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Providers need protocols in place to better treat transgender youth
WASHINGTON – Practices and clinics should implement cultural humility training and gender protocols for dealing with transgender youth because many of these youth and their parents find health care experiences to be difficult when procedures for treating and interacting with transgender youth are confusing or nonexistent.
The study is part of an ongoing effort to “provide high-quality, respectful health care for transgender youth [because] these youth are at greatly increased risk of issues including substance abuse, depression, anxiety, homelessness, and suicide,” explained Julia M. Crouch of Seattle Children’s Research Institute.
“A growing body of evidence shows improved health outcomes for transgender youth who received support from family, schools, and providers, and there are now an increasing number of multidisciplinary gender clinics throughout the country [that] have been demonstrated to be a feasible and effective way to provide coordinated care to this population,” Ms. Crouch said at the annual meeting of the Society for Adolescent Health and Medicine.
Ms. Crouch and her coinvestigators recruited transgender youth between the ages of 14 and 22 years, along with parents of transgender youth, all of whom were evaluated and enrolled from the Seattle metropolitan area. Both parents and youth were given the option of participating in either a semistructured interview or a focus group discussion, during which investigators learned about the concerns and experiences of both youth and parents when visiting their health care clinics (J Adolesc Health. 2011 Apr;48[4]:351-7; J Adolesc Health. 2011 Apr;48(4):351-7)..
In total, 13 youth and 16 parents – the latter of whom were not made up of 8 pairs of parents, but rather 16 individual parents of transgender youth who were not necessarily the same 13 youth recruited for the study – were eventually selected for inclusion. The parents split evenly between opting for interviews and focus groups, while four of the youth chose interviews and the remaining nine chose focus groups. Seven youth identified themselves as male, three identified as female, and the remaining three identified as “genderqueer or gender fluid.”
Analysis of interview and focus group conversations identified six key “barriers to care” that Ms. Crouch and her coauthors call necessary to rectify in order to improve the quality of health care provided to transgender youth. These are:
• The dearth of health care providers with sufficient knowledge and interest in working with transgender youth.
• The lack of access to pubertal blockers and cross-sex hormones.
• Doctors and their staff who are unable or unwilling to use the names and pronouns that youths prefer to go by.
• Patients being made to feel uncomfortable or “not normal” by health care providers,
• The lack of a set protocol or treatment methodology for dealing with transgender youth.
• The lack of coordination between health care providers and specialties on treating transgender youth – specifically, a lack of cohesive care between mental and medical health care.
“ ‘It was hard enough to find providers who were accepting new patients, worked with adolescents and my insurance, [and] on top of it, finding someone who was transfriendly made it all but impossible,’ ” Ms. Crouch recalled one transgender youth saying during the study.
Ms. Crouch also recounted that providers’ inability to consistently use the correct pronoun when talking about or to a transgender patient was harmful, and despite most instances being dismissed as unintentional, several were said to be intentional and malicious.
“For example, one parent told us [their] doctor said, ‘her, her, her,’ and [her] son, who was 10 years old, said, ‘him, him, him,’ and the doctor got mad, became dismissive and irritated, and kept saying ‘her,’ ” said Ms. Crouch.
The average age of the youth was 18 years, and of the parents was 49 years. The parents were 88% white and 75% female, with 44% holding at least a college degree. Most of the youth were white (69%), and 77% had either completed high school or some college. Youth and parents were recruited in 2015 from local clinics in the Seattle area, as well as through local and national listservs. Thirty-three percent of the parents were from outside the state of Washington.
The study was funded by the Center for Diversity and Health Equity, and the Clinical and Translational Research Faculty Research Support Fund, at Seattle Children’s Research Institute. Ms. Crouch did not report any relevant financial disclosures.
WASHINGTON – Practices and clinics should implement cultural humility training and gender protocols for dealing with transgender youth because many of these youth and their parents find health care experiences to be difficult when procedures for treating and interacting with transgender youth are confusing or nonexistent.
The study is part of an ongoing effort to “provide high-quality, respectful health care for transgender youth [because] these youth are at greatly increased risk of issues including substance abuse, depression, anxiety, homelessness, and suicide,” explained Julia M. Crouch of Seattle Children’s Research Institute.
“A growing body of evidence shows improved health outcomes for transgender youth who received support from family, schools, and providers, and there are now an increasing number of multidisciplinary gender clinics throughout the country [that] have been demonstrated to be a feasible and effective way to provide coordinated care to this population,” Ms. Crouch said at the annual meeting of the Society for Adolescent Health and Medicine.
Ms. Crouch and her coinvestigators recruited transgender youth between the ages of 14 and 22 years, along with parents of transgender youth, all of whom were evaluated and enrolled from the Seattle metropolitan area. Both parents and youth were given the option of participating in either a semistructured interview or a focus group discussion, during which investigators learned about the concerns and experiences of both youth and parents when visiting their health care clinics (J Adolesc Health. 2011 Apr;48[4]:351-7; J Adolesc Health. 2011 Apr;48(4):351-7)..
In total, 13 youth and 16 parents – the latter of whom were not made up of 8 pairs of parents, but rather 16 individual parents of transgender youth who were not necessarily the same 13 youth recruited for the study – were eventually selected for inclusion. The parents split evenly between opting for interviews and focus groups, while four of the youth chose interviews and the remaining nine chose focus groups. Seven youth identified themselves as male, three identified as female, and the remaining three identified as “genderqueer or gender fluid.”
Analysis of interview and focus group conversations identified six key “barriers to care” that Ms. Crouch and her coauthors call necessary to rectify in order to improve the quality of health care provided to transgender youth. These are:
• The dearth of health care providers with sufficient knowledge and interest in working with transgender youth.
• The lack of access to pubertal blockers and cross-sex hormones.
• Doctors and their staff who are unable or unwilling to use the names and pronouns that youths prefer to go by.
• Patients being made to feel uncomfortable or “not normal” by health care providers,
• The lack of a set protocol or treatment methodology for dealing with transgender youth.
• The lack of coordination between health care providers and specialties on treating transgender youth – specifically, a lack of cohesive care between mental and medical health care.
“ ‘It was hard enough to find providers who were accepting new patients, worked with adolescents and my insurance, [and] on top of it, finding someone who was transfriendly made it all but impossible,’ ” Ms. Crouch recalled one transgender youth saying during the study.
Ms. Crouch also recounted that providers’ inability to consistently use the correct pronoun when talking about or to a transgender patient was harmful, and despite most instances being dismissed as unintentional, several were said to be intentional and malicious.
“For example, one parent told us [their] doctor said, ‘her, her, her,’ and [her] son, who was 10 years old, said, ‘him, him, him,’ and the doctor got mad, became dismissive and irritated, and kept saying ‘her,’ ” said Ms. Crouch.
The average age of the youth was 18 years, and of the parents was 49 years. The parents were 88% white and 75% female, with 44% holding at least a college degree. Most of the youth were white (69%), and 77% had either completed high school or some college. Youth and parents were recruited in 2015 from local clinics in the Seattle area, as well as through local and national listservs. Thirty-three percent of the parents were from outside the state of Washington.
The study was funded by the Center for Diversity and Health Equity, and the Clinical and Translational Research Faculty Research Support Fund, at Seattle Children’s Research Institute. Ms. Crouch did not report any relevant financial disclosures.
WASHINGTON – Practices and clinics should implement cultural humility training and gender protocols for dealing with transgender youth because many of these youth and their parents find health care experiences to be difficult when procedures for treating and interacting with transgender youth are confusing or nonexistent.
The study is part of an ongoing effort to “provide high-quality, respectful health care for transgender youth [because] these youth are at greatly increased risk of issues including substance abuse, depression, anxiety, homelessness, and suicide,” explained Julia M. Crouch of Seattle Children’s Research Institute.
“A growing body of evidence shows improved health outcomes for transgender youth who received support from family, schools, and providers, and there are now an increasing number of multidisciplinary gender clinics throughout the country [that] have been demonstrated to be a feasible and effective way to provide coordinated care to this population,” Ms. Crouch said at the annual meeting of the Society for Adolescent Health and Medicine.
Ms. Crouch and her coinvestigators recruited transgender youth between the ages of 14 and 22 years, along with parents of transgender youth, all of whom were evaluated and enrolled from the Seattle metropolitan area. Both parents and youth were given the option of participating in either a semistructured interview or a focus group discussion, during which investigators learned about the concerns and experiences of both youth and parents when visiting their health care clinics (J Adolesc Health. 2011 Apr;48[4]:351-7; J Adolesc Health. 2011 Apr;48(4):351-7)..
In total, 13 youth and 16 parents – the latter of whom were not made up of 8 pairs of parents, but rather 16 individual parents of transgender youth who were not necessarily the same 13 youth recruited for the study – were eventually selected for inclusion. The parents split evenly between opting for interviews and focus groups, while four of the youth chose interviews and the remaining nine chose focus groups. Seven youth identified themselves as male, three identified as female, and the remaining three identified as “genderqueer or gender fluid.”
Analysis of interview and focus group conversations identified six key “barriers to care” that Ms. Crouch and her coauthors call necessary to rectify in order to improve the quality of health care provided to transgender youth. These are:
• The dearth of health care providers with sufficient knowledge and interest in working with transgender youth.
• The lack of access to pubertal blockers and cross-sex hormones.
• Doctors and their staff who are unable or unwilling to use the names and pronouns that youths prefer to go by.
• Patients being made to feel uncomfortable or “not normal” by health care providers,
• The lack of a set protocol or treatment methodology for dealing with transgender youth.
• The lack of coordination between health care providers and specialties on treating transgender youth – specifically, a lack of cohesive care between mental and medical health care.
“ ‘It was hard enough to find providers who were accepting new patients, worked with adolescents and my insurance, [and] on top of it, finding someone who was transfriendly made it all but impossible,’ ” Ms. Crouch recalled one transgender youth saying during the study.
Ms. Crouch also recounted that providers’ inability to consistently use the correct pronoun when talking about or to a transgender patient was harmful, and despite most instances being dismissed as unintentional, several were said to be intentional and malicious.
“For example, one parent told us [their] doctor said, ‘her, her, her,’ and [her] son, who was 10 years old, said, ‘him, him, him,’ and the doctor got mad, became dismissive and irritated, and kept saying ‘her,’ ” said Ms. Crouch.
The average age of the youth was 18 years, and of the parents was 49 years. The parents were 88% white and 75% female, with 44% holding at least a college degree. Most of the youth were white (69%), and 77% had either completed high school or some college. Youth and parents were recruited in 2015 from local clinics in the Seattle area, as well as through local and national listservs. Thirty-three percent of the parents were from outside the state of Washington.
The study was funded by the Center for Diversity and Health Equity, and the Clinical and Translational Research Faculty Research Support Fund, at Seattle Children’s Research Institute. Ms. Crouch did not report any relevant financial disclosures.
AT SAHM 16
Key clinical point: Cultural humility training and gender protocols should be adopted for all centers handling transgender youth.
Major finding: A small group of transgender youth and parents of transgender youth outlined six specific protocols that should be adopted by clinicians to improve the treatment of transgender youth.
Data source: A study of 13 transgender youth and 16 parents via interview and focus group discussions.
Disclosures: The study was funded by the Center for Diversity and Health Equity, and the Clinical and Translational Research Faculty Research Support Fund, at Seattle Children’s Research Institute. Ms. Crouch did not report any relevant financial disclosures.
Gender nonconforming LGBTQ youth more prone to bullying, harassment
WASHINGTON – Lesbian, gay, bisexual, transgender, questioning (LGBTQ) children and adolescents who are gender nonconforming are more susceptible to bullying at school than are those who don’t, so schools should make it a point to integrate LGBTQ outreach into its programs and to combat bullying against this group of students .
“In recent years, there’s been heightened national attention in the United States [on] harassment, bullying, and violence victimization, especially in schools and particularly targeting [LGBT] youth,” explained Allegra R. Gordon, Sc.D., of Boston Children’s Hospital.
“There’s substantial public health literature documenting an array of mental and physical health correlates of such victimization. However, there’s been less focus on discrimination and violence victimization targeting gender expression, broadly, although there is some evidence that this is an area of concern,” said Dr. Gordon, who presented the findings at the annual meeting of the Society for Adolescent Health and Medicine.
Dr. Gordon and her coinvestigators analyzed data on 5,503 public school students in grades 9-12 from four specific school districts in the United States: Los Angeles; San Diego; Chicago; and Broward County, Fla. These school districts were chosen because they had recently added a new question to the survey regarding socially assigned gender expression, making them the first districts in the nation to do so in 2013.
The data accumulated came from the 2013 Youth Risk Behavior Surveillance System, a survey conducted by the Centers for Disease Control and Prevention every 2 years to determine “the prevalence of health risk behaviors [and] assess whether health risk behaviors increase, decrease, or stay the same over time,” among other things.
The primary outcome of the study was to determine if sex and/or sexual orientation was in any way responsible for whether or not a student conformed to a specific gender – if not, the student was marked as GNC, or gender nonconformity – and if there was any association between GNC youths and in-school victimization. Youth who responded as being GNC were categorized as either most conforming, moderately nonconforming, or most noncomforming.
Nonconformity for each subject was defined based on “socially assigned gender expression, which is the extent to which a person is perceived by others as conforming or not conforming to culturally defined ideas of masculine or feminine appearance and behavior,” Dr. Gordon explained.
Results indicated a strong association between youths identifying as GNC and school-based victimization, with incidences of bullying increasing with greater GNC identification. Out of all GNC youth, 14% reported experiencing some form of bullying, 8% reported missing school because they felt unsafe being there, and 6% reported either being threatened or having been physically injured because of their gender identification.
After adjustment, Dr. Gordon and her coinvestigators found that the higher the degree of GNC a subject had, the more likely they would be victims of bullying, with steadily increasing odds ratios as the level of GNC rose: moderately nonconforming, 1.40 (range, 1.18-1.68) and most nonconforming, 2.01 (1.38-2.93). The latter group also had the highest odds of being absent from school, with an OR of 2.06 (2.10-4.44), and being either threatened with injury or actually getting injured having an OR of 2.79 (1.58-4.91).
“A key take-home here as well is given that the majority of the youth in the sample are heterosexual, the majority of youth in that most gender nonconforming group are heterosexual, so these are issues that apply across sexual orientation identities,” said Dr. Gordon.
Dr. Gordon did not report any relevant financial disclosures.
WASHINGTON – Lesbian, gay, bisexual, transgender, questioning (LGBTQ) children and adolescents who are gender nonconforming are more susceptible to bullying at school than are those who don’t, so schools should make it a point to integrate LGBTQ outreach into its programs and to combat bullying against this group of students .
“In recent years, there’s been heightened national attention in the United States [on] harassment, bullying, and violence victimization, especially in schools and particularly targeting [LGBT] youth,” explained Allegra R. Gordon, Sc.D., of Boston Children’s Hospital.
“There’s substantial public health literature documenting an array of mental and physical health correlates of such victimization. However, there’s been less focus on discrimination and violence victimization targeting gender expression, broadly, although there is some evidence that this is an area of concern,” said Dr. Gordon, who presented the findings at the annual meeting of the Society for Adolescent Health and Medicine.
Dr. Gordon and her coinvestigators analyzed data on 5,503 public school students in grades 9-12 from four specific school districts in the United States: Los Angeles; San Diego; Chicago; and Broward County, Fla. These school districts were chosen because they had recently added a new question to the survey regarding socially assigned gender expression, making them the first districts in the nation to do so in 2013.
The data accumulated came from the 2013 Youth Risk Behavior Surveillance System, a survey conducted by the Centers for Disease Control and Prevention every 2 years to determine “the prevalence of health risk behaviors [and] assess whether health risk behaviors increase, decrease, or stay the same over time,” among other things.
The primary outcome of the study was to determine if sex and/or sexual orientation was in any way responsible for whether or not a student conformed to a specific gender – if not, the student was marked as GNC, or gender nonconformity – and if there was any association between GNC youths and in-school victimization. Youth who responded as being GNC were categorized as either most conforming, moderately nonconforming, or most noncomforming.
Nonconformity for each subject was defined based on “socially assigned gender expression, which is the extent to which a person is perceived by others as conforming or not conforming to culturally defined ideas of masculine or feminine appearance and behavior,” Dr. Gordon explained.
Results indicated a strong association between youths identifying as GNC and school-based victimization, with incidences of bullying increasing with greater GNC identification. Out of all GNC youth, 14% reported experiencing some form of bullying, 8% reported missing school because they felt unsafe being there, and 6% reported either being threatened or having been physically injured because of their gender identification.
After adjustment, Dr. Gordon and her coinvestigators found that the higher the degree of GNC a subject had, the more likely they would be victims of bullying, with steadily increasing odds ratios as the level of GNC rose: moderately nonconforming, 1.40 (range, 1.18-1.68) and most nonconforming, 2.01 (1.38-2.93). The latter group also had the highest odds of being absent from school, with an OR of 2.06 (2.10-4.44), and being either threatened with injury or actually getting injured having an OR of 2.79 (1.58-4.91).
“A key take-home here as well is given that the majority of the youth in the sample are heterosexual, the majority of youth in that most gender nonconforming group are heterosexual, so these are issues that apply across sexual orientation identities,” said Dr. Gordon.
Dr. Gordon did not report any relevant financial disclosures.
WASHINGTON – Lesbian, gay, bisexual, transgender, questioning (LGBTQ) children and adolescents who are gender nonconforming are more susceptible to bullying at school than are those who don’t, so schools should make it a point to integrate LGBTQ outreach into its programs and to combat bullying against this group of students .
“In recent years, there’s been heightened national attention in the United States [on] harassment, bullying, and violence victimization, especially in schools and particularly targeting [LGBT] youth,” explained Allegra R. Gordon, Sc.D., of Boston Children’s Hospital.
“There’s substantial public health literature documenting an array of mental and physical health correlates of such victimization. However, there’s been less focus on discrimination and violence victimization targeting gender expression, broadly, although there is some evidence that this is an area of concern,” said Dr. Gordon, who presented the findings at the annual meeting of the Society for Adolescent Health and Medicine.
Dr. Gordon and her coinvestigators analyzed data on 5,503 public school students in grades 9-12 from four specific school districts in the United States: Los Angeles; San Diego; Chicago; and Broward County, Fla. These school districts were chosen because they had recently added a new question to the survey regarding socially assigned gender expression, making them the first districts in the nation to do so in 2013.
The data accumulated came from the 2013 Youth Risk Behavior Surveillance System, a survey conducted by the Centers for Disease Control and Prevention every 2 years to determine “the prevalence of health risk behaviors [and] assess whether health risk behaviors increase, decrease, or stay the same over time,” among other things.
The primary outcome of the study was to determine if sex and/or sexual orientation was in any way responsible for whether or not a student conformed to a specific gender – if not, the student was marked as GNC, or gender nonconformity – and if there was any association between GNC youths and in-school victimization. Youth who responded as being GNC were categorized as either most conforming, moderately nonconforming, or most noncomforming.
Nonconformity for each subject was defined based on “socially assigned gender expression, which is the extent to which a person is perceived by others as conforming or not conforming to culturally defined ideas of masculine or feminine appearance and behavior,” Dr. Gordon explained.
Results indicated a strong association between youths identifying as GNC and school-based victimization, with incidences of bullying increasing with greater GNC identification. Out of all GNC youth, 14% reported experiencing some form of bullying, 8% reported missing school because they felt unsafe being there, and 6% reported either being threatened or having been physically injured because of their gender identification.
After adjustment, Dr. Gordon and her coinvestigators found that the higher the degree of GNC a subject had, the more likely they would be victims of bullying, with steadily increasing odds ratios as the level of GNC rose: moderately nonconforming, 1.40 (range, 1.18-1.68) and most nonconforming, 2.01 (1.38-2.93). The latter group also had the highest odds of being absent from school, with an OR of 2.06 (2.10-4.44), and being either threatened with injury or actually getting injured having an OR of 2.79 (1.58-4.91).
“A key take-home here as well is given that the majority of the youth in the sample are heterosexual, the majority of youth in that most gender nonconforming group are heterosexual, so these are issues that apply across sexual orientation identities,” said Dr. Gordon.
Dr. Gordon did not report any relevant financial disclosures.
AT THE SAHM ANNUAL MEETING
Key clinical point: Gender identification among LGBTQ youth may predispose them to bullying at school by their peers.
Major finding: Among gender nonconforming youth, 14% reported being bullied, 8% reported missing school, and 6% reported being threatened or injured.
Data source: Retrospective cohort analysis of 5,503 students in grades 9-12 from four counties in the United States, collected in 2013.
Disclosures: Dr. Gordon did not report any relevant disclosures.
Condom use low among female teens using LARC
WASHINGTON – While use of long-acting reversible contraception (LARC) has steadily been increasing over recent years, a new study shows that adolescent females who use LARC might be neglecting to wear condoms when engaging in sexual intercourse, regardless of their number of partners, thus predisposing them to a high risk of contracting sexually transmitted infections (STIs).
“Like moderately effective methods of contraception, [LARC] does not protect against STIs, and so use of a condom in conjunction with [LARC] is recommended for STI prevention,” lead author Riley J. Steiner of the Centers for Disease Control and Prevention in Atlanta, explained at the annual meeting of the Society for Adolescent Health and Medicine. The study also was published in JAMA Pediatrics (2016 Mar 14. doi:10.1001/jamapediatrics.2016.0007)
She added that, “We really think that establishing a link between LARC and condom use early on, prior to widespread adolescent uptake of LARC, can help provide a useful reference point for future monitoring and, ultimately, inform STI prevention efforts as LARC is brought to scale.”
Ms. Steiner and her coinvestigators used data from the 2013 national Youth Risk Behavior Survey, a self-administered “paper and pencil” questionnaire conducted every 2 years for students in grades 9-12 in public and private high schools across the United States. Analysis of the data – which looked for age, race, and type of contraceptive used – was conducted in July and August of 2015.
Primary outcome of the analysis was to determine the contraceptive method used the most recent time a female had sexual intercourse: either LARC – via an intrauterine device or an implant – oral contraceptives, Depo-Provera, a patch, or a ring. In total, 2,288 females were included in the study; 41% used condoms, 22% used oral contraceptives, 16% used no contraceptive methods whatsoever, 12% used “withdrawal or other method,” 6% used either Depo-Provera, a patch, or a ring, 2% said they were unsure of what contraceptive, if any, they used, and only 2% of females used LARC.
However, of the 2% that used LARC, adjusted odds ratios revealed that they were significantly more likely not to use condoms (adjusted prevalence ratio [aPR], 0.42; 95% confidence interval, 0.21-0.84) as opposed to females on oral contraceptives. There was no significant difference found in condom use between females on LARC versus those on Depo-Provera, a patch, or a ring (aPR = 0.57; 95% CI, 0.26-1.25).
“Health care professionals may be more likely to offer LARC to adolescents who report not using condoms or using them infrequently, as LARC methods are particularly well suited for adolescents who have difficulty adhering to coitally dependent methods,” Ms. Steiner and her associates said, adding that it is currently unknown “whether the association varies by partnership type; it is possible that the observed differences occur largely among adolescents who consider themselves to be in committed partnerships and thus are less concerned about STIs.”
Females included in the study were 57% white, with just over a third of all 2,288 subjects being in the 12th grade. Condom use was most prevalent among 9th graders (47%), while non-Hispanic blacks and Hispanic females tended to use condoms the most (47% and 46%, respectively). LARC use, though low overall, was highest among 12th graders (3%) and non-Hispanic whites (2%).
The study was funded partly by grants from the National Institute of Allergy and Infectious Diseases, and the Centers for Disease Control and Prevention. Ms. Steiner did not report any relevant financial disclosures.
WASHINGTON – While use of long-acting reversible contraception (LARC) has steadily been increasing over recent years, a new study shows that adolescent females who use LARC might be neglecting to wear condoms when engaging in sexual intercourse, regardless of their number of partners, thus predisposing them to a high risk of contracting sexually transmitted infections (STIs).
“Like moderately effective methods of contraception, [LARC] does not protect against STIs, and so use of a condom in conjunction with [LARC] is recommended for STI prevention,” lead author Riley J. Steiner of the Centers for Disease Control and Prevention in Atlanta, explained at the annual meeting of the Society for Adolescent Health and Medicine. The study also was published in JAMA Pediatrics (2016 Mar 14. doi:10.1001/jamapediatrics.2016.0007)
She added that, “We really think that establishing a link between LARC and condom use early on, prior to widespread adolescent uptake of LARC, can help provide a useful reference point for future monitoring and, ultimately, inform STI prevention efforts as LARC is brought to scale.”
Ms. Steiner and her coinvestigators used data from the 2013 national Youth Risk Behavior Survey, a self-administered “paper and pencil” questionnaire conducted every 2 years for students in grades 9-12 in public and private high schools across the United States. Analysis of the data – which looked for age, race, and type of contraceptive used – was conducted in July and August of 2015.
Primary outcome of the analysis was to determine the contraceptive method used the most recent time a female had sexual intercourse: either LARC – via an intrauterine device or an implant – oral contraceptives, Depo-Provera, a patch, or a ring. In total, 2,288 females were included in the study; 41% used condoms, 22% used oral contraceptives, 16% used no contraceptive methods whatsoever, 12% used “withdrawal or other method,” 6% used either Depo-Provera, a patch, or a ring, 2% said they were unsure of what contraceptive, if any, they used, and only 2% of females used LARC.
However, of the 2% that used LARC, adjusted odds ratios revealed that they were significantly more likely not to use condoms (adjusted prevalence ratio [aPR], 0.42; 95% confidence interval, 0.21-0.84) as opposed to females on oral contraceptives. There was no significant difference found in condom use between females on LARC versus those on Depo-Provera, a patch, or a ring (aPR = 0.57; 95% CI, 0.26-1.25).
“Health care professionals may be more likely to offer LARC to adolescents who report not using condoms or using them infrequently, as LARC methods are particularly well suited for adolescents who have difficulty adhering to coitally dependent methods,” Ms. Steiner and her associates said, adding that it is currently unknown “whether the association varies by partnership type; it is possible that the observed differences occur largely among adolescents who consider themselves to be in committed partnerships and thus are less concerned about STIs.”
Females included in the study were 57% white, with just over a third of all 2,288 subjects being in the 12th grade. Condom use was most prevalent among 9th graders (47%), while non-Hispanic blacks and Hispanic females tended to use condoms the most (47% and 46%, respectively). LARC use, though low overall, was highest among 12th graders (3%) and non-Hispanic whites (2%).
The study was funded partly by grants from the National Institute of Allergy and Infectious Diseases, and the Centers for Disease Control and Prevention. Ms. Steiner did not report any relevant financial disclosures.
WASHINGTON – While use of long-acting reversible contraception (LARC) has steadily been increasing over recent years, a new study shows that adolescent females who use LARC might be neglecting to wear condoms when engaging in sexual intercourse, regardless of their number of partners, thus predisposing them to a high risk of contracting sexually transmitted infections (STIs).
“Like moderately effective methods of contraception, [LARC] does not protect against STIs, and so use of a condom in conjunction with [LARC] is recommended for STI prevention,” lead author Riley J. Steiner of the Centers for Disease Control and Prevention in Atlanta, explained at the annual meeting of the Society for Adolescent Health and Medicine. The study also was published in JAMA Pediatrics (2016 Mar 14. doi:10.1001/jamapediatrics.2016.0007)
She added that, “We really think that establishing a link between LARC and condom use early on, prior to widespread adolescent uptake of LARC, can help provide a useful reference point for future monitoring and, ultimately, inform STI prevention efforts as LARC is brought to scale.”
Ms. Steiner and her coinvestigators used data from the 2013 national Youth Risk Behavior Survey, a self-administered “paper and pencil” questionnaire conducted every 2 years for students in grades 9-12 in public and private high schools across the United States. Analysis of the data – which looked for age, race, and type of contraceptive used – was conducted in July and August of 2015.
Primary outcome of the analysis was to determine the contraceptive method used the most recent time a female had sexual intercourse: either LARC – via an intrauterine device or an implant – oral contraceptives, Depo-Provera, a patch, or a ring. In total, 2,288 females were included in the study; 41% used condoms, 22% used oral contraceptives, 16% used no contraceptive methods whatsoever, 12% used “withdrawal or other method,” 6% used either Depo-Provera, a patch, or a ring, 2% said they were unsure of what contraceptive, if any, they used, and only 2% of females used LARC.
However, of the 2% that used LARC, adjusted odds ratios revealed that they were significantly more likely not to use condoms (adjusted prevalence ratio [aPR], 0.42; 95% confidence interval, 0.21-0.84) as opposed to females on oral contraceptives. There was no significant difference found in condom use between females on LARC versus those on Depo-Provera, a patch, or a ring (aPR = 0.57; 95% CI, 0.26-1.25).
“Health care professionals may be more likely to offer LARC to adolescents who report not using condoms or using them infrequently, as LARC methods are particularly well suited for adolescents who have difficulty adhering to coitally dependent methods,” Ms. Steiner and her associates said, adding that it is currently unknown “whether the association varies by partnership type; it is possible that the observed differences occur largely among adolescents who consider themselves to be in committed partnerships and thus are less concerned about STIs.”
Females included in the study were 57% white, with just over a third of all 2,288 subjects being in the 12th grade. Condom use was most prevalent among 9th graders (47%), while non-Hispanic blacks and Hispanic females tended to use condoms the most (47% and 46%, respectively). LARC use, though low overall, was highest among 12th graders (3%) and non-Hispanic whites (2%).
The study was funded partly by grants from the National Institute of Allergy and Infectious Diseases, and the Centers for Disease Control and Prevention. Ms. Steiner did not report any relevant financial disclosures.
AT THE SAHM ANNUAL MEETING
Key clinical point: Adolescent females using LARC to prevent pregnancy often don’t use condoms, even if they have more than one sexual partner, leading to a high risk of contracting and transmitting STIs.
Major finding: 1.8% of sexually active females included in the study used LARC; however, these females were 60% less likely to use condoms, compared with females using oral contraceptives.
Data source: Cross-sectional analysis of data on 2,288 sexually active females from the 2013 national Youth Risk Behavior Survey of U.S. students in grades 9-12.
Disclosures: The study was funded partly by grants from the National Institute of Allergy and Infectious Diseases, and the CDC. Ms. Steiner did not report any relevant financial disclosures.
