An Exploration of Contraceptive Choice Pathways in Adolescents and Young Adults.

PURPOSE: To visualize contraceptive choice pathways among adolescent and young adults (AYA) designated female at birth (DFAB) as a means of exploring the relationships between current contraceptive use, desired contraceptive, and ultimately, chosen contraceptive method. METHODS: A retrospective cross-sectional study was conducted of AYA DFAB (N=2369), aged 14-24 years, presenting for initial visit at a contraceptive clinic with standardized efficacy-based counseling. Sankey diagrams were utilized to visualize patient flow through the contraceptive decision-making process. Outcomes of interest were current contraceptive method, desired contraceptive prior to contraceptive counseling, and then chosen contraception. Chi-Square tests were conducted to quantify the strength of the relationships identified by the Sankey diagrams. RESULTS: Sankey diagrams demonstrated a fair amount of change from current contraceptive to desired contraceptive and from current contraceptive to chosen contraceptive. A stronger relationship was evident between desired contraceptive method and chosen method; most patients did not change their desired contraceptive after receiving counseling except AYA who were undecided about their desired contraceptive who flowed variably into all available methods. Chi-Square test assessing the association between desired and chosen contraceptive method was significant at p-value <0.001, validating the patterns identified with the Sankey diagrams. DISCUSSION: We identified distinct contraceptive decision-making pathways among AYA which could inform the framework for a more tailored counseling approach. These findings are aligned with national medical organizations' recommendations for provision of non-coercive, patient-centered contraceptive counseling to promote adolescent reproductive autonomy.

Adrenal Crisis Masked as Septic Shock in a Patient With Opioid Use Disorder on Buprenorphine.

Opioid-induced adrenal insufficiency is a known side effect of chronic opioid use, but opioid-induced adrenal insufficiency related to chronic buprenorphine-naloxone therapy is less well-known. We present a case of a patient with opioid use disorder on chronic buprenorphine-naloxone therapy admitted with presumed septic shock and found to be in an adrenal crisis. The patient presented to our hospital with a shock-like presentation, requiring vasopressors, intubation, empiric glucocorticoids, and antibiotics. As her steroids were weaned, she developed bradycardia and blood glucose in the 60s. A low- and high-dose cosyntropin stimulation test confirmed the presence of secondary adrenal insufficiency, presumed to be due to her chronic buprenorphine-naloxone use. She was discharged on maintenance hydrocortisone and continued buprenorphine-naloxone therapy. With the high prevalence of opioid use disorder and the common need for medication for opioid use disorder, it is important that healthcare providers properly identify opioid-induced adrenal insufficiency in order to quickly and correctly diagnose and treat adrenal crises.

Patterns and perceptions of nicotine use among U.S. adolescents and young adults receiving medication treatment for opioid use disorder.

Nicotine use among U.S. youth is cause for concern, as previous studies have shown that nicotine use in adolescence increases the risk of developing substance use disorders later in life. This exploratory study aimed to understand patterns of nicotine use and perceptions of various nicotine products among adolescents and young adults (AYA) receiving medication treatment for opioid use disorder (MOUD). We administered an adapted version of the National Youth Tobacco Survey via REDCap to AYA (n = 32) receiving outpatient care in the Medication-Assisted Treatment of Addiction at Nationwide Children's Hospital in Columbus, Ohio, U.S.A. Thirty (97%) participants had tried a combustible cigarette and 27 (90%) had tried an electronic cigarette. By age 13, nineteen (61%) participants had tried combustible cigarettes and eight (25%) had tried opioids. Twenty-two (71%) participants reported smoking combustible cigarettes every day for the past 30 days, and 15 (48%) reported smoking more than 10 cigarettes per day on average. Only ten (32%) participants reported e-cigarette use in the last 30 days. Participants universally agreed that tobacco products are dangerous, and twenty (67%) current tobacco users reported that they planned to quit in the next year. Nicotine use patterns among AYA receiving MOUD differ from that previously shown in the general population, primarily by high prevalence of nicotine use in early adolescence and high current combustible cigarette use. Interventions such as universal screening for nicotine use before age 13 and tailored smoking cessation programs for AYA with OUD may help optimize care for these individuals.

Implementing Evidence-Based, Electronic, Substance-Use Screening in a Primary Care Clinic.

PURPOSE: Substance use is common among adolescents, and among those with substance use disorders; use often persists into middle age, underlying the importance of early detection and treatment. The goal of this quality improvement project was to increase the electronic substance use screening rate of adolescents presenting for preventative health visits from 0% to 50% between March 2021 and September 2021. METHODS: This is an ongoing quality improvement project. Participants included patients ≥12 who presented to the Adolescent Medicine Clinic for preventative health visits. We incorporated the Screening to Brief Intervention into the existing Car, Relax, Alone, Forget, Friends, Trouble tool within the electronic health record. We completed a Plan-Do-Study-Act cycle by reviewing every patient's chart who did not receive screening and identified that a common reason for missed screening was designating the visit as "establishing care" rather than preventative health visit. We modified our eligible patient criteria to include all adolescents presenting to establish primary care. RESULTS: We achieved a statistically significant center-line shift with a p value (<.001) from approximately 0% at baseline to a new baseline of 85% from June 2021 to June 2022. After broadening our eligibility criteria, our electronic screening rate improved from 78% in November 2021, to 83% in December 2021. DISCUSSION: Electronic health record integration of the Screening to Brief Intervention/Car, Relax, Alone, Forget, Friends, Trouble is an effective method to systematically and electronically screen adolescents for SUD at preventative health visits. Integration using similar approaches may benefit other institutions interested in providing standardized SUD screening.

Expedited Partner Therapy in Female Adolescents: A Study of Acceptance and the Impact on Reinfection Rates.

BACKGROUND: Given the high risk of sexually transmitted infections (STIs) in adolescents and young adults (AYAs), this study evaluated expedited partner therapy (EPT) acceptance and STI reinfection rates in female AYA before and after availability of EPT. METHODS: The pre-EPT cohort was a 3-year (November 2012 to November 2015) retrospective chart review of female AYA positive for Chlamydia trachomatis (CT) and/or Trichomonas vaginalis (TV) before introduction of EPT. An EPT protocol for CT and TV infections was implemented after legalization in Ohio in 2016. The post-EPT cohort was a prospective review of patients positive for CT and TV for 2 years (5/2016-5/2018) after EPT introduction. We evaluated EPT acceptance and compared reinfection rates (positive test 1-6 months after initial infection) in the pre-EPT versus post-EPT cohorts and by EPT acceptance. RESULTS: Among patients offered EPT, 28% (67/237) with CT and 25% (24/97) with TV accepted EPT. There were no significant differences in the reinfection rates for CT or TV in the pre-EPT versus post-EPT cohorts (CT: 24% (57/240) vs 20% (38/192), P = 0.42; TV: 23% (22/97) versus 14% (12/87), P = 0.11). Although lower, reinfections rates were not significantly different among patients who accepted versus did not accept EPT (CT, 13% (6/48) vs 21% (23/110), P = 0.50 and TV, 6% (1/18) vs 18% (9/49), P = 0.69). CONCLUSIONS: Despite the implementation of an EPT protocol, STI reinfection rates among female AYA remained high, and many declined EPT. Further research is needed to identify barriers to the provision and acceptance of EPT and ways to address these factors.

Disparities in HIV Education and Testing Between Metropolitan and Nonmetropolitan Adolescents and Young Adults in the U.S.

PURPOSE: To examine receipt of formal sexual health education on Human Immunodeficiency Virus (HIV)/Acquired Immunodeficiency Syndrome (AIDS) and receipt of HIV testing in adolescents and young adults (AYAs) residing in nonmetropolitan versus metropolitan areas. METHODS: A secondary data analysis of the 2015-2017 National Survey of Family Growth of AYAs ages 15-24 years (N = 3,114). Logistic regression models predicted associations between nonmetropolitan versus metropolitan status and outcomes of interest (formal sexual health education on HIV/AIDS and HIV testing). RESULTS: Most AYAs (85.3%) reported receiving formal sexual health education on HIV/AIDS, while less than half (46.9%) indicated receiving HIV testing. Residing in a nonmetropolitan area was associated with a lower odds of reporting formal sexual health education on HIV/AIDS (OR = .47, CI = [.29, .77]) but not with HIV testing (OR = 1.33, CI = [.89, 2.01]). CONCLUSIONS: AYAs living in nonmetropolitan areas are less likely to receive formal sexual health education on HIV/AIDS.

Diagnosis and Treatment of Polycystic Ovary Syndrome in Adolescent Females.

The diagnosis of polycystic ovary syndrome (PCOS) in adolescents is complicated by the overlap of normal puberty with features of PCOS. To address this difficulty, recent diagnostic guidelines have worked to modify adult diagnostic criteria for use in adolescents. These guidelines stress that a definitive diagnosis of PCOS is not needed to initiate treatment. Deferring diagnosis, while providing symptom treatment and regular follow-up, is one recommended option. Treatment options for PCOS should be individualized to the presentation, needs, and preferences of each patient. The goals of treatment are to improve the quality of life and long-term health outcomes.