Hot Topics

The Hot Topics sessions is one of the most popular components of SAHM annual meetings. There are two sessions, each consisting of three twenty minute presentations on today's hottest topics in adolescent health.  


Hot Topics I: Wednesday, March 11 - 10:30 - 11:30 a.m.

Moderator: Gregg Montalto, MD, MPH

Exploring SAHM's new position paper: Preventing Firearm Violence in Youth through Evidence-Informed Strategies
Eric Sigel, MD
University of Colorado School of Medicine

Epidemiology of Firearm Violence: In 2017, 7,939 United States (US) adolescents and young adults (AYA) aged 12-24 died from firearm injuries, including 4,486 homicides, 3,128 suicides and 125 unintentional deaths; the highest firearm mortality rate since the early 1990’s. Firearms now outpace motor vehicles as the leading mechanism of death for 12-24-year-olds – a rate of 14.3/100,000, compared to 12.6/100,000 for motor vehicles. An additional 40,073 AYA suffered non-fatal firearm injuries SAHM Position Paper: In response to this ongoing crisis, SAHM has issued a new position paper updating recommendations that SAHM members can adopt with the goal of decreasing the health impact of firearms on AYA. This presentation will review the salient recommendations, which include evidence-based clinical approaches, effective legislation proven to decrease firearm mortality, school and community approaches, calling on the government to increase funding for firearm research, and to encourage providers to increase their knowledge base. Specific clinical tools to address firearm violence include screening youth and parents for firearm access, delivering a safe storage message, and distributing locking devices through the clinic setting. The topic of firearm violence directly reflects the conference theme- Transforming Risk to Wellness- as the entire focus of the position statement seeks to mitigate the risk firearms- the leading cause of death in AYA- pose to the health and well-being of those we serve. Though recognized as a uniquely US issue, international attendees will also learn approaches that may also be effective in the countries they reside in.

Learning Objectives:

  1. Discuss the epidemiology of e-cigarette or vaping associated lung injury (EVALI) among adolescents and young adults with a focus on demographic and substance use risk factors    
  2. Describe the clinical presentation and pathophysiology of EVALI, including common signs and symptoms, as well as typical imaging and laboratory findings   
  3. Determine how providers with medical, nursing, psychology, social work, and other professional backgrounds can screen for and address EVALI in their own clinical practices using evidence-based strategies.

#thisisourlane: Leveraging Teachable Moments to Promote Wellness After Firearm Injury
Alison Culyba, MD, PhD, MPH
UPMC Children's Hospital of Pittsburgh, University of Pittsburgh
Firearm-related injuries now outpace motor vehicle collision as the leading cause of death among U.S. AYA ages 12-24, and far exceed the rates in other high-income countries. According to 2017 YRBSS, 4.8% of U.S. high school students reported carrying a gun in the past year, increasing risk for violent injury. While mass shootings and school shootings often dominate the news, youth of color in marginalized communities bear a disproportionate burden of firearm violence. Recognizing firearm violence and injury as a public health issue offers important opportunities for prevention.

Violently-injured youth are at high risk for re-injury and mental health sequelae; 25-40% experience reinjury and 15-75% experience post-traumatic stress symptoms. Hospital-initiated violence intervention programs (HVIPs) provide a novel approach that capitalizes on the post-injury period as a teachable moment to engage youth and families through individualized case management and linkage to community-based resources. Emerging research across the Health Alliance for Violence Intervention network demonstrates that HVIPs can reduce reinjury and promote healing and recovery. 

Grounded in the voices of violently-injured youth and frontline violence intervention specialists, this Hot Topic presentation will provide a brief overview of the epidemiology of firearm violence, highlight the disproportionate burden experienced by young people of color, examine the role of HVIPs in firearm violence prevention, and translate HVIP best-practices into brief trauma-informed strategies all adolescent health professionals (physicians, nurses, social workers, psychologists, advanced practice providers, other health professionals) can use to foster wellbeing following violent injury.

Learning Objectives:

  1. Frame firearm violence as a public health issue firmly in the domain of AYA health
  2. Identity key components of hospital-initiated violence intervention programs (HVIPs)
  3. Describe practical strategies for adolescent health providers engaging with youth to promote healing and recovery following violent injury

Ensuring Access to Safe, Legal Abortion for Young People: What Adolescent Health Professionals Need to Know about Self Managed Abortion
Krishna K. Upadhya, MD, MPH
Planned Parenthood Federation of America
While the prevalence of self managed abortion (SMA) is difficult to measure, research indicates many adolescents and young adults are seeking information about SMA online. This is not surprising given that youth are particularly vulnerable to geographic, legal, political, and cultural barriers to abortion care. Even in the absence of barriers some individuals prefer SMA to in-clinic abortion.

Use of mifepristone followed by misoprostol is a safe and effective medication abortion regimen endorsed by the World Health Organization (WHO). In the United States, the Food and Drug Administration’s Risk Evaluation and Mitigation Strategy (REMS) restrictions require mifepristone to be dispensed to patients only in clinics, medical offices, and hospitals under the supervision of a certified prescriber. In combination with restrictive state laws, REMS limit the growth of novel and patient-centered approaches to delivery of medication abortion, including telemedicine and pharmacy dispensing.

Under an increasingly restrictive abortion access landscape, travel to a clinical site may be especially challenging for youth, and may increase the need and/or desire to end an unwanted pregnancy outside of the healthcare system. Research indicates mifepristone and misoprostol ordered online can be safe and effective, but legally risky. Criminal charges related to young people attempting abortion outside of a healthcare system, including by obtaining medications by mail, have occurred in the United States. Advocacy by adolescent health professionals and organizations to ensure access to safe, effective abortion care and to eliminate criminal penalties for individuals self managing abortion is important to promoting youth health and wellness.

Learning Objectives:

  1. Understand the current context and extant research on self managed abortion in the United States
  2. Describe the World Health Organization recognized regimens for medication abortion, emerging evidence regarding innovative approaches to delivery of medication abortion services, and data on the safety and effectiveness of these approaches
  3. Understand the importance of expanding access to both in-clinic and self-managed medication abortion, and the importance of decriminalizing self-managed abortion, especially for young people

Hot Topics II: Thursday, March 12 - 10:15 - 11:15 a.m.

Moderator: TBD

No Vapor Without Fire: a primer on e-cigarette and vaping associated lung injuries
Nicholas Chadi, MD, MPH
Sainte-Justine University Hospital Centre/University of Montreal

E-cigarette or vaping associated lung injury (EVALI) is a newly recognized clinical entity that can lead to severe illness and even death. While EVALI can affect individuals of all ages, more than 50% of cases have been reported in youth under the age of 25. Most affected individuals report using vaping products containing tetrahydrocannabinol, the main psychoactive substance found in marijuana. Use of flavored or unflavored vaping products, with or without nicotine, as well as use of vaping products purchased from the black market are also common among affected individuals. -Individuals with EVALI present with severe respiratory symptoms such as shortness of breath, cough and chest pain, often accompanied by gastro-intestinal symptoms such as nausea, vomiting, diarrhea and abdominal pain. They can also present with constitutional symptoms such as fever, chills and weight loss. The pathophysiology of EVALI involves an acute and non-specific pattern of lung inflammation, in the absence of a known infectious cause, which is clearly visible on chest imaging studies. -Providers can screen for use of e-cigarettes and other vaping products using short validated screening tools. Youth presenting with non-specific respiratory, constitutional and gastro-intestinal symptoms should be asked about use of vaping products in the past 90 days. Management of youth with suspected EVALI includes close inpatient or outpatient monitoring, corticosteroid administration and cessation of e-cigarette or vaping product use. Different strategies such as behavioral counseling, motivational interviewing, cognitive-behavioral therapy and use of nicotine replacement therapy can be helpful in supporting cessation efforts.    

Learning Objectives:

  1. Discuss the epidemiology of e-cigarette or vaping associated lung injury (EVALI) among adolescents and young adults with a focus on demographic and substance use risk factors    
  2. Describe the clinical presentation and pathophysiology of EVALI, including common signs and symptoms, as well as typical imaging and laboratory findings    
  3. Determine how providers with medical, nursing, psychology, social work, and other professional backgrounds can screen for and address EVALI in their own clinical practices using evidence-based strategies.    

Treatment of Chronic Hepatitis C in Youth: Leveraging a Transition from Risk to Wellness
Scott E. Hadland, MD, MPH, MS
Boston Medical Center / Boston University School of Medicine
This Hot Topics presentation will highlight the critical role of clinicians of all disciplines in treating hepatitis C virus (HCV). Recent data from the World Health Organization (WHO) highlight the rising global prevalence of HCV, reaching 1 in 43 individuals in some countries. Risk factors—often established during youth—include injection drug use, sexual intercourse, human immunodeficiency virus, and incarceration. In many settings, the incidence of HCV is rising more rapidly among young adults than any other group. Receipt of treatment remains low, and disparities exist by gender, nationality, and race/ethnicity.
The presentation will review treatment with direct-acting antivirals (DAAs) for youth ≥12 years, and underscore how treatment can be incorporated into an interdisciplinary care continuum. Medication choice has historically been based on age, genotype, viral load, and fibrosis. However, at the time of writing, several regulatory agencies had approved 8-week treatment with glecaprevir/pibrentasvir for all youth ≥12 regardless of genotype, dramatically simplifying treatment choices. By the time of the Hot Topics presentation, this simplified treatment regimen will likely be recommended by WHO. Even still, clinicians will need to advocate for expansion of these expensive medications into resource-poor settings.
Last, the presentation will show how clinicians, by incorporating HCV treatment into routine care, can support a transition from risk to wellness. Since treatment can engage difficult-to-reach populations in healthcare, the presentation will use youths’ direct quotes to show how their clinicians leveraged this opportunity to offer other medical and mental health services to traditionally underserved youth.

Learning Objectives: 

  1. Provide a brief overview of the global epidemiology of hepatitis C, including risk factors, unmet need for treatment, and disparities by gender, nationality, race, and ethnicity.
  2. Determine hepatitis C treatment regimens (including newer simplified algorithms, as well as those defined by patient age, hepatitis C genotype, viral load, and fibrosis), and assess the availability of treatment in resource-poor settings.
  3. Identify ways that clinicians from medical, nursing, psychology, social work and other backgrounds can address hepatitis C in their practices, and through youths’ quotes, highlight how treatment can leverage the transition from risk to wellness.

New Regulations for Transgender Athletes
Dale Ahrendt, M.D.
San Antonio Health Education Consortium

In October of 2019 the International Association of Athletics Federations (IAAF) Council approved the World Athletics Eligibility Regulations for Transgender Athletes establishing new rules for transgender athletes to compete. It is expected that the majority of the major athletic organizations will soon adopt these guidelines as well. What is the science upon which they based their decisions? One of the essential questions is how hormone therapy affects athletic performance. Especially for professional sports organizations that have gender specific divisions, where does the transgender athlete compete? Transgender individuals are faced with many challenges during their quest to discover and become the person they are and to have an equal place in society. Exercise through both recreational and professional sports is an important tool to help mitigate these problems and promote wellness. The ability to participate in competitive sports is a principal component in that process, but many organizations have rules that create barriers instead of a pathway for participation. In this presentation I will review the process that led to the new regulations and summarize some of the principal research upon which it was based. I will conclude with a list of important science-based principles that can be used to advocate for the transgender athlete so they can be included instead of excluded. Exercise for wellness should be a right for everyone.  

Learning Objectives:

  1. Analyze the new IAAF World Athletics Eligibility Regulations for Transgender Athletes    
  2. Summarize the performance-related effects of cross-sex hormone treatment on both male and female transgender athletes    
  3. Advocate for transgender sports participation at both the recreational and professional level  

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