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Objective: Assess the prevalence of headache in transgender and gender‐diverse adolescents, comparing prevalence with and without exposure to gender‐affirming hormone therapy. Background: Transgender and gender‐diverse youth are an understudied group in whom we can study the effects of sex steroids on adolescents' development of headache. We hypothesized that transfeminine adolescents treated with estrogen would have higher odds of headache than those not treated, and that transmasculine adolescents treated with testosterone would have lower odds of headache than those not treated. Methods: This retrospective case–control study analyzed all patients seen at the Boston Children's Hospital Gender Multispecialty Service clinic from 2007 to 2017. Cases were defined as patients with headache, controls as those without headache, and exposure as treatment with gender‐affirming hormone therapy (i.e., estrogen or testosterone). A computerized search identified cases that were then validated by chart review. Results: Fifty‐two of the 763 transgender and gender‐diverse patients seen were confirmed to have headache. Of 273 transfeminine patients 45% (123/273) received estrogen treatment. Transfeminine patients receiving estrogen were more likely to have headache than those not receiving estrogen (7% [9/123] vs. 1% [2/150]; odd ratio [OR] 5.84 (95% confidence interval [CI] 1.24–27.6), p = 0.026). Of 490 transmasculine patients, 46% (227/490) received testosterone. Transmasculine patients receiving testosterone were more likely to have headache than those not receiving testosterone (12% [28/227] vs. 5% (13/263); OR 2.71 (95% CI 1.37–5.4), p = 0.005). Conclusion: Among transfeminine and transmasculine youth, those who received gender‐affirming hormone therapy had higher odds of headache compared to those not taking gender‐affirming hormone therapy. Further prospective studies to guide headache care of transgender and gender‐diverse youth and adults are needed. Our results could be generalizable to other pediatric gender management clinics and may be worth discussing with patients considering treatment. [ABSTRACT FROM AUTHOR]

Objective: The COVID‐19 pandemic hastened a transition to treatment delivery via telehealth. While barriers still exist, the increased uptake of telehealth has the potential to increase access to mental health treatment for all diagnoses, including eating disorders. Delivery of evidence‐based treatment as well as adjunctive treatments, including those that are hard to find in‐person, have been modified to virtual format to increase accessibility and allow for continuity of care for adolescents with anorexia nervosa. Method: We describe how to modify and deliver Cognitive Remediation Therapy for youth with anorexia nervosa (CRT‐AN) via a telehealth platform. Preliminary and practical guidance for best practice for both group and individual delivery is established. Results: With minimal modifications, CRT‐AN can be delivered via telehealth for both individual and group delivery. More disengagement in group delivery was noted; however, overall application of the treatment via a remote platform was observed. Discussion: As more treatment moves to a telehealth format, highlighting how an adjunctive treatment like CRT‐AN can combined with other treatments in a telehealth format has the potential to increase research in its implementation and furthermore increase its dissemination. Public Significance: Cognitive Remediation Therapy for Anorexia Nervosa (CRT‐AN) requires significant manipulation of materials and supplementary human guidance. Suggestions for how to modify CRT‐AN for remote delivery via telehealth are provided. Modifications grew out of immediate changes made during the beginning of the COVID‐19 pandemic and can be used to inform changes therapists and programs can make to continue to or begin to use CRT‐AN in a remote fashion. [ABSTRACT FROM AUTHOR]

Background: Simultaneous use of alcohol and cannabis to enhance each other's effect can cause potential harm. Time trends are diverging in adolescent use of alcohol, which is declining, and cannabis, which is increasing among certain subgroups. However, little is known about trends in their simultaneous and non‐simultaneous use. Racial and socioeconomic disparities are emerging in cannabis use, which may portend consequences to public health. Methods: The 2000 to 2020 Monitoring the Future surveys included approximately 38,000 U.S. 12th‐grade students with information on simultaneous use and pertinent demographic factors. A 5‐level alcohol/cannabis measure included past‐year simultaneous use (i.e., alcohol and cannabis use at the same time), non‐simultaneous alcohol and cannabis use, alcohol‐use‐only, cannabis‐use‐only, and no use. Multinomial logistic regressions estimated associations (adjusted relative risk ratios; aRRR) with time period (2000 to 2004, 2005 to 2009, 2010 to 2014, 2015 to 2020). Models were adjusted and included interactions with sex, race/ethnicity, and parental education. Results: Between 2000 and 2020, simultaneous alcohol/cannabis use among 12th graders decreased from 24.4% to 18.7%. From 2015 to 2020 compared to 2000 to 2004, the odds of simultaneous use (adjusted relative risk ratio (aRRR) vs. no use = 0.57, 95% CI [0.50, 0.66]) and alcohol‐use‐only (aRRR = 0.55, 95% CI [0.49, 0.61]) decreased, while cannabis‐use‐only odds increased (aRRR = 2.59, 95% CI [1.87, 3.59]). Notably, the prevalence of cannabis‐use‐only more than doubled from 2011 to 2019. The odds of simultaneous use, alcohol‐use‐only, and non‐simultaneous use of alcohol and cannabis declined more rapidly among males than females, whereas the odds for cannabis‐use‐only increased faster for females than males. Increases in cannabis‐use‐only were faster for non‐white adolescents. Conclusion: Simultaneous use of alcohol and cannabis is declining among U.S. adolescents, but the decline is slower among females than males. Declines in simultaneous use are largely concomitant with historical declines in alcohol use, indicating that a continued focus on reducing alcohol use among adolescents and young adults has extended benefits to other adolescent substance use. However, cannabis use without any reported past‐year alcohol use more than doubled in the last decade, a concerning trend. [ABSTRACT FROM AUTHOR]

BACKGROUND Being bullied online is associated with being bullied in school. However, links between online bullying and violence‐related experiences are minimally understood. We evaluated potential disparities in these associations to illuminate opportunities to reduce school‐based violence. METHODS: We used five cohorts of Youth Risk Behavior Survey national cross‐sectional data (2011‐2019, Ntotal = 73 074). We used survey‐weighted logistic and multinomial models to examine links between online bullying and five school‐based violence‐related experiences: offline bullying, weapon carrying, avoiding school due to feeling unsafe, being threatened/injured with a weapon, and physical fighting. We examined interactions by sex, race/ethnicity, and sexual identity. RESULTS: Being bullied online was positively associated with all offline violence‐related behaviors. Groups with stronger associations between online bullying and physical fighting, including boys, adolescents whose sexual identity was gay/lesbian or unsure, and many adolescents of color (Black, Hispanic/Latino, and Asian/Pacific Islander adolescents), had stronger associations between online bullying and either weapon carrying or avoiding school. CONCLUSIONS: Online bullying is not an isolated harmful experience; many marginalized adolescents who experience online bullying are more likely to be targeted in school, feel unsafe, get in fights, and carry weapons. Reduction of online bullying should be prioritized as part of a comprehensive school‐based violence prevention strategy. [ABSTRACT FROM AUTHOR]