of Evidence-Based Practice, Children’s Mercy Hospitals and Clinics, Kansas City, MO
| | | | - Andrew Park
- Department of Emergency Medicine, University of Kansas Hospital, Kansas City, KS
| | - Kathy Goggin
- Center for Health Services Research, Children’s Mercy Hospitals and Clinics, Kansas City, MO
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17
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Emergency Department Directors Are Willing to Expand Reproductive Health Services for Adolescents. J Pediatr Adolesc Gynecol 2019; 32:170-174. [PMID: 30339833 PMCID: PMC6401284 DOI: 10.1016/j.jpag.2018.09.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Revised: 09/27/2018] [Accepted: 09/28/2018] [Indexed: 12/31/2022]
Abstract
STUDY OBJECTIVE Nearly 20 million adolescents receive emergency department (ED) care each year, many of whom have untreated reproductive health issues. ED visits represent an opportunity to provide appropriate care, however, ED physician reproductive health care practices and capabilities in the United States have not been described. We sought to characterize pediatric ED director's individual practice and ED system resources for providing adolescent reproductive health care. DESIGN, SETTING, PARTICIPANTS, AND INTERVENTIONS We invited pediatric ED division and/or medical directors nationally to participate in an anonymous, online survey. MAIN OUTCOME MEASURES Outcomes included ED directors' personal practice regarding providing adolescent patients reproductive health care, and their ED's resources and standard practice regarding screening adolescents for sexually transmitted infections (STIs) and other reproductive health concerns. RESULTS One hundred thirty-five of 442 (30.5%) ED directors responded. Respondents were 73% (90/124) male, with a median of 18 (interquartile range, 13-23) years of experience and 63% (84/134) working in urban EDs. Seventy-one percent (90/130) preferred face-to-face interviews for obtaining a sexual history, but only 59% (77/130) of participants "always ask parents to leave the room for sensitive questions." Eighty-four percent (106/127) were receptive to pregnancy prevention interventions being initiated in the ED, with 75% (80/106) of those willing to provide an intervention. Only 16% (21/128) indicated their ED has a universal STI screening program, and only 18% (23/126) "always" successfully notify patients of a positive STI test. CONCLUSION ED directors are comfortable providing adolescent reproductive health care, and many individual- and ED-level opportunities exist to provide improved reproductive health care for adolescents in the ED.
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18
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Effective Contraception Use by Usual Source of Care: An Opportunity for Prevention. Womens Health Issues 2018; 28:306-312. [DOI: 10.1016/j.whi.2018.03.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Revised: 02/08/2018] [Accepted: 03/05/2018] [Indexed: 11/18/2022]
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Chernick LS, Stockwell MS, Wu M, Castaño PM, Schnall R, Westhoff CL, Santelli J, Dayan PS. Texting to Increase Contraceptive Initiation Among Adolescents in the Emergency Department. J Adolesc Health 2017; 61:786-790. [PMID: 29056437 PMCID: PMC5701840 DOI: 10.1016/j.jadohealth.2017.07.021] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2017] [Revised: 07/21/2017] [Accepted: 07/21/2017] [Indexed: 11/30/2022]
Abstract
PURPOSE To evaluate the feasibility and acceptability of a text messaging intervention to increase contraception among adolescent emergency department patients. METHODS A pilot randomized controlled trial of sexually active females aged 14-19 receiving 3 months of theory-based, unidirectional educational and motivational texts providing reproductive health information versus standardized discharge instructions. Blinded assessors measured contraception initiation via telephone follow-up and health record review at 3 months. RESULTS We randomized 100 eligible participants (predominantly aged 18-19, Hispanic, and with a primary provider); 88.0% had follow-up. In the intervention arm, 3/50 (6.0%) participants opted out, and 1,172/1,654 (70.9%) texts were successfully delivered; over 90% of message failures were from one mobile carrier. Most (36/41; 87.7%) in the intervention group liked and wanted future reproductive health messages. Contraception was initiated in 6/50 (12.0%) in the intervention arm and in 11/49 (22.4%) in the control arm. CONCLUSIONS A pregnancy prevention texting intervention was feasible and acceptable among adolescent females in the emergency department setting.
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Affiliation(s)
- Lauren S Chernick
- Division of Pediatric Emergency Medicine, Department of Pediatrics, Columbia University Medical Center, New York, New York.
| | - Melissa S Stockwell
- Department of Child and Adolescent Health, Columbia University Medical Center, New York, New York; Department of Population and Family Health, Mailman School of Public Health, Columbia University Medical Center, New York, New York
| | - Mengfei Wu
- Department of Biostatistics, Columbia University, New York, New York
| | - Paula M Castaño
- Department of Obstetrics-Gynecology, Columbia University Medical Center, New York, New York
| | | | - Carolyn L Westhoff
- Department of Population and Family Health, Mailman School of Public Health, Columbia University Medical Center, New York, New York; Department of Obstetrics-Gynecology, Columbia University Medical Center, New York, New York
| | - John Santelli
- Department of Child and Adolescent Health, Columbia University Medical Center, New York, New York; Department of Population and Family Health, Mailman School of Public Health, Columbia University Medical Center, New York, New York
| | - Peter S Dayan
- Division of Pediatric Emergency Medicine, Department of Pediatrics, Columbia University Medical Center, New York, New York
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20
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Solomon M, Badolato GM, Chernick LS, Trent ME, Chamberlain JM, Goyal MK. Examining the Role of the Pediatric Emergency Department in Reducing Unintended Adolescent Pregnancy. J Pediatr 2017; 189:196-200. [PMID: 28709634 PMCID: PMC5614815 DOI: 10.1016/j.jpeds.2017.06.053] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Revised: 05/25/2017] [Accepted: 06/22/2017] [Indexed: 11/22/2022]
Abstract
OBJECTIVES To determine pregnancy risk and receptiveness to emergency department (ED)-based pregnancy prevention interventions among adolescents accessing care in the ED. STUDY DESIGN Cross-sectional electronic survey of adolescent females in a pediatric ED used to calculate the Pregnancy Risk Index, a validated measure estimating the annual risk of becoming pregnant based on recent sexual activity, contraceptive method(s), method-specific contraceptive failure rates, and interest in receipt of ED-based contraceptive services. RESULTS Of 229 participants, 219 were not pregnant, and 129 reported sexual experience. Overall, 72.4% (n = 166) endorsed negative pregnancy intentions. The overall Pregnancy Risk Index for the 219 nonpregnant participants was 9.6 (95% CI 6.8-12.4), and was 17.5 (95% CI 12.8-22.2) for the 129 sexually experienced participants. A Pregnancy Risk Index greater than the national average of 5 was associated with older age (aOR 3.0; 95% CI 1.5-5.85), nonprivate insurance (aOR 7.1; 95% CI 1.6-32.1), prior pregnancy (aOR 2.7; 95% CI 1.2-6.0), and chief complaint potentially related to a reproductive health concern (aOR 2.6; 95% CI 1.4-5.1). In this cohort, 85.1% (n = 194) believed that the ED should provide information about pregnancy prevention, the majority of whom (64.9%; n = 148) believed that pregnancy prevention services should be offered at all ED visits. CONCLUSION This study demonstrates a high unintended pregnancy risk among adolescents accessing care in the ED. Adolescents report interest in receiving pregnancy prevention information and services in the ED, regardless of reason for visit. Strategies to incorporate successfully the provision of reproductive health services into ED care should be explored.
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Affiliation(s)
- Michelle Solomon
- Department of Pediatrics, Children's National Health System, Washington, DC
| | - Gia M Badolato
- Department of Pediatrics, Children's National Health System, Washington, DC
| | | | - Maria E Trent
- Department of Pediatrics, Johns Hopkins University, Baltimore, MD
| | | | - Monika K Goyal
- Department of Pediatrics, Children's National Health System, Washington, DC.
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Pereira J, Pires R, Araújo Pedrosa A, Vicente L, Bombas T, Canavarro MC. Sociodemographic, sexual, reproductive and relationship characteristics of adolescents having an abortion in Portugal: a homogeneous or a heterogeneous group? EUR J CONTRACEP REPR 2016; 22:53-61. [PMID: 27960606 DOI: 10.1080/13625187.2016.1266323] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVES The aims of the study were to describe the sociodemographic, sexual, reproductive and relational characteristics of adolescents having an abortion in Portugal and to explore the differences between three adolescent age groups. METHODS We recruited a nationally representative sample of 224 adolescents (<16 years, n = 18; 16-17 years, n = 103; 18-19 years, n = 103) who had an abortion. Data were collected from 16 health care services that provide abortion. RESULTS The adolescents were predominantly single, were from non-nuclear families, had low-socioeconomic status and were students. Mean age at first sexual intercourse was 15 years and mean gynaecological age was 5 years. Most had had multiple sexual partners, and for most it was their first pregnancy. At conception, the majority were involved in a long-term romantic relationship, were using contraception but did not identify the contraceptive failure that led to the pregnancy. Significant age group differences were found. Compared with the younger age groups, the 18-19 year age group was more frequently married or living with a partner, had finished school, had attained a higher educational level (as had their partner), intended to go to university, and had a greater number of sexual partners. Compared with the other groups, those under 16 years of age reported earlier age at menarche and at first sexual intercourse, and had a lower gynaecological age. CONCLUSIONS Our study characterises the life contexts of Portuguese adolescents who had an abortion. It highlights the need to recognise the heterogeneity of this group according to age. The findings have important implications for the development of age-appropriate guidelines to prevent unplanned pregnancy.
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Affiliation(s)
- Joana Pereira
- a Faculty of Psychology and Educational Sciences , Cognitive-Behavioural Research Centre (CINEICC), University of Coimbra , Coimbra , Portugal.,b Psychological Intervention Unit , Daniel de Matos Maternity Hospital, Coimbra University Hospitals (CHUC EPE) , Coimbra , Portugal
| | - Raquel Pires
- a Faculty of Psychology and Educational Sciences , Cognitive-Behavioural Research Centre (CINEICC), University of Coimbra , Coimbra , Portugal.,c School of Psychology and Life Sciences, Lusófona University of Humanities and Technology , Lisbon , Portugal
| | - Anabela Araújo Pedrosa
- b Psychological Intervention Unit , Daniel de Matos Maternity Hospital, Coimbra University Hospitals (CHUC EPE) , Coimbra , Portugal
| | - Lisa Vicente
- d Division of Infant, Youth, Reproductive and Sexual Health , Directorate-General of Health , Lisbon , Portugal
| | - Teresa Bombas
- e Obstetric Service , Coimbra University Hospitals (CHUC EPE) , Coimbra , Portugal
| | - Maria Cristina Canavarro
- a Faculty of Psychology and Educational Sciences , Cognitive-Behavioural Research Centre (CINEICC), University of Coimbra , Coimbra , Portugal.,b Psychological Intervention Unit , Daniel de Matos Maternity Hospital, Coimbra University Hospitals (CHUC EPE) , Coimbra , Portugal
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22
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Chernick LS, Schnall R, Stockwell MS, Castaño PM, Higgins T, Westhoff C, Santelli J, Dayan PS. Adolescent Female Text Messaging Preferences to Prevent Pregnancy After an Emergency Department Visit: A Qualitative Analysis. J Med Internet Res 2016; 18:e261. [PMID: 27687855 PMCID: PMC5064124 DOI: 10.2196/jmir.6324] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Revised: 08/07/2016] [Accepted: 08/08/2016] [Indexed: 11/16/2022] Open
Abstract
Background Over 15 million adolescents use the emergency department (ED) each year in the United States. Adolescent females who use the ED for medical care have been found to be at high risk for unintended pregnancy. Given that adolescents represent the largest users of text messaging and are receptive to receiving text messages related to their sexual health, the ED visit represents an opportunity for intervention. Objective The aim of this qualitative study was to explore interest in and preferences for the content, frequency, and timing of an ED-based text message intervention to prevent pregnancy for adolescent females. Methods We conducted semistructured, open-ended interviews in one urban ED in the United States with adolescent females aged 14-19 years. Eligible subjects were adolescents who were sexually active in the past 3 months, presented to the ED for a reproductive health complaint, owned a mobile phone, and did not use effective contraception. Using an interview guide, enrollment continued until saturation of key themes. The investigators designed sample text messages using the Health Beliefs Model and participants viewed these on a mobile phone. The team recorded, transcribed, and coded interviews based on thematic analysis using the qualitative analysis software NVivo and Excel. Results Participants (n=14) were predominantly Hispanic (13/14; 93%), insured (13/14; 93%), ED users in the past year (12/14; 86%), and frequent text users (10/14; 71% had sent or received >30 texts per day). All were interested in receiving text messages from the ED about pregnancy prevention, favoring messages that were “brief,” “professional,” and “nonaccusatory.” Respondents favored texts with links to websites, repeated information regarding places to receive “confidential” care, and focused information on contraception options and misconceptions. Preferences for text message frequency varied from daily to monthly, with random hours of delivery to maintain “surprise.” No participant feared that text messages would violate her privacy. Conclusions Adolescent female patients at high pregnancy risk are interested in ED-based pregnancy prevention provided by texting. Understanding preferences for the content, frequency, and timing of messages can guide in designing future interventions in the ED.
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Affiliation(s)
- Lauren Stephanie Chernick
- Division of Pediatric Emergency Medicine, Department of Pediatrics, Columbia University Medical Center, New York, NY, United States.
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Batur P, Kransdorf LN, Casey PM. Emergency Contraception. Mayo Clin Proc 2016; 91:802-7. [PMID: 27261868 DOI: 10.1016/j.mayocp.2016.02.018] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Revised: 02/22/2016] [Accepted: 02/23/2016] [Indexed: 12/30/2022]
Abstract
Emergency contraception (EC) may help prevent pregnancy in various circumstances, such as contraceptive method failure, unprotected sexual intercourse, or sexual assault, yet it remains underused. There are 4 approved EC options in the United States. Although ulipristal acetate requires a provider's prescription, oral levonorgestrel (LNG) is available over the counter for women of all ages. The most effective method of EC is the copper intrauterine device, which can be left in place for up to 10 years for efficacious, cost-effective, hormone-free, and convenient long-term primary contraception. Ulipristal acetate tends to be more efficacious in pregnancy prevention than is LNG, especially when taken later than 72 hours postcoitus. The mechanism of action of oral EC is delay of ovulation, and current evidence reveals that it is ineffective postovulation. Women who weigh more than 75 kg or have a body mass index greater than 25 kg/m(2) may have a higher risk of unintended pregnancy when using oral LNG EC; therefore, ulipristal acetate or copper intrauterine devices are preferable in this setting. Providers are often unaware of the range of EC options or are unsure of how to counsel patients regarding the access and use of EC. This article critically reviews current EC literature, summarizes recommendations, and provides guidance for counseling women about EC. Useful tips for health care providers are provided, with a focus on special populations, including breast-feeding women and those transitioning to long-term contraception after EC use. When treating women of reproductive age, clinicians should be prepared to counsel them about EC options, provide EC appropriately, and, if needed, refer for EC in a timely manner.
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MESH Headings
- Administration, Oral
- Attitude of Health Personnel
- Body Mass Index
- Breast Feeding
- Contraception, Postcoital/adverse effects
- Contraception, Postcoital/economics
- Contraception, Postcoital/methods
- Contraceptive Agents, Female/administration & dosage
- Contraceptive Agents, Female/adverse effects
- Contraceptive Agents, Female/economics
- Contraceptive Agents, Female/supply & distribution
- Contraceptives, Postcoital/administration & dosage
- Contraceptives, Postcoital/adverse effects
- Contraceptives, Postcoital/economics
- Contraceptives, Postcoital/supply & distribution
- Female
- Health Knowledge, Attitudes, Practice
- Humans
- Intrauterine Devices, Copper/adverse effects
- Intrauterine Devices, Copper/economics
- Intrauterine Devices, Copper/supply & distribution
- Levonorgestrel/administration & dosage
- Levonorgestrel/adverse effects
- Levonorgestrel/economics
- Levonorgestrel/supply & distribution
- Nonprescription Drugs/economics
- Nonprescription Drugs/standards
- Nonprescription Drugs/supply & distribution
- Norpregnadienes/administration & dosage
- Norpregnadienes/adverse effects
- Norpregnadienes/economics
- Norpregnadienes/supply & distribution
- Ovulation/drug effects
- Patient Education as Topic/methods
- Pregnancy
- Prescription Drugs/economics
- Prescription Drugs/standards
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Affiliation(s)
- Pelin Batur
- Department of Internal Medicine, Primary Care Women's Health, Cleveland Clinic, Cleveland, OH
| | - Lisa N Kransdorf
- Division of Women's Health Internal Medicine, Mayo Clinic, Scottsdale, AZ
| | - Petra M Casey
- Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, MN.
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Miller MK, Randell KA, Barral R, Sherman AK, Miller E. Factors Associated With Interest in Same-Day Contraception Initiation Among Females in the Pediatric Emergency Department. J Adolesc Health 2016; 58:154-9. [PMID: 26802990 PMCID: PMC4724387 DOI: 10.1016/j.jadohealth.2015.10.016] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2015] [Revised: 10/20/2015] [Accepted: 10/21/2015] [Indexed: 10/22/2022]
Abstract
PURPOSE The purposes were to describe interest in hormonal contraception initiation among female adolescent in the emergency department (ED) and to assess for associations with factors known to increase pregnancy risk such as violence victimization. METHODS We used a computerized survey to assess sexual and dating practices, pregnancy history/likelihood, contraception use (including long-acting reversible contraception [LARC]) and concerns, contraception initiation interest, violence victimization, medical utilization, and demographics among sexually experienced females aged 14-19 years in our ED. The primary outcome was interest in contraception initiation. We compared responses between subgroups using the chi-square test. RESULTS A total of 168 adolescents participated (82% of approached; mean age 16.6 years; 41% white; 48% black; 21% commercial insurance). Interest in contraception initiation was high: 60% overall and 70% among those not using hormonal contraception (n = 96). Among those using non-LARC contraception (n = 59), 29% were interested in LARC initiation. Contraception/LARC interest was positively associated with lack of recent well care (p < .06) and concerns about cost (p < .01), privacy (p = .03), and where to obtain contraception (p < .01). Nearly all planned on avoiding pregnancy, although many (23%) used no contraception at last intercourse. One third (36%) reported violence victimization. Most (70%) reported ≥1 concern about contraception (most commonly cost). CONCLUSIONS Many reported behaviors and exposures, including violence victimization, that increase their risk for pregnancy and most expressed interest in same-day initiation of hormonal contraception, including LARC. These findings may inform novel strategies for increased adolescent access to contraception and pregnancy prevention through use of nontraditional sites such as EDs.
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Affiliation(s)
- Melissa K Miller
- Division of Emergency and Urgent Care, Department of Pediatrics, Children's Mercy Hospitals and Clinics, Kansas City, Missouri.
| | - Kimberly A Randell
- Division of Emergency and Urgent Care, Department of Pediatrics, Children's Mercy Hospitals and Clinics, Kansas City, Missouri
| | - Romina Barral
- Division of Adolescent Medicine, Department of Pediatrics, Children's Mercy Hospitals and Clinics, Kansas City, Missouri
| | - Ashley K Sherman
- Center for Health Services Research, Children's Mercy Hospitals and Clinics, Kansas City, Missouri
| | - Elizabeth Miller
- Division of Adolescent and Young Adult Medicine, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, Pennsylvania
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Batur P, Cleland K, McNamara M, Wu J, Pickle S. Emergency contraception: A multispecialty survey of clinician knowledge and practices. Contraception 2015; 93:145-52. [PMID: 26363429 DOI: 10.1016/j.contraception.2015.09.003] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2015] [Revised: 09/04/2015] [Accepted: 09/08/2015] [Indexed: 12/30/2022]
Abstract
OBJECTIVES To assess knowledge and provision of emergency contraception (EC), particularly the most effective methods. STUDY DESIGN A web-based survey was distributed to a cross-sectional convenience sample of healthcare providers across specialties treating reproductive-aged women. The survey was sent to 3260 practicing physicians and advanced practice clinicians in 14 academic centers between February 2013 and April 2014. We analyzed responses by provider specialty using multivariable logistic regression. RESULTS The final sample included 1684 providers (response rate=51.7%). Ninety-five percent of the respondents had heard of levonorgestrel (LNG) EC. Among reproductive health specialists, 81% provide LNG EC in their practice, although only half (52%) had heard of ulipristal acetate (UPA) and very few provide it (14%). The majority in family medicine (69%) and emergency medicine (74%) provide LNG, in contrast to 42% of internists and 55% of pediatricians. However, the more effective methods [UPA and copper intrauterine device (IUD)] were little known and rarely provided outside of reproductive health specialties; 18% of internists and 14% of emergency medicine providers had heard of UPA and 4% provide it. Only 22% of emergency providers and 32% of pediatricians had heard of the copper IUD used as EC. Among reproductive health specialists, only 36% provide copper IUD as EC in their practice. Specialty, provider type and proportion of women of reproductive age in the practice were related to knowledge and provision of some forms of EC. CONCLUSIONS Awareness and provision of the most effective EC methods, UPA and the copper IUD (which are provider dependent), are substantially lower than for LNG EC, especially among providers who do not focus on reproductive health. IMPLICATIONS In our sample of 1684 healthcare providers from diverse specialties who treat reproductive-aged women, knowledge and provision of the most effective forms of EC (UPA and the copper IUD) are far lower than for LNG EC. Women should be offered the full range of EC methods.
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Affiliation(s)
- Pelin Batur
- Department of Internal Medicine and Primary Care Women's Health at the Cleveland Clinic, Cleveland, OH, USA.
| | - Kelly Cleland
- Office of Population Research at Princeton University, Princeton, NJ, USA
| | - Megan McNamara
- Department of Internal Medicine at the Louis Stokes Department of Veterans Affairs Medical Center Hospital of Case Western Reserve University, Cleveland, OH, USA
| | - Justine Wu
- Department of Family Medicine and Community Health at Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Sarah Pickle
- Department of Family Medicine and Community Health at Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
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Communicating With the Adolescent: Consent and Confidentiality Issues. CLINICAL PEDIATRIC EMERGENCY MEDICINE 2015. [DOI: 10.1016/j.cpem.2015.04.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Morrison-Beedy D, Xia Y, Passmore D. Sexual risk factors for partner age discordance in adolescent girls and their male partners. J Clin Nurs 2015; 22:3289-99. [PMID: 24580784 DOI: 10.1111/jocn.12408] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/29/2013] [Indexed: 12/17/2022]
Abstract
AIMS AND OBJECTIVES To investigate differences in sexual risk factors between adolescent girls reporting similar-aged or older sex partners. BACKGROUND Adolescent girls are at significant risk of heterosexual-acquired HIV infection and other long-term reproductive health issues. Sexual partner age discordance in teen girls has been correlated with STIs, lack of protection, multiple partners and earlier age of sexual transition. DESIGN A descriptive study comparing girls currently involved with age-discordant partners to those with similar-aged partners. Two-sample t-test for continuous variables and chi-squared test or Fisher's exact test for categorical variables were used to compare groups. METHODS Baseline data from 738 sexually active, urban, adolescent girls aged 15-19 were analysed to determine which behaviours were more likely to occur in girls with older partners. Data were collected as part of a gender-specific HIV-prevention intervention in a randomised controlled trial (RCT) tailored to adolescent girls. RESULTS Multiple reported sexual risk behaviours were found to significantly differ between the two groups at baseline. Overall, girls with older partners had more episodes of sexual instances (vaginal, anal and oral). Specific sexual risk behaviours were found to be statistically significant between the two groups. Girls with older partners started having sex at earlier ages, had more lifetime sexual partners, higher incidents of STIs and were reluctant to discuss using condoms with their partners. Girls with similar-aged partners were less willing to engage in risky sexual behaviours. CONCLUSIONS Findings from this investigation support data from other studies. Relationships with older male partners place adolescent girls at increased risk of HIV/STIs and unintended pregnancy. RELEVANCE TO CLINICAL PRACTICE Adolescent girls in age-discordant relationships are at risk of immediate and long-term sexual health morbidities. Identifying girls who are at increased risk by asking tailored questions will enable nurses to recommend appropriate diagnostics for this population and provide age-specific counselling.
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Chernick LS, Westhoff C, Ray M, Garcia M, Garth J, Santelli J, Dayan PS. Enhancing Referral of Sexually Active Adolescent Females from the Emergency Department to Family Planning. J Womens Health (Larchmt) 2015; 24:324-8. [DOI: 10.1089/jwh.2014.4994] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Affiliation(s)
- Lauren S. Chernick
- Department of Pediatrics, Columbia University Medical Center, New York, New York
| | - Carolyn Westhoff
- Department of Obstetrics and Gynecology, Columbia University Medical Center, New York, New York
- Department of Population and Family Health, Mailman School of Public Health, New York, New York
| | - Margaret Ray
- Department of Pediatrics, Columbia University Medical Center, New York, New York
| | - Madelyn Garcia
- Department of Pediatrics, Columbia University Medical Center, New York, New York
| | - Janet Garth
- Department of Obstetrics and Gynecology, Columbia University Medical Center, New York, New York
- New York-Presbyterian Hospital, New York, New York
| | - John Santelli
- Department of Pediatrics, Columbia University Medical Center, New York, New York
- Department of Population and Family Health, Mailman School of Public Health, New York, New York
| | - Peter S. Dayan
- Department of Pediatrics, Columbia University Medical Center, New York, New York
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Chernick LS, Schnall R, Higgins T, Stockwell MS, Castaño PM, Santelli J, Dayan PS. Barriers to and enablers of contraceptive use among adolescent females and their interest in an emergency department based intervention. Contraception 2014; 91:217-25. [PMID: 25499588 DOI: 10.1016/j.contraception.2014.12.003] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2014] [Revised: 12/02/2014] [Accepted: 12/08/2014] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Over 15 million adolescents, many at high risk for pregnancy, use emergency departments (EDs) in the United States annually, but little is known regarding reasons for failure to use contraceptives in this population. The purpose of this study was to identify the barriers to and enablers of contraceptive use among adolescent females using the ED and determine their interest in an ED-based pregnancy prevention intervention. STUDY DESIGN We conducted semistructured, open-ended interviews with females in an urban ED. Eligible females were 14-19 years old, sexually active, presenting for reproductive health complaints and at risk for pregnancy, defined as nonuse of effective (per the World Health Organization) contraception. Interviews were recorded, transcribed and coded based on thematic analysis. Enrollment continued until no new themes emerged. A modified Health Belief Model guided the organization of the data. RESULTS Participants (n=14) were predominantly Hispanic (93%), insured (93%) and in a sexual relationship (86%). The primary barrier to contraceptive use was perceived health risk, including effects on menstruation, weight and future fertility. Other barriers consisted of mistrust in contraceptives, ambivalent pregnancy intentions, uncertainty about the future, partner's desire for pregnancy and limited access to contraceptives. Enablers of past contraceptive use included the presence of a school-based health clinic and clear plans for the future. All participants were receptive to ED-based pregnancy prevention interventions. CONCLUSIONS The identified barriers and enablers influencing hormonal contraceptive use can be used to inform the design of future ED-based adolescent pregnancy prevention interventions. IMPLICATIONS Adolescents who visit the emergency department (ED) identify contraceptive side effects, mistrust in contraceptives, limited access, pregnancy ambivalence and partner pregnancy desires as barriers to hormonal contraception use. They expressed interest in an ED-based intervention to prevent adolescent pregnancy; such an intervention could target these themes to maximize effectiveness.
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Affiliation(s)
- Lauren S Chernick
- Division of Pediatric Emergency Medicine, Department of Pediatrics, Columbia University Medical Center, NY, NY, United States.
| | - Rebecca Schnall
- Department of Nursing, Columbia University Medical Center, NY, NY, United States
| | - Tracy Higgins
- Department of Nursing, Columbia University Medical Center, NY, NY, United States
| | - Melissa S Stockwell
- Division of Child and Adolescent Health, Department of Pediatrics, Columbia University Medical Center, NY, NY, United States; Population and Family Health, Mailman School of Public Health, Columbia University Medical Center, NY, NY, United States
| | - Paula M Castaño
- Department of Obstetrics & Gynecology, Columbia University Medical Center, NY, NY, United States
| | - John Santelli
- Division of Child and Adolescent Health, Department of Pediatrics, Columbia University Medical Center, NY, NY, United States; Population and Family Health, Mailman School of Public Health, Columbia University Medical Center, NY, NY, United States
| | - Peter S Dayan
- Division of Pediatric Emergency Medicine, Department of Pediatrics, Columbia University Medical Center, NY, NY, United States
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