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Liu Y, Ying X, Li Y, Zhu X, Jing W, Wang X, He Z. Age at first sexual intercourse, age at menarche, and age at menopause: a mendelian randomization study on lung cancer risk. Transl Lung Cancer Res 2024; 13:1718-1726. [PMID: 39118897 PMCID: PMC11304150 DOI: 10.21037/tlcr-24-480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2024] [Accepted: 07/10/2024] [Indexed: 08/10/2024]
Abstract
Background There is increasing evidence that sex hormones are involved in the development of lung cancer, but the correlation between the reproductive behavior that changes sex hormone levels and lung cancer is not yet clear. Many previous studies have investigated the association between reproductive factors and lung cancer risk, but the results have been inconsistent. Therefore, we conducted a two-sample Mendelian randomization (MR) analysis to explore the potential relationship between age at first sexual intercourse (AFS), age at menarche, and age at menopause, and lung cancer. Methods We performed a MR analysis of the data from the genome-wide association study (GWAS) of European ancestry to evaluate the independent effects of three reproductive behaviors on lung cancer overall (LUCA), lung adenocarcinoma (LUAD), lung squamous cell carcinoma (LUSC), and small cell lung cancer (SCLC). We mainly used the inverse-variance weighting method for the MR analysis. Sensitivity was determined by a MR-pleiotropy residual sum and outlier analysis, a weighted median analysis, a MR-Egger analysis, and a leave-one-out analysis. Results The MR analysis results revealed that older AFS had a causal relationship with LUCA [odds ratio (OR) =0.6283, 95% confidence interval (CI): 0.4959-0.7961, P=0.0001), LUAD (OR =0.7042, 95% CI: 0.4967-0.9984, P=0.049), and LUSC (OR =0.6231, 95% CI: 0.4386-0.8853, P=0.0083). Conclusions Our results revealed a causal relationship between older AFS and a lower risk of lung cancer. Our findings emphasize the importance of providing sex education, as early sexual intercourse may have undesirable effects. In addition, early psychological treatment is also essential.
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Affiliation(s)
- Yifan Liu
- Department of Thoracic Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Xinxin Ying
- Department of Thoracic Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Yao Li
- Department of Thoracic Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Xingyu Zhu
- Department of Thoracic Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Wangwei Jing
- Department of Cardiology, Affiliated Hangzhou First People’s Hospital, School of Medicine, Westlake University, Hangzhou, China
| | - Xiaohong Wang
- Zhejiang Provincial Centre for Medical Science, Technology and Education Development, Hangzhou, China
| | - Zhengfu He
- Department of Thoracic Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
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Harper CC, Yarger J, Mangurian C, Hopkins K, Rossetto I, Elmes S, Hecht HK, Sanchez A, Hernandez R, Shokat M, Steinberg JR. Mental Health Distress and Delayed Contraception Among Older Adolescents and Young Adults. J Womens Health (Larchmt) 2024; 33:870-878. [PMID: 38465503 PMCID: PMC11302189 DOI: 10.1089/jwh.2023.0549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/12/2024] Open
Abstract
Background: Symptoms of mental distress increased sharply during the COVID-19 pandemic, especially among older adolescents and young adults. Mental health distress may make it more challenging for young people to seek other needed health care, including contraception. This study explored the association of symptoms of depression, anxiety, and stress with delays in getting a contraceptive method or prescription. Materials and Methods: Data from a supplementary study (May 15, 2020-March 20, 2023) to a cluster randomized trial in 29 sites in Texas and California were used. The diverse study sample included community college students assigned female at birth of ages 18-29 years (n = 1,665 with 7,023 observations over time). We measured the association of depression (CES-D [Center for Epidemiologic Studies Depression Scale]) or anxiety and stress (DASS-21 [Depression Anxiety Stress Scales]) symptoms with delayed contraceptive care-seeking with mixed-effects multivariable regression with random effects for individual and site. We controlled for age and sociodemographic factors important for access to care. Results: Over one-third of participants (35%) reported they delayed getting the contraceptive method they needed. Multivariable regression results showed increased odds of delayed contraceptive care among participants with symptoms of depression (adjusted odds ratio [aOR] 1.58, 95% confidence interval [CI] 1.27-1.96). Likewise, delays were associated with anxiety and stress symptoms (aOR 1.46, 95% CI 1.17-1.82). Adolescents were more likely to delay seeking contraception than young adults (aOR 1.32, 95% CI 1.07-1.63). Conclusions: Results showed a strong association between mental distress and delayed contraception. Interventions are needed to increase contraceptive access for young people delaying care, along with supportive mental health care services, including for adolescents who face elevated odds of delay. ClinicalTrials.gov Identifier: NCT03519685.
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Affiliation(s)
- Cynthia C. Harper
- Department of Obstetrics, Gynecology & Reproductive Sciences, Bixby Center for Global Reproductive Health, School of Medicine, University of California, San Francisco, California, USA
| | - Jennifer Yarger
- Department of Obstetrics, Gynecology & Reproductive Sciences, Bixby Center for Global Reproductive Health, School of Medicine, University of California, San Francisco, California, USA
| | - Christina Mangurian
- Department of Psychiatry & Behavioral Sciences, Weill Institute for Neurosciences, School of Medicine, University of California, San Francisco, California, USA
| | - Kristine Hopkins
- Population Research Center, University of Texas at Austin, Austin, Texas, USA
| | - Irene Rossetto
- Population Research Center, University of Texas at Austin, Austin, Texas, USA
| | - Sarah Elmes
- Department of Obstetrics, Gynecology & Reproductive Sciences, Bixby Center for Global Reproductive Health, School of Medicine, University of California, San Francisco, California, USA
| | - Hannah K. Hecht
- Department of Obstetrics, Gynecology & Reproductive Sciences, Bixby Center for Global Reproductive Health, School of Medicine, University of California, San Francisco, California, USA
| | - Audrey Sanchez
- Population Research Center, University of Texas at Austin, Austin, Texas, USA
| | | | - Mitra Shokat
- School of Medicine, Oregon Health & Science University, Portland, Oregon, USA
| | - Julia R. Steinberg
- Department of Family Science, School of Public Health, University of Maryland, College Park, Maryland, USA
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Underwood AL, Hyzak KA, Ebersole A, Bunger AC, Berlan ED. Assessing perspectives on an intervention connecting adolescents in outpatient psychiatry care to contraceptive counseling in the United States. PERSPECTIVES ON SEXUAL AND REPRODUCTIVE HEALTH 2024; 56:171-181. [PMID: 38544347 DOI: 10.1111/psrh.12261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/22/2024]
Abstract
BACKGROUND Adolescents with psychiatric disorders have high rates of unintended pregnancy and experience barriers to accessing sexual and reproductive health (SRH) care. Outpatient psychiatry visits are potential opportunities to connect adolescents to SRH care. This study informs the development of the Link2BC intervention which links adolescents in outpatient psychiatry care to SRH care. METHODS We conducted group interviews with adolescents (3 groups, 7 total participants) and caregivers (3 groups, 9 total participants) and individual interviews with 8 psychiatry providers who received or provided outpatient psychiatric treatment in clinics in a pediatric hospital in a city in the Midwestern United States. We asked questions about the acceptability of Link2BC, potential implementation needs, and implementation determinants. Using consensus-building techniques, two coders analyzed transcriptions using a codebook informed by the Consolidated Framework for Implementation Research 2.0. RESULTS Participants agreed on the need for interventions that expand access to SRH care. Adolescents emphasized that services should be confidential and accessible and were open to their psychiatrists introducing SRH topics during appointments. Providers expressed preference for training and clear workflows. Participants agreed that psychiatry providers could serve as liaisons between adolescents and their caregivers to facilitate conversations about contraception. Participants had concerns about time constraints during visits but mentioned few other barriers to the intervention. CONCLUSION This study demonstrates the acceptability of connecting adolescents in outpatient psychiatry care to contraceptive counseling and informs the refinement and implementation of Link2BC. Integrating contraception counseling in outpatient psychiatry settings is an innovative approach to prevent unintended pregnancy among adolescents by increasing access to SRH care services.
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Affiliation(s)
| | - Kathryn A Hyzak
- Department of Physical Medicine & Rehabilitation, The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Ashley Ebersole
- Divison of General Internal Medicine, The Ohio State University College of Medicine, Columbus, Ohio, USA
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Alicia C Bunger
- Divison of General Internal Medicine, The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Elise D Berlan
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, Ohio, USA
- Division of Adolescent Medicine, Nationwide Children's Hospital, Columbus, Ohio, USA
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Wittenberg MF, Fitzgerald S, Pluhar E. Depressive symptomatology in pregnant adolescents: considerations for care. Curr Opin Pediatr 2023; 35:415-422. [PMID: 36988280 DOI: 10.1097/mop.0000000000001250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/30/2023]
Abstract
PURPOSE OF REVIEW Adolescents who are pregnant experience higher levels of depressive symptoms than nonpregnant peers and pregnant adults. Clinicians caring for youth are often the first point of clinical contact for pregnant adolescents but report low confidence in assessing and treating reproductive health concerns. In the current review, we outline risk factors for depressive symptoms among pregnant adolescents and provide guidance on best practices in assessment and treatment of depressive symptoms in this pediatric sub-population. RECENT FINDINGS Depressive symptoms are persistent across pregnancy. In adolescents, they are linked to greater risk of suicidal ideation, suicidal behavior, and nonsuicidal self-injury. Risk factors for prenatal depressive symptoms among adolescents include lower levels of income, history of depression, exposure to childhood maltreatment and/or recent abuse, and/or lifetime exposure to racial/ethnic discrimination. These risk factors likely interact with each other. SUMMARY Clinicians should assess carefully for depressive symptoms in all pregnant adolescents using a standardized, validated measure supplemented by thoughtful clinical interviewing. Clinicians can educate adolescents on the distinction between symptoms of pregnancy versus symptoms of depression. We encourage clinicians to increase their comfort in providing psychopharmacological treatment, consulting with colleagues in psychiatry, and referring adolescents for psychopharmacological treatment and therapy as needed.
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Affiliation(s)
| | - Shannon Fitzgerald
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital
- Department of Pediatrics, Harvard Medical School
| | - Emily Pluhar
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital
- Division of Sports Medicine, Boston Children's Hospital, Boston, Massachusetts, USA
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Thomas JL, Colich NL, McLaughlin KA, Sumner JA. Dimensions of Early Adversity and Sexual Behavior in a US Population-Based Adolescent Sample. J Adolesc Health 2023; 72:560-567. [PMID: 36529620 PMCID: PMC11107430 DOI: 10.1016/j.jadohealth.2022.10.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Revised: 10/06/2022] [Accepted: 10/19/2022] [Indexed: 12/23/2022]
Abstract
PURPOSE Early life adversity (ELA) is associated with sexual risk, but ELA dimensions-and potential mechanisms-have been less examined. We evaluated associations between threat and deprivation-two key ELA dimensions-and sexual behaviors in adolescents. Secondary analyses investigated age at menarche as a mechanism linking ELA with sexual outcomes in girls. We predicted associations between threat and sexual behaviors, with younger age at menarche as a pathway. METHODS Data were from the National Comorbidity Survey, Adolescent Supplement. Adolescents and caregivers reported on youths' ELA experiences, which were categorized as threat- or deprivation-related. Adolescents reported if they engaged in sex (N = 9,937) and on specific sexual risk indicators, including age at first sex, number of past-year sexual partners, and condom use consistency ("always" vs. "not always" used). Girls reported age at menarche. RESULTS Threat (odds ratio [OR] = 1.76 [95% confidence interval [CI], 1.62-1.92]) and deprivation (OR = 1.51 [95% CI, 1.24-1.83]) were each linked with engagement in sex, ps<.05. Threat-related experiences were associated with multiple sexual risk markers, even when accounting for deprivation: earlier age at first sex (b = -0.20 [95% CI, -0.27 to 0.13]), greater number of partners (b = 0.17 [95% CI, 0.10-0.25]), and inconsistent condom use (OR = 0.72 [95% CI, 0.64-0.80]), ps <.001. Deprivation was not associated with sexual risk when adjusting for threat. We observed no significant indirect effects through age at menarche. DISCUSSION Although threat and deprivation were related to engagement in sexual activity, threat-related experiences were uniquely associated with sexual risk. Screening for threat-related ELA may identify adolescents at-risk for poor sexual health.
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Affiliation(s)
- Jordan L Thomas
- Department of Psychology, University of California Los Angeles (UCLA), Los Angeles, California.
| | - Natalie L Colich
- Department of Psychology, Harvard University, Cambridge, Massachusetts
| | | | - Jennifer A Sumner
- Department of Psychology, University of California Los Angeles (UCLA), Los Angeles, California
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Tebb KP, Brindis CD. Understanding the Psychological Impacts of Teenage Pregnancy through a Socio-ecological Framework and Life Course Approach. Semin Reprod Med 2022; 40:107-115. [PMID: 34991169 DOI: 10.1055/s-0041-1741518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The relationship between mental health and teenage pregnancy is complex. Mental health can be both an antecedent and contributing factor to teenage pregnancy and a concurrent factor wherein pregnancy itself can contribute to depression. Expectant and parenting teens (EPT) are faced with the simultaneous challenges of pregnancy and parenting while navigating the developmental tasks of adolescence which increases their risk for mental health problems. In addition, adolescents growing up in stressful community or home situations where their parents experienced depression, further places them and their children at greater risk of repeated patterns over time. However, adverse mental health outcomes are not inevitable. The socio-ecological model combined with a life course perspective provides a framework for understanding the complexity of risk and protective factors at multiple levels that influence knowledge, attitudes, behaviors, and other health outcomes later in life and across generations. This approach has important implications for reducing adolescents' risk of an unintended/mistimed pregnancy and improving mental health and other outcomes for EPT. This paper describes the prevalence of mental health problems in EPT and using a socio-ecological framework and life course perspective explains variations in mental health outcome among EPT. Implications for interventions and innovative approaches are also discussed.
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Affiliation(s)
- Kathleen P Tebb
- Department of Pediatrics, Division of Adolescent and Young Adult Medicine, University of California, California, San Francisco
| | - Claire D Brindis
- Department of Pediatrics, Division of Adolescent and Young Adult Medicine, Adolescent and Young Adult Health National Resource Center, University of California, California, San Francisco.,The Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, University of California, California, San Francisco
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Ford CA, Boyer CB, Gordon CM, Halpern CT, Ross DA. The Distinguished Dozen: 2020 Journal of Adolescent Health Articles Making Distinguished Contributions to Adolescent and Young Adult Health. J Adolesc Health 2021; 68:435-438. [PMID: 33610232 DOI: 10.1016/j.jadohealth.2020.12.124] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 12/10/2020] [Indexed: 01/10/2023]
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