But He Loves Me: Teens' Comments about Healthy and Unhealthy Romantic Relationships.

Romantic relationships can positively affect adolescent development. However, adolescents may not always have a clear understanding of what healthy dating looks like, which may place some adolescents at risk for dating violence. The present study examined the following research questions: (1) What are adolescents' perceptions of healthy and unhealthy attributes of romantic relationships? (2) How do adolescents perceive jealousy and potentially controlling behaviors? (3) What is the relationship between adolescents' attitudes towards jealousy and controlling behaviors and their willingness to intervene in a peer's unhealthy romantic relationship? The study included a predominantly female, ethnically diverse sample of 72 adolescents (M = 17.5 years) who participated in an internet-based health promotion intervention that allowed peers and health educators to interact. Adolescents commented on message boards and completed a survey. Findings showed that adolescents can articulate both healthy and unhealthy romantic relationship attributes. Some adolescents struggled to understand relationship attributes including jealousy and possessiveness, as these behaviors can be perceived as expressions of strong romantic interest. Adolescents may benefit from programs that strengthen healthy dating behaviors, teach youth to distinguish healthy from unhealthy behaviors, address conflict in respectful ways, and tactfully intervene when they witness abusive behaviors in the relationships of others.

The Moderating Influence of School Adult Connectedness on Adolescent Dating Violence and Mental Health.

BACKGROUND: Adolescent dating violence (ADV) continues to be a health concern. Most previous research has examined physical and or sexual ADV with little attention to verbal violence. METHODS: Drawing on the social-ecological framework, the current study examined the moderating influence of school adult connectedness on experiences of verbal only, physical and/or sexual violence (combination ADV), and mental health outcomes among 11th graders (n = 31,459) in one Midwestern state. RESULTS: Overall, 24.0% and 28.8% of adolescents met thresholds for depression and anxiety symptoms, respectively. Rates of mental health symptoms were higher among adolescents reporting ADV compared to those who did not report experience of ADV. In logistic regressions, higher level of school adult connectedness was associated with lower odds of depressive and anxiety symptoms, respectively. In moderation analyses, school adult connectedness was protective for mental health outcomes regardless of ADV experience. CONCLUSION: Adolescent dating violence-including verbal violence alone-can be traumatic for young people. Schools can leverage the protective nature of school adult connection to promote mental health for all students, including adolescents who have experienced ADV. Incorporating trauma-informed education practice of providing unconditional positive regard toward adolescents might be 1-way schools can support adolescents in cultivating healthy relationships and well-being.

Provider Facilitation of Parent-Adolescent Health Communication: Findings From a National Survey.

INTRODUCTION: Primary care providers are well-positioned to facilitate parent-adolescent health communication. We examined provider-facilitated parent-adolescent health communication prevalence and associations with parent-adolescent health communication. METHOD: Using data from a national survey of parent-adolescent dyads (n = 853), we calculated the prevalence of provider-facilitated parent-adolescent health communication about 11 topics as a result of adolescent's last preventive visit. We examined correlates of of provider-facilitatedparent-adolescent communication and associations with with parent-adolescent communication. RESULTS: Eighteen percent of adolescents reported that a provider helped them talk with their parent about a health concern, with little variability by adolescent, parent, or provider characteristics. Prevalence of parent-adolescent communication because of an adolescent's last preventive visit ranged between 38.4% and 79.5%. Provider facilitation was positively associated with parent-adolescent communication for all topics. DISCUSSION: Given the low prevalence of provider-facilitated-parent-adolescent health communication and positive associations between provider facilitation and parent-adolescent communication about multiple important health-related topics, efforts to improve this practice could be beneficial.

Utility of the cerebroplacental ratio (CPR) in marijuana exposed growth restricted fetuses.

OBJECTIVE: Fetal growth restriction (FGR) is associated with an increased risk of adverse perinatal outcomes. The cerebroplacental ratio (CPR) represents the interaction of alterations in blood flow to the fetal brain and placenta. CPR has been utilized as a superior reflection of fetal hypoxia/acidemia and therefore a better predictor of fetal morbidity. We sought to determine the role of the CPR as an adjunctive tool to identify fetuses at increased risk of adverse perinatal outcomes in a study population of marijuana (MJ) exposed FGR fetuses. METHODS: This was a retrospective cohort study of high-risk singleton pregnancies over a 4-year period. Self-identified daily MJ users with FGR fetuses in the 3rd trimester were isolated. Fetal biometry, amniotic fluid indices, and CPRs were calculated. A CPR <1 was considered abnormal. FGR fetuses with normal and abnormal CPRs were then compared. RESULTS: 26/192 (13.5%) of MJ exposed fetuses were diagnosed with FGR in the 3rd trimester. 12/26 (46%) had an abnormal CPR and 14 had a normal CPR (mean CPR 0.60 vs 1.57, p = .0001). The mean EFW percentile was lower in the abnormal CPR group in comparison to the group with normal CPR (3.33 vs 7.64, p = .0001). Both groups showed evidence of brain sparing with an overall mean head circumference of 17.55 in comparison to a mean abdominal circumference of 5.63. A CPR <1 was associated with more severe FGR, oligohydramnios, and abnormal UA Doppler studies. CONCLUSIONS: Approximately half of the MJ exposed FGR fetuses had an abnormal CPR. In this subset of patients, >90% had severe FGR, a higher proportion had absence/reversal of end diastolic flow in the UA, and a higher proportion had oligohydramnios. This demonstrates that an abnormal CPR identifies a group of FGR fetuses at a greater risk of adverse perinatal outcomes.

Development of a Shelter-based Health Empowerment Program for Pregnant and Parenting Youth Experiencing Homelessness.

BACKGROUND: Pregnancy and parenthood are common among youth experiencing homelessness and are associated with significant health risk for both parent and child. Yet, little is known regarding how to best promote health among this vulnerable population. OBJECTIVES: To understand stakeholder perceptions of needs and factors required for successful implementation of a shelter-based health empowerment program for pregnant and parenting youth experiencing homelessness and their children. METHODS: Applying frameworks from implementation science, we conducted interviews and focus groups with three groups of stakeholders (youth experiencing homelessness [n = 17], shelter staff [n = 8], community experts [n = 5]). We used qualitative content analysis to identify program content areas and design elements required for successful implementation. We then used a consensus-building process to engage community stakeholders in selecting and adapting an evidence-informed intervention. RESULTS: Stakeholders described several desired content areas for a group-based curriculum: sexual and reproductive health, mental health and child health. With respect to program design, stakeholders emphasized adaptability; a strengths-based, culturally responsive, and trauma-informed approach; a skills-oriented focus; staff training; access to health care; and the integration of youth voices. Driven by these findings, our community-based team proposed a health empowerment program with three elements: 1) a weekly health empowerment group, 2) health training and support for shelter staff, and 3) shelter-based health care services. CONCLUSIONS: Our study is among the first to assess the health care needs of pregnant and parenting youth in shelter, and to describe factors associated with the development and implementation of a shelter-based health empowerment program specifically targeting this vulnerable population.

Parents' Sources of Adolescent Sexual Health Information and Their Interest in Resources From Primary Care.

OBJECTIVE: To examine sources of information used by parents to facilitate parent-adolescent communication about sexual and reproductive health (SRH), parents' preferences for receiving SRH information through primary care, and factors associated with parents' interest in primary-care-based SRH information (ie, resources recommended or offered in the primary care setting). METHODS: In this cross-sectional study, a nationally representative sample of 11-17-year-old adolescents and their parents (n = 1005 dyads) were surveyed online; 993 were retained for these analyses. Parents were asked about their use of 11 resources to help them talk with their adolescents about SRH and rated the likelihood of using specific primary-care-based resources. We used multivariable logistic regression to examine characteristics associated with parent interest in primary-care-based SRH resources. RESULTS: Only 25.8% of parents reported receiving at least a moderate amount of SRH information from primary care; half (53.3%) reported receiving no SRH information from their adolescent's provider. Parents received the most information from personal connections (eg, spouse/partner, friends). Most parents (59.1%) reported being likely to utilize a primary-care-based resource for SRH information. Parents who previously received SRH information from primary care sources had greater odds of reporting they would be likely to utilize a primary-care-based resources (AOR = 4.06, 95% CI: 2.55-6.46). CONCLUSIONS: This study provides insights into parents' sources of information for communicating with their adolescents about SRH and ways primary care practices might increase support for parents in having SRH conversations with their adolescents. Future studies are needed to establish clinical best practices for promoting parent-adolescent communication about SRH.

Sexual and Reproductive Health Discussions During Preventive Visits.

OBJECTIVES: To quantify adolescent- and parent-perceived importance of provider-adolescent discussions about sexual and reproductive health (SRH), describe prevalence of provider confidentiality practices and provider-adolescent discussions about SRH topics during preventive visits, and identify missed opportunities for such conversations. METHODS: We used data from a national Internet survey of 11- to 17-year-old adolescents and their parents. Data were weighted to represent the noninstitutionalized US adolescent population. Adolescents who had a preventive visit in the past 2 years and their parents reported on perceived importance of provider-adolescent discussions about SRH topics: puberty, safe dating, gender identity, sexual orientation, sexual decision-making, sexually transmitted infections and HIV, methods of birth control, and where to get SRH services. Adolescents and parents reported whether they had ever discussed confidentiality with the adolescent's provider. Adolescents reported experiences at their most recent preventive visit, including whether a provider spoke about specific SRH topics and whether they had time alone with a provider. RESULTS: A majority of adolescents and parents deemed provider-adolescent discussions about puberty, sexually transmitted infections and HIV, and birth control as important. However, fewer than one-third of adolescents reported discussions about SRH topics other than puberty at their most recent preventive visit. These discussions were particularly uncommon among younger adolescents. Within age groups, discussions about several topics varied by sex. CONCLUSIONS: Although most parents and adolescents value provider-adolescent discussions of selected SRH topics, these discussions do not occur routinely during preventive visits. Preventive visits represent a missed opportunity for adolescents to receive screening, education, and guidance related to SRH.

Adolescent Women's Sexual Self-Efficacy: Associations with Personal and Perceived Partner Beliefs that Condoms Interfere with Pleasure.

Sexual self-efficacy, an individual's confidence in the domain of sexual health behaviors, was studied among an ethnically diverse sample of 128 sexually active adolescent women between the ages of 14 and 18 years. A hypothesized interaction between women's belief that condoms interfere with sexual pleasure and her perception of a partner's belief that condoms interfere with sexual pleasure was not supported. Both adolescent women's belief that condoms interfere with pleasure and their perception that their partner believed condoms interfere with pleasure were separately associated with lower self-efficacy to refuse sex without condoms and use condoms. Both a partner's and one's own sexual pleasure may be important determinants of adolescent women's confidence to engage in health protective sexual behaviors. Adolescents' self-efficacy to experience pleasure when using condoms should be enhanced.

Understanding Primary Care Providers' Perceptions and Practices in Implementing Confidential Adolescent Sexual and Reproductive Health Services.

PURPOSE: Substantial gaps exist between professional guidelines and practice around confidential adolescent services, including private time between health-care providers and adolescents. Efforts to provide quality sexual and reproductive health services (SRHS) require an understanding of barriers and facilitators to care from the perspectives of primary care providers working with adolescents and their parents. METHODS: We conducted structured qualitative interviews with a purposive sample of pediatricians, family physicians, and nurse practitioners (n = 25) from urban and rural Minnesota communities with higher and lower rates of adolescent pregnancy. Provider interviews included confidentiality beliefs and practices; SRHS screening and counseling; and referral practices. RESULTS: The analysis identified two key themes: (1) individual and structural factors were related to variations in SRH screening and counseling and (2) a wide range of factors influenced provider decision-making in initiating private time. A nuanced set of factors informed SRHS provided, including provider comfort with specific topics; provider engagement and relationship with parents; use of adolescent screening tools; practices, policies, and resources within the clinic setting; and community norms including openness with communication about sex and religious considerations regarding adolescent sexuality. Factors that shaped providers' decisions in initiating private time included adolescent age, developmental stage, health behaviors and other characteristics; observed adolescent-parent interactions; parent support for private time; reason for clinic visit; laws and professional guidelines; and cultural considerations. CONCLUSIONS: Findings suggest opportunities for interventions related to provider and clinic staff training, routine communication with adolescents and their parents, and clinic policies and protocols that can improve the quality of adolescent SRHS.