Association of the COVID-19 Pandemic With Adolescent and Young Adult Eating Disorder Care Volume.

Importance: The COVID-19 pandemic has affected youth mental health. Increases in site-specific eating disorder (ED) care have been documented; however, multisite studies demonstrating national trends are lacking. Objective: To compare the number of adolescent/young adult patients seeking inpatient and outpatient ED care before and after onset of the COVID-19 pandemic. Design, Setting, and Participants: Using an observational case series design, changes in volume in inpatient and outpatient ED-related care across 15 member sites (14 geographically diverse hospital-based adolescent medicine programs and 1 nonhospital-based ED program) of the US National Eating Disorder Quality Improvement Collaborative was examined. Sites reported monthly volumes of patients seeking inpatient and outpatient ED care between January 2018 and December 2021. Patient volumes pre- and postpandemic onset were compared separately for inpatient and outpatient settings. Demographic data such as race and ethnicity were not collected because this study used monthly summary data. Exposures: Onset of the COVID-19 pandemic. Main Outcomes and Measures: Monthly number of patients seeking inpatient/outpatient ED-related care. Results: Aggregate total inpatient ED admissions were 81 in January 2018 and 109 in February 2020. Aggregate total new outpatient assessments were 195 in January 2018 and 254 in February 2020. Before the COVID-19 pandemic, the relative number of pooled inpatient ED admissions were increasing over time by 0.7% per month (95% CI, 0.2%-1.3%). After onset of the pandemic, there was a significant increase in admissions over time of 7.2% per month (95% CI, 4.8%-9.7%) through April 2021, then a decrease of 3.6% per month (95% CI, -6.0% to -1.1%) through December 2021. Prepandemic, pooled data showed relative outpatient ED assessment volume was stable over time, with an immediate 39.7% decline (95% CI, -50.4% to -26.7%) in April 2020. Subsequently, new assessments increased by 8.1% (95% CI, 5.3%-11.1%) per month through April 2021, then decreased by 1.5% per month (95% CI, -3.6% to 0.7%) through December 2021. The nonhospital-based ED program did not demonstrate a significant increase in the absolute number of admissions after onset of the pandemic but did see a significant increase of 8.2 (95% CI, 6.2-10.2) additional inquiries for care per month in the first year after onset of the pandemic. Conclusions and Relevance: In this study, there was a significant COVID-19 pandemic-related increase in both inpatient and outpatient volume of patients with EDs across sites, particularly in the first year of the pandemic. Given inadequate ED care availability prior to the pandemic, the increased postpandemic demand will likely outstrip available resources. Results highlight the need to address ED workforce and program capacity issues as well as improve ED prevention strategies.

Menstrual Health and Hygiene among Adolescents in the United States.

STUDY OBJECTIVE: Menstrual health in adolescents has been understudied in the United States. We aimed to assess patient and provider perspectives surrounding menstrual health management and screening. DESIGN: Our mixed-methods approach consisted of provider surveys, patient surveys, and patient interviews. SETTING: Participants were recruited from a pediatric gynecology practice or an adolescent medicine clinic at an urban tertiary academic center. PARTICIPANTS: Providers were pediatrics faculty or residents. Patients aged 13-24 years were eligible. INTERVENTION: Participants completed an anonymous survey or semi-structured interview about their experiences with menstrual health. MAIN OUTCOME MEASURES: Descriptive statistics and thematic content analysis were used for quantitative and qualitative data, respectively. Convergent parallel analysis elucidated key findings in both data sets. RESULTS: The provider survey response rate was 65% (69/106); 15% (9/69) of providers consistently asked patients about menstrual products, whereas 44% (27/68) were concerned patients could not afford products. The patient survey response rate was 85% (101/119); 19% (19/101) of respondents reported menstrual hygiene insecurity, 55% (55/101) missed commitments during menses, and 45% (45/101) discussed menstrual products with providers. Fifteen patients were invited for qualitative interviews; 10 were conducted, and thematic saturation occurred. Interviews highlighted the importance of comprehensive early menstrual health education and providers' role in menstrual management. CONCLUSION: Adolescence is a crucial point of entry into health care. Because taboos surrounding menstruation could limit access to health care, menstrual health education must be emphasized. Menstrual health education is provided piecemeal by parents, schools, and providers. Current practice should be reevaluated to consider comprehensive educational approaches in which health care leads.

HPV Vaccine in Adolescents.

Human papillomavirus (HPV), the most common sexually transmitted viral infection worldwide, is the causative agent for cervical cancer and attributed to anogenital cancers as well as oropharyngeal cancer. Three effective, safe, prophylactic HPV vaccines have been licensed, and studies have demonstrated decreases in HPV prevalence and HPV-related disease endpoints without evidence of waning protection to date. In the United States, only the 9-valent vaccine, which covers 90% of the cancers attributed to HPV in US registries, is available. Because higher titers are found at younger ages, two rather than three doses are needed if the first dose is given prior to age 15 years. HPV vaccination rates in the US lag compared to tetanus-diptheria-acellular pertussis and meningococcal conjugate vaccines. Current efforts are aimed at improving vaccination rates through delivering strong and consistent clinician recommendations at the same time as discussing other adolescent vaccines and preventing missed opportunities for vaccination. [Pediatr Ann. 2019;48(2):e71-e77.].

The Impact of Health Education Counseling on Rate of Recurrent Sexually Transmitted Infections in Adolescents.

STUDY OBJECTIVE: To evaluate the effectiveness of a sexually transmitted infection (STI) intervention by a health educator that included partner notification, condom use, and retesting within 3 months. DESIGN, SETTING, AND PARTICIPANTS: Retrospective chart review was conducted, and data were collected from 274 sexually active adolescent girls, aged 15 to 19 years, who were diagnosed with gonorrhea (GC), Chlamydia (CT), and Trichomonas (TV) infection, during a 9-month span in an urban hospital-based adolescent medicine clinic. METHODS: Data regarding recurrent STIs (GC, CT, and TV) were collected for 12 months following the incident infection. There were 161 in the intervention group (health educator counseling), and 113 controls who received usual care. Differences between groups were analyzed using χ(2) and survival analyses. RESULTS: There were no significant differences in age, gender, or race between the intervention and control groups at baseline. The majority in both groups were diagnosed initially with CT infection (57% CT, 16% GC, and 5% TV in the intervention group; 46% CT, 21% GC, and 12% TV in the control group). There was a significantly lower rate of STI in the intervention group for those retested within 12 months of the initial diagnosis (P = .002). The median (SD) time to recurrence in the intervention group was greater: 134 (14.7) days versus 116 (12.1) days (P = .034). Health education counseling, initial diagnosis with TV, and duration of time from initial diagnosis to retest (interval to retest) were significant protective factors for recurrent STI. CONCLUSIONS: Health education counseling in an urban adolescent clinic is effective in reducing recurrent infection at 12-month follow-up and can serve as an important component in reducing STI recidivism.

Screening for sexually transmitted diseases in short-term correctional institutions: summary of evidence reviewed for the 2010 Centers for Disease Control and Prevention Sexually Transmitted Diseases Treatment Guidelines.

Young persons entering US jails and youth detention facilities have high rates of sexually transmitted diseases (STDs). The Centers for Disease Control and Prevention added STD screening guidelines specific to correctional settings to the 2010 STD Treatment Guidelines. This article summarizes published evidence from 1990 to 2009 used to develop the recommendations. The literature supports routine screening of adolescents and young women (aged ≤35 years, or on the basis of local institutional prevalence data) for chlamydia and gonorrhea because of high prevalence and the subsequent risk of adverse reproductive outcomes. Chlamydia positivity among young women (aged <20 years) in juvenile detention facilities and adult facilities is more than 14%. Men in correctional settings are also at high risk for chlamydia and gonorrhea. Among boys in juvenile detention facilities, chlamydia positivity is estimated at 6.6%; among young men in adult facilities, positivity is 16.6%. Screening men (to reduce sequelae among women) should be considered based on local epidemiology and resource availability. Syphilis screening is not strongly supported in published literature because of low prevalence and is not routinely recommended; however, some screening may be warranted based on local prevalence. Although there is a great diversity in the organization of correctional facilities, implementation of screening recommendations is possible owing to improvements in test technology (urine specimens) and through integration of a standard screening protocol. Based on the high burden of disease and substantial opportunities to reach a high-risk population, correctional facilities are important venues to target efforts to control STDs.

Safety, efficacy, actions, and patient acceptability of drospirenone/ethinyl estradiol contraceptive pills in the treatment of premenstrual dysphoric disorder.

Premenstrual dysphoric disorder (PMDD) is estimated to affect 3%-8% of reproductive age women. Multiple therapeutic modalities have been evaluated with varying efficacy for the associated somatic and mood symptoms. The majority of older studies had shown that oral contraceptive pills (OCs) were most effective for the physical symptoms. However, newer OCs containing a novel progestin, drospirenone, have shown promise in alleviating both the somatic and affective/behavioral symptoms. This progestin, which is a derivative of spironolactone, has both antimineralocorticoid and antiandrogenic activity. A 24/4 formulation containing 20 µg of ethinyl estradiol has been found effective in randomized double-blind placebo-controlled trials utilizing established scales documenting symptoms associated with PMDD. Multiple studies have shown that drospirenone-containing OCs are safe without evidence of clinically adverse effects on carbohydrate metabolism, lipids, blood pressure, weight, serum potassium or increased thrombotic events compared to other low dose OCs. In addition, significant improvements have been demonstrated in acne, hirsutism, and fluid retention symptoms. Several open label studies demonstrated good patient compliance and reported satisfaction with the method. Because of the significant placebo effect demonstrated in the blinded placebo-controlled trials, additional large randomized placebo-controlled trials are needed to confirm the efficacy of the drospirenone OCs in the treatment of PMDD. However, this OC formulation appears to be a promising therapeutic modality.

American Academy of Pediatrics. Clinical report--gynecologic examination for adolescents in the pediatric office setting.

The American Academy of Pediatrics promotes the inclusion of the gynecologic examination in the primary care setting within the medical home. Gynecologic issues are commonly seen by clinicians who provide primary care to adolescents. Some of the most common concerns include questions related to pubertal development; menstrual disorders such as dysmenorrhea, amenorrhea, oligomenorrhea, and abnormal uterine bleeding; contraception; and sexually transmitted and non-sexually transmitted infections. The gynecologic examination is a key element in assessing pubertal status and documenting physical findings. Most adolescents do not need an internal examination involving a speculum or bimanual examination. However, for cases in which more extensive examination is needed, the primary care office with the primary care clinician who has established rapport and trust with the patient is often the best setting for pelvic examination. This report reviews the gynecologic examination, including indications for the pelvic examination in adolescents and the approach to this examination in the office setting. Indications for referral to a gynecologist are included. The pelvic examination may be successfully completed when conducted without pressure and approached as a normal part of routine young women's health care.

Adolescent preferences for human immunodeficiency virus testing methods and impact of rapid tests on receipt of results.

PURPOSE: Rapid human immunodeficiency virus (HIV) tests may be more acceptable to adolescents and may improve receipt of test results. We conducted a study to determine (a) adolescent preferences for different HIV testing methods (rapid oral fluid vs. rapid fingerstick vs. traditional venipuncture), (b) factors associated with choice of a rapid vs. traditional test, and (c) whether those who chose a rapid method were more likely to receive test results. METHODS: Participants (N=99, 13-22 years old, both genders) were recruited from an urban hospital-based adolescent primary care clinic, agreed to HIV testing with their choice of method, and completed a questionnaire assessing demographic characteristics and attitudes about HIV testing. Logistic regression modeling was used to determine factors associated with choice of a rapid versus traditional test. RESULTS: Half (50.5%) of participants chose rapid oral fluid testing, 30.3% traditional venipuncture testing, and 19.2% rapid fingerstick testing (p < .01). Factors independently associated with choice of a rapid versus traditional method included preference for an oral fluid versus blood test and perceived approval of HIV testing by one's healthcare provider. Participants who chose a rapid test were more likely to receive their test results within the follow-up period than participants who chose a traditional test (91.3% vs. 46.7%, p < .001). CONCLUSIONS: In this study, 70% of adolescents preferred rapid to traditional HIV testing, and rapid testers were more likely to receive their results within the follow-up period. Offering rapid testing may lead to improved receipt of results among adolescents in urban primary care settings.

Menstrual symptoms in adolescent girls: association with smoking, depressive symptoms, and anxiety.

PURPOSE: Dysmenorrhea affects quality of life and contributes to absenteeism from school and work, thereby diminishing opportunities for successful psychosocial and cognitive development during adolescence. In adults, depression, anxiety, and smoking have an impact on menstrual cycles and dysmenorrhea. Associations between these problems have not been examined in adolescents. The purpose of this study was to examine relations between depressive symptoms and anxiety with menstrual symptoms. Smoking was examined as a moderator of this association. METHODS: This study enrolled 154 postmenarcheal girls from a sample of 207 girls age 11, 13, 15, and 17 years (mean = 15.4 years [+/-1.9]). Self-reported measures included the Menstrual Symptom Questionnaire (MSQ), Children's Depression Inventory, State-Trait Anxiety Inventory, and smoking behavior. Generalized linear regression modeled MSQ outcomes separately for depressive symptoms and anxiety. RESULTS: More depressive symptoms/anxiety were related to higher numbers of menstrual symptoms (r = 0.23-0.44, p < .05). Smoking status (ever) was related to higher MSQ scores. Moderating effects of smoking and depressive symptoms or anxiety on menstrual symptoms were consistent across most MSQ factors where effects were stronger in never smokers. CONCLUSION: This is the first study in adolescents showing smoking status and depressive symptoms/anxiety are related to menstrual symptoms, and that the impact of depressive symptoms/anxiety on menstrual symptoms is stronger in never smokers. The dynamic and complex nature of smoking, moods, and dysmenorrhea cannot be disentangled without longitudinal analyses. Efforts to reduce menstrual symptoms should begin at a young gynecological age and include consideration of mood and smoking status.

Body art: piercing, tattooing, and scarification.

Body art, particularly piercings and tattoos, is becoming more common. Many patients get their first piercing or tattoo during adolescence or young adulthood. Clinicians should understand the potential complications of these procedures and their management. It also is important for clinicians to feel comfortable counseling adolescents and their families about practices in safer body art facilities.

HIV/STD risk reduction interventions for African American and Latino adolescent girls at an adolescent medicine clinic: a randomized controlled trial.

BACKGROUND: Adolescent girls in the United States and around the world are at a heightened risk for sexually transmitted diseases (STDs), including human immunodeficiency virus (HIV). OBJECTIVE: To determine the efficacy of a skill-based HIV/STD risk-reduction intervention in reducing self-reported unprotected sexual intercourse among African American and Latino adolescent girls. DESIGN: Randomized controlled trial with 3-, 6-, and 12-month follow-ups. SETTING AND PARTICIPANTS: Sexually experienced African American and Latino adolescent girls recruited from the adolescent medicine clinic of a children's hospital serving a low-income inner-city community (N = 682, mean age, 15.5 years); 88.6% were retained at the 12-month follow-up. INTERVENTIONS: Three 250-minute interventions based on cognitive-behavioral theories and elicitation research: an information-based HIV/STD intervention provided information necessary to practice safer sex; a skill-based HIV/STD intervention provided information and taught skills necessary to practice safer sex; or a health-promotion control intervention concerned with health issues unrelated to sexual behavior. MAIN OUTCOME MEASURES: Primary outcome measure was self-reported frequency of unprotected sexual intercourse; secondary outcomes included the frequency of sexual intercourse while intoxicated, the number of sexual partners, biologically confirmed STDs, and theoretical mediator variables, including the intention to use condoms, beliefs about using condoms, and condom-use knowledge. RESULTS: No differences between the information intervention and the health control intervention were statistically significant. Skills-intervention participants (mean [SE], 2.27 [0.81]) reported less unprotected sexual intercourse at the 12-month follow-up than did information-intervention participants (mean [SE], 4.04 [0.80]; P = .03), or health control-intervention participants (mean [SE], 5.05 [0.81]; P = .002). At the 12-month follow-up, skills-intervention participants (mean [SE], 0.91 [0.05]) reported fewer sexual partners (P = .04) compared with health control-intervention participants (mean [SE], 1.04 [0.05]) and were less likely to test positive for STD (mean [SE], 10.5% [2.9%]) than were health control-intervention participants (mean [SE], 18.2% [2.8%]; P = .05). No differences in the frequency of unprotected sexual intercourse, the number of partners, or the rate of STD were observed at the 3- or 6-month follow-up between skill-intervention participants and information-intervention or health control-intervention participants. CONCLUSION: Skill-based HIV/STD interventions can reduce sexual risk behaviors and STD rate among African American and Latino adolescent girls in clinic settings.

Vaginitis in adolescents.

Vaginitis is a common complaint of adolescent females. It can cause extreme distress for some patients, especially those with recurrent symptoms. Thus, it is important to take care when evaluating these patients and to acknowledge their frustration when appropriate. A thoughtful and thorough history will determine most causes, with the most common being yeast, trichomoniasis, and BV.