To determine if urban youth (“metropolitan” status) are at greater risk of engaging in risk behaviors than suburban or rural youth.
We analyzed data on substance use and sexual risk behaviors from ...the national school-based Youth Risk Behavior Survey (YRBS) conducted in 1999, an anonymous questionnaire self-administered by students in grades 9 through 12. The national survey employs a multistage cluster sample to produce a nationally representative sample of high school students. Data were analyzed using SUDAAN software to take into account the sampling model.
In 1999, metropolitan status was not a significant determining factor for involvement in risk behaviors. Of the specific risk factors examined in this analysis, there were no significant differences between rural and suburban youth, and these two groups were combined as “nonurban.” In subsequent analysis of urban vs. nonurban youth, no significant differences in risk behaviors were found on bivariate or multivariate analyses.
This analysis suggests that metropolitan status has little if any association with youth engaging in substance use and sexual risk behaviors. In addition, it appears that urban youth are engaging in these risk behaviors no more frequently than their nonurban counterparts.
Excessive uterine bleeding Talib, Hina J; Coupey, Susan M
Adolescent medicine (Elk Grove Village, Ill.)
23, Številka:
1
Journal Article
Recenzirano
Menstrual bleeding that falls outside the range of normal in adolescents is often a cause of great concern for both girls and their families. Often, much of this anxiety can be alleviated with proper ...anticipatory guidance about menarche and early menstrual bleeding patterns. Eliciting a menstrual history from an adolescent girl is challenging, and the use of concrete methods to chart their patterns and flow, such as menstrual calendars and pictorial bleeding assessment calendar (PBAC) tools, may be helpful. The importance of obtaining a confidential history from the adolescent girl cannot be overestimated. A confidential sexual history is essential so that pregnancy and infectious causes of bleeding are addressed. Not all menstrual bleeding in young girls is attributable to immaturity of the HPO axis. Anovulation and DUB from other clinically relevant conditions in adolescent girls must also be considered. Chief among these is PCOS, which should always be ruled out when a girl presents with excessive bleeding associated with clinical signs of hyperandrogenism, obesity, or insulin resistance. Attention must also be paid to signs or a family history of a bleeding disorder, as vWD is commonly associated with excessive uterine bleeding. Importantly, the laboratory testing for both PCOS and vWD is affected by therapies for the excessive bleeding, and it should be performed before hormonal interventions or blood products are administered or during the placebo phase if treatment has begun. Management goals for excessive uterine bleeding include stabilizing the endometrium and stopping further blood loss, as well as preventing future uncontrolled blood loss. Hormonal stabilization of the endometrium is often helpful regardless of the cause of bleeding and especially in those with hormonally mediated anovulation. New antifibrinolytics, such as tranexamic acid, may also be helpful in the emergent setting and in adolescents with bleeding disorders.
Purpose: Access to reproductive healthcare for adolescent girls with medical conditions requiring use of mycophenolate mofetil or sodium (MMF), a teratogenic immunosuppressant, is important to ...prevent unintended pregnancy and birth defects in offspring. Highly effective long acting reversible contraception (LARC), intrauterine devices (IUDs) and contraceptive implants, is recommended for this population. Our children's hospital through its division of adolescent medicine provides easy access for adolescent patients to all forms of contraception including LARC. The aim of this study is to describe the population of girls prescribed MMF at our hospital and the reproductive healthcare they received. Methods: We searched electronic health records (EHR) to identify females aged 10 through 20 years prescribed MMF at our children's hospital from January 2010 through December 2019. Of the 225 patients identified, we excluded 64 who initiated MMF before January 2010. We reviewed the EHRs of 161 subjects starting with the first visit, either inpatient or outpatient, when the MMF was prescribed and prospectively reviewed all subspecialty, primary care and reproductive health visit notes thereafter. We entered the date and type of each health visit as well as EHR documentation of menarche, coitarche, sexual activity, pregnancies, and contraceptive use into an online database, REDCap. Results: Of the 161 subjects: 50% had systemic lupus erythematosus (SLE), 25% solid organ or bone marrow transplant, 25% other disease; 39% were Hispanic, 32% Black. At MMF initiation, mean age was 15.2 ± 3.9 years; 89% were post-menarchal; 19% had coitarche. We recorded subjects' EHR data for a mean of 5 ± 3 years after MMF initiation. 42% ever had sex, with mean time to EHR documentation of sexual activity of-0.7 ± 2.4 years since MMF initiation. Of the 68 subjects who ever had sex, a higher proportion had SLE v. transplant v. other disease, 66% v. 19% v. 15%, p<0.001. Of all 161 subjects, 68(42%) attended a reproductive health visit (49/68(72%) with adolescent medicine) a mean of 1.7 ± 1.8 years after MMF initiation. Within 3 months of the first reproductive health visit, 37/68(54%) were using an effective contraceptive method: 24(35%) IUD; 7(10%) contraceptive implant; 5(7%) combined oral contraceptive pill; 1(2%) progestin only pill. Of the 22 subjects who had a pregnancy, 14 were unplanned, 6 were using MMF at the time of diagnosis of pregnancy. Conclusions: We found that adolescent girls prescribed the teratogenic immunosuppressant mycophenolate need reproductive health care; a majority were post-menarchal and more than 40% were sexually active, especially those with SLE. We also found a high uptake of LARC methods of contraception in those who attended a reproductive health visit suggesting that increasing access to contraceptive services for these high-risk adolescent girls may reduce their risk of adverse pregnancy outcomes.
Eating disorders have become increasingly prevalent in adolescents. Like their peers without eating disorders, many of these adolescents are sexually active and require contraception. There is a ...paucity of data on long-acting reversible contraception (LARC) use by those with an eating disorder diagnosis (EDO). We hypothesized that weight concerns may lead to lower acceptance and higher device removal rates in adolescents with an EDO compared to peers.
We conducted a secondary analysis of data from a prospective cohort study from 2017-2021 of LARC insertions from 4 academic U.S. Adolescent Medicine practices. Each of the 4 practices obtained IRB approval at their institutions. We compared groups with and without an EDO, by participant characteristics, selected device type, one-year continuation rate, and reasons for insertion & removal.
Overall, 2361 LARCs were inserted; 80 (3.4%) in adolescents with a pre-existing EDO (mean time from diagnosis 1.8 ± 1.8 years). Of these, 27 (34%) had anorexia nervosa, 17 (21%) unspecified feeding or eating disorder, 13 (16%) binge eating disorder, 12 (15%) other specified feeding or eating disorder, 6 (8%) bulimia nervosa, & 5 (6%) avoidant restrictive food intake disorder. Mean age at insertion was 18.6 ± 2.2 years for those with an EDO & 18.8 ± 2.5 for those without. Of those with an EDO, 85% had LARC inserted for contraception as did 84% of those without. Of those with an EDO, 56 (70%) had an IUD inserted & 24 (30%) had an implant vs. 1144 (50%) & 1137 (50%), respectively of those without an EDO, (p< 0.001). Most IUDs inserted in both groups were levonorgestrel releasing, 52 (93%) in those with an EDO and 1087 (95%) in those without an EDO. One-year continuation rate for all LARCs was 77% for both groups. No devices in the EDO group were removed due to concern for weight changes.
Overall, the IUD was preferred over implants by adolescents with an EDO when compared to those without an EDO. This may be an indicator of their interest in a more localized hormonal delivery method, IUDs are often cited by clinicians as associated with less weight gain than implants. One-year continuation of LARC methods was similar for adolescents with and without an EDO suggesting these are satisfactory methods of contraception for adolescents with an EDO.
