Adolescent and Young Adult Women's Knowledge of and Attitudes Toward Etonogestrel Implants.

STUDY OBJECTIVE: Long acting reversible contraceptives, including etonogestrel implants, are top tier contraceptives for adolescents, yet they remained underutilized. This study aimed to assess awareness of and attitudes toward etonogestrel implants among adolescent and young adult women. DESIGN, MAIN OUTCOME MEASURES: This is a cross sectional study. We distributed an original, self-administered survey to a convenience sample of anonymous subjects. The survey assessed demographic information, pregnancy and sexual history, general contraceptive preferences, and awareness of implants. Subjects then read a brief description of implants before completing the section assessing attitudes toward them. We used chi-square and t-test analyses to identify factors associated with awareness of and positive attitudes toward implants. SETTING, PARTICIPANTS: Women aged 10-24 attending a birth control education group at an adolescent health center in New York City. RESULTS: Of the 129 participants, only 40% had heard of etonogestrel implants. Some (33%) reported positive attitudes toward implants. Positive attitudes were associated with preferences for birth control convenience (OR = 3.3, 95% CI = 1.1- 9.5) and privacy (OR = 2.2, 95% CI = 1.0- 4.8). Neutral or negative attitudes were associated with a preference for birth control that maintained menstrual regularity (OR = 0.4, 95% CI = 0.2- 0.8) and with having experienced at least 1 unintended pregnancy (OR = 0.4, 95% CI = 0.2- 0.9). Age, race, and education were not associated with participants' attitudes toward implants. CONCLUSIONS: Women who value convenience and privacy are more likely to report positive attitudes toward implants, and thus may represent especially receptive candidates for them.

Obtaining a history of sexual victimization from adolescent females seeking routine health care.

OBJECTIVE: To evaluate the clinical practice of direct physician inquiry of adolescent females during routine history taking and medical examination, with regard to their experience of childhood sexual abuse and/or assault. METHOD: During a one-year period, a female physician directly questioned 146 consecutive female patients, aged 12-22, who were being seen for routine medical histories and physical examinations, as to whether they had ever been sexually victimized. Patients who disclosed histories of sexual victimization were immediately counseled and provided with appropriate on-site mental health referrals. Follow-up of these referrals was conducted to determine if patients complied with referrals to seek mental health services. RESULTS: For 141 of the 146 patients, the physician was unaware of a history of sexual victimization. Of these 141 patients, thirty-two (23%) cases were identified using this clinical strategy. Almost all (93%) of these young women accepted referrals for on-site psychotherapy, and 81% kept their initial appointments for psychotherapy. CONCLUSIONS: The routine medical history and physical examination may be an appropriate setting for health care providers to accurately and comfortably elicit a history of sexual victimization from adolescent females, and provide appropriate referrals for mental health counseling.

Legal and ethical issues facing adolescent health care professionals.

This article reviews the legal standards and ethical dilemmas surrounding the provision of care to adolescent patients. Uncertainty and ambiguity in this area has contributed to the underserving of the adolescent population. Usually, the legal right to consent to treatment resides with the adolescent's parent or legal guardian; however, there are many cases in which adolescents may provide their own consent. The determination that the adolescent is "mature" is one important factor. The law generally upholds a provider's determination of maturity of a patient. Minors also have the right to confidentiality in almost all situations in which they have the right to consent. The issue of confidentiality poses legal and ethical challenges to the provider in five discussed areas. Providers should be aware of the laws specific to their state, while keeping foremost the best interest of their patients. Providers should also encourage parental involvement and communication concerning treatment, while respecting adolescents' right to confidentiality.

CHIP: new opportunities in adolescent health care delivery.

Children's Health Insurance Programs (CHIP), usually targeted to infants, toddlers, and school-aged children, have been expanded to include adolescents. Adolescents need some form of health insurance in order to access needed care. Moreover, programs and services that provide them with health care must be adolescent-friendly, adolescent-focused and adolescent-sensitive, and include specialized training for primary care providers. Translating this philosophy into a successful health care delivery program involves addressing the psychological, institutional and financial barriers that make it difficult for adolescents to access health care. Overcoming these barriers, especially the financial ones, requires that primary care providers advocate for teenagers and take advantage of resources made available for them. CHIP provides a critical opportunity for policy-makers and health care providers to further improve adolescent health care and to more fully integrate adolescents into the health care system.