A Qualitative Assessment to Understand the Barriers and Enablers Affecting Contraceptive Use Among Adolescent Male Emergency Department Patients

Trauma Informed Care in the Prevention of High-Risk Sexual Behaviors and Unplanned Pregnancy in Adolescents with Mental Health Disorders

Although teen pregnancy and birth rates have declined over the decades, all adolescentpopulations are at risk. Disparities among adolescent pregnancies still exist, including increased risk and rates of unplanned pregnancy among vulnerable adolescents, including those with a mental health diagnosis.Adolescent girls with mental health disorders are notably at higher risk and are three timesmore likely to become pregnant than those without a mental illness. Adolescents who have experienced trauma and have a mental health diagnosis are much more likely to engage in high-risk sexual activity, to not participate in contraceptive use, and to become pregnant than their counterparts.Using Trauma Informed Care (TIC) to assess mental health diagnoses, high-risk sexual behaviors, and risk for unplanned pregnancy among adolescent populations can be an effective approach for primary prevention. There is increased expectation for clinicians to practice TIC and to establish relationships with patients while understanding how mental health diagnoses can impact health behaviors. The focus of this paper is to examine the effects of adolescent unplanned pregnancy, identify the increased risk for adolescents with mental health disorders, and discuss general methods for TIC in clinical practice.

Young Men's Communication With Partners and Contraception Use: A Systematic Review

PURPOSE

The rate of adolescent unintended pregnancy in the U.S. is high compared with that in other developed countries. While past research and interventions have focused on young women, the role of young men in pregnancy prevention has increasingly been recognized. Studies have assessed young men's knowledge and attitudes toward pregnancy prevention as well as their role in male-controlled methods of birth control such as condoms or withdrawal. However, less is known about how young men contribute to decision-making about contraceptive methods other than condoms with female partners. The purpose of this systematic review was to explore how young men communicate with their female partners and the effect of such communication on contraception use to prevent pregnancy.

METHODS

We conducted a systematic review of six databases to identify English language articles published from January 1, 2002, through March 24, 2019. The review specifically explored how young men aged 11-24 years communicate with and affect their female partner (noncondom) contraceptive use. The systematic review explored additional questions, including those pertaining to the timing of partner communication in a relationship, communication strategies used by young men, and which dynamics of partner communication were measured in studies.

RESULTS

Of the 12 articles identified as exploring male partner communication, five of the articles used quantitative analysis to measure any association between partner communication and contraception use, three of which produced statistically significant findings suggesting that communication increases the use of contraception other than condoms. Seven qualitative studies provided supporting narratives from young men describing communication with partners and how they influence contraception use by female partners. The articles also explored timing and strategies of communication, as well as topics, prompts, and communication cues used by young men. Measurements of both communication and contraception varied across studies.

CONCLUSIONS

With the small number of studies identified in this systematic review, we conclude that future research needs to corroborate the relationship between partner communication and contraception use with more robust and precise measurements of both communication and contraception.

Sex Without Contraceptives in a Multicenter Study of Adolescent Emergency Department Patients

OBJECTIVES

In the United States, rates of teenage pregnancy and sexually transmitted infections (STIs) remain exceptionally high, and racial and ethnic disparities persist. Emergency departments (EDs) care for over 19 million adolescents each year, the majority being minority and low socioeconomic status. Single-center studies demonstrate infrequent use of contraceptives among adolescent ED patients and an association between risky sex and behaviors such as alcohol and drug use; however, no multicenter ED data exist. The objectives of this study were to 1) determine the prevalence of sex without contraceptives in a large multicenter adolescent ED study and 2) assess patient demographic and risky behaviors associated with sex without contraceptives.

METHODS

Participants aged 14 to 17 years (n = 3,247) in 16 pediatric EDs across the United States completed an electronic survey. Questions focused on validated measures of risky sex; use of alcohol, tobacco, marijuana, and other drugs; and depression and violence. In this secondary analysis, we constructed univariable and multivariable models to identify demographic and behavioral factors associated with sex without contraceptives (our primary outcome), separately for adolescent males and females.

RESULTS

In the prior year, 17.4% (236/1,356) of males and 15.8% (299/1,891) of females had sex without contraceptives. In the multivariable model, sex without contraceptives for both genders was more likely among teens who were black, with conduct problems and participated in casual sex, binge drinking, or cannabis use. Sex without contraceptives was also more likely among Hispanic and cigarette-smoking males, as well as depressed females.

CONCLUSIONS

Adolescent ED patients across the United States are participating in risky sexual behaviors that increase their likelihood of pregnancy and STI acquisition. These adolescents report a number of problem behaviors, including substance use, which are strongly correlated with unprotected sex. The ED visit may be an opportunity to identify at-risk adolescent patients, address risky behaviors, and intervene to improve adolescent health.

Identifying barriers to post-placental intrauterine device placement: male partners' views

Objective: The use of post-placental intrauterine devices (IUDs) has potential to address the health issues of suboptimal breastfeeding rates and short inter-pregnancy intervals. An understudied factor that may influence choice of breastfeeding-compatible contraception among postpartum women is their romantic partner. We aimed to identify male partner influences on women's postpartum breastfeeding-compatible contraception choices.Methods: Questionnaires were administered to 75 men in Cleveland, OH, USA. Data on partner priorities, opinions and knowledge about breastfeeding and contraception, and barriers to partner IUD receipt were collected. Survey data were summarised using frequencies and percentages, and univariate logistic regression models were used to explore associations between responses.Results: Participants were predominantly African American, unmarried and had at least one child. Twenty-six participants (36%) reported using contraception with their current partner; men who had discussions and agreed about contraception with their partner were more likely to use it. Thirty-nine men (54%) intended for a future child to breastfeed; this intention was more likely for men who had a child that was breastfed previously and for those with knowledge of breastfeeding benefits. Only 25 (35%) thought a post-placental IUD was safe for breastfeeding mothers; correct IUD knowledge and a partner's positive IUD experience were significantly associated with this response.Conclusion: Our findings suggest that knowledge about breastfeeding and contraception as well as experiential learning regarding breastfeeding and contraception within a partnered relationship are important and that minimal prior experience and low knowledge in these areas may be a male partner barrier to post-placental IUD placement for breastfeeding mothers.