Sexual and Reproductive Health Care Receipt Among Young Males Aged 15-24

A Provider-Focused Intervention to Increase Universal HIV Testing among Adolescents in School-Based Health Centers

We describe a provider-focused intervention to increase universal HIV testing among adolescent users in a network of School-Based Health Centers (SBHC) and compare the rate of HIV test offer and acceptance for SBHCs with and without the HIV testing intervention. The intervention was implemented at the six largest SBHCs in the 12-site network and included system- and staff-level initiatives, including an implementation coach to support SBHC associates. Rates of HIV test offer and acceptance at six sites in the Intervention Cohort were compared to that at the six sites in a Non-Intervention Cohort which was not randomly selected but had comparable distributions by age, gender and race/ethnicity. The model showed an intervention effect for universal HIV test offer, but no overall effect for test acceptance. Analyzing the intervention effect by whether a patient had a history of sexual activity, the intervention was very effective early in its implementation at increasing test offer to those with no history of sexual activity, and late in its implementation at increasing test acceptance for those with no or unknown sexual activity. Increasing and sustaining universal HIV testing in SBHCs may benefit from using Implementation Science frameworks to guide adaptation of the intervention.

Healthcare professionals discourses on men and masculinities in sexual healthcare: a focus group study

Studies have reported that men's uptake of sexual health services is low, that these services make them feel vulnerable, and that they experience sexual healthcare (SHC) as stressful, heteronormative, potentially sexualised and "tailored for women". They also suggest that healthcare professionals (HCPs) working in SHC view masculinity as problematic, and situated in private relationships. This study aimed to explore how HCPs construct the gendered social location in SHC, specifically in terms of masculinity and a perception that masculinity is situated in relationships. Critical Discourse Analysis was used to analyse transcripts from seven focus group interviews with 35 HCPs working with men's sexual health in Sweden. The study found that gendered social locations were discursively constructed in four ways: (I) by problematising and opposing masculinity in society; (II) through discursive strategies where a professional discourse on men and masculinity is lacking; (III) by constructing SHC as a feminine arena where masculinity is a visible norm violation; (IV) by constructing men as reluctant patients and formulating a mission to change masculinity. The discourses of HCPs constructed the gendered social location of masculinity in society as incompatible with SHC, and saw masculinity in SHC as a violation of feminine norms. Men seeking SHC were constructed as reluctant patients, and HCPs were seen as agents of change with a mission to transform masculinity. The discourses of HCPs risk othering men in SHC, which could prevent care on equal terms. A shared professional discourse on masculinity could create a common foundation for a more consistent, knowledge-based approach to masculinity and men's sexual health in SHC.

Understanding the Sexual and Reproductive Health Needs of Hospitalized Adolescent Males

OBJECTIVES

To describe sexual behaviors and acceptability of receiving sexual and reproductive health (SRH) services among hospitalized adolescent males.

METHODS

We performed a cross-sectional survey of hospitalized adolescents. Eligible participants were males aged 14 to 20 years admitted at 2 academic medical centers. Outcome measures included reported healthcare utilization, sexual health behaviors (eg, sexual activity), contraception use, and acceptability of SRH discussions during a hospitalization.

RESULTS

Among 145 participants, 42% reported a history of vaginal sex, 27% current sexual activity, 12% early sexual debut, and 22% 4 or more prior sexual partners. At last sex, condom use was reported by 63% and use of reversible contraception by 36%. Nearly half (45%) agreed that hospital-based SRH discussions were acceptable, particularly among those with history of sexual activity (P < .01). Some (12%) reported they had not accessed care in the past year when they felt they should.

CONCLUSIONS

Hospitalized males in our study had similar rates of sexual activity as compared with the general population but had higher rates of early sexual debut and number of prior partners, which are independently linked with negative sexual health outcomes (eg, sexually transmitted infections). Our participants found SRH discussions to be generally acceptable. These findings reveal opportunities to screen for unmet SRH needs and provide SRH education and services for adolescent males in the hospital.

Disclosure of male attraction to primary care clinicians by adolescent sexual minority males

INTRODUCTION

Adolescent sexual minority males (ASMM) experience higher rates of HIV and other sexually transmitted infections (STIs) relative to their heterosexual peers. Primary care clinicians (PCCs) are well positioned to discuss sexual health and STI prevention with adolescent males; however, ASMM report they are rarely asked about their sexual health, especially with respect to attraction and identity. This study sought to determine variables associated with disclosure of male attraction ("being out") to a PCC.

METHODS

ASMM (N=206; 14 to 17 years in the United States) completed an online sexual health survey in 2017. We assessed socio-demographics, sexuality, being out to a guardian, and being out to a PCC, and calculated proportions and associations among the variables using univariable (Fisher exact) and multivariable (Firth logistic regression) analyses.

RESULTS

Only 20% (n=41) of ASMM were out to their PCC even though 53% (n=109) were out to a parent or guardian. ASMM who were out to a parent or guardian were seven times more likely to be out to their PCC (adjusted odds ratio = 6.69, 95% confidential interval 2.69 to 16.60). No other variables were associated with being out to a PCC.

CONCLUSIONS

Among ASMM, the only predictor of outness to a PCC in this study was outness to a parent or guardian, yet only half were out to a parent or guardian.

POLICY IMPLICATIONS

PCCs should proactively and routinely inquire about sexual health and screen adolescent males for same sex attraction and sexual minority identity in order to provide optimal health care.

A Comparison of Sex-Specific Reproductive and Sexual Health Needs between Addiction Medicine and Primary Care Treatment Settings

Introduction: Reproductive and sexual health (RSH) is an important component of wellness and recovery for people with substance use disorder (SUD). Evidence to guide better integration of RSH services into SUD treatment is limited. Our objectives were to compare 1) unmet RSH needs; and 2) barriers to RSH service utilization between care settings providing treatment for SUD or other chronic medical conditions. Methods: Participants at two outpatient clinics, addiction medicine (women n = 91, men n = 75) and primary care (women n = 59, men n = 50), completed a one-time electronic survey between July and September 2019. Separately for men and women, comparisons between addiction medicine and primary care groups were made using Pearson χ², Fisher's Exact, and T-tests. Results: Participants were 75.0% Black and aged 49.4 years. Overall, unmet RSH needs were less prevalent among participants at the primary care than the addiction medicine clinic, such as receipt of a past 12-month sexual exam (men: 36.0% vs. 17.3%; women: 55.6% vs. 30.1%). The most common barrier to RSH service receipt was cost (men: 59.4%; women: 52.6%), followed by fear of judgment for drug/alcohol use for SUD participants (men: 33% vs. 12%; women: 26% vs. 7%). Many SUD participants expressed high desire for integrated RSH services into the addiction medicine clinic (men: 51.4%; women: 59.8%). Conclusion/Implications: The integration of RSH into addiction medicine is lagging compared to care settings for people with other chronic medical conditions. Future research should focus on advancing sex- and gender-informed RSH service integration into SUD treatment settings.

Quality Initiative to Increase Delivery of Adolescent Hospital-Based Reproductive Health Care

OBJECTIVES

Hospitals are an important nontraditional setting in which to address adolescent reproductive health. However, opportunities for intervention are frequently missed, especially for boys and patients hospitalized for noningestion complaints. Our global aim was to increase delivery of reproductive health care to adolescents hospitalized through our children's hospital Pediatric Hospital Medicine service.

METHODS

We performed 2 quality improvement intervention cycles: (1) provider education and monthly reminder e-mails and (2) an automated electronic health record (EHR) adolescent history and physical note template with social history prompts while discontinuing reminder e-mails. The primary outcome measure was sexual history documentation (SHD). Secondary measures were sexually transmitted infection (STI) testing and contraception provision. Statistical process control charts were used to analyze effectiveness of interventions.

RESULTS

From July 2018 through June 2019, 528 Primary Hospital Medicine encounters were included in this study and compared with published baseline data on 150 encounters. Control charts revealed a special cause increase in SHD from 60% to 82% overall, along with 37% to 73% for boys and 57% to 80% for noningestion hospitalizations. Increased SHD correlated with cycle 1 and was maintained through cycle 2. Percent STI testing significantly increased but did not shift or trend toward special cause variation. Contraception provision, length of stay, and patient relations consultations were not affected.

CONCLUSIONS

The interventions were successful in increasing SHD, including among boys and noningestion hospitalizations. The EHR enhancement maintained these increases after reminder emails were discontinued. Future interventions should specifically address STI testing and provision of contraception.

Engaging Young Black Males in Sexual and Reproductive Health Care: A Review of the Literature

Young Black males (YBM) ages 18 to 24 years are more at risk of contracting sexually transmitted infections (STIs) and have a substantially greater need for sexual reproductive health (SRH) services than other groups. Despite this significant need, the extant literature does not provide a comprehensive picture of how YBM seek preventive care services (e.g., STI testing). Therefore, the purpose of this review is to address YBM’s SRH access and use of STI/HIV testing and screening in this population, with a specific emphasis on young heterosexual Black males, by identifying barriers and facilitators of engaging with SRH care. An electronic search was performed using Cumulative Index to Nursing and Allied Health Literature (CINAHL), PsycInfo, PubMed, and Scopus online databases. Keywords were adapted to each database and included variations of “Black males,” “sexual reproductive healthcare services,” “youth (18-24 years old),” and “healthcare access and utilization.” Studies from the review reported that barriers to engaging in SRH care included lack of health insurance, ideas of masculinity that conflict with SRH care, stigma related to accessing services, and lack of knowledge regarding available services and care options. The top facilitators for utilizing SRH care were engagement on behalf of health clinics, confidence gained from social support, access to quality health care in one’s community, and trust in the health care system and providers. This review contributes to the current state of the science and is important to the improvement of high-quality services for this population, including respect, choice in care, confidentially, and compassion.

Parent, partner and individual contexts of very early first sex experiences among young men and their links to subsequent reproductive health outcomes

Research indicates that upwards to 30% of US urban Black male adolescents report first sex younger than age 13; however, there is limited literature on the sexual and reproductive health outcomes and contexts of these early first sex experiences. This exploratory study described sexual and reproductive health histories and explored personal, partner and parent contextual factors associated with first sex experiences occurring at 13 years or younger among a sample of US urban young men aged 15-24. Participants were assessed on their demographics and sexual health histories and a subset of young men were assessed on the contextual factors related to their first sex experience. Pearson chi-squared tests examined factors associated with early first sex and Fisher's exact tests examined associated contextual factors. First sex at 13 years or younger was reported by 29% of young men. A higher proportion of young men who had first sex at 13 or younger than those who had sex onset at 14 or older reported having got someone pregnant, having a "much older" first partner, and relationship satisfaction with their mother (16%) and father (12%). Study findings highlight the need to better understand urban young men's early first sex experiences, including the support needed to promote their healthy sexual development.

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.

Exploring experience of and engagement in coercive pregnancy behaviors among sexually active young men from five clinics in Baltimore, MD

OBJECTIVES

To explore young men's perceived experience of coercive pregnancy behaviors by female partners, and engagement in and behavioral overlap of these occurrences in this sample.

STUDY DESIGN

Heterosexually active young men aged 15 to 24 (n = 39), recruited from 3 primary care and 2 sexually transmitted disease clinics in Baltimore, MD city over a 2-week period, were surveyed on their perceived experience of and engagement in coercive pregnancy behaviors, attitudes about women, and background characteristics.

RESULTS

Of 130 invited, 66 (51%) agreed to participate, 39 of whom were heterosexual young men; 87% were non-Hispanic Black and 59% were aged 20 to 24. Eleven (28%) perceived one or more coercive pregnancy behaviors by a partner and nine (23%) engaged in one or more coercive behavior. Most (58%) agreed women are responsible for birth control decisions, but 55% believed women could not be trusted to tell the truth about contraceptive use and 68% believe women would like to get pregnant.

CONCLUSIONS

Over one-third of young men in this sample perceived experience of coercive pregnancy behaviors by partners and/or engaged in these behaviors. Findings have implications for promoting healthy relationships among young people.

IMPLICATIONS

This study found over one-third of young men perceived experience of coercive pregnancy behaviors by partners and/or engaged in these behaviors. Findings highlight the need for research to include young men in examining coercive pregnancy behaviors. Findings also highlight the need to develop strategies to support educational and clinical approaches to address young men's role as partners in healthy contraceptive practices.

Missed Opportunities for Discussing Contraception in Adolescent Primary Care

BACKGROUND

Over half of adolescents are sexually active by age 18 years and represent half of sexually transmitted infections (STI). These individuals often do not obtain routine medical care, so discussing contraception at each visit becomes imperative. Our study objectives were to determine the frequency of visits before contraception was discussed/initiated, and to assess factors affecting primary care contraception provision.

METHODS

A retrospective chart review (January 2009-June 2019) was conducted for preventive, follow-up, and sick visits; Title X confidential visits were excluded. Questions were asked about method at start and end of the visit. Nonparametric median tests for continuous variables and chi-squared tests for categorical variables assessed for differences for patient age, race, gender, insurance type, visit type, and provider gender. The institutional review board approved the study as exempt.

RESULTS

Patients (n = 12,619; median = 15 years; 58% female) were seen in primary care clinic. Providers asked about contraception for 82% of visits, and averaged 3 visits before contraception was discussed. For patients asked about contraception, 60% were using a contraceptive method, 15% left the visit on a new method (24.9% long-acting reversible contraception [LARC]). For patients not using contraception, 39.9% left the visit on a method. Patients asked about contraception were female, older, Hispanic, had public insurance, and were seen by female providers (P < .001). Follow-up/sick visits represented <20% of patients asked about contraception.

CONCLUSIONS

Multiple visits occur before contraception is discussed in adolescent primary care, and factors including age, race, and gender affect these discussions. Strategies to increase contraception discussions at all visits is essential, as adolescents do not always present for yearly visits.

Emerging Issues in Male Adolescent Sexual and Reproductive Health Care

Pediatricians are encouraged to address male adolescent sexual and reproductive health on a regular basis, including taking a sexual history, discussing healthy sexuality, performing an appropriate physical examination, providing patient-centered and age-appropriate anticipatory guidance, and administering appropriate vaccinations. These services can be provided to male adolescent patients in a confidential and culturally appropriate manner, can promote healthy sexual relationships and responsibility, can and involve parents in age-appropriate discussions about sexual health.

In everybody's interest but no one's assigned responsibility: midwives' thoughts and experiences of preventive work for men's sexual and reproductive health and rights within primary care

Background

Sexual and reproductive health and rights (SRHR) have historically been regarded as a woman’s issue. It is likely that these gender norms also hinder health care providers from perceiving boys and men as health care recipients, especially within the area of SRHR. The aim of this study was to explore midwives’ thoughts and experiences regarding preventive work for men’s sexual and reproductive health and rights in the primary care setting.

Methods

An exploratory qualitative study. Five focus group interviews, including 4–5 participants in each group, were conducted with 22 midwives aged 31–64, who worked with reproductive, perinatal and sexual health within primary care. Data were analysed by latent content analysis.

Results

One overall theme emerged, in everybody’s interest, but no one’s assigned responsibility, and three sub-themes: (i) organisational aspects create obstacles, (ii) mixed views on the midwife’s role and responsibility, and (iii) beliefs about men and women: same, but different.

Conclusions

Midwives believed that preventive work for men’s sexual and reproductive health and rights was in everybody’s interest, but no one’s assigned responsibility. To improve men’s access to sexual and reproductive health care, actions are needed from the state, the health care system and health care providers.

Understanding Quality of Care and Satisfaction With Sexual and Reproductive Healthcare Among Young Men

OBJECTIVE

Sexual and reproductive healthcare (SRHC) guidelines recommend the delivery of quality preventive SRHC to males beginning in adolescence. A quality of care (QOC) framework was used to examine factors associated with young male's perceptions of QOC and satisfaction with care, which can influence their engagement and use of SRHC.

METHODS

Cross-sectional surveys were conducted from August 2014 to September 2016 with 385 male patients aged 15-24 years, recruited from primary care and sexually transmitted disease (STD) clinics. Surveys measured QOC received, satisfaction with care, and domains of a QOC framework. Poisson regression analyses examined associations between domains of quality and perceived QOC as well as satisfaction with care.

RESULTS

Over half of males reported QOC as excellent (59%) and were very satisfied with the services (56.7%). Excellent QOC and high satisfaction with services was associated with timely care, higher Clinician-Client Centeredness, and being a bisexual male. Excellent QOC was also associated with greater comfort in the clinic, being tested for human immunodeficiency virus/STDs, attending primary care settings, and receipt of higher number of SRHC services.

CONCLUSIONS

Using a QOC framework as part of providing SRHC to young males can be important in improving their perceptions of QOC and satisfaction with services.

Characteristics of the Provider-Patient Encounter Associated With Awareness of and Willingness to Take PrEP Among Young Minority Urban Males in Baltimore City

We aimed to identify provider encounter characteristics associated with awareness of and willingness to take PrEP among young urban minority males at higher risk for HIV acquisition. The 74 individuals included in this analysis from a cross-sectional survey of males aged 15-24 being seen at a Baltimore city clinic were those who identified as a man who had sex with men (MSM), reported injection drug use, were in a serodiscordant relationship, had a sexually transmitted infection (STI) in the past 6 months, or reported condomless sex with a partner with unknown HIV status. Topics of provider-initiated conversations associated with willingness to take PrEP included one's sexual behavior (OR 7.35, 95% CI [2.23, 24.26]), whether one had been hurt by a partner (OR 4.71, 95% CI [1.40, 15.87]), and risk reduction (OR 6.91, 95% CI [2.10, 22.81]). This study may yield new targets for provider-level interventions for increasing PrEP uptake.

Prevalence of Sexual Initiation Before Age 13 Years Among Male Adolescents and Young Adults in the United States

IMPORTANCE

Despite similar sexual activity rates among male and female adolescents, males are more likely to have their first sexual intercourse before age 13 years. The developmental needs and pathways to healthy trajectories for young males remain unknown.

OBJECTIVE

To examine the prevalence of sexual intercourse before age 13 years among male adolescents; the variation by race/ethnicity, location, and maternal educational level; and the wantedness of this first sexual experience.

DESIGN, SETTING, AND PARTICIPANTS

This cross-sectional analysis was conducted from September 2017 to June 2018, using pooled 2011, 2013, and 2015 data from the school-based Youth Risk Behavior Surveillance System (YRBSS) and the 2006 to 2015 data of males aged 15 to 24 years from the household-based National Survey of Family Growth (NSFG). The percentage of males reporting sexual onset before age 13 years was estimated using survey-weighted logistic regression to test for differences by race/ethnicity within each national survey and within metropolitan areas (for YRBSS, high school and middle school samples). Among NSFG survey respondents, differences in wantedness of first sexual intercourse by age at first sexual intercourse were examined, along with the associations between sexual initiation and socioeconomic covariates.

MAIN OUTCOMES AND MEASURES

Sexual onset before age 13 years.

RESULTS

Data from a total of 19 916 male high school students (from YRBSS) and 7739 males aged 15 to 24 years (from NSFG) were included in the analysis. The sample was largely composed of non-Hispanic white males: 8789 (57.1%) from the YRBSS and 3737 (58.0%) from the NSFG. Sexual onset before age 13 years was reported nationally by 7.6% (95% CI, 6.8%-8.4%) of male high school students and 3.6% (95% CI, 3.0%-4.2%) of males aged 15 to 24 years. The proportion of male students who reported having sexual intercourse before age 13 years varied across metropolitan sites, from 5% (95% CI, 4%-7%) in San Francisco, California, to 25% (95% CI, 23%-28%) in Memphis, Tennessee, with elevated rates among non-Hispanic black and Hispanic males in most metropolitan areas. In the NSFG data set, respondents whose mothers had a college degree or higher educational level were statistically significantly less likely (OR, 0.31; 95% CI, 0.19-0.49) to report having sexual intercourse before age 13 years compared with those whose mothers did not have a college degree. Among males who reported having their first sexual experience before age 13 years, 8.5% (95% CI, 3.8%-17.8%) described their first sexual intercourse as unwanted.

CONCLUSIONS AND RELEVANCE

Rates of sexual onset before age 13 years among young males varied by race/ethnicity, location, and maternal educational level, presenting important implications for the provision of early, inclusive, and comprehensive sex education and sexual and reproductive health care to male children and adolescents.

Exploring variation in parental worries about HPV vaccination: a latent-class analysis

Background. Prior research has identified diverse worries that parents have about HPV vaccination. We sought to understand how parents prioritize worries and to identify subgroups of parents according to shared patterns of worry. Methods. We surveyed a national sample of 431 U.S. parents of adolescents who reported never having talked to their child's healthcare provider about HPV vaccination. Parents completed a best-worst scaling experiment designed to prioritize 11 common worries about HPV vaccination. The experiment used a balanced incomplete block design to present 11 choice tasks consisting of repeated subsets of worries. We used conditional logistic regression to prioritize worries and latent class models with 1-10 classes to identify subgroups of parents with shared worries. Results. Parents most often worried about long-term side effects of HPV vaccination, which about one-third (36%) ranked as their top worry. Other common top-ranked worries were how new the vaccine is (12%), motives of drug companies (12%), short-term side effects (10%), and that it may be unnecessary (10%). Latent class analyses suggested a relatively large number of distinct worry profiles, with most classes characterized by a worry about long-term side effects in combination with one other worry. Discussion. Our findings suggest that providers should be prepared to address concerns about long-term side effects, as this worry was prioritized across many subgroups of parents. However, to best address worry, a tailored, rather than targeted, communication approach may be needed.

Evaluation of an Adapted Project Connect Community-based Intervention Among Professionals Serving Young Minority Men

BACKGROUND

To address sexual and reproductive health (SRH) needs of young minority urban males, we developed and evaluated Project Connect Baltimore (Connect), which was adapted from a program with demonstrated effectiveness among young females. The objectives were to determine (1) the feasibility of Connect as adapted for young minority men, (2) whether the program increased SRH knowledge and resource sharing of youth-serving professionals (YSPs) working with young men, and (3) whether the program improved awareness and use of resources for young minority men in Baltimore City, an urban environment with high rates of sexually transmitted diseases.

METHODS

Connect developed a clinic referral guide for male youth-friendly resources for SRH. The YSPs working with partners and organizations serving young minority men were trained to use Connect materials and pretraining, immediate, and 3-month posttraining surveys were conducted to evaluate program effects. A before-after evaluation study was conducted among young men attending five urban Connect clinics where sexually transmitted disease/human immunodeficiency virus rates are high, recruiting young men in repeated cross-sectional surveys from April 2014 to September 2017.

RESULTS

Two hundred thirty-five YSPs were trained to use Connect materials, including a website, an article-based pocket guide, and were given information regarding SRH for young men. These professionals demonstrated increased knowledge about SRH for young men at immediate posttest (60.6% to 86.7%, P < 0.05), and reported more sharing of websites for SRH (23% to 62%, P < 0.05) from pretraining to 3-month posttraining. 169 young minority men were surveyed and reported increased awareness of Connect over 3 and a half years (4% to 11%, P = 0.015), although few young men reported using the website to visit clinics.

CONCLUSIONS

Project Connect Baltimore increased knowledge of SRH needs among youth-serving professionals and sharing of SRH resources by these professionals with young men. This program also demonstrated increases in awareness of SRH resources among young minority urban men.

Missed Opportunities to Address Pregnancy Prevention With Young Men in Primary Care

Young men (aged 15-24 years) have pregnancy prevention needs, yet little is known about whether they perceive they learn about pregnancy prevention in primary care. A sample of 190 young men seen in primary care in one city from April 2014 to September 2016 were assessed on perceived learning about pregnancy prevention, background and visit characteristics, pregnancy prevention care receipt, and contraception needs at last sex. The majority of participants were non-Hispanic black (92%), aged 15 to 19 years (54%), seen for a physical examination (52%), and established patients (87%). Few participants perceived they learned about pregnancy prevention (32%), regardless of sexual activity (33% among sexually active participants, 26% among never sexually active). Poisson regression models determined that perceived learning about pregnancy prevention was independently associated with young men's pregnancy prevention care receipt and contraception needs at last sex. Findings highlight the need to improve providers' delivery of pregnancy prevention services to young men.

Integrating Pregnancy Prevention Into an HIV Counseling and Testing Program in Pediatric Primary Care

PURPOSE

Certified health educator (CHE)-based HIV counseling and testing typically focus on HIV and sexually transmitted infection (STI) prevention only. A quality improvement initiative examined integrating assessment of reproductive life plans, counseling about pregnancy prevention, and contraception referral into a CHE-based HIV testing program.

METHODS

Between February 2014 and January 2017, in one urban pediatric primary care clinic serving patients aged 0-25, CHEs assessed sexual history, HIV risk, short-term (i.e., the next 6-12 months) pregnancy desire, and current contraception method and satisfaction among patients aged 13-25 who had ever had vaginal sex, using a standardized questionnaire. Data were analyzed using a de-identified administrative dataset that also tracked referrals to initiate contraception and actual method initiation.

RESULTS

Of 1,211 patients, most (96%) reported no short-term pregnancy or partner pregnancy desire. Use of less effective or no contraception, as well as method dissatisfaction, was common. A high proportion of female patients referred to new methods opted for more effective methods (62%) and initiated these methods (76%); a high proportion of male patients opted for receipt of condoms (67%). Patients reporting short-term pregnancy desire reported higher rates of previous pregnancy and STIs.

CONCLUSIONS

Program findings highlight the potential benefit of integrating assessment for and counseling about pregnancy prevention in a CHE-based HIV testing program. This can more effectively address the needs of patients with concomitant risks of STI/HIV and unintended pregnancy, and link patients who do not desire pregnancy to more effective methods.