SAHM Position & Statement Papers
Refeeding Hypophosphatemia in Hospitalized Adolescents With Anorexia NervosaRefeeding hypophosphatemia in hospitalized adolescents with anorexia nervosa is correlated with degree of malnutrition, with a high index of suspicion for severely malnourished patients (<70% median body mass index). Weight history (greater magnitude or rate of weight loss prior to admission) regardless of presentation weight has also been associated with lower serum phosphate. Higher energy meal-based refeeding starting at 2,000 kcal has not been shown to be associated with higher rates of refeeding hypophosphatemia than the traditional standard of care, lower energy refeeding.
Medical Management of Restrictive Eating Disorders in Adolescents and Young AdultsThe medical provider plays an important role in the management of adolescents and young adults (AYAs) with restrictive eating disorders (EDs), including anorexia nervosa (AN), atypical anorexia nervosa, and avoidant/restrictive food intake disorder. The focus of this article is the medical management of AYAs with restrictive EDs, which can be performed by a number of different medical providers, including pediatricians, family physicians, internists, nurse practitioners, and, in some countries, psychiatrists.
COVID Vaccines in Adolescents and Young AdultsWorldwide, a number of COVID-19 vaccines have been approved or granted Emergency Use Authorization (EUA) or Emergency Use Listing for adolescents and young adults (AYA), which has brought hope to many across the globe. Extension of the EUA for a COVID-19 vaccine to children and adolescents aged 5 through 15 years is exciting news for children, adolescents, parents, and providers of AYA. Many countries around the globe have extended immunization against COVID-19 to younger age groups. At the same time, the COVID-19 pandemic has led to a decrease globally in administration of other adolescent vaccines.
Recommendations for Promoting the Health and Well-being of Sexual and Gender–diverse Adolescents Through Supportive Families and Affirming Support NetworksAdolescent and young adult (AYA) health care providers (HCPs) frequently serve sexual and gender–diverse (SGD) youth. Sexual orientation refers to a person's sexual identity in relation to the gender(s) to which they are attracted. Gender-diverse, sometimes addressed as gender-expansive, persons are a subset of the population whose gender identity, expressions, or behaviors differ from those typically associated with the sex they were assigned at birth in the society in which they live. These constructs may develop separately, and terminology should acknowledge and include the broad range of SGD identities that exist.
Medication for Adolescents and Young Adults With Opioid Use DisorderOpioid-related morbidity and mortality have risen in many settings globally. It is critical that practitioners who work with adolescents and young adults (AYAs) provide timely, evidence-based treatment for opioid use disorder (OUD). Such treatment should include medications for opioid use disorder (MOUD), including buprenorphine, naltrexone, and methadone. Medication treatment is associated with reduced mortality, fewer relapses to opioid use, and enhanced recovery and retention in addiction care, among other positive health outcomes.
Preventing Nutritional Disorders in Adolescents by Encouraging a Healthy Relationship With FoodNutritional disorders, including overweight, underweight, and/or nutrient deficiency, are a significant cause of morbidity and mortality. These disorders are frequently related to abnormal patterns of eating and/or physical activity, which commonly begin in adolescence and persist into adulthood. Abnormal eating and exercise behaviors may stem from an unhealthy relationship with food, which often takes root in preadolescence or early adolescence. To prevent eating disorders, overweight, underweight, and nutritional deficiencies in adolescence and beyond, health care providers need to proactively support early adolescents and their caregivers to develop a healthy relationship with food and their bodies.
Improving Integration of Behavioral Health Into Primary Care for Adolescents and Young AdultsProblems related to mood, substance use, anxiety, body image issues, post-traumatic stress, and suicidality are common in adolescence and become even more common in young adulthood. Integrated behavioral health (IBH) in primary care has shown great promise in identifying and treating adolescents and young adults who have these problems. Treatment outcomes in IBH settings outperform those in usual primary care settings where a primary care provider may identify behavioral health problems and refer youth to colocated or outside behavioral health specialists.
Promoting Health Equality and Nondiscrimination for Transgender and Gender-Diverse YouthAdolescent and young adult health-care providers often care for transgender and gender-diverse (TGD) youth—youth whose gender identity is incongruent with the gender assigned to them at birth. This patient population faces health challenges distinct from their cisgender peers (i.e., youth whose gender identity aligns with their assigned gender at birth), which include the health impacts from gender dysphoria and from societal stigma and discrimination. SAHM encourages adolescent and young adult health-care providers to receive training in providing culturally effective, evidence-based care for TGD youth; calls for more research on gender-affirming health care; and advocates for policies that protect the rights of TGD youth and minimize barriers to attaining healthcare.
Transition to Adulthood for Youth With Chronic Conditions and Special Health Care NeedsIn 2003, the Society for Adolescent Medicine issued a position paper joining the American Academy of Pediatrics, the American Academy of Family Physicians, and the American College of Physicians in endorsing a national consensus statement regarding successful transition to adult care, for all young people, including youth with special health care needs. This consensus statement was followed by a clinical report in 2011, which was updated in 2018. Since the original publication, the development of professional guidelines, several iterations of U.S.-based national survey data, and a growing global evidence base characterizing the consequences of suboptimal transitions have advanced the field of health care transition substantially.
Preventing Firearm Violence in Youth Through Evidence-Informed StrategiesFirearm injuries are the leading cause of death for adolescents and young adults (AYA) aged 12–24 years in the U.S. The Society for Adolescent Health and Medicine (SAHM) believes that a comprehensive approach addressing firearm access for AYA can decrease the morbidity and mortality that AYA experience due to firearms. SAHM's position paper builds on the 2005 position statement, the scientific literature, and expert opinion. SAHM believes that the safest home for AYA is one without firearms. If firearms are present, they must be stored unloaded, locked up, with ammunition locked and stored separately.
Crisis Pregnancy Centers in the U.S.: Lack of Adherence to Medical and Ethical Practice Standards: A Joint Position Statement of the Society for Adolescent Health and Medicine and the North American Society for Pediatric and Adolescent GynecologyCrisis pregnancy centers (CPCs) attempt to dissuade pregnant people from considering abortion, often using misinformation and unethical practices. While mimicking health care clinics, CPCs provide biased, limited, and inaccurate health information, including incomplete pregnancy options counseling and unscientific sexual and reproductive health information. The centers do not provide or refer for abortion or contraception but often advertise in ways that give the appearance that they do provide these services without disclosing the biased nature and marked limitations of their services.
Advocating for Adolescent and Young Adult Male Sexual and Reproductive Health: A Position Statement From the Society for Adolescent Health and MedicineThere is a critical need to improve the sexual and reproductive health (SRH) education and care of adolescent and young adult (AYA) males around the globe, as SRH is a basic human right for all AYAs. This special attention toward the SRH of AYA males is warranted given the fact that they often have difficulty accessing SRH services and education relative to their female counterparts and have higher rates of sexual risk behaviors than females. To promote AYA males’ SRH and the health of their sexual partners and children, the Society for Adolescent Health and Medicine (SAHM) recommends that leaders in research, policy, public health, and clinical practice develop and implement evidence-based, comprehensive SRH education that supports AYA males at school, within communities and families, and through healthcare services that are developmentally appropriate, gender affirming, inclusive of, and informed by AYA males.
HIV Pre-Exposure Prophylaxis Medication for Adolescents and Young Adults: A Position Paper of the Society for Adolescent Health and MedicinePre-exposure prophylaxis (PrEP) is a biomedical prevention intervention that has demonstrated high efficacy in reducing human immunodeficiency virus (HIV) transmission. While an increasing number of jurisdictions have endorsed the use of emtricitabine/tenofovir disoproxil fumarate (FTC/TDF) for PrEP, access to PrEP varies widely. Adolescents and young adults (AYAs), especially those at high risk of HIV acquisition, such as young gay, bisexual, and other men having sex with men (YGBMSM) and individuals living in countries where HIV is endemic, face multiple barriers that limit their access to PrEP.
Condom Availability in Schools: A Practical Approach to the Prevention of Sexually Transmitted Infection/HIV and Unintended PregnancyAdolescents and young adults are highly impacted by sexually transmitted infections (STIs) and unplanned pregnancy in the United States and globally. Consistent and correct use of male latex condoms is associated with protection against both STIs and pregnancy. Providing adolescents and young adults with access to free condoms in schools may increase the use of condoms by improving condom availability, eliminating cost, and decreasing embarrassment associated with purchasing condoms. Studies demonstrate that condom availability in schools is associated with the increased use of condoms and improved overall sexual health.
Young Adult Health and Well-Being: A Position Statement of the Society for Adolescent Health and MedicineYoung adulthood is a unique and critical period of development during which unmet health needs and disparities in access to appropriate care, health status, and mortality rates are high. This is a time when purposeful prevention and intervention strategies may still alter trajectories and decrease threats to health along the adult life course. The Society for Adolescent Health and Medicine provides leadership, advocacy, and supports health policies, practice recommendations, and research that specifically help to ensure the health and well-being of young adults.
Preventing and Treating Adolescent Obesity: A Position Paper of the Society for Adolescent Health and MedicineAdolescent obesity is an international problem that is a major public health concern with short- and long-term health consequences. Its prevention and treatment require that all health care professionals (HCPs) work together. To date, very little evidence supports effective treatment approaches for adolescents.
International Youth Justice Systems: Promoting Youth Development and Alternative Approaches: A Position Paper of the Society for Adolescent Health and MedicineYouth incarceration is an international public health concern among developed and developing countries. Worldwide, youth are held in incarceration, detention, and other secure settings that are inappropriate for their age and developmental stages, jeopardizing their prosocial development, and reintegration into society. Youth incarceration lacks evidence and cost-effectiveness. The well-being of youth is a key indicator of the welfare of families, communities, and society at large; therefore, the Society for Adolescent Health and Medicine (SAHM) supports a paradigm shift in the role of the justice system as it relates to treatment of youth.
Confidentiality Protections for Adolescents and Young Adults in the Health Care Billing and Insurance Claims ProcessThe importance of protecting confidential health care for adolescents and young adults is well documented. State and federal confidentiality protections exist for both minors and young adults, although the laws vary among states, particularly for minors. However, such confidentiality is potentially violated by billing practices and in the processing of health insurance claims. To address this problem, policies and procedures should be established so that health care billing and insurance claims processes do not impede the ability of providers to deliver essential health care services on a confidential basis to adolescents and young adults covered as dependents on a family's health insurance plan.
Position Paper of the Society for Adolescent Health and Medicine: Medical Management of Restrictive Eating Disorders in Adolescents and Young AdultsThe medical provider plays an important role in the management of adolescents and young adults with restrictive eating disorders including anorexia nervosa. This position paper clarifies the role of the medical provider in diagnosing and treating eating disorders, proposes an evidence-based method for determining degree of malnutrition, and advocates for standardization of terminology and consistency in the use of terms referring to ideal, expected, or median body weight. The need for medical monitoring at each level of care is underscored.
Refeeding Hypophosphatemia in Hospitalized Adolescents With Anorexia Nervosa: A Position Statement of the Society for Adolescent Health and MedicineRefeeding hypophosphatemia in hospitalized adolescents with anorexia nervosa is correlated with degree of malnutrition. Therefore, when initiating nutritional rehabilitation, clinicians should have a heightened awareness of the possibility of refeeding hypophosphatemia in severely malnourished patients (<70% median body mass index).
Sexual and Reproductive Health Care: A Position Paper of the Society for Adolescent Health and MedicineSexual and reproductive health (SRH) is an important aspect of normal adolescent growth and development that encompasses biological sex, gender roles and identity, sexual orientation, sexual behavior, and reproduction [1,2]. Achieving healthy adolescent sexual development involves managing the many physical, social, and emotional changes experienced during adolescence. Medically accurate and developmentally appropriate SRH education and barrier-free access to related clinical services  contribute to successful navigation of this developmental task.
Recommendations for Electronic Health Record Use for Delivery of Adolescent Health CareAdolescents stand to benefit greatly from improved electronic access to reliable health information and health care. Use of electronic health records (EHRs) can potentially improve health care accessibility, effectiveness, and safety but can create challenges for the ongoing protection of patient confidentiality and privacy. Protection of adolescent confidentiality as dictated by applicable laws is a responsibility shared by EHR vendors, hospital and clinic administrators, clinicians, patients, and families.
Influenza Vaccine: An Updated Position Statement of the Society for Adolescent Health and MedicineGlobally each year, 5%–10% of adults and 20%–30% of children experience influenza infections . During the 2009–2010 H1N1 influenza pandemic, these rates were higher and children and adolescents were disproportionately affected . Specifically, in the United States this pandemic was estimated to have caused 86,000 hospitalizations and 1,280 deaths among children 0–17 years of age . Worldwide, it is estimated that there were 44,500 deaths among youth 0–17 years attributable to pandemic influenza infection .
Adolescent Consent for Vaccination: A Position Paper of the Society for Adolescent Health and MedicineVaccines currently recommended for adolescents by the Advisory Committee on Immunization Practices have the potential to improve the health of youth by preventing conditions such as: tetanus, pertussis, meningococcal disease, influenza, and genital warts, as well as later adult outcomes such as cervical and other human papillomavirus–related cancers. Adolescent vaccine coverage lags behind that for younger age groups. A requirement to obtain parental consent for vaccination can present a significant barrier to improving adolescent vaccine uptake across all health care settings in which adolescents access care.
Substance Use and Sexual Intercourse Onsets in Adolescence: A Genetically Informative Discordant Twin DesignUsing a genetically informed, discordant twin analysis, the objective of this study was to examine whether earlier onset of drinking and smoking behaviors predicted early sexual intercourse onset.