Frequency of pregnancy testing among adolescent emergency department visits

OBJECTIVE: To estimate the frequency of pregnancy testing among adolescent emergency department (ED) patients and to determine factors associated with testing. METHODS: This was a retrospective cross-sectional study using the National Hospital Ambulatory Medical Care Survey (NHAMCS) from 2005-2009 of ED visits by females ages 14 to 21 years. We estimated the frequency of pregnancy testing among all visits, those for potential reproductive health complaints, and those associated with exposure to potentially teratogenic radiation. Multivariable logistic regression modeling was performed to calculate adjusted probabilities and odds ratios with 95% confidence intervals to evaluate factors associated with pregnancy testing by patient characteristics. RESULTS: We identified 11,531 visits, representing an estimated 41.0 million female adolescent ED visits. Of these, 20.9% (95% CI 19.3%, 22.5%) included pregnancy testing. Among visits for potential reproductive health complaints and those associated with exposure to potentially teratogenic radiation, 44.5% (95% CI 41.3%, 47.8%) and 36.7% (95% CI 32.5%, 40.9%), respectively, included pregnancy testing. Among the entire study population, we found statistically significant differences in pregnancy by testing (p<0.001 for all) by age, race/ethnicity, hospital admission, and geographic region. CONCLUSIONS: A minority of female adolescent ED visits included pregnancy testing even if patients presented with potential reproductive health complaints or received exposure to ionizing radiation. Small but statistically significant differences in pregnancy testing rates were noted based on age, race/ethnicity, ED disposition, and geographic region. Future studies should focus on designing quality improvement interventions to increase pregnancy testing in adolescent ED patients, especially among those in whom pregnancy complications or the risk of potentially teratogenic radiation exposure is higher

Black Adolescent Females’ Perceptions of Racial Discrimination When Accessing Reproductive and General Health Care

Adolescents, like adults, frequently experience discrimination, which can be particularly salient in the context of reproductive health care. We examined urban Black adolescent females’ perceived experiences of racial discrimination during reproductive health care encounters. Structured face-to-face interviews were conducted with female African American patients, from age 13 through 20, who obtained reproductive health care services at a single site. Twenty-four participants were enrolled. All were in or graduated from high school, with a mean age of 16.8 years. These young Black women reported infrequent race-based discrimination in the health care setting; however, many reported commonly experiencing discrimination in other places. An awareness of the discrimination that minority young women experience in non–health care settings can help providers demonstrate cultural humility when addressing such concerns with their patients. With this information, providers can provide anticipatory guidance and the tools necessary to navigate complex social systems

Good-Parent Beliefs of Parents of Seriously Ill Children

IMPORTANCE: Parents’ beliefs about what they need to do to be a good parent when their children are seriously ill influence their medical decisions, and better understanding of these beliefs may improve decision support. OBJECTIVE: To assess parents’ perceptions regarding the relative importance of 12 good-parent attributes. DESIGN, SETTING, AND PARTICIPANTS: A cross-sectional, discrete-choice experiment was conducted at a children’s hospital. Participants included 200 parents of children with serious illness. MAIN OUTCOMES AND MEASURES: Ratings of 12 good-parent attributes, with subsequent use of latent class analysis to identify groups of parents with similar ratings of attributes, and ascertainment of whether membership in a particular group was associated with demographic or clinical characteristics. RESULTS: The highest-ranked good-parent attribute was making sure that my child feels loved, followed by focusing on my child’s health, making informed medical care decisions, and advocating for my child with medical staff. We identified 4 groups of parents with similar patterns of good-parent–attribute ratings, which we labeled as: child feels loved (n = 68), child’s health (n = 56), advocacy and informed (n = 55), and spiritual well-being (n = 21). Compared with the other groups, the child’s health group reported more financial difficulties, was less educated, and had a higher proportion of children with new complex, chronic conditions. CONCLUSIONS AND RELEVANCE: Parents endorse a broad range of beliefs that represent what they perceive they should do to be a good parent for their seriously ill child. Common patterns of how parents prioritize these attributes exist, suggesting future research to better understand the origins and development of good-parent beliefs among these parents. More important, engaging parents individually regarding what they perceive to be the core duties they must fulfill to be a good parent may enable more customized and effective decision support