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Purpose: Adolescent access to confidential care is codified by most states with age-specific laws; however, adolescent and guardian awareness of these laws are poorly understood. In this study, we assessed adolescent and guardian perceptions of conditional confidentiality in health care., Methods: We surveyed youth aged 11-18 years, and guardians accompanying youth seeking care at an urban adolescent outpatient clinic that provides adolescent primary and subspecialty care. Participants completed brief True/False surveys which queried whether a parent would be notified for common, hypothetical scenarios. We analyzed adolescent responses by age group and compared responses of adolescents and guardians., Results: Two hundred seventy nine adolescents and 178 guardians completed the survey. Among participants, 86% of adolescents and 67% of guardians believed they understood which health topics were confidential. Adolescent and guardian answers aligned with mandatory reporting laws for scenarios concerning safety and suicidality. Younger adolescents consistently underestimated their legal right to privacy for all hypothetical scenarios. Many adolescents anticipated disclosure to parents for confidential services, including contraception, pregnancy, and sexually transmitted infection testing. Guardians expected disclosure about sexual health services at higher rates than they did about substance use., Discussion: We identified age-associated knowledge gaps among participants pertaining to adolescent privacy in the clinical setting. These deficits were found in a setting where adolescent privacy is routinely discussed, and our findings may underestimate the knowledge gap in the general pediatric population where confidentiality may not be discussed as often. Providers caring for adolescents share the responsibility of educating both youth and families about the importance of adolescent confidentiality., (Copyright © 2024 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.)

Purpose: The purpose of this study is to evaluate where adolescents and young adults (AYAs) learn about sexual consent and how they communicate and interpret sexual consent and refusal in sexual encounters., Methods: A convenience sample of patients attending either an adolescent medicine primary care or a title X-supported adolescent family planning clinic completed an anonymous survey about their communication and interpretation of sexual consent and refusal., Results: One hundred fifty participants, aged 14-24 years, completed the survey; 43% were male, and 78% were sexually active. Most (87.6% females vs. 71.9% males) reported having discussed sexual consent with someone, 34.8% (46.1% females vs. 19.7% males) said they had done so with a health care provider. Males and females indicated and interpreted consent and refusal differently. Of sexually active participants, females were significantly more likely to use verbal cues to communicate (94.7% vs. 77.3%) and interpret (96% vs. 54.4%) consent. Females were also significantly more likely to use verbal cues to communicate (98.7% vs. 56.8%) and interpret (90.7% vs. 59.1%) refusal. Approximately half of males and females indicated consent by "no response". Significant gender discordance was found in both the communication and interpretation of sexual consent and refusal., Discussion: AYA use verbal and nonverbal cues to communicate and interpret sexual consent and refusal. Males and females may communicate and interpret consent and refusal differently. Education about sexual consent should incorporate real-life AYA communication practices to reduce sexual assault and promote healthy and sexually fulfilling relationships., (Copyright © 2021 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.)

Objectives: To determine rates of luteal phase pregnancy (LPP) in young women initiating subdermal implants on any day of the menstrual cycle., Study Design: We assessed a retrospective cohort of young women receiving contraceptive implants at an adolescent Title-X clinic. Patients with negative pregnancy tests were eligible for same-day insertion, regardless of cycle day, contraceptive use, or last intercourse. We computed LPP rates for those within manufacturer guidelines for insertion (≤5 days of menstrual onset or ≤7 days post-discontinuing hormonal contraception) and outside these guidelines. We reviewed medical records for last menstrual period (LMP), current hormonal contraception, emergency contraception (EC) provision, and pregnancy tests ≤12 weeks post-implant placement, or later evidence of pregnancy. For patients with positive pregnancy tests or reports, we used standard obstetrical dating (LMP and ultrasound) to determine if conception occurred ±2 weeks of implant placement., Results: Of 3180 insertions, 1868 (58.8%) were outside recommended guidelines. Women with insertions within-guidelines were older (20.2 vs. 19.3 years; p<0.001) and more likely to be white (40.4% vs. 29.5%; OR=1.6, 95% CI: 1.4-1.9). Definitive pregnancy data was documented for 1726 patients: 660 (50.3%) in the within guidelines group, and 1066 (57.0%) in the outside guidelines group. Rates of LPP were 0.3% (2/660; 95% CI=0.0-1.1%) in the within guidelines group and 0.9% (10/1066; 95% CI=0.5-1.7%) in the outside guidelines group., Conclusion: The risk of LPP following any-cycle-day insertion of contraceptive implants with negative pregnancy testing is low, regardless of menstrual cycle timing, recent contraceptive use or use of EC., Implications: Adopting a protocol of contraceptive implant placement that includes insertion on any cycle day with a negative pregnancy test, and EC as indicated, does not increase the risk of luteal phase pregnancies, even in a young population with complex reproductive behaviors and challenging historical narratives., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Purpose: To examine young men's awareness of emergency contraception (EC) and its association with their contraceptive decision-making contributions within a relationship., Methods: A convenience sample of English-speaking male patients aged 13-24 years were surveyed regarding their childbearing intentions, contraceptive awareness (including EC), perceived contraceptive knowledge, and communication about birth control with providers and within a relationship., Results: An ethnically diverse sample of adolescent males was recruited with a mean age of 18.9 years. Most had previously been sexually active (75%) and felt it was important to avoid pregnancy (84%) and 61% reported ever having spoken to a health care provider about birth control (other than condoms), but only 42% had heard of EC. Participants who had heard of EC were more likely to have spoken to a health care provider about contraception in the past (51.5% vs. 29.8%; p = .050), to feel they should participate in contraceptive decisions in a relationship (97.4% vs. 76.5%; p = .006), and to have discussed contraception with a partner (76.9% vs. 29.2%; p < .001)., Conclusions: Counseling young men about EC, as well as other methods of birth control, may empower them to become actively involved in contraceptive decisions within a relationship if they do not desire fatherhood., (Copyright © 2016 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.)