Hot Topics

Hot Topics I

The Call to Action for a Global Forum for Adolescent Health and Well-being

Presenter: Jonathan Klein, MD, MPH

There are 1.8 Billion adolescents and youth in the world; but many countries lag in establishing policies and programs to meet young people’s needs. PMNCH, the Partnership for Womens’, Childrens’ and Adolescents’ Health, has launched a global call to action for adolescent health and well-being (defined by both Ross et al and by adolescents, is being able to thrive and achieve their full potential.)
 
The goal of this session is to provide SAHM members an overview of plans for the October 2023 Global Forum on Adolescence, including ways to become directly involved and engage with key stakeholders during the activities building-up to these global events.
 
The Global Forum calls on governments, funders, UN agencies, and civil society/professional organizations to mobilize new national financial, policy and service delivery commitments to young peoples’ health and well-being, engaging young people as leaders, and network for advocacy and investments in youth. Investments which yield a “triple benefit”: for youth, in adulthood, and for the next generation. This hot topic session will describe the five domains of well-being (Good health and optimum nutrition; Connectedness, positive values, and contribution to society; Safety and a supportive environment; Learning, competence, education, skills, and employability; and Agency and resilience); new evidence reports which support the call to action; the economic case for investing in adolescents; new implementation guidance; and, measurement tools to ensure accountability for investments in health, education and other systems to meet young peoples’ needs.

Educational Objectives
At the completion of the presentation, participants will be able to:
1.  understand why there is an urgent need for new global investments to address growing disparities in adolescent health and wellbeing;
2.  understand the role of evidence, advocacy, and accountability reporting in mobilizing national governments and global agencies to improve health and other needed services for adolescences;
3. understand the opportunities for SAHM member and other stakeholders to advocate for and support new policy, financing, and program or systems commitments to help meet adolescents’ needs.

Surging Fentanyl Overdoses in Adolescents and Young Adults: What Interdisciplinary Healthcare Professionals Can Do

Presenter: Scott E. Hadland, MD. MPH

This Hot Topics presentation will highlight the critical role of clinicians of all disciplines in addressing rising fentanyl overdose rates among adolescents and young adults (AYAs) internationally. In 2022, overdose death mortality reached an unprecedented level globally, including in the US, which recently recorded its millionth overdose death since 1999. During the Covid pandemic, US adolescent overdose deaths more than doubled, and three-quarters of all deaths now involve fentanyl. Fentanyl is a highly potent opioid ubiquitous in drug markets internationally. It is present in the surging counterfeit prescription pill market and is increasingly a contaminant in other drugs (e.g., cocaine). Opioid misuse most commonly begins during adolescence and young adulthood; however, receipt of evidence-based treatment for opioid use disorder remains low among AYAs, and disparities exist by gender, race, and ethnicity.
 
The presentation will review cutting-edge data on fentanyl overdose prevention and addiction treatment for AYAs, with relevance for clinicians across disciplines. Evidence-based overdose prevention strategies reviewed will include naloxone provision, developmentally-responsive overdose education, and use of fentanyl test strips. Treatment strategies will include medications for opioid use disorder and behavioral interventions.
 
The presentation will highlight how to translate the ever-evolving evidence base on overdose prevention and addiction treatment to real-world care delivered by interdisciplinary clinicians worldwide. The presentation will share AYAs’ direct quotes to show the impact of delivering such care, and in promoting health and well-being among AYAs at risk for fentanyl overdose.

Educational Objectives
1. Provide a brief overview of the global epidemiology of fentanyl overdose, with a focus on risk factors, unmet need for addiction treatment, and disparities by gender, nationality, race, and ethnicity.

2. Delineate evidence-based strategies to prevent fentanyl overdose among adolescents and young adults, including naloxone provision, developmentally-responsive overdose education for AYAs, use of fentanyl test strips, and treatment for opioid use disorder.

3. Identify ways that clinicians from medical, nursing, psychology, social work, and other backgrounds from across the globe can help prevent fentanyl overdose, with the impact of this care highlighted through quotes from real-world adolescents and young adults.

Care Under Attack: Experiences of Targeted Harassment Among Adolescent Gender Care Providers Across the United States 

Presenter: Landon Hughes

Over the past year, gender-affirming care for youth has become a hot socio-political topic and has resulted in several states severely restricting or banning the provision of such care despite support for this care from every major medical association. The restriction of evidence-based medical decision-making by state governments has dire consequences for transgender and gender diverse youth, their families, and providers, such as increased suicidality and self-harm among youth, threats of child abuse prosecution against parents, and threats of revocation of medical licensure and prison time for providers. While many of these laws and policies have been put on hold by the courts, the changing political, social, and legal environment has complicated the work of gender-affirming care providers. Our research has shown that in the past year, these providers have experienced targeted harassment, threats of violence, and significant clinic disruptions. For example, providers have indicated they’ve experienced doxing, personal death threats, and bomb threats via social media, text messages, emails, and phone calls. Furthermore, providers have described disinformation asserting that they are “grooming” children and committing child abuse circulating online and on some new outlets as being particularly troubling. Using data from our recent study of medical and mental health providers across the United States, we will share the current state of adolescent gender care and highlight strategies for advocacy and self and clinic protection.

Educational Objectives
1. Describe how the politicization of gender-affirming care for youth has affected providers’ safety.
2. Investigate strategies others are using to address this politicization and to protect providers, youth, and their families.
3. Develop coalition-building strategies to support gender-affirming care providers.

Hot Topics II

Our Burning Planet: Climate Change Action Now!

Presenter: Sadhana k. Dharmapuri, MD
 
Climate change is the biggest health threat facing humanity. Urgent and immediate action is needed to avert catastrophic health impacts from rising temperatures. No aspect of adolescent health is spared from the consequences of global warming: food and housing security, heat related morbidity and mortality, water-bourne diseases, internal displacement and migration, conflict, gender violence, infectious diseases (including STIs and HIV), and mental health disorders will all become worse. Vulnerable populations, including youth, low-income countries and communities, and minority populations that have contributed the least to global warming are the ones whose health will be most affected.

“Our house is on fire” and our youth are looking to us to stand with them and ensure that they have healthy futures. Adolescent Health Providers can and should help lead global climate action, supporting mitigation and adaptation strategies that protect young people. An accountable rights-based approach to prevention, mitigation, and adaptation framework is needed to achieve global climate change goals. Adolescent health professionals must advocate for climate justice and equitable resources, urge health systems to mitigate their adverse impacts on the environment, advocate for professional and health organizations to focus on green investments, be leaders in climate education of the next generation of adolescent health providers, and focus research on equitable strategies to reduce climate harms .

Educational Objectives
1. Understand the impact of climate change on adolescent health and demonstrate actions to improve adolescent health, as it relates to those changes.

2. Identify strategies for healthcare providers to advocate for mitigation and adaptation to global warming in health care and advocate in the broader community for curbing fossil fuel use and halting and/or mitigating climate change.

3. Promote climate justice and research on equitable strategies to reduce climate harms as they relate to adolescent health.

Resetting the Narrative: Teens, Tech and Mental Health

Presenter: Megan Moreno, MD, MSEd, MPH


The past decade has seen increasing adolescent digital media engagement. The dominant narrative among US news media and medical science has centered on social media risks for teen mental health. Previous research has focused on social media time and mental health consequences. Findings have been elevated via news media via fear-based messaging. Previous research supports that fear-based messages in news media can lead parents to feel hopeless and helpless.
Today, research has illustrated other important factors regarding social media and adolescent mental health. These factors include quality of social media experiences, and parents’ social media engagement. Further, new tools exist to support teens and parents in navigating the digital world. These newer findings and tools are not reflected in the current fear-based narrative.

As adolescent health providers, researchers and advocates, we have the opportunity to be at the forefront of advancing a new narrative around teens, tech and mental health. This narrative should reflect current evidence and provide agency to teens and their families to guide their technology interactions. This hot topic will arm audience members with the newest evidence on key factors in adolescent mental wellbeing and technology. We will share how this evidence informs the work of the new American Academy of Pediatrics Center of Excellence: Creating a Healthy Digital Ecosystem for Children and Youth, and why resetting the narrative is a first priority for this work. Finally, we will share opportunities for involvement in the next steps of research, patient education and center engagement.

Learning Objectives
1.  Analyze the current evidence for how narrative impacts public health

2. Identify factors that affect the relationship between adolescent mental health and wellbeing, and digital technology use

3. Identify opportunities for involvement to advance the narrative around adolescent mental health and wellbeing and digital technology use

The status of over-the-counter oral contraceptive pills in the United States: recent updates and future directions

Presenter: Alana Otto, MD, MPH
 
Oral contraceptive pills (OCPs) are available over the counter in over 100 countries; however, currently, no OCPs are available over the counter in the United States (US). For the first time, the US Food and Drug Administration (FDA) is considering an application for over-the-counter status for an OCP. FDA approval of an over-the-counter OCP represents an unprecedented opportunity to dramatically increase access to this method of contraception in the US, particularly for adolescents and young adults, including those who have been underserved by or excluded from the healthcare system.

OCPs are a safe and effective method of contraception that require no specific evaluation or testing prior to use, making them appropriate for over-the-counter use. Data indicate people, including adolescents, can interpret OCP drug fact labels and accurately determine whether they can safely use these pills.

Health professionals who work with adolescents have critical roles to play in advocating for over-the-counter access to OCPs and other effective forms of contraception, in supporting adolescents and young adults seeking and using over-the-counter OCPs, and in conducting further research the use of over-the-counter OCPs among adolescents. The experience and knowledge of professionals working in countries where OCPs are already available over the counter can be particularly valuable to inform practice and policy in the US.

Learning Objectives
1. Describe the status of over-the-counter oral contraception in the United States, including the pending application for FDA approval for over-the-counter status for a norgestrel-only pill

2. Evaluate information regarding over-the-counter use of OCPs, including data related to efficacy, tolerability, and safety, for adolescent patients 

3. Interpret recent research findings that may be used to inform policies regarding over-the-counter OCPs and identify resources for ongoing learning and advocacy

Hot Topics III

Credit Hour(s): 1

We will review the newest hormonal contraceptive methods available in the U.S., updating providers on new contraceptive patch, new contraceptive ring, plant-based OCP, new POP, and vaginal gel.
 
We will describe evidenced-based updates to duration of efficacy for some of the long-acting reversible contraceptive methods.
 
We will discuss best practices in non-coercive contraceptive counseling grounded in a reproductive justice framework–shifting focus from effectiveness of pregnancy prevention to bodily autonomy, patient priorities, and cultural beliefs.

Educational Objectives
1. Describe new hormonal contraceptive options for adolescents and young adults

2. Understand the updated evidence-based duration of efficacy for common long-active reversible contraceptive methods

3. Implement reproductive justice informed contraceptive counseling for their patients

Reproductive Justice, Conscientious Action, and Civil Disobedience

Presenter: Nomi Sherwin

.Conscientious objection has long been a part of the moral discourse for adolescent providers, and professional societies have longstanding best practice guidelines on when and how providers may refuse to provide care. Recent legislation at the federal, state, and local levels have sparked debates about situations where adolescent providers may have a moral obligation for action, in effect bringing discussion about conscientious provision of care. Abortion, contraceptive access, and gender-affirming care are three areas where claims of conscience have arisen.

With claims of conscience (both refusal of care and action), there is value in respecting the individual providers’ moral integrity and beliefs about the rightness or wrongness of care. This value must be balanced against patient access to accurate health information and evidence-based medical care. The adolescents most affected by claims of conscience are those that are the most vulnerable and experience the greatest health inequities: young people of color, gender diverse and sexual minority youth, young women, rural youth, and poor youth.

Human rights documents outline a clear standard of reproductive health care for adolescents. The need for civil disobedience arises when providers feel that legislation is unjust and acts as a barrier to adolescents receiving necessary health information and evidence-based care. While some professional societies, like the American Medical Association, support civil disobedience in limited instances, others, like the American Nursing Association, are silent on the matter. SAHM does not currently have a statement discussing civil disobedience or conscientious action.

Educational Objectives
1. Define claims of conscience and the ethical arguments for and against claims of conscience.

2. Differentiate civil disobedience from claims of conscience

3. Describe the reproductive justice landscape driving claims of conscience and civil disobedience

The rapidly evolving playing field of transgender athletes participation in sports

Presenter: Dale M. Ahrendt, MD, FSAHM


The participation of transgender athletes in sports has become a controversial and rapidly evolving topic in the US and world-wide. At least 20 US states have passed laws banning transgender athletes at the K-12 level from participating in school sports. Some have tried to extend those bans to the college level without success. Collegiate athletes must still deal with changing rules that can leave them unsure of their ability to compete.

In 2021 the International Olympic committee issued guidelines for transgender athletes in sports which then left it to individual international sports governing bodies to implement their own rules. The NCAA policy is to follow the rules of the governing bodies. Some have issued rules, but they are diverse and provisional. Many have yet to do so.

The research supporting the development of these policies is limited but growing. It is likely that many of these rules will (and should) continue to evolve with the science.

Where does that leave the transgender athlete who wants to participate in sports? How does it affect their ability to get and keep college scholarships? How do policies that restrict sports participation impact their lives?

An overview of this topic will be provided to allow clinicians to address questions that come up now and give you the background information you need to understand the changes that occur in the future.

Educational Objectives
1. Interpret the IOC guidelines for transgender sports participation and how they are to be used in the development of regulations for individual sports

2. Analyze the data on the impact of gender affirming hormonal therapy on sports performance

3. Counsel individual transgender patients on determining their eligibility to compete in sports at all levels