STUDY OBJECTIVE: The objective of this study was to examine racial/ethnic disparities in contraceptive delivery for adolescent patients within an adolescent medicine subspecialty clinical system before and during the COVID-19 pandemic. Secondarily, we aimed to assess the relationship between race and contraceptive delivery by telehealth.

DESIGN: Retrospective cohort study using electronic health record data SETTING: Three adolescent medicine subspecialty clinics in a large academic hospital system, including an urban location and 2 suburban locations PARTICIPANTS: Patients assigned female sex at birth prescribed hormonal contraception between January 1st, 2018, and May 31st, 2021.

MAIN OUTCOME MEASURES: Method and type of contraceptive prescribed (short-acting, medium-acting, long-acting reversible contraception [LARC]) RESULTS: There were 2453 patients in the study; 47.5% were White, 36.0% were Black, and 8.1% identified as Hispanic. After controlling for insurance and age, Black patients, compared with non-Black patients, had twofold higher odds of receiving LARC compared with a short-acting method across the study period (aOR = 2.0; 95% CI, 1.52-2.62). We identified effect modification with significant interaction between Black race and the pandemic period, with evidence of a higher marginal probability of Black patients receiving LARCs during the pandemic. Additionally, during the pandemic, patients receiving new contraceptive prescriptions via telehealth were less likely to be Black (aOR = 0.63; 95% CI, 0.41-0.94) or publicly insured (aOR = 0.56; 95% CI, 0.38-0.81).

CONCLUSION: Our data show significantly higher prescribing of LARCs to Black adolescents by clinicians, which could suggest differences in physician contraceptive counseling with a bias toward preferentially counseling Black patients toward LARCs. Our data also show that Black and publicly insured patients had decreased utilization of contraceptive care by telehealth during the pandemic.

STUDY OBJECTIVES: To evaluate the impact of bed provision and sleep education through the Beds for Kids (BfK) program on early childhood sleep and behavior, and maternal mood and sleep.

METHODS: Twenty-seven mother-child dyads (child= 2-5 yrs, 85.2% Black) living in poverty and without an individual child bed were randomly assigned (multi-method randomized waitlist control trial design) to BfK intervention ~1-week post-baseline (initial intervention) or ~2 weeks post-baseline (waitlist control), with follow-up at one-month. BfK intervention (home bed delivery and written sleep health education) was provided to all families. Children wore actigraphs and mothers completed daily diaries to assess child and maternal sleep, child behavior, and maternal mood for the initial one-week comparison period. Maternal-reported child sleep and behavior (internalizing and externalizing problems) were collected at one-month post BfK-participation for all families; n=11 completed a qualitative interview at one-month assessment.

RESULTS: At one-week post-BfK, mothers' sleep duration increased by 1 hour compared to waitlist controls. No changes were found in child sleep, child behavior, or maternal mood. However, at one-month post-BfK intervention, improvements were found in mother-reported child night awakenings, sleep quality and sleep problems, and behavior. Mothers qualitatively reported significant BfK benefits for child sleep and family wellbeing, although noted challenges to transitioning young children to sleeping independently.

CONCLUSIONS: Bed provision and sleep education for families living in poverty has a more immediate impact on maternal sleep and reported wellbeing. Child sleep and behavioral improvements are seen by one month, with children experiencing an initial adjustment period to sleeping independently.

CLINICAL TRIAL REGISTRATION: Registry: ClinicalTrials.gov; Name: Impact of Beds for Kids Program on Child Sleep; Identifier: NCT03392844; URL: https://www.clinicaltrials.gov/ct2/show/NCT03392844.

OBJECTIVES: To test effects of a social media-based parenting program for mothers with postpartum depressive symptoms.

METHODS: We conducted a randomized controlled trial from December 2019 to August 2021 of a parenting program using Facebook. Women with mild-to-moderate depressive symptoms (Edinburgh Postnatal Depression Scale [EPDS] 10-19) were randomized to the program, plus online depression treatment or depression treatment alone for 3 months. Women completed the EPDS monthly and the Parent-Child Early Relational Assessment, Parenting Stress Index-Short Form, and Parenting Sense of Competence pre- and postintervention. Differences among groups were assessed using intention-to-treat analysis.

RESULTS: Seventy-five women enrolled and 66 (88%) completed the study. Participants were predominantly Black (69%), single (57%), with incomes <$55 000 (68%). The parenting group reported a more rapid decline in depressive symptoms than the comparison group (adjusted EPDS difference, -2.9; 95% confidence interval, -4.8 to -1.0 at 1 month). There were no significant group X time interactions for the Parent-Child Early Relational Assessment, Parenting Stress Index-Short Form, or Parenting Sense of Competence scores. Forty-one percent of women sought mental health treatment for worsening symptoms or suicidality. Women in the parenting group who exhibited greater engagement or reported mental health treatment had greater parenting responsiveness.

CONCLUSIONS: A social media-based parenting program led to more rapid declines in depressive symptoms but no differences in responsive parenting, parenting stress, or parenting competence relative to a comparison group. Social media can provide parenting support for women with postpartum depressive symptoms, but greater attention to engagement and treatment access are needed to improve parenting outcomes.

Many adolescents use the emergency department (ED) as their primary source of health care. As a result, the ED serves as a unique opportunity to reach adolescents. Although many adolescent visits to the ED are related to reproductive health, ED providers report barriers to providing this care, including lack of training. Nurse practitioners (NPs) and physician assistants (PAs) serve a vital role in the provision of consistent care to adolescents in the ED. The purpose of this study was to create a curriculum to train NPs and PAs at two pediatric institutions to provide patient-centered contraceptive counseling to adolescents in the pediatric ED regardless of their chief complaint. To do this, we created a four-part webinar followed by an in-person training session. Participants completed training and then conducted counseling sessions with adolescents in the ED. Counseling sessions were recorded and reviewed for fidelity to delineated counseling principles, and data from post-counseling surveys were collected. 27 NPs and PAs completed the training and conducted 99 counseling sessions. Nearly all sessions incorporated essential content and communication principles such as shared decision making (90%) and teach-back methods (75%). All NPs and PAs who participated reported satisfaction and subjective improvement in knowledge and competence from the training. This curriculum offers a novel and feasible approach to train NPs and PAs to deliver patient-centered contraception counseling to adolescents in the ED setting, and it can serve as a model for how to educate different providers to incorporate reproductive health education into the busy ED visit.

Importance: In May 2019, new federal regulations regarding Title X funding were introduced. There has been no formal evaluation of the impact of this regulatory shift as it pertains to minors' access to services.

Objective: To explore the geography of federally funded clinics providing confidential reproductive care to adolescents following changes to Title X funding regulations.

Design, Setting, and Participants: This retrospective cross-sectional study used a population-based sample of US Census tracts. All clinics participating in the Title X program in August 2018 and August 2020 were included in the analysis. Data were analyzed from January to December 2021.

Exposures: Period, defined as before and after the 2019 Title X rule change (August 2018 and August 2020, respectively).

Main Outcomes and Measures: US Census tracts were evaluated for the availability of confidential family planning care within a 30-minute drive, according to the presence of a Title X clinic or a permissive state law. Census tracts in which minors lost access to confidential care after the rule change were characterized in terms of demographic characteristics. Univariate logistic regression evaluated associations between Census tract characteristics and the odds of losing vs maintaining access to legally protected confidential minor services.

Results: The study included 72 620 Census tracts, accounting for approximately 324 697 728 US residents (99.96% of the population). After the Title X rule change, 1743 clinics in the Title X program left (39.0%) and minors living in 6299 Census tracts (8.7%) lost access to confidential family planning care, corresponding to an estimated 933 649 youth aged 15 to 17 years. Minors living in rural Census tracts (odds ratio [OR], 1.27; 95% CI, 1.18-1.36) and those in the Midwest (OR, 2.41; 95% CI, 2.24-2.60) had higher odds of losing access to care. Minors living in Census tracts with a higher Social Vulnerability Index (OR, 0.51; 95% CI, 0.47-0.55), a larger proportion of Black individuals (OR, 0.34; 95% CI, 0.31-0.37), and/or a larger proportion of Hispanic individuals (OR, 0.45; 95% CI, 0.42-0.49) were less likely to lose access to care.

Conclusions and Relevance: These findings suggest that there were losses in access to legally protected confidential reproductive health services for youth after the 2019 Title X rule change. Although evidence-based Title X guidelines have since been reinstated, state laws that ensure adolescent confidentiality in obtaining family planning services may protect youth from future alterations to the Title X program.

<p><strong>BACKGROUND: </strong>Incidence of syphilis has been rising in recent years and disproportionately affects young adults, racial/ethnic minority men, and people living with HIV. This study describes patterns of syphilis infection and syphilis-related care utilization among adolescents and young adults living with HIV (AYALH) in Philadelphia.</p>

<p><strong>METHODS: </strong>We conducted a retrospective cohort study of AYALH receiving care at an adolescent-specialty clinic who received a syphilis test and/or benzathine penicillin for syphilis treatment from 2011 to 2018 ( = 335). Syphilis incidence rates were calculated by baseline demographic characteristics and by calendar year. Recurrent survival analysis was used to explore how demographic and neighborhood-level factors were associated with incident syphilis and syphilis-related care utilization.</p>

<p><strong>RESULTS: </strong>Syphilis-related care was provided 145 times and there were 109 episodes of confirmed syphilis among 83 unique participants between 2011 and 2018. The overall syphilis incidence rate was 13.50 (95% CI: 10.9-16.5) cases per hundred person-years. Participants assigned male sex at birth had higher hazards of infection (HR: 6.12, 95% CI: 1.53-24.48), while older participants (HR: 0.64, 95% CI: 0.58-0.72) and those living further from the clinic had lower hazards of infection (HR: 0.97, 95% CI: 0.94-1.00). Race, insurance status, neighborhood diversity index, and neighborhood social disadvantage index were not associated with hazard of infection or syphilis-related care utilization.</p>

<p><strong>CONCLUSIONS: </strong>Our study found high incidence of syphilis infection among a cohort of AYALH. Integrating comprehensive sexually transmitted infection prevention services into HIV care and improving syphilis prevention services in communities with high syphilis rates should be a priority in future intervention work.</p>

<p><strong>STUDY OBJECTIVE: </strong>To describe sexual initiation pattern in female adolescents and examine its association with adolescent characteristics and racial disparities in adverse sexual health across adolescence into early adulthood.</p>

<p><strong>DESIGN: </strong>A prospective, longitudinal, observational study from adolescence to adulthood.</p>

<p><strong>SETTING: </strong>Nationally representative, the National Longitudinal Study of Adolescent to Adult Health data, ranged 24-32 years old at final assessment.</p>

<p><strong>PARTICIPANTS: </strong>43,577 US females in 1994-2008.</p>

<p><strong>INTERVENTIONS AND MAIN OUTCOME MEASURES: </strong>Adolescent sex related characteristics in individual-family-school peer level were accessed, and multiple sex partners, STIs/HIV, and inter-partner violence (IPV) were longitudinally tracked. The sexual initiation pattern and its longitudinal association with sexual health were analyzed using latent class analysis and Mixed-effects Poisson regression models.</p>

<p><strong>RESULTS: </strong>The sexual initiation patterns were determined as normative (65.9%), late (24.8%) and early but unempowered (9.3%). The highest rate of early-unempowered group was shown in Hispanics (14.4%); they were more likely to be depressed, unsatisfied with their bodies and on welfare and have less educated/permissive parents to their sexual initiation than others. The late group had a higher BMI and more satisfaction with their bodies. The highest number of STIs/HIV and IPV victimization was shown in non-Hispanic blacks (NHBs) and Hispanics, respectively. However, NHB females' higher STIs/HIV was shown in late/normative groups, not in early-unempowered group. Among Hispanic females, adolescent sexual initiation patterns were not directly associated with their frequent IPV victimization.</p>

<p><strong>CONCLUSIONS: </strong>NHB females' higher STI/HIV in late/normative groups and Hispanic females' frequent IPV victimization regardless of their sexual initiation patterns may indicate that racial/ethnic disparities in female sexual health was not directly determined by adolescent risk behaviors.</p>

<p><strong>BACKGROUND AND OBJECTIVES: </strong>Rates of sexually transmitted infections (STIs) have increased over the decade. Guidelines recommend HIV testing with incident STIs. Prevalence and factors associated with HIV testing in acute STIs are unknown in adolescents. Our objective was to determine the prevalence of completed HIV testing among adolescents with incident STIs and identify patient and health care factors associated with HIV testing.</p>

<p><strong>METHODS: </strong>Retrospective study of STI episodes (gonorrhea, <em>Chlamydia,</em>&nbsp;trichomoniasis, or syphilis) of adolescents between 13 and 24 years old from July 2014 to December 2017 in 2 urban primary care clinics. We performed mixed effects logistic regression modeling to identify patient and health care factors associated with HIV testing within 90 days of STI diagnosis.</p>

<p><strong>RESULTS: </strong>The 1313 participants contributed 1816 acute STI episodes. Mean age at STI diagnosis was 17.2 years (SD = 1.7), 75% of episodes occurred in females, and 97% occurred in African Americans. Only half (55%) of acute STI episodes had a completed HIV test. In the adjusted model, female sex, previous STIs, uninsured status, and confidential sexual health encounters were associated with decreased odds of HIV testing. Patients enrolled in primary care at the clinics, compared with those receiving sexual health care alone, and those with multipathogen STI diagnoses were more likely to have HIV testing.</p>

<p><strong>CONCLUSIONS: </strong>HIV testing rates among adolescents with acute STIs are suboptimal. Patient and health care factors were found to be associated with receipt of testing and should be considered in clinical practice.</p>