First name
Jungwon
Last name
Min

Title

Adolescent Access to Federally Funded Clinics Providing Confidential Family Planning Following Changes to Title X Funding Regulations.

Year of Publication

2022

Number of Pages

e2217488

Date Published

06/2022

ISSN Number

2574-3805

Abstract

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.

DOI

10.1001/jamanetworkopen.2022.17488

Alternate Title

JAMA Netw Open

PMID

35713904

Title

Incidence of syphilis infection and syphilis-related care utilization among adolescents and young adults living with HIV.

Year of Publication

2021

Number of Pages

9564624211048774

Date Published

2021 Nov 02

ISSN Number

1758-1052

Abstract

<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>

DOI

10.1177/09564624211048774

Alternate Title

Int J STD AIDS

PMID

34727755

Title

Racial/ethnic disparities in female sexual health from adolescence to young adulthood: how adolescent characteristics matter?

Year of Publication

2020

Date Published

2020 Nov 20

ISSN Number

1873-4332

Abstract

<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>

DOI

10.1016/j.jpag.2020.11.005

Alternate Title

J Pediatr Adolesc Gynecol

PMID

33227423

Title

HIV Testing Among Adolescents With Acute Sexually Transmitted Infections.

Year of Publication

2020

Date Published

2020 Mar 16

ISSN Number

1098-4275

Abstract

<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>

DOI

10.1542/peds.2019-2265

Alternate Title

Pediatrics

PMID

32179661

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