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Bailey C, Shaw J, Harris A. Adolescents and sexual assault: A critical integrative review. AMERICAN JOURNAL OF COMMUNITY PSYCHOLOGY 2024. [PMID: 38303610 DOI: 10.1002/ajcp.12740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 12/19/2023] [Accepted: 01/03/2024] [Indexed: 02/03/2024]
Abstract
Adolescents are sexually assaulted at remarkably high rates. Adolescents are also unique given the specific dynamics of adolescent sexual assault, their current stage in human development, their limited legal standing and rights, and their experiences navigating postassault services and resources. While literature exists within each of these domains, it is somewhat disconnected and overlooks how adolescents are often relegated to the margins in research and practice. The purpose of this integrative review is to (1) provide a more complete understanding of adolescent sexual assault and survivors' nuanced needs; (2) frame adolescent survivors as a too-often-overlooked oppressed group that researchers and responders must consider and center in their work, lest contribute to their further marginalization; and (3) inspire and orient social justice-minded scholar activists to various action steps to take to center and prioritize adolescents in research and practice. Through our intersectional feminist approach, we offer specific action steps for social justice-minded scholar activists to recenter adolescents in their research and practice.
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Affiliation(s)
- Caroline Bailey
- Department of Psychology, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Jessica Shaw
- Department of Psychology, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Abril Harris
- School of Social Work, University of Washington, Seattle, Washington, USA
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You JGT, Potter JE, Mishuris RG. Electronic Health Record Adolescent Confidentiality in a Safety Net Setting. Appl Clin Inform 2023; 14:878-882. [PMID: 37640057 PMCID: PMC10620039 DOI: 10.1055/a-2161-0800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 08/25/2023] [Indexed: 08/31/2023] Open
Abstract
BACKGROUND The 21st Century Cures Act provides improved access to one's medical record but presents new challenges to adolescent confidentiality in the domain of health care information technology. Adolescent patients, who have the right to confidential care in certain areas as dictated by state law, face the prospect of parents and guardians erroneously accessing their confidential health information. OBJECTIVES Our institution, the largest safety net hospital in our region, sought to quantify the proportion of adolescent patient portal accounts likely being accessed by guardians and to implement corrective measures for the patient portal sign-up process in our electronic health record (EHR) system. METHODS We manually reviewed our institution's adolescent patient portal accounts based on email addresses associated with adolescents' accounts. We implemented EHR changes to address the potential for breach of confidentiality as a result of adolescent patient portal account creation by guardians. One intervention was creating a "guardrail rule" to prevent guardians from creating adolescent patient portal accounts with their own email addresses. After email reminders to adolescent patients to update their accounts, we deactivated accounts with concern for erroneous guardian access. RESULTS Sixty percent of our institution's adolescent patient portal accounts had possible direct access by guardians. Following requests to update account access, 425 (18.8%) of accounts had email addresses updated by adolescent patients and 1,830 (81.2%) accounts were deactivated. CONCLUSION More nuanced EHR functionality for adolescent patients and their guardians can help health care systems provide confidential, patient-centered care for adolescents, while allowing guardians to access appropriate health information to facilitate care. There is an opportunity for a national consensus on how adolescents and their guardians can access health information by patient portal.
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Affiliation(s)
- Jacqueline Guan-Ting You
- Department of Pathology, Massachusetts General Hospital/Brigham and Women's Hospital, Boston, Massachusetts, United States
- Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, United States
| | - Julia Esther Potter
- Department of Pediatrics, Mass General Hospital for Children, Boston, Massachusetts, United States
| | - Rebecca Grochow Mishuris
- Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, United States
- Digital, Mass General Brigham, Somerville, Massachusetts, United States
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Buitrago Ramírez F, Ciurana Misol R, Fernández Alonso MDC, Tizón JL. [Prevention of mental health disorders in primary care: Pregnancy in adolescence]. Aten Primaria 2022; 54 Suppl 1:102494. [PMID: 36435587 PMCID: PMC9705218 DOI: 10.1016/j.aprim.2022.102494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Adolescent pregnancy is generally an unwanted pregnancy, a situation that involves significant biological, psychological and social overloads, with repercussions on the health of the mother and the child. But the psychosocially important fact is that an unwanted pregnancy in its entirety gives rise to the birth of an ambivalently wanted child, a high-risk child. Those born in Spain in 2020 to women under 20 years of age were 8,305, which corresponds to 1.97% of all births. This review presents measures and recommendations for the protection and prevention of the mental health of the mother and child when pregnancy takes place in adolescence.
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Affiliation(s)
- Francisco Buitrago Ramírez
- Medicina Familiar y Comunitaria, Centro de Salud Universitario La Paz, Servicio Extremeño de Salud, Badajoz, España,Autor para correspondencia.
| | | | | | - Jorge L. Tizón
- Psiquiatría y Neurología, Psicología y Psicoanalismo, Institut Universitari de Salut Mental, Universitat Ramon Llull, Barcelona, España
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Abstract
Although teenage pregnancy rates have decreased over the past 30 years, many adolescents become pregnant every year. It is important for pediatricians to have the ability and the resources to make a timely pregnancy diagnosis in their adolescent patients and provide them with nonjudgmental counseling that includes the full range of pregnancy options. Counseling includes an unbiased discussion of the adolescent's options to continue or terminate the pregnancy, supporting the adolescent in the decision-making process, and referring the adolescent to appropriate resources and services. It is important for pediatricians to be familiar with laws and policies impacting access to abortion care, especially for minor adolescents, as well as laws that seek to limit health care professionals' provision of unbiased pregnancy options counseling and referrals, either for abortion care or continuation of pregnancy in accordance with the adolescent's choice. Pediatricians who choose not to provide such discussions should promptly refer pregnant adolescent patients to a health care professional who will offer developmentally appropriate pregnancy options counseling that includes the full range of pregnancy options. Pediatricians should be aware of and oppose policies that restrict their ability to provide pregnant adolescents with unbiased counseling that includes the full range of pregnancy options. This approach to pregnancy options counseling has not changed since the original 1989 American Academy of Pediatrics statement on this issue.
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Isbell T, Brewster R, Soderborg T, Javalkar K. "My Body, Whose Choice?" A Call to Advance Reproductive Justice in Pediatric Training. Pediatrics 2022; 150:186811. [PMID: 35445273 DOI: 10.1542/peds.2021-054936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/18/2022] [Indexed: 11/24/2022] Open
Affiliation(s)
- Tasia Isbell
- Department of Pediatrics, Boston University, Boston, Massachusetts.,Department of Pediatrics, Boston Medical Center, Boston, Massachusetts.,Department of Pediatrics, Harvard Medical School, Boston, Massachusetts.,Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts
| | - Ryan Brewster
- Department of Pediatrics, Boston University, Boston, Massachusetts.,Department of Pediatrics, Boston Medical Center, Boston, Massachusetts.,Department of Pediatrics, Harvard Medical School, Boston, Massachusetts.,Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts
| | - Taylor Soderborg
- Department of Pediatrics, Boston University, Boston, Massachusetts.,Department of Pediatrics, Boston Medical Center, Boston, Massachusetts.,Department of Pediatrics, Harvard Medical School, Boston, Massachusetts.,Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts
| | - Karina Javalkar
- Department of Pediatrics, Boston University, Boston, Massachusetts.,Department of Pediatrics, Boston Medical Center, Boston, Massachusetts.,Department of Pediatrics, Harvard Medical School, Boston, Massachusetts.,Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts
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White K, Narasimhan S, Hartwig SA, Carroll E, McBrayer A, Hubbard S, Rebouché R, Kottke M, Hall KS. Parental Involvement Policies for Minors Seeking Abortion in the Southeast and Quality of Care. SEXUALITY RESEARCH & SOCIAL POLICY : JOURNAL OF NSRC : SR & SP 2022; 19:264-272. [PMID: 38736735 PMCID: PMC11086958 DOI: 10.1007/s13178-021-00539-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/18/2021] [Indexed: 05/14/2024]
Abstract
Introduction Thirty-seven states require minors seeking abortion to involve a parent, either through notification or consent. Little research has examined how implementation of these laws affect service delivery and quality of care for those who involve a parent. Methods Between May 2018 and September 2019, in-depth interviews were conducted with 34 staff members involved in scheduling, counseling, and administration at abortion facilities in three Southeastern states. Interviews explored procedures for documenting parental involvement, minors' and parents' reactions to requirements, and challenges with implementation and compliance. Both inductive and deductive codes, informed by the Institute of Medicine's healthcare quality framework, were used in the thematic analysis. Results Parental involvement laws adversely affected four quality care domains: efficiency, patient-centeredness, timeliness, and equity. Administrative inefficiencies stemmed from the extensive documentation needed to prove an adult's relationship to a minor, increasing the time and effort needed to comply with state reporting requirements. If parents were not supportive of their minor's decision, participants felt they had a duty to intervene to ensure the minor's decision and needs remained centered. Staff further noted that delays to timely care accumulated as minors navigated parental involvement and other state mandates, pushing some beyond gestational age limits. Lower income families and those with complex familial arrangements had greater difficulty meeting state requirements. Conclusions Parental involvement mandates undermine health service delivery and quality for minors seeking abortion services in the Southeast. Policy Implications Removing parental involvement requirements would protect minors' reproductive autonomy and support the provision of equitable, patient-centered healthcare.
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Affiliation(s)
- Kari White
- Steve Hicks School of Social Work and Department of Sociology, University of Texas at Austin, TX, Austin, USA
| | - Subasri Narasimhan
- Department of Behavioral, Social, and Health Education Sciences and Center for Reproductive Health Research in the Southeast, Emory University, Atlanta, GA, USA
| | - Sophie A. Hartwig
- Department of Behavioral, Social, and Health Education Sciences and Center for Reproductive Health Research in the Southeast, Emory University, Atlanta, GA, USA
| | - Erin Carroll
- Department of Health Care Organization and Policy, University of Alabama at Birmingham, AL, Birmingham, USA
| | - Alexandra McBrayer
- Department of Health Care Organization and Policy, University of Alabama at Birmingham, AL, Birmingham, USA
| | | | - Rachel Rebouché
- Beasley School of Law, Temple University, Philadelphia, PA, USA
| | - Melissa Kottke
- Department of Gynecology and Obstetrics and Jane Fonda Center, Emory University, Atlanta, GA, USA
| | - Kelli Stidham Hall
- Heilbrunn Department of Population & Family Health, Columbia University Mailman School of Public Health, New York City, NY, USA
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Reisner SL, Mateo C, Elliott MN, Tortolero S, Davies SL, Lewis T, Li D, Schuster M. Analysis of Reported Health Care Use by Sexual Orientation Among Youth. JAMA Netw Open 2021; 4:e2124647. [PMID: 34714346 PMCID: PMC8556619 DOI: 10.1001/jamanetworkopen.2021.24647] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
IMPORTANCE In the United States, adolescents who are lesbian, gay, or bisexual (LGB) face disparities across physical and mental health outcomes compared with non-LGB youth, yet few studies have looked at patterns of health care utilization by sexual orientation. OBJECTIVE To compare health care utilization indicators for LGB and non-LGB youth. DESIGN, SETTING, AND PARTICIPANTS This cohort study analyzed wave 3 data from Healthy Passages, a longitudinal observational study of diverse public school students in Birmingham, Alabama; Houston, Texas; and Los Angeles County, California. Multivariable logistic regression models tested sexual-orientation differences in the past 12-month health care utilization measures, controlling for youth age, gender, race and ethnicity, household education, income, and marital status. Data collection began in 2010 when students were in the 5th grade (mean [SE] age, 11.13 [0.01] years) (wave 1) and continued 2 years later (wave 2, 7th grade) and 5 years later (wave 3, 10th grade). Permission to be contacted was provided for 6663 children, and 5147 (77%) participated in audio computer-assisted self-administered interviews. This study included 4256 youth (640 LGB, 3616 non-LGB) who completed interviews at wave 1 and wave 3 and answered key items used in this analysis. Analyses were completed in June 2021. EXPOSURES Sexual orientation (LGB vs non-LGB). MAIN OUTCOMES AND MEASURES Health care utilization and communication difficulty with a physician in the past 12 months. RESULTS Among 4256 youths included in the study at baseline in 5th grade (wave 1), 2171 (48.9%) were female; 1502 (44.5%) were Hispanic or Latino; 1479 (28.9%) were Black; the mean (SE) age was 11.19 (0.03) years; and 640 (14.5%) were LGB at wave 3. Compared with non-LGB youth, a higher proportion of LGB youth reported not receiving needed medical care in the last 12 months (adjusted odds ratio [aOR], 1.68; 95% CI,1.38-2.05), most commonly for sexually transmitted infections, contraception, and substance use. LGB youth more frequently reported difficulty communicating with their physician (aOR, 1.71; 95% CI, 1.27-2.30) than non-LGB youth. CONCLUSIONS AND RELEVANCE This study's results found that health care utilization differs by sexual orientation for youth. These findings suggest that clinician training is needed to address the health care needs of LGB youth. Routinely capturing sexual orientation data might enable tracking of health care utilization indicators for LGB youth.
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Affiliation(s)
- Sari L. Reisner
- Pediatrics, Boston Children's Hospital, Boston, Massachusetts
- Division of Endocrinology, Diabetes & Hypertension, Brigham and Women's Hospital, Boston, Massachusetts
- Department of Medicine, Harvard Medical School, Boston, Massachusetts
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Camila Mateo
- Pediatrics, Boston Children's Hospital, Boston, Massachusetts
- Department of Medicine, Harvard Medical School, Boston, Massachusetts
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | | | | | | | | | - Dennis Li
- Northwestern University, Evanston, Illinois
| | - Mark Schuster
- Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, California
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Garney W, Wilson K, Ajayi KV, Panjwani S, Love SM, Flores S, Garcia K, Esquivel C. Social-Ecological Barriers to Access to Healthcare for Adolescents: A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:4138. [PMID: 33919813 PMCID: PMC8070789 DOI: 10.3390/ijerph18084138] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 04/11/2021] [Accepted: 04/12/2021] [Indexed: 11/17/2022]
Abstract
Access to healthcare for adolescents is often overlooked in the United States due to federal and state-sponsored insurance programs such as Medicaid and the Children's Health Insurance Program. While these types of programs provide some relief, the issue of healthcare access goes beyond insurance coverage and includes an array of ecological factors that hinder youths from receiving services. The purpose of this scoping review was to identify social-ecological barriers to adolescents' healthcare access and utilization in the United States. We followed the PRISMA and scoping review methodological framework to conduct a comprehensive literature search in eight electronic databases for peer-reviewed articles published between 2010 and 2020. An inductive content analysis was performed to thematize the categories identified in the data extraction based on the Social-Ecological Model (SEM). Fifty studies were identified. Barriers across the five SEM levels emerged as primary themes within the literature, including intrapersonal-limited knowledge of and poor previous experiences with healthcare services, interpersonal-cultural and linguistic barriers, organizational-structural barriers in healthcare systems, community-social stigma, and policy-inadequate insurance coverage. Healthcare access for adolescents is a systems-level problem requiring a multifaceted approach that considers complex and adaptive behaviors.
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Affiliation(s)
- Whitney Garney
- Department of Health and Kinesiology, Texas A&M University, College Station, TX 77843, USA; (K.W.); (K.V.A.); (S.P.); (S.M.L.); (S.F.); (K.G.); (C.E.)
- Laboratory for Community Health Evaluation and Systems Science (CHESS), Texas A&M University, College Station, TX 77843, USA
| | - Kelly Wilson
- Department of Health and Kinesiology, Texas A&M University, College Station, TX 77843, USA; (K.W.); (K.V.A.); (S.P.); (S.M.L.); (S.F.); (K.G.); (C.E.)
| | - Kobi V. Ajayi
- Department of Health and Kinesiology, Texas A&M University, College Station, TX 77843, USA; (K.W.); (K.V.A.); (S.P.); (S.M.L.); (S.F.); (K.G.); (C.E.)
- Laboratory for Community Health Evaluation and Systems Science (CHESS), Texas A&M University, College Station, TX 77843, USA
- Education, Direction, Empowerment, & Nurturing (EDEN) Foundation, Abuja 900211, Nigeria
| | - Sonya Panjwani
- Department of Health and Kinesiology, Texas A&M University, College Station, TX 77843, USA; (K.W.); (K.V.A.); (S.P.); (S.M.L.); (S.F.); (K.G.); (C.E.)
- Laboratory for Community Health Evaluation and Systems Science (CHESS), Texas A&M University, College Station, TX 77843, USA
| | - Skylar M. Love
- Department of Health and Kinesiology, Texas A&M University, College Station, TX 77843, USA; (K.W.); (K.V.A.); (S.P.); (S.M.L.); (S.F.); (K.G.); (C.E.)
- Laboratory for Community Health Evaluation and Systems Science (CHESS), Texas A&M University, College Station, TX 77843, USA
| | - Sara Flores
- Department of Health and Kinesiology, Texas A&M University, College Station, TX 77843, USA; (K.W.); (K.V.A.); (S.P.); (S.M.L.); (S.F.); (K.G.); (C.E.)
- Laboratory for Community Health Evaluation and Systems Science (CHESS), Texas A&M University, College Station, TX 77843, USA
| | - Kristen Garcia
- Department of Health and Kinesiology, Texas A&M University, College Station, TX 77843, USA; (K.W.); (K.V.A.); (S.P.); (S.M.L.); (S.F.); (K.G.); (C.E.)
- Laboratory for Community Health Evaluation and Systems Science (CHESS), Texas A&M University, College Station, TX 77843, USA
| | - Christi Esquivel
- Department of Health and Kinesiology, Texas A&M University, College Station, TX 77843, USA; (K.W.); (K.V.A.); (S.P.); (S.M.L.); (S.F.); (K.G.); (C.E.)
- Laboratory for Community Health Evaluation and Systems Science (CHESS), Texas A&M University, College Station, TX 77843, USA
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What Is New in Abortion Care?: Best Articles From the Past Year. Obstet Gynecol 2019; 134:1109-1111. [PMID: 31599838 DOI: 10.1097/aog.0000000000003535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This month we focus on current research in abortion care. Dr. Allen discusses five recent publications, which are concluded with a "bottom line" that is the take-home message. A complete reference for each can be found on on this page along with direct links to the abstracts.
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Mutua MM, Manderson L, Musenge E, Achia TNO. Policy, law and post-abortion care services in Kenya. PLoS One 2018; 13:e0204240. [PMID: 30240408 PMCID: PMC6150499 DOI: 10.1371/journal.pone.0204240] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Accepted: 08/14/2018] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Unsafe abortion is still a leading cause of maternal death in most Sub-Saharan African countries. Post-abortion care (PAC) aims to minimize morbidity and mortality following unsafe abortion, addressing incomplete abortion by treating complications, and reducing possible future unwanted pregnancies by providing contraceptive advice. In this article, we draw on data from PAC service providers and patients in Kenya to illustrate how the quality of PAC in healthcare facilities is impacted by law and government policy. METHODS A cross-sectional design was used for this study, with in-depth interviews conducted to collect qualitative data from PAC service providers and seekers in healthcare facilities. Data were analyzed both deductively and inductively, with diverse sub-themes related to specific components of PAC quality. RESULTS The provision of quality PAC in healthcare facilities in Kenya is still low, with access hindered by restrictions on abortion. Negative attitudes towards abortion result in the continued undirected self-administration of abortifacients. Intermittent service interruptions through industrial strikes and inequitable access to care also drive unsafe terminations. Poor PAC service availability and lack of capacity to manage complications in primary care facilities result in multiple referrals and delays in care following abortion, leading to further complications. Inefficient infection control exposes patients and caregivers to unrelated infections within facilities, and the adequate provision of contraception is a continued challenge. DISCUSSION Legal, policy and cultural restrictions to access PAC increase the level of complications. In Kenya, there is limited policy focus on PAC, especially at primary care level, and no guidelines for health providers to provide legal, safe abortion. Discrimination at the point of care discourages women from presenting for care, and discourages providers from freely offering post-abortion contraceptive guidance and services. Poor communication between facilities and communities continues to result in delayed care and access-related discrimination. CONCLUSION Greater emphasis should be placed on the prevention of unsafe abortion and improved access to post-abortion care services in healthcare facilities. There is a definite need for service guidelines for this to occur.
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Affiliation(s)
- Michael Mbithi Mutua
- African Population and Health Research Center (APHRC), Nairobi, Kenya
- School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Lenore Manderson
- School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
- Institute at Brown for Environment & Society (IBES), Brown University, Providence, Rhode Island, United States of America
| | - Eustasius Musenge
- School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Thomas Noel Ochieng Achia
- School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
- Centers for Disease Control and Prevention, Nairobi, Kenya
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Baldridge S, Symes L. Just between Us: An Integrative Review of Confidential Care for Adolescents. J Pediatr Health Care 2018; 32:e45-e58. [PMID: 29249646 DOI: 10.1016/j.pedhc.2017.09.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Revised: 08/13/2017] [Accepted: 09/03/2017] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Confidential care is recommended for all adolescents to facilitate risk behavior screening and discussion of sensitive topics. Only 40% of adolescents receive confidential care. The purpose of this integrative review is to describe research related to the practice of confidential care for adolescents. Evidence was analyzed to identify strategies to increase confidential care and improve risk behavior screening. METHOD Whittemore and Knafl's integrative literature review process was applied. RESULTS The 26 research articles included in this review included patients', parents', and physicians' perspectives. Confidential care practice is inconsistent. Strategies to improve practice are known. CONCLUSIONS Four key elements should be considered to establish a practice culture of confidential care for adolescents. Strategies for implementing the key elements of confidential care and supporting resources for efficient use of time alone are provided.
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Fuentes L, Ingerick M, Jones R, Lindberg L. Adolescents' and Young Adults' Reports of Barriers to Confidential Health Care and Receipt of Contraceptive Services. J Adolesc Health 2018; 62:36-43. [PMID: 29157859 PMCID: PMC5953199 DOI: 10.1016/j.jadohealth.2017.10.011] [Citation(s) in RCA: 63] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Revised: 10/04/2017] [Accepted: 10/16/2017] [Indexed: 11/13/2022]
Abstract
PURPOSE The purpose of this study was to describe adolescents' and young adults' concerns about confidential reproductive health care and experience with time alone with a provider, and examine the association of these confidentiality issues with receipt of contraceptive services. METHODS Data from the 2013 to 2015 National Survey of Family Growth were analyzed using Poisson regression to describe 15- to 25-year-olds' confidential reproductive health-care concerns and time alone with a provider at last health-care visit according to sociodemographic characteristics. We also assessed whether confidentiality issues were associated with obtaining contraceptive services among females. RESULTS Concerns about confidential reproductive health care were less common among 15- to 17-year-olds who were covered by Medicaid compared to their parents' private insurance (adjusted risk ratio [ARR] = .61, confidence interval [CI] .41-.91) and had high-school graduate mothers compared to college-graduate mothers (ARR = .68, CI .47-.99), and were more common among those who lived with neither parent compared to living with both parents (ARR = 2.0, CI 1.27-3.16). Time alone with a provider was more common among black girls than white girls (ARR = 1.57, CI 1.11-2.22) and less common among girls covered by Medicaid than those with parents' private insurance (ARR = .72, CI .56-.92). Time alone was less common among boys living with neither parent compared to living with two parents (ARR = .48, CI .25-.91) and with high-school graduate mothers compared to college-graduate mothers (ARR = .59, CI .42-.84). Among sexually experienced girls and women, confidentiality concerns were associated with a reduced likelihood of having received a contraceptive service in the past year. CONCLUSIONS Greater efforts are needed to support young Americans in receiving confidential care.
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Marcell AV, Burstein GR, Braverman P, Adelman W, Alderman E, Breuner C, Hornberger L, Levine D. Sexual and Reproductive Health Care Services in the Pediatric Setting. Pediatrics 2017; 140:peds.2017-2858. [PMID: 29061870 DOI: 10.1542/peds.2017-2858] [Citation(s) in RCA: 97] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Pediatricians are an important source of health care for adolescents and young adults and can play a significant role in addressing their patients' sexual and reproductive health needs, including preventing unintended pregnancies and sexually transmitted infections (STIs), including HIV, and promoting healthy relationships. STIs, HIV, and unintended pregnancy are all preventable health outcomes with potentially serious permanent sequelae; the highest rates of STIs, HIV, and unintended pregnancy are reported among adolescents and young adults. Office visits present opportunities to provide comprehensive education and health care services to adolescents and young adults to prevent STIs, HIV, and unintended pregnancies. The American Academy of Pediatrics, other professional medical organizations, and the government have guidelines and recommendations regarding the provision of sexual and reproductive health information and services. However, despite these recommendations, recent studies have revealed that there is substantial room for improvement in actually delivering the recommended services. The purpose of this clinical report is to assist pediatricians to operationalize the provision of various aspects of sexual and reproductive health care into their practices and to provide guidance on overcoming barriers to providing this care routinely while maximizing opportunities for confidential health services delivery in their offices.
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Affiliation(s)
- Arik V. Marcell
- Division of General Pediatrics and Adolescent Medicine, Department of Pediatrics, School of Medicine and
- Department of Population, Family and Reproductive Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland; and
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Abstract
Parental consent generally is required for the medical evaluation and treatment of minor children. However, children and adolescents might require evaluation of and treatment for emergency medical conditions in situations in which a parent or legal guardian is not available to provide consent or conditions under which an adolescent patient might possess the legal authority to provide consent. In general, a medical screening examination and any medical care necessary and likely to prevent imminent and significant harm to the pediatric patient with an emergency medical condition should not be withheld or delayed because of problems obtaining consent. The purpose of this policy statement is to provide guidance in those situations in which parental consent is not readily available, in which parental consent is not necessary, or in which parental refusal of consent places a child at risk of significant harm.
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