Hot Topics

Hot Topics I

Credit Hour(s): 1

Moderator: Damian Woods

Eating Disorders in Pop Culture and Social Media in 2022

Eating disorders have increased dramatically during the COVID-19 pandemic, with many patients reporting learned behaviors from social media while at home. This impact will last long after the pandemic. -Presentation will explore social media platforms and their uses, which will aid providers of all specialties, including physicians and mental health providers, to assess social media risk and use in their patients. They will have an understanding of the platforms and be able to use specific terminology in interview and discussion. -Eating disorders are prevalent in pop culture, and this awareness will allow for risk discussions with patients and their support personnel regarding consumption of books, movies, etc.

Presenter: Melanie C. Watt, MD

Educational Objectives

1. Discuss the depiction of eating disorders in books, television, and movies
2. Understand the basic functions of popular social media platforms and describe the ways pro-ED content evades social media restriction
3. Apply information learned to individualize approaches to patients and assess social-media related patient risk

Youth Suicide Prevention: Applying Science into Action via the new Blueprint for Youth Suicide Prevention

Suicide among youth and young adults is a public health crisis. In the United States, suicide is the second leading cause of death among youth 10-24 years old, with significant disparities by race, ethnicity, gender, and sexual orientation. Youth suicide rates have been increasing for decades, a trend that has been further complicated by the unique mental health challenges associated with the COVID-19 pandemic, social isolation, and the persistence of systemic racism. Suicide can be prevented. Multi-sectoral partnerships are needed to identify and support youth at risk for suicide and to address upstream factors that cause and intensify disparities in risk. The public’s readiness to address metal health needs and suicide risk is at an all-time high. In response to this public health crisis, the American Academy of Pediatrics, American Foundation for Suicide Prevention, and National Institute of Mental Health collaborated to develop a Blueprint for Youth Suicide Prevention, which serves as a strategic plan to engage healthcare providers in youth suicide prevention in clinical and community settings. The Blueprint outlines interventions to promote early identification of youth at risk for suicide, utilize clinical care pathways to assess and manage risk, and build the capacity of healthcare providers and community members to build partnerships, promote resilience, identify warning signs, and support youth at risk of suicide. This hot-topic session will describe the urgent need for adolescent health providers to identify those at risk for suicide and ensure youth receive critical mental health support in clinical, school, and community settings.

Presenter: Lisa Horowitz, PhD, MPH

Educational Objectives
1. Apply the public health model to suicide prevention and identify strategies that can be implemented in primary care settings
2. Incorporate workflows into clinical settings to support screening, risk assessment, and treatment for youth and young adults at risk for suicide
3. Identify key strategies for clinical-community partnerships to identify youth at risk for suicide and ensure supportive actions

Adolescent Mental Healthcare Utilization during the COVID-19 Pandemic

The COVID-19 pandemic added hurdles to the delivery capacity of mental healthcare services in the United States due to social isolation. Yet, little is known about how the COVID-19 pandemic affected mental healthcare utilization in the adolescent population and disparities in mental healthcare utilization during the COVID-19 pandemic. Hence, our primary aim was to characterize the impact of the COVID-19 pandemic on adolescent mental healthcare utilization. • COVID-19 Relevance: Our cohorts included adolescents ages 12-17 years enrolled with Kaiser Permanente Mid-Atlantic States (Maryland, DC, and Virginia, a multi-specialty integrated health system). We retrospectively reviewed the presence of a behavioral health visit stratified by age, gender, race/ethnicity, chronic medical conditions, and neuropsychiatric diagnosis by ICD-10 codes and evaluated differences between pre-COVID-19 pandemic (March 1, 2019 – February 28, 2020) and during the COVID-19 pandemic (March 1, 2020 – February 28, 2021). We performed Chi Squared test and residual analyses to determine differences between sociodemographic categories and neuropsychiatric diagnoses. • Diversity/Disparities: 13,424 (28.4%) of 47,339 adolescents had a neuropsychiatric diagnosis documented before COVID-19 declining to 12,399 (26.8%) of 46,196 adolescents during COVID-19. Minority races accessed mental healthcare visits at a lower rate compared to White/Caucasian adolescents during both time periods, which narrowed during the COVID-19 pandemic. Female adolescents accessed mental healthcare visits at a higher rate than males during the COVID-19 pandemic, not seen prior to the COVID-19 pandemic. Thus, our findings demonstrate racial disparities within adolescent mental healthcare utilization and patterns of access varying by gender.

Presenter: Tierra D. Burrell. MD, MHS

Educational Objectives
1. Characterize the impact of the COVID-19 pandemic on adolescent mental healthcare utilization
2. Compare differences between adolescent mental healthcare utilization prior to the COVID-19 pandemic and during COVID-19
3. Describe disparities in adolescent mental health care utilization

Hot Topics II

Credit Hour(s): 1

Moderator: Merrian Brooks

Pre-Exposure Prophylaxis (PrEP) for HIV – Key Advances in Therapy and Clinical Updates for 2022

The CDC released a new recommendation in Dec 2021 that healthcare providers should counsel all sexually active patients about pre-exposure prophylaxis for HIV, regardless of currently reported sexual behaviors. This is a significant change from the previous recommendation to counsel “high-risk” groups only. We will review the new CDC guidelines, including new recommendations for HIV testing for patients on PrEP, monitoring renal function, and PrEP delivery for transgender individuals. • The FDA approved intramuscular cabotegravir (CAB) in December 2021 as a method of PrEP that can be given bi-monthly. This will introduce a significant paradigm shift in PrEP delivery, particularly in adolescents, as the daily medication regimen and confidentiality are the most significant hurdles to increasing use and adherence. • PrEP is one of the critical tools healthcare providers have to end the HIV epidemic. However, uptake remains low among several key groups, including adolescents and Black and Latinx individuals. We will highlight successful strategies to increase PrEP uptake among these adolescents to reverse the disproportionate HIV incidence in sexual and gender minority youth.

Presenter: Joseph Whelihan, MD

Educational Objectives

1. State the CDC’s new 2021 guidelines for pre-exposure prophylaxis for HIV

2. Describe innovations in PrEP formulations, including injectable cabotegravir

3. Appraise the importance of increasing equitable uptake of pre-exposure prophylaxis for HIV as a means of ending the HIV epidemic

Diminished Healthcare Autonomy Among Minoritized Adolescents During the COVID-19 Pandemic: Disparities, Consequences, and A Path Forward

COVID-19 has disproportionately impacted the health and wellbeing of racial/ethnic minority adolescents (REMA) and sexual and gender minority adolescents (SGMA). Understanding how minoritized adolescents engage with COVID-19 treatment and prevention strategies, particularly adolescents under 18 or those living at home, is critical to informing interventions that improve adolescent health. We therefore conducted 1,100 surveys and 40 qualitative interviews with adolescents ages 14-24 to capture overall health, medical engagement, vaccine uptake and how varied levels of healthcare autonomy impacted COVID-19-related experiences and healthcare seeking. ● Limited healthcare autonomy had major consequences for REMA/SGMA COVID-19 vaccination, prevention, and mental health. Adolescents largely wanted to make their own COVID-19 vaccination decisions, but differing opinions about vaccine uptake between adolescents and their parents prevented vaccinations and increased familial tension. Youth also reported increased feelings of anxiety and depression during COVID-19, but many were unable to seek mental healthcare because of their parents. Even adolescents with treatment access expressed discomfort about limited privacy with telehealth, particularly SGMA who experienced homo/transphobia at home. ● Familial interference and parental consent requirements can create barriers to adolescents’ healthcare access and autonomy. Even those with care access, or who made choices contrary to parental wishes, reported barriers such as transportation and privacy. Variability in healthcare access can further health inequities and accelerate COVID-19 transmission and mental health crises among adolescents. Clinicians should ensure adolescents can actively participate in their own treatment and advocate for policy-level changes to ensure adolescent autonomy in vaccine and mental health related decisions.

Presenter: Morgan Philbin, PhD, MHS

Learning Objectives

1. Describe how a lack of healthcare autonomy affected adolescents’ healthcare seeking behavior and vaccine uptake during the COVID-19 pandemic.

2. Analyze how diminished healthcare autonomy during COVID-19 uniquely affected racial/ethnic minority and sexual and gender minority youth compared to their white, heterosexual and cis-gender counterparts.

3. Identify clinical and policy level solutions to provide additional medical autonomy to adolescents currently and in the post-pandemic world.

Anticipating Teenage Sexuality After Social Isolation and Quarantine: Caregivers and Providers Addressing Sex and Health with LGBTQ Youth 

In anticipation of a gradual return to teenage life that will include the formation of peer, romantic and sexual relationships, caregivers and providers are in unique positions to prevent the formation of negative sexual health outcomes. In particular, providers can enhance the efficacy of caregivers and youth to engage in mutually respectful sexual health discussions that minimizes awkwardness, stigmatizing attitudes, and unfamiliarity with LGBTQ-specific sexual health concerns. – Pandemic mitigation strategies, such as social distancing, quarantines and online classroom instructions, over time, may have detrimental impact on LGBTQ youths’ need to socialize and forge bonds for social support. However, concepts underlying these public health interventions may be transferrable when communicating with youth about the value of preventive sexual health. – The normative questions and concerns of youth that are hallmarks of puberty can be addressed by caregivers and providers without disregarding LGBTQ youths’ emergent attractions, behaviors and identities. Triadic interventions must be devised to capitalize on pandemic-related teaching opportunities.

Presenter: Dalmacio Flores, PhD, ACRN

Learning Objectives

1. Compare sexual health educational strategies that work differentially for cisgender and heterosexual youth and LGBTQ-identifying youth

2. Describe ways that caregivers may be supported in providing anticipatory guidance for LGBTQ youth’s sexual health development

3. Identify ways providers can enhance caregivers’ and youths’ efficacy to communicate about LGBTQ-specific sexual health concerns

Hot Topics III

Credit Hour(s): 1

Moderator: Maria Rahmandar, MD

Research Insights Informing Amplifying the Voices of Vaccine-Positive Parents of Adolescents and Young Adults to be Social Media Micro-Influencers

Adolescents and young adults (AYA) lag in recovery to pre-pandemic vaccination rates vs. younger cohorts. Throughout the pandemic, according to Unity’s national multi-wave surveys conducted in 5/20, 8/20, 6/21, parental concern about vaccine safety rose significantly from 52% (8/20) to 63% (6/21). Unity is addressing this significant barrier to AYA vaccination. From 10/2021-1/2022, Unity conducted research with parents of AYAs to understand vaccine hesitancy and attitudes about sharing pro-vaccine information on social media (SM), and its relationship with social media experience and activity. An innovative, multi-phase iterative research approach is utilized. Phase 1 included interviews with select adolescent health SM influencers and phase 2 leveraged innovative online asynchronous, moderated OLB discussions with 60 diverse groups of parents of AYAs. The participants were overpopulated with underserved populations including Black, Hispanic and rural households. OLB results indicate most participants had COVID-19 vaccine safety concerns, with 73% somewhat/very concerned. Furthermore, vaccine hesitancy has extended to routine vaccines, especially HPV vaccine (53% concerned) and flu vaccine (40% concerned). One parent summarized “Covid is making people … question vaccines in general.” Select parents expressed interest in becoming SM micro-influencers to promote vaccine confidence with peers. Caring for adolescents in the future should include building vaccine confident parents and AYAs. Study results will be used to activate and empower vaccine-positive parents/caregivers to amplify their voices on SM with the goal of creating micro-influencers. Together, we will work to bring vaccine coverage back to pre-pandemic levels.

Presenter: Judy Klein, BS, BA

Educational Objective

1. Describe the current landscape of social media influence on vaccine hesitancy and its long-term impact, from a diverse perspective of parents of adolescents and young adults.

2. Discuss the importance of addressing vaccine hesitancy by mobilizing vaccine positive parents as social media micro-influencers to improve the long-term health and well-being of adolescents and young adults in a post-pandemic world

3. Describe utilizing innovative market research approaches including asynchronous, moderated online discussion boards (OLB) to understand the unique perspectives of hard-to-reach diverse parental audiences 

Systemic racism in health services for young people: a scoping review

Although racism is increasingly being recognized as a social determinant of health, greater understanding of systemic racism within healthcare services for adolescents, an age demographic known to face barriers to access and use across many systems, is needed. Examining existing literature to map what is known about adolescent experiences of racism in healthcare access and use provides a starting point in understanding how racism manifests in healthcare and its impact on young people’s health and wellbeing. • This presentation will outline key findings from a systematic scoping review of extant literature on racism and healthcare for adolescents. The results will include studies documenting the experiences and contexts of individuals from diverse racial and ethnocultural backgrounds and from a variety of nations, making it relevant to attendees who self-identify with various ethnicities and nationalities. This presentation will also be of interest to researchers exploring the health outcomes and experiences of racialized groups. • The COVID-19 pandemic highlighted existing racial disparities in current society and systems, including healthcare. In a post-COVID context, it is critical to recognize and eliminate racism in healthcare for adolescents to improve service delivery and address health inequities. Implications of racism in healthcare will be discussed in terms of adolescent health outcomes, adolescent health practice and services, and future research.

Presenter: Carla Hilario, RN, PhD, MScN, BScN

Educational Objectives 

1. Identify the main foci of the existing literature on racism and adolescent healthcare.

2. Describe how racism is presented in the literature including the level of racism under study, field of health or health service where racism takes places, and subgroups of adolescents included.

3. Outline implications of racism on adolescent health outcomes and areas for further work.

Free the Pill: Youth Are Ready for An Over-The-Counter Oral Contraceptive and It’s Coming Soon

It is anticipated that there will be an application for a prescription-to- over-the-counter (OTC) switch for an oral contraceptive (OC) submitted to the U.S. Food and Drug Administration (FDA) in 2022. Youth and adolescent health experts have an important voice in that process. This presentation will provide an overview of the evidence in support of OTC OC access for all ages, with specific considerations for adolescents. This will include: evidence of the safety of oral contraceptives for young people; the ability for adolescents to self-screen for contraindications; and adolescents’ attitudes toward OTC OCs. The COVID-19 pandemic has exacerbated barriers to contraceptive access and interrupted routine health care for adolescents. As such, adolescents are seeking alternative ways to meet their needs, and the landscape of OC access is changing in an attempt to meet these needs. It is important that providers and public health professionals understand and adapt to this changing landscape to better meet the needs of adolescents in a post-pandemic world. Adolescents face a number of specific barriers to contraceptive access that can be alleviated by availability of OTC OCs. Recognizing these barriers can help providers better understand their adolescent patients’ needs and support making OCs OTC. This presentation will share case examples of adolescents across the US who have struggled to access contraception. Some of the specific barriers mentioned by adolescent respondents include affordability and insurance challenges; logistical issues such as accessibility of doctor’s appointments; privacy concerns; and provider refusal/error.

Presenter: Angela Mattke, MS, BS

Educational Objectives

1. Name and explain the evidence in support of over-the-counter oral contraceptive access and prepare colleagues and young people for the anticipated Food and Drug Administration (FDA) approval of an over-the-counter pill

2. Analyze how events such as the COVID-19 pandemic have presented unforeseen barriers to contraceptive access and changed the landscape of contraceptive access overall

3. Discuss specific barriers to contraceptive access faced by adolescents and explain how over-the-counter oral contraceptives may alleviate these barriers

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