Assessing Weight Status in Adolescent and Young Adult Users of the Etonogestrel Contraceptive Implant.

STUDY OBJECTIVE: There are inconsistent data regarding hormonal contraception and weight. Weight concerns might deter teens from using highly effective contraception such as the etonogestrel subdermal implant (ENG). There is little literature about weight gain and adolescent ENG use; most studies involve adult women. The purpose of this study was to evaluate weight/body mass index (BMI) change in adolescent and young adult ENG users compared with nonusers. DESIGN: Retrospective chart review of 197 ENG users and age, race, BMI, and follow-up time-matched controls. SETTING: Adolescent medicine clinic. PARTICIPANTS: Individuals who had been using ENG for 6 months or more were eligible. A control group of non-ENG users who had been seen during the same period was identified to compare weight/BMI over time. Cases were matched to controls on age, BMI, and race. INTERVENTIONS AND MAIN OUTCOME MEASURES: Electronic medical records were reviewed for weight/BMI change and ENG side effects. The study was designed to have 80% power to detect a 2-kg weight difference between cases and controls. RESULTS: Participant mean age was 17 (±2) years. Mean follow-up was 24.5 (±9.3) months. Forty-three of 197 ENG users removed the implant early; 3/43 (6.3%) patients cited weight gain as the primary reason for removal. Mean weight change for ENG users was +3.6 (±7.8) kg vs +3.1 (±5.9) kg for controls (P = .43); mean BMI change was +1.3 (±2.9) in cases vs +1.0 (±2.3) in controls (P = .204). Overall regression analyses showed no group differences among cases and controls. CONCLUSION: Long-term ENG use did not lead to significant weight gain in this sample of adolescent and young adult women. This study supports the statement that ENGs are an effective and weight-neutral option.

Strategies for conducting adolescent health research in the clinical setting: the Mount Sinai Adolescent Health Center HPV experience.

BACKGROUND: Clinical research with adolescents can be challenging due to issues of informed consent, parental involvement, institutional review board requirements, and adolescent psychosocial development. These requirements present a dilemma, particularly in the area of sexual health research, as adolescents are disproportionately affected by sexually transmitted infections such as human papillomavirus (HPV). To successfully conduct adolescent research in the clinical setting, one requires an awareness of state statutes regarding adolescent confidentiality and consent for medical care, and a close partnership with the IRB. CASE STUDY: In 2007, the Mount Sinai Adolescent Health Center in collaboration with the Albert Einstein College of Medicine developed a longitudinal research study to examine the natural history of oral, cervical, and anal HPV in an adolescent female population engaged in high-risk sexual behaviors. We use this research project as a case study to explore the ethical, methodological, and clinical issues related to conducting adolescent health research. SUMMARY AND CONCLUSIONS: Several strategies were identified to promote adolescent study participation, including: (1) building a research team that is motivated to work with adolescents; (2) combining research and patient care visits to avoid duplication of services; and (3) establishing a personalized communication network with participants. Using these methods, adolescent sexual health research can successfully be integrated into the clinical setting. While retaining a prospective cohort of adolescents has its challenges, a persistent and multi-disciplinary approach can help improve recruitment, sustain participation, and acquire critical data that will lead to improved healthcare knowledge applicable to understudied populations of adolescents.

Exposure to sexually explicit Web sites and adolescent sexual attitudes and behaviors.

PURPOSE: Mass media play an important role in the socialization of youth. Given its expanding nature and accessibility, the Internet may be at the forefront of this education. However, the extent of the Internet's impact on adolescent sexual attitudes and behaviors is not yet known. METHODS: A total of 433 adolescents completed an anonymous survey at a health center in New York City. The cross-sectional survey assessed Internet accessibility, exposure to sexually explicit Web sites (SEWs), sexual behaviors, and sexually permissive attitudes. RESULTS: Of the participants, 96% had Internet access, and 55.4% reported ever visiting a SEW. Logistic regression analyses revealed that adolescents exposed to SEWs were more likely to have multiple lifetime sexual partners (OR=1.8, CI=1.2, 2.9), to have had more than one sexual partner in the last 3 months (OR=1.8, CI=1.1, 3.1), to have used alcohol or other substances at last sexual encounter (OR=2.8, CI=1.5, 5.2), and to have engaged in anal sex (OR=2.0, CI=1.2, 3.4). Adolescents who visit SEWs display higher sexual permissiveness scores compared with those who have never been exposed (2.3 vs. 1.9, p