Reducing Barriers for Expedited Partner Treatment in Adolescents and Young Adults: A Quality Improvement Initiative.

BACKGROUND: Adolescents and young adults (AYAs) face significant barriers to screening, testing, and treatment of sexually transmitted infections (STIs). Expedited partner therapy (EPT) streamlines partner treatment of STIs, but use among adolescents is low. We aimed to increase EPT offering and provision at 2 adolescent medicine clinics (AMCs) and the emergency department (ED) in an urban children's hospital. We addressed barriers at provider, pharmacy, and patient levels. We compared EPT offering and provision for chlamydia ( Chlamydia trachomatis [CT]) and trichomonas ( Trichomonas vaginalis [TV]) infection at baseline and across 2 intervention cycles. METHODS: Baseline data were collected from July 2019 to March 2020 and our intervention time frame spanned from April 2020 to October 2021. Laboratory codes identified patients with CT or TV infections. Cycle 1 allowed providers to order EPT within a patient's chart. The second cycle targeted education and standardization for STI/EPT notification and counseling. During this cycle, notification of ED patients was centralized to the AMC nurses. RESULTS: A total of 747 CT and TV cases were identified. In the AMC, EPT offering increased from 77.3% to 87.7% ( P = 0.01). Expedited partner therapy provision increased from 32.3% to 69.9% ( P < 0.001). Expedited partner therapy offering for ED patients increased by 82.3%. Retesting rates remained consistent, with a significant drop in reinfection rates ( P = 0.003) within patients seen in the AMC. CONCLUSIONS: This quality improvement initiative successfully increased EPT offering and provision among the cases identified. Future cycles may include longer-term follow-up to confirm partner treatment and testing per guidelines.

Communication and Interpretation of Sexual Consent and Refusal in Adolescents and Young Adults.

PURPOSE: The purpose of this study is to evaluate where adolescents and young adults (AYAs) learn about sexual consent and how they communicate and interpret sexual consent and refusal in sexual encounters. METHODS: A convenience sample of patients attending either an adolescent medicine primary care or a title X-supported adolescent family planning clinic completed an anonymous survey about their communication and interpretation of sexual consent and refusal. RESULTS: One hundred fifty participants, aged 14-24 years, completed the survey; 43% were male, and 78% were sexually active. Most (87.6% females vs. 71.9% males) reported having discussed sexual consent with someone, 34.8% (46.1% females vs. 19.7% males) said they had done so with a health care provider. Males and females indicated and interpreted consent and refusal differently. Of sexually active participants, females were significantly more likely to use verbal cues to communicate (94.7% vs. 77.3%) and interpret (96% vs. 54.4%) consent. Females were also significantly more likely to use verbal cues to communicate (98.7% vs. 56.8%) and interpret (90.7% vs. 59.1%) refusal. Approximately half of males and females indicated consent by "no response". Significant gender discordance was found in both the communication and interpretation of sexual consent and refusal. DISCUSSION: AYA use verbal and nonverbal cues to communicate and interpret sexual consent and refusal. Males and females may communicate and interpret consent and refusal differently. Education about sexual consent should incorporate real-life AYA communication practices to reduce sexual assault and promote healthy and sexually fulfilling relationships.

Long-Acting Reversible Contraceptive Attitudes and Acceptability in Adolescents and Young Adults: A Key to Patient-Centered Contraceptive Counseling.

PURPOSE: To examine the attitudes of adolescent and young adults (AYA) toward long-acting reversible contraception (LARC), and to assess how attitudes are associated with acceptability. DESIGN: Survey. SETTING: Children's Hospital Colorado Adolescent Family Planning Clinic in Aurora, Colorado. PARTICIPANTS, INTERVENTIONS, AND MAIN OUTCOME MEASURES: Young persons 14-24 years of age presenting for any type of visit between March and August 2018. RESULTS: A total of 332 participants were enrolled; the majority (62.3%) had high LARC acceptability. We found 5 "attitude" factors: 77.7% of the sample endorsed "Effective" attitudes (eg, wants most effective method), 37.3% endorsed "Good attributes" (eg, discreet, convenient), 23.1% endorsed "Scary" (eg, fears device will move), 16.1% endorsed "Bad for health," (eg, too many side effects), and 9% endorsed "Not for me" (eg, concerns about pain). Although participants who endorsed "Effective" (OR 6.60, 95% CI 3.01-14.49) and "Good attributes" (OR 3.17, 95% CI 1.51-6.66) were more likely to have high LARC acceptability than those who endorsed "Scary" (OR 0.28, 95% CI: (0.13-0.61)) and "Not for me" (OR 0.07, 95% CI 0.01-0.41) factors, approximately 10% of participants with high LARC acceptability endorsed "Scary" or "Bad for health" attitudes, whereas 54% of those with low LARC acceptability endorsed "Effective" attitudes. CONCLUSION: Although most participants had high LARC acceptability and valued contraceptive effectiveness, the association between LARC attitudes and acceptability is nuanced. Providers should identify and discuss young people's contraceptive knowledge, attitudes, and acceptability.

Best Practices for Counseling Adolescents about the Etonogestrel Implant.

Among young persons, ease of use, high efficacy, and high acceptability makes the etonogestrel contraceptive implant an important choice for this age group. Adolescent-friendly, patient-centered counseling considers the patient's cognitive development, the influence of friends and family, as well as their own preferences and values. Age-appropriate language, graphics, and models are useful to explain contraceptive options and relevant side effects. Effectiveness, reversibility, safety, noncontraceptive benefits, and side effects are important attributes and should be discussed when teens are choosing a contraceptive method. In this review we describe suggested best practices for counseling adolescents about the etonogestrel implant so they can make informed, prudent decisions about using this contraceptive method.

Contraception and Adolescent Males: An Opportunity for Providers.

PURPOSE: To examine young men's awareness of emergency contraception (EC) and its association with their contraceptive decision-making contributions within a relationship. METHODS: A convenience sample of English-speaking male patients aged 13-24 years were surveyed regarding their childbearing intentions, contraceptive awareness (including EC), perceived contraceptive knowledge, and communication about birth control with providers and within a relationship. RESULTS: An ethnically diverse sample of adolescent males was recruited with a mean age of 18.9 years. Most had previously been sexually active (75%) and felt it was important to avoid pregnancy (84%) and 61% reported ever having spoken to a health care provider about birth control (other than condoms), but only 42% had heard of EC. Participants who had heard of EC were more likely to have spoken to a health care provider about contraception in the past (51.5% vs. 29.8%; p = .050), to feel they should participate in contraceptive decisions in a relationship (97.4% vs. 76.5%; p = .006), and to have discussed contraception with a partner (76.9% vs. 29.2%; p < .001). CONCLUSIONS: Counseling young men about EC, as well as other methods of birth control, may empower them to become actively involved in contraceptive decisions within a relationship if they do not desire fatherhood.

Human Papillomavirus Vaccine: Continuation, Completion, and Missed Opportunities.

STUDY OBJECTIVE: To examine human papillomavirus (HPV) series completion in older adolescents and assess vaccination completion opportunities missed by providers. DESIGN, SETTING, PARTICIPANTS, INTERVENTIONS, AND MAIN OUTCOME MEASURES: Electronic medical records were queried for women 18-24 years old who initiated the HPV vaccine in the Adolescent Medicine, Young Mother's, or Family Planning clinics at Children's Hospital Colorado from January 1, 2010-December 31, 2012. Clinic visits during appropriate dosing intervals of HPV vaccine at which the second (4-14 weeks after first dose) or third (21-40 weeks after first dose and >12 weeks after second dose) doses were not administered were counted as "missed opportunities." RESULTS: A total of 1072 female adolescents initiated the HPV series during the study period; 20.9% completed the series within 1 year. Of these, 33.7% who did not receive their second dose had at least 1 missed opportunity and 25.5% who received the second but not the third had a missed opportunity. Women who initiated the vaccine in the Family Planning clinic were less likely to have missed opportunities than those in other adolescent clinics (36.2% vs 56.4%; P < .001). CONCLUSION: A significant number of female adolescents who initiated the HPV vaccine attended clinic visits at which opportunities for vaccine continuation and completion were missed. This emphasizes the importance of provider awareness of vaccine updates at every adolescent visit. Our overall completion rate is significantly lower than published rates and might reflect older adolescents' inexperience in managing their own preventive health care. Our results clearly identify the need for provider and patient interventions to improve vaccine series completion.

Adolescents: their futures and their contraceptive decisions.

PURPOSE: Pregnancy prevention counseling addresses future goals as a motivator for contraceptive use, but this is often unsuccessful. This study investigated how adolescent females define success and whether they believe teen childbearing will be a barrier to their success. METHODS: A racially and ethnically diverse group of 84 nulliparous, high-risk adolescent females in teen clinics completed a survey asking about how they define success, future plans, and barriers to their success and future plans. RESULTS: Most respondents defined a successful person as one who has a higher education (73%) and/or a good job (73%). Most saw themselves finishing high school (70%), in college (62%), or working at a job (75%) in 3-5 years. Participants who left with a prescription contraceptive method were not more likely to feel that education/career were important for success. Most reported that having a child would have no (52%) or a positive effect (30%) on their education. The majority felt childbearing would have a negative impact on many aspects of their life. But feeling their finances would be negatively affected was the only predictor of obtaining contraception. CONCLUSIONS: We found that high-risk adolescents did not differ in conventional goals and aspirations regardless of their contraceptive choice. Although most girls felt that education/career was important, many of them felt that childbearing would not be a barrier to or may even improve their educational attainment. This challenges counseling that uses conventional goals as a motivator to remain non-pregnant. Further study of novel motivators for contraceptive use is needed.