Adolescents are at high risk for sexually transmitted infections (STIs) and pregnancy. Since many adolescents have poor access to preventive care, hospitalizations present a critical opportunity to address adolescents' reproductive health. The purpose of this study was to assess provision of reproductive health services within a hospital setting.
Retrospective study of a consecutive sample of adolescent patients aged 13 years and older hospitalized on the hospitalist service at a large academic pediatric tertiary care center. Measures included sexual history documentation, pregnancy and STI testing, Human papillomavirus immunization status and administration, and provision of contraception.
Only 55% of 150 patients had sexual history documentation, and of those, 47% endorsed sexual activity. Associations with increased likelihood of sexual history documentation included female patients (67% vs. 36%, p < .01), hospitalizations for ingestion (71% vs. 48%, p < .01), hospitalizations to hospital medicine compared with critical care (59% vs. 14%, p < .01), and admission note written by an intern compared with a senior resident, advanced practice provider, or fellow (67% vs. 44%, 29%, 13%, p < .01). Eighteen patients (12%) were tested for STIs. Only 19% of patients due for human papillomavirus immunization received it. Sixty percent of females received a pregnancy test. Contraception was provided in two encounters (2% of females).
Results demonstrate a substantial missed opportunity to provide reproductive health services to hospitalized adolescents. Providers in hospital settings should optimize the opportunity to screen for sexual activity and reproductive health needs, provide indicated services, and offer education regarding reproductive health to hospitalized adolescents.
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Published online: March 13, 2019
Accepted: January 3, 2019
Received: November 2, 2018
Conflicts of interest: The authors have no conflicts of interest to disclose.
© 2019 Society for Adolescent Health and Medicine. All rights reserved.
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- Caring for Hospitalized Adolescents: Opportunities to Identify and Address Unmet Reproductive Health NeedsJournal of Adolescent HealthVol. 64Issue 6
- PreviewAdolescents in the U.S. experience disproportionately high rates of sexually transmitted infections (STIs) and unplanned pregnancy compared with other industrialized countries, in part due to unmet reproductive health needs [1–4] Nearly 90% of adolescent pregnancies are unplanned, and 29% end in abortion . Rates of STIs among adolescents remain high and are increasing, with nearly one in four females testing positive for an STI annually [4,6]. In addition, 51% of adolescents in the U.S. are not fully vaccinated against the human papillomavirus (HPV) and adolescents have higher rates of missed opportunities for HPV vaccination than other vaccines [7–9].