Covering the Distance: A Study of Parent and Teen Attitudes on COVID-19 Mitigation Measures During the COVID-19 Pandemic.

Background The Unity® Consortium surveyed teens and parents and guardians of teens across the country at three distinct time points or waves during the COVID-19 pandemic to assess participant attitudes and beliefs regarding COVID-19 mitigation guidelines, such as mask-wearing and physical distancing. Methodology A third-party market research company conducted 15-minute, online surveys from nationally representative panels. Surveys were conducted at three distinct time points or waves (August 2020, February 2021, and June 2021) with 300 teens aged 13-18 years in each wave and 593/531/500 parents and guardians of teens aged 13-18 years in each wave, respectively. Participants responded using a five-point Likert scale (strongly agree to strongly disagree) on their COVID-19 experiences, including the perceived importance of strictly following mask-wearing and/or social distancing guidelines and the perceived effectiveness of mask-wearing and social distancing in preventing the spread of COVID-19. Data were analyzed for differences across waves and demographic variables. Statistical analyses included frequencies, analysis of variance (ANOVA), and t-tests/z-tests. Results While significantly more parents and teens in Waves 2 and 3 knew someone who was hospitalized or died due to COVID-19 compared to Wave 1, significantly fewer in Wave 3 reported experiencing a lot or some stress and worry regarding the pandemic. By Wave 3, 58% of teens and 56% of parents had received at least one dose of a COVID-19 vaccine. Despite changes in experiences over time, a significant majority of parents and teens consistently agreed on the importance and effectiveness of social distancing and masking guidelines against the spread of COVID-19. In Wave 3, the demographic variables significantly associated with agreement on importance included race (Black (92%) > White (80%)), community type (urban (91%) > suburban (79%) and rural (73%)), and positive vaccination status of parents and teens (92%/89%) > not vaccinated (73%/73%), respectively). The demographic variables significantly associated with agreement on effectiveness included race (Black (91%) > White (81%)), community type (urban (89%) > suburban (83%) and rural (71%)), and positive vaccination status of parents and teens (94%/90% > not vaccinated (72%/70%), respectively). Conclusions This study into the perceived importance and perceived effectiveness of mitigation strategies during the COVID-19 pandemic revealed differences in attitudes among sociodemographic groups. Understanding these differences can help shape how adherence to public health guidelines in a pandemic is promoted.

Confidentiality and Contraception: Protecting Adolescent Care in Response to One State's "Parents' Bill of Rights".

PURPOSE: This study aims to analyze parent responses to current strict Oklahoma confidentiality and consent laws in an outpatient subspecialty setting. METHODS: A consent for treatment form including an explanation of the benefits of qualified confidential care for adolescents was given to parents of patients under 18 years of age. The form asked parents to waive the right to access confidential portions of the medical record, be present for the physical exam, be present for risk behavior discussions, and consent for hormonal contraception including a subdermal implant. Demographic information was collected using patient medical records. Data were analyzed using frequencies, chi-square, and t tests. RESULTS: Of the 507 parent forms, 95% of total parents gave permission for providers to have confidential conversations with the patients, 86% allowed providers to examine the patient alone, 84% of parents allowed providers to prescribe contraception, and 66% gave permission for subdermal implant. New patient status, race, ethnicity, assigned sex at birth, and insurance type did not correlate with parents' willingness to provide permissions. There was a statistically significant difference between patient gender identity and percentage of parents who granted permission for a confidential physical exam. Groups more likely to discuss questions about confidential care with the health care provider included parents of new patients, Native American and Black patients, and cisgender female patients. DISCUSSION: Despite laws that limit adolescent ability to access confidential care in Oklahoma, the majority of parents who were provided an explanatory document allowed their children the right to access this care.

Adolescents, Young Adults, and Vaccine Hesitancy: Who and What Drives the Decision to Vaccinate?

Although vaccines are important for all age groups, issues of vaccine uptake and vaccine hesitancy have particular salience for the adolescent and young adult age group. This article reviews the importance of vaccination for adolescents and young adults, the variability in uptake of different vaccines, the reasons for vaccine hesitancy for this age group, and the legal framework for consent for vaccination. One important difference between vaccine hesitancy for adolescents and hesitancy for younger children or adults is the unique developmental, clinical, ethical, and legal context in which the decision to vaccinate is made.

Facing an eating disorder: A case of body dysmorphic disorder and avoidant/restrictive food intake disorder.

Eating disorders can be notoriously difficult to diagnose and treat. This patient is an 18-year-old female who presents to care severely underweight and notably cachexic. For a number of years, she had experienced depressive symptoms, anxiety, and continued loss of appetite. She denied purposefully restricting foods, recognized that she was thin, and denied a fear of gaining weight. She was admitted to a disordered eating unit for refeeding and during her inpatient stay disclosed that she had a long-standing "hatred of face." Ultimately, she received the diagnoses of avoidant/restrictive food intake disorder and body dysmorphic disorder. This case highlights the importance of differentiating body dysmorphia, seen in body dysmorphic disorder, and distorted body image, as seen in anorexia nervosa. This differentiation is significant as the treatment approaches to these distinct diagnoses are not the same.

Hypogammaglobulinemia Associated With Oxcarbazepine Use in a Teen.

BACKGROUND: There are no prior cases in the literature that report immunoglobulins dropping secondary to oxcarbazepine use in an adolescent patient. CASE: This patient was an adolescent female taking buspirone, mirtazapine, and oxcarbazepine for mood stabilization. She was admitted to an inpatient disordered eating program for malnutrition. During her malnutrition evaluation, the patient was found to have low serum IgA, low IgM, and low-normal IgG. A slow wean of oxcarbazepine was initiated, and all immunoglobulins showed an increasing trend after stopping oxcarbazepine. DISCUSSION: Gabapentin was an added medication during hospitalization but is not known to affect immunoglobulins. Malnutrition is the only other significant factor that changed during the patient's hospital stay. With malnutrition alone, immunoglobulins are normal and IgA could be increased; this essentially rules out malnutrition and disordered eating as the cause of this patient's hypogammaglobulinemia, implicating oxcarbazepine as the cause. CONCLUSION: Chronic oxcarbazepine use was the most likely cause of the hypogammaglobulinemia seen in this patient; this is not currently a reported side effect of oxcarbazepine. This case highlights the importance of judicious use of all medications given the risk of even rare potential side effects.

Making a Shared Decision on Meningococcal B Vaccine: Provider Feedback on an Educational Tool Developed for Use With Patients.

BACKGROUND: In 2015, the Advisory Committee on Immunization Practices recommended Meningococcal B vaccination for healthy 16- to 23-year-olds based on shared clinical decision-making between the patient and the provider. There has been some confusion regarding how to implement this recommendation. METHODS: Through discussions among the authors, a review of relevant literature, and consultation with vaccine experts, we developed educational materials for providers that included a patient handout to help initiate and guide conversations leading to shared clinical decision-making for the Meningococcal B vaccine. Materials were distributed to 88 health care providers who subsequently completed surveys to evaluate their impressions of the materials and the utility of the materials for clinical practice. RESULTS: The survey results from the 88 providers revealed that they valued the materials; 93% percent indicated they would share these materials with colleagues, and 95% agreed or strongly agreed that they would share these materials with patient families. Responses to an open-ended question indicate that some providers initiated discussions regarding the Meningococcal B vaccine in ways that truncated conversation rather than encouraging a shared decision-making process. CONCLUSIONS: Overall, the materials developed and implemented for this project support the initiation of, and help standardize provider conversations regarding, Meningococcal B vaccination for healthy adolescents.

Menstrual Patterns Among Patients With Anorexia Nervosa and Avoidant/Restrictive Food Intake Disorder: Does "Junk Food" Play a Role?

PURPOSE: Few studies have examined menstrual differences between patients with anorexia nervosa (AN) versus avoidant/restrictive food intake disorder (ARFID). After observing that many patients with ARFID maintain regular menses despite weight loss, we sought to characterize these menstrual differences in the context of specific eating behaviors. METHODS: Patients with AN or ARFID in a disordered eating database at the University of Oklahoma Health Sciences Center were included. Bivariate analyses explored group differences in demographics, age, percentage of median body mass index for age (%mBMI), time since last menstrual period (LMP), and reported eating behaviors, including whether self-reported diet history included "junk food" consumption in the past 24 hours. Regression analysis examined whether diagnosis and variables that were associated with diagnosis significantly predicted time since LMP. RESULTS: The analyses included 89 participants diagnosed with AN or ARFID (AN: n = 70; ARFID: n = 19). The AN group had higher %mBMI for age than the ARFID group (83.4% vs 76.4%, respectively, P = .004) and was less likely to have reported consuming junk food the day prior (36.8% vs 76.5%, respectively, P = .003). Time since LMP was longer for those with AN versus ARFID (174 vs 13 days, respectively, P < .0001). A 2-predictor model with diagnosis and junk food explained a significant proportion of variance in time since LMP (P = .012). CONCLUSION: This paper may be the first to describe menstrual differences among individuals with AN and ARFID in the context of eating behaviors. In addition to diagnosis, having no self-reported junk food consumption in the past 24 hours was significantly associated with longer time since LMP. Studies that include specific measures of food intake and hormonal responses to food quality are warranted to further explore the etiology of menstrual differences among patients with AN and ARFID.

Vaccine Hesitancy in the Time of COVID-19: Attitudes and Intentions of Teens and Parents Regarding the COVID-19 Vaccine.

To assess attitudes and intentions related to the COVID-19 vaccine during the pandemic, we surveyed adolescents aged 13-18 years and the parents of 13-18-year-olds using national research panels on three occasions or "waves": before the COVID-19 vaccine was available, after it was available for adults, and after it was available for ages ≥12 years. Data on experiences with COVID-19, the importance of adolescent vaccines, and intentions regarding COVID-19 vaccination were analyzed across time points. We found that parental concerns about vaccine safety significantly increased from Wave 1 to 2. Social media had a negative influence on parents' and adolescents' opinions about vaccine safety. Demographic variables were associated with vaccination rates reported in Wave 3, consistent with known inequities related to vaccine access. Parents (70%) were supportive of concomitant COVID-19 vaccination with other adolescent vaccines for teens. It is important to address variables associated with vaccine hesitancy to increase COVID-19 vaccine coverage rates in the US.

A weighty issue: refeeding an adolescent patient on dialysis.

BACKGROUND: For malnourished patients with end stage renal disease (ESRD) on hemodialysis (HD), refeeding is complex; true weight (dry weight) gain must be accounted for as it accrues to safely dialyze. OBJECTIVE: This case describes the challenge of following true weight to appropriately adjust treatment for a patient with ESRD on HD requiring inpatient refeeding. METHODS: A 17-year-old female presented to an adolescent clinic after referral from her nephrologist for malnutrition and disordered eating. Her weight was 38.3 kg and height was 155.2 cm (76.2% of mean estimated body mass index, MEBMI). Her history was remarkable for a diagnosis of ESRD. The patient was admitted to the inpatient disordered eating program. The patient continued HD three times a week and was followed by nephrology. The team noted that the patient's dry weight for dialysis had not yet been adjusted, leading to increasingly aggressive dialysis. The nephrology team addressed the need for reassessments of dry weight by utilizing the "crit line" method. RESULTS: Frequent assessment allowed the nephrology team to account for intensive renourishment of the patient. After a 64 day hospital stay, the patient achieved 88.1% of MEBMI, calculated using her most up to date dry weight. CONCLUSION: Among patients with malnutrition and ESRD requiring HD, it is imperative to determine a patient's dry weight at the beginning of refeeding so the treatment plan can be adjusted according to the dynamic, true weight of the patient. This case illustrates the importance of interdisciplinary teamwork when managing a patient with malnutrition and ESRD on HD.

Adolescent identity: The importance of the social history.

This is a unique case of a patient with trichotillomania, depression, and anxiety for 2 years, serving as coping strategies for underlying gender dysphoria. To our knowledge, a case of a patient presenting with this unique constellation of comorbid conditions has not previously been reported. This case stresses the importance of providers obtaining a full social history consistently and repeatedly while providing a nonjudgmental environment for patients to disclose sensitive and potentially fluid information related to gender identity and sexuality.

Emetophobia: A case of nausea leading to dehydration in an adolescent female.

Emetophobia is defined as the specific fear of vomiting and avoidance behaviors related to vomiting situations; the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, specifies this condition as a Specific Phobia: Other type: Vomiting (SPOV). Our case report describes an adolescent presenting with medical complications, specifically notable dehydration, due to new onset Specific Phobia: Other type: Vomiting after experiencing a bout of viral gastroenteritis. In this patient's case, her severe anxiety served as the root cause for a significant decrease in her quality of life for a year and was not identified by healthcare providers until after an extensive medical workup had taken place. Treatment involved alleviating her dehydration with slow introduction of foods with high water content into her diet and addressing her anxiety with hydroxyzine as a short-term intervention and a selective serotonin reuptake inhibitor for long-term management. This treatment plan allowed for our patient's symptoms to resolve over the course of a few months and she was able to return to her usual activities of daily living. With discussing emetophobia, this case highlights a topic that is not largely discussed in the literature surrounding adolescent health.

Case series: gaming vs. eating-comorbidity of ARFID and IGD.

This case series includes innovative information regarding the relationship between Avoidant/Restrictive Food Intake Disorder and the recently formulated diagnosis of Internet Gaming Disorder. The series illustrates two clinical cases in which both disorders were simultaneously recognized during diagnosis and treatment. Both disorders were utilized by patients as maladaptive coping strategies in efforts to avoid emotional distress and are potential risk factors that interfere with physical and mental health functioning. This case series highlights the unique relationship between these disorders and the compounding contribution of these two risk factors to poor physical and mental health outcomes, which is a unique contribution to the eating disorder literature. Level IV Evidence obtained from multiple time series with or without the intervention, such as case studies.

A Clinical Conundrum: Chronic Cervicitis.

BACKGROUND: Cervicitis is most commonly caused by sexually transmitted infections. "Normal vaginal flora" are rarely responsible for inflammation of the cervix. CASE: We describe a 22-year-old female patient with chronic cervicitis who had negative test results for bacterial and viral pathogens most commonly responsible for cervicitis. After 21 months of symptoms and multiple courses of empiric antibiotics addressing the most common causes of cervicitis, a course of antibiotics targeting group B streptococcus found on a genital culture resolved the patient's illness. SUMMARY AND CONCLUSION: Bacteria considered to be "normal vaginal flora" in a nonpregnant young female adult should be considered as a potential pathogen when test results for more routine pathogens associated with cervicitis are negative.

Protecting Adolescent Confidentiality: A Response to One State's "Parents' Bill of Rights".

PURPOSE: In November, 2014, the State of Oklahoma enacted legislation potentially eliminating the provision of conditional confidential pediatric care. A consent form for treatment specific to adolescent confidential care was developed in response. This study examines parent/guardian response to the consent form. METHODS: The consent to treatment form describes the clinical and developmental benefits of conditional confidential treatment of adolescent minors and asks parent/guardians to waive the right to: (1) access confidential portions of the medical record, (2) be present for the physical exam, (3) be present for risk behavior discussions, and (4) consent for hormonal contraception, if indicated. RESULTS: Of 269parent/guardian respondents to the consent form, over 95% waived their rights for each of the four provisions. CONCLUSIONS: When provided with information on the rationale for provision of conditional confidential care, a diverse group of parent/guardians in a conservative state overwhelmingly agree to this standard of care.

Trends and Substance Use Associations With E-Cigarette Use in US Adolescents.

Concerns exist that e-cigarette use may introduce adolescents to drugs. This study explores trends and associations of inhaled tobacco use with drug use. We performed a secondary data analysis on the National Youth Risk Behavior Survey examining the inhaled tobacco and drug use patterns among US teens. Adjusted odds ratios were calculated using bivariate and multivariate analyses between inhaled tobacco use with other drug use, adjusting for age, race/ethnicity, and gender. When adjusting for gender, age, and race/ethnicity, teens who use only e-cigarettes had a higher odds than peers who do not use any inhaled tobacco products to have ever tried marijuana or alcohol, currently use marijuana or alcohol, have lifetime drug use, and misused prescription medications. Drug risk behavior appears stratified with type of inhaled tobacco used, with generally exclusive e-cigarette use linked to lowest risk and conventional and e-cigarette use associated with highest risk of drug use.