Sexual & reproductive health information on minor consent forms for pubertal suppression and gender affirming hormones.

Introduction: Transgender and Nonbinary (TNB) youth need specialized sexual and reproductive health (SRH) information and counseling. One avenue for providing this information is the use of informed consent documents before initiating pubertal suppression (PS) and/or gender-affirming hormones (GAHs). This study aims to compare the type and amount of SRH information included on informed consent documents used across clinical sites providing PS and GAH to youth. Methods: As part of a larger, IRB-approved survey on informed consent, providers of gender-related care to youth uploaded informed consent forms used in clinical practice. Publicly available forms were also included in analysis. Content analysis of these forms was undertaken using published clinical guidelines to inform coding and reflect the SRH implications of starting PS and GAH. Results: 21 unique consent documents were included in the content analysis (PS = 7, Masculinizing = 7, Feminizing = 7). SRH information on consent documents fell into 4 broad categories: (1) changes in sexual organs and functioning; (2) pregnancy and fertility information; (3) cancer risk; and (4) sexually transmitted infections. Forms varied considerably in the level of detail included about these SRH topics and most forms included implicit or explicit acknowledgement of the uncertainty that exists around certain SRH outcomes for TNB youth. Conclusions: There was substantial variability in both SRH content and context across consent forms. The role of consent forms in fostering TNB youth's understanding of complex SHR information when initiating PS and GAHs needs further clarification and development. Future research should focus on ways to ensure provision of adequate SRH information for TNB youth.

Transgender and Gender Diverse Fertility Choices: Supporting the Decision-Making Process for Adolescents and Young Adults.

OBJECTIVE: To qualitatively examine the fertility-related decision making process of transgender and gender diverse (TGD) adolescents and young adults (AYAs) and their parents, in the setting of pursing gender affirming treatments. STUDY DESIGN: Twenty-five TGD AYAs and 6 parents of TGD AYAs participated in a focus group or individual semistructured interviews focused on participants' experience learning about the effects of gender affirming treatments on fertility as well as the process of making a fertility preservation decision. Using open coding, data were analyzed in an iterative process identifying emerging themes and relationships. A decisional satisfaction score was collected and/or coded for each participant. RESULTS: Four broad themes related to the decision-making process were identified: (1) Critical steps include awareness, gathering information, and conversations; (2) External constraints limit choices; (3) Expanding the conversation beyond preservation; and (4) Emotional distress, conflict, and decisional satisfaction. Despite reporting emotional distress or conflict during the decision, TGD AYAs and parents of TGD AYAs generally reported a high level of satisfaction with their fertility preservation decision. CONCLUSIONS: There are specific ways health care professionals and family members can support TGD AYAs in their fertility-related decision making process. Decisional satisfaction was common, regardless of whether TGD AYAs chose to pursue fertility preservation or not.

Patterns of Fertility Discussions and Referrals for Youth at an Interdisciplinary Gender Clinic.

Purpose: We examined fertility discussion and referral practice patterns in a gender clinic serving nonmetropolitan youth. Methods: Chart review collected data on demographics, gender-related health care visits, and fertility discussions and referrals from January 2010 to December 2017, inclusive. Results: Of 66 patients, 78.8% had at least one documented fertility discussion. Eleven patients received referrals and 2 successfully preserved gametes. Neither location of primary residence (county vs. city) nor distance driven to the clinic were significantly associated with a documented fertility discussion or referral. Conclusion: Most youth discussed fertility, but declined preservation. Further research on provider- and patient-specific factors affecting preservation decisions is needed.

Self-Expansion is Associated with Better Adherence and Obesity Treatment Outcomes in Adults.

BACKGROUND: Previous studies have shown that self-expansion (e.g., increasing positive self-content via engaging in novel, rewarding activities) is associated with smoking cessation and attenuated cigarette-cue reactivity. PURPOSE: This study examined whether self-expansion is associated with better adherence, weight loss, and physical activity (PA) outcomes within a weight loss intervention. METHODS: Participants from Shape Up Rhode Island 2012, a Web-based community wellness initiative, took part in a randomized controlled trial that involved a 12-week behavioral weight loss intervention [1]. At baseline and post-intervention, objective weights and self-reported self-expansion and PA were obtained from 239 participants. Treatment adherence was assessed objectively. RESULTS: Self-expansion during treatment was significantly associated with percent weight loss including clinically significant weight loss (i.e., 5 %), minutes of PA, and treatment adherence. These results held after controlling for relevant covariates. CONCLUSIONS: This is the first study to show that self-expansion is associated with better behavioral weight loss outcomes including weight loss, adherence, and PA. These results suggest that self-expansion is a promising novel target for future research which could inform health interventions.

Can that really happen? Children's knowledge about the reality status of fantastical events in television.

Although popular children's cartoons are replete with fantastical events, we know little about whether children understand that these events are fantastical rather than real. In Study 1, 54 children ages 4 to 6 years and 18 adults were shown 10 real and 10 fantastical events portrayed in 4s video clips from a popular cartoon. After viewing each clip, participants were asked to judge the reality status of the event and to explain their judgments. Results indicated that even 4-year-olds have a fairly good understanding of fantastical events in animated cartoons but that they underestimate the reality status of real events in such cartoons. In Study 2, 35 4- to 6-year-olds and 18 adults watched video clips of 10 real and 10 fantastical events performed by real people from a Chinese television show. Once again, 4-year-olds underestimated the reality status of real events shown on television. However, against the "real" backdrop in this study, 4-year-olds also judged nearly half of the fantastical events to be real. The implications for children's reality-fantasy discrimination and their media viewing are discussed.

Further examination of the immediate impact of television on children's executive function.

Three studies examined the short-term impact of television (TV) on children's executive function (EF). Study 1 (N = 160) showed that 4- and 6-year-olds' EF is impaired after watching 2 different fast and fantastical shows, relative to that of children who watched a slow, realistic show or played. In Study 2 (N = 60), 4-year-olds' EF was as depleted after watching a fast and fantastical educational show as it was after a fast and fantastical entertainment 1, relative to that of children who read a book based on the educational show. Study 3 (N = 80) examined whether show pacing or fantasy was more influential, and found that only fantastical shows, regardless of their pacing, disrupted 4-year-olds' EF. Taken together, these studies show that 10-20 min watching televised fantastical events, relative to other experiences, results in lower EF in young children.

Benefits of adding small financial incentives or optional group meetings to a web-based statewide obesity initiative.

OBJECTIVE: To examine whether adding either small, variable financial incentives or optional group sessions improves weight losses in a community-based, Internet behavioral program. METHODS: Participants (N = 268) from Shape Up Rhode Island 2012, a 3-month Web-based community wellness initiative, were randomized to: Shape Up+Internet behavioral program (SI), Shape Up+Internet program+incentives (SII), or Shape Up+Internet program+group sessions (SIG). RESULTS: At the end of the 3-month program, SII achieved significantly greater weight losses than SI (SII: 6.4% [5.1-7.7]; SI: 4.2% [3.0-5.6]; P = 0.03); weight losses in SIG were not significantly different from the other two conditions (SIG: 5.8% [4.5-7.1], P's ≥ 0.10). However, at the 12-month no-treatment follow-up visit, both SII and SIG had greater weight losses than SI (SII: 3.1% [1.8-4.4]; SIG: 4.5% [3.2-5.8]; SI: 1.2% [-0.1-2.6]; P's ≤ 0.05). SII was the most cost-effective approach at both 3 (SII: $34/kg; SI: $34/kg; SIG: $87/kg) and 12 months (SII: $64/kg; SI: $140/kg; SIG: $113/kg). CONCLUSIONS: Modest financial incentives enhance weight losses during a community campaign, and both incentives and optional group meetings improved overall weight loss outcomes during the follow-up period. However, the use of the financial incentives is the most cost-effective approach.