Examining Parental Acceptance of Confidential Contraception Initiation in a Pediatric Emergency Department

BACKGROUND

The pediatric emergency department (PED) is a valuable site for contraceptive services among adolescents at risk for pregnancy. Studies have shown that adolescents are interested in such services; however, little is known about parental opinions on contraceptive care in the PED. We aimed to (1) assess parental acceptance of confidential provisions of contraception in the PED and (2) identify facilitators/barriers to parental acceptance of contraception in this setting.

METHODS

This study included parents/guardians of females aged 14 to 19 years who presented to the PED with any chief complaint. Participants completed a self-administered 25-question survey based on previously validated questions to assess their acceptance of contraception provisions, both confidentially and with parental involvement, for their adolescent in the PED. χ 2 or Fisher exact tests were used to examine variables associated with parental acceptance of confidential contraception.

RESULTS

Of the 102 parents/guardians surveyed, most parents (58/102, 57%) were accepting of confidential contraception for their adolescent. However, more parents (82/101, 81%) were accepting of contraception in the ED with their involvement, as opposed to confidentially without their involvement. Those accepting had an increased perceived risk of their adolescent having sex or becoming pregnant (mean [SD], 13 [20]; P = 0.02; odds ratio, 1.05; 95% confidence interval, 1.00-1.09), were aware of their adolescent's rights to confidential contraception (62%; P = 0.006; odds ratio, 3.18; 95% confidence interval, 1.39-7.28), and had slightly older teens (16 vs 15.5 years, P = 0.01). More parents accepted OCPs over IUDs in the PED (53/58, 91% vs 26/57, 46%).

CONCLUSIONS

Although most parents were accepting of the PED provider offering confidential contraception to their adolescent, more parents preferred to be involved with decisions regarding contraception, in a collaborative approach. Further research is necessary to better elucidate parental/adolescent preferences.

Dietary Macronutrient Composition Determines the Contribution of DGAT1 to Alcoholic Steatosis

Background

The first stage of alcoholic liver disease is hepatic steatosis. While alcohol is known to profoundly impact hepatic lipid metabolism, gaps in our knowledge remain regarding the mechanisms leading to alcohol‐induced hepatic triglyceride (TG) accumulation. As the sole enzymes catalyzing the final step in TG synthesis, diacylglycerol O‐acyltransferase (DGAT) 1 and 2 are potentially important contributors to alcoholic steatosis. Our goal was to study the effects of dietary fat content on alcohol‐induced hepatic TG accumulation, and the relative contribution of DGAT1 and DGAT2 to alcoholic steatosis.

Methods

These studies were carried out in wild‐type (WT) mice fed alcohol‐containing high‐fat or low‐fat formulations of Lieber‐DeCarli liquid diets, as well as follow‐up studies in Dgat1^−/− mice.

Results

A direct comparison of the low‐fat and high‐fat liquid diet in WT mice revealed surprisingly similar levels of alcoholic steatosis, although there were underlying differences in the pattern of hepatic lipid accumulation and expression of genes involved in hepatic lipid metabolism. Follow‐up studies in Dgat1^−/− mice revealed that these animals are protected from alcoholic steatosis when consumed as part of a high‐fat diet, but not a low‐fat diet.

Conclusions

Dietary macronutrient composition influences the relative contribution of DGAT1 and DGAT2 to alcoholic steatosis, such that in the context of alcohol and a high‐fat diet, DGAT1 predominates.