Adolescent And Young Adult Women Research Articles

Discordant and Concordant Substance Use and Daily Partner Violence in Adolescent and Young Adult Relationships With Baseline Dating Violence

PurposeIntimate partner violence (IPV) and substance use in adolescents and young adults (AYAs) are significant public health issues in the United States. Together, they can harm emotional regulation and romantic relationship functioning. This study examines the role of concordant and discordant substance use on IPV within AYA relationships. MethodsA prospective cohort of community-recruited AYA women in a heterosexual dating relationship with past-month IPV completed four months of daily surveys via a cell phone. Each day, participants reported any IPV perpetration and/or victimization, their alcohol and drug use, and observed partner substance use. Concordant substance use was coded when the participant and partner used drugs or alcohol on the same day. Discordant use was coded when only the participant or partner used drugs or alcohol on a given day. Alcohol and drug use were modeled separately. Generalized estimating equations accounted for the correlation of repeated measures. ResultsParticipants (N = 143) were 18.2 (1.1) years old, 93% African American race. Discordant alcohol and drug use was associated with same-day victimization, perpetration, and co-occurring violence compared to concordant nonuse. Similarly, concordant alcohol use, drug use, and alcohol/drug use were associated with increased odds of victimization, perpetration, and co-occurring violence compared to concordant nonuse. DiscussionDaily data illustrated that dyadic patterns of substance use are associated with IPV. These findings may facilitate the development of effective and developmentally appropriate IPV intervention programs for AYA that also integrate strategies to reduce substance use.

Illness Uncertainty and Intrusiveness in Adolescent and Young Adult Women with Self-Reported Chronic Migraines

ABSTRACT Background Chronic migraines result in debilitating pain requiring complex and multifaceted daily management, including acting purposefully to attenuate symptoms and decrease impairment. Experiencing migraines may be more psychologically challenging for adolescent and young adult (AYA) women due to complex and recurrent stressors. Purpose This study examined the relationships between illness specific cognitive appraisal mechanisms (i.e., illness uncertainty and illness intrusiveness) and psychological adjustment (i.e., anxious and depressive symptoms) in AYA women with self-reported chronic migraines. Methods AYA women (N = 74, Mage = 20.19, SD = 3.41) with chronic migraines completed measures of illness uncertainty, illness intrusiveness, anxious, and depressive symptoms. Results Two hierarchical regression analyses indicated that illness uncertainty (B = .44, p < .001) and intrusiveness (B = .27, p = .026) significantly predicted anxious, F(4, 68) = 12.83, p < .001, and depressive symptoms, F(4, 68) = 8.48, p < .001, B = .31, p = .021 and B = .27, p = .037. Discussion Greater illness uncertainty and illness intrusiveness were associated with greater anxious and depressive symptoms. Thus, it may be that AYA women who experience chronic migraines have increased perceptions of ambiguity, unpredictability, and disruption to their life that significantly contribute to their psychological adjustment outcomes. Translation to Health Education Practice This study demonstrates a need for health education on the role of illness related cognitive appraisal mechanisms for AYA women with chronic migraines.

Birth Defects in Offspring of Adolescent and Young Adults with a History of Cancer: A Population-Based Study of 27,000 Women.

We examined birth defects in offspring of adolescent and young adult (AYA) women with a history of cancer (age 15-39 years at diagnosis). We identified AYA women diagnosed with cancer between January 1, 1999, and December 31, 2015 using population-based data from the Texas Cancer Registry; data were linked with live birth and fetal death certificates through December 31, 2016 to identify singleton births to AYA women after diagnosis. Birth defects in offspring through age 12 months were ascertained from the Texas Birth Defects Registry. We estimated risk of birth defects in offspring of AYA women and women without cancer (matched 3:1 by maternal race/ethnicity, maternal age, and offspring year of birth) and compared risk using log binomial regression models. There were 6,882 singleton births to AYA women after diagnosis. Common cancer types were thyroid (28.9%), lymphoma (12.5%), and breast (10.7%). Risk of any birth defect was higher in offspring of AYA women (6.0%) compared with offspring of women without cancer [n = 20,646; 4.8%; risk ratio (RR) 1.24; 95% confidence interval (CI), 1.11-1.38]. Risk of eye or ear (RR, 1.39; 95% CI, 1.03-1.90), heart and circulatory (RR, 1.32; 95% CI, 1.09-1.60), genitourinary (RR, 1.38; 95% CI, 1.12-1.69), and musculoskeletal (RR, 1.37; 95% CI, 1.13-1.66) defects was also higher. Risk of birth defects was elevated in liveborn and stillborn offspring of AYA women. Although birth defects are rare, AYA women making decisions about pregnancy and prenatal care should receive appropriate counseling and surveillance.

A deep-learning-based clinical risk stratification for overall survival in adolescent and young adult women with breast cancer.

The objective of this study is to construct a novel clinical risk stratification for overall survival (OS) prediction in adolescent and young adult (AYA) women with breast cancer. From the Surveillance, Epidemiology, and End Results (SEER) database, AYA women with primary breast cancer diagnosed from 2010 to 2018 were included in our study. A deep learning algorithm, referred to as DeepSurv, was used to construct a prognostic predictive model based on 19 variables, including demographic and clinical information. Harrell's C-index, the receiver operating characteristic (ROC) curve, and calibration plots were adopted to comprehensively assess the predictive performance of the prognostic predictive model. Then, a novel clinical risk stratification was constructed based on the total risk score derived from the prognostic predictive model. The Kaplan-Meier method was used to plot survival curves for patients with different death risks, using the log-rank test to compared the survival disparities. Decision curve analyses (DCAs) were adopted to evaluate the clinical utility of the prognostic predictive model. Among 14,243 AYA women with breast cancer finally included in this study, 10,213 (71.7%) were White and the median (interquartile range, IQR) age was 36 (32-38) years. The prognostic predictive model based on DeepSurv presented high C-indices in both the training cohort [0.831 (95% CI 0.819-0.843)] and the test cohort [0.791 (95% CI 0.764-0.818)]. Similar results were observed in ROC curves. The excellent agreement between the predicted and actual OS at 3 and 5years were both achieved in the calibration plots. The obvious survival disparities were observed according to the clinical risk stratification based on the total risk score derived from the prognostic predictive model. DCAs also showed that the risk stratification possessed a significant positive net benefit in the practical ranges of threshold probabilities. Lastly, a user-friendly Web-based calculator was generated to visualize the prognostic predictive model. A prognostic predictive model with sufficient prediction accuracy was construct for predicting OS of AYA women with breast cancer. Given its public accessibility and easy-to-use operation, the clinical risk stratification based on the total risk score derived from the prognostic predictive model may help clinicians to make better-individualized management.

Preferences for Rectal Sexually Transmitted Infection Sample Collection and Sexual Behaviors Among Adolescent and Young Adult Women Accessing Primary Care Services.

High prevalence of asymptomatic rectal chlamydia and gonorrhea among women is increasingly recognized. Screening is controversial because of lack of natural history data. Barriers to screening may include reluctance to discuss anal sex and collect rectal samples. This study describes the prevalence of sexual contact exposing adolescent and young adult women to extragenital sexually transmitted infections and acceptability of self-collection and clinician collection of rectal samples, preference for self- versus clinician-collected rectal samples, and preference for home or doctor's office for sample collection. Participants were recruited from a primary care office and completed structured interviews assessing types of sexual contact and attitudes about rectal sampling. Differences were tested using χ2 and 2-sided Fisher exact test. Of 110 cisgender women (aged 14-22 years) enrolled, the average age was 18.4 years (SD, 1.7 years), 83% reported a history of extragenital contact, 22% reported history of receptive anal intercourse. A majority of participants reported self- and clinician-collected rectal samples to be acceptable (86% and 73%, respectively), with preferences for self-collection (71%) over clinician collection (29%, P < 0.001) and collection at the doctor's office (85%) over home (15%, P < 0.001). Adolescent and young adult (AYA) women engage in behaviors that increase the risk of rectal sexually transmitted infection (STI). Self- and clinician-collected rectal samples were acceptable. A majority of AYA women preferred to collect rectal samples in the doctor's office rather than at home. This may reduce adolescents' access to direct-to-consumer STI services. Offering in-clinic, self-collected rectal samples may improve uptake of rectal STI screening in adolescent girls.

Racial, Lifestyle, and Healthcare Contributors to Perceived Cancer Risk among Physically Active Adolescent and Young Adult Women Aged 18-39 Years.

The cancer incidence among adolescents and young adults (AYAs) has significantly increased in recent years, but there is limited information about the factors that influence the perceived cancer risk among AYAs. A cross-sectional, web-based survey of 281 physically active Black and White AYA women was administered to assess the influences of demographic characteristics, family history of cancer, cancer risk factor knowledge, and lifestyle-related risk and protective behaviors on perceived cancer risk. Linear regression analyses were performed in SAS version 9.4. Self-reported Black race (β = -0.62, 95% CI: -1.07, -0.17) and routine doctor visits (β = -0.62, 95% CI: -1.18, -0.07) were related to a lower perceived cancer risk. Family history of cancer (β = 0.56, 95% CI: 0.13, 0.99), cancer risk factor knowledge (β = 0.11, 95% CI: 0.03, 0.19), and current smoking status (β = 0.80, 95% CI: 0.20, 1.40) were related to a higher perceived cancer risk. Perceptions of cancer risk varied among this sample of physically active, AYA women. Lower perceptions of cancer risk among Black AYA women demonstrate a need for culturally tailored cancer educational information that presents objective data on lifetime cancer risk. Reportedly higher perceptions of cancer risk among AYA smokers presents an ideal opportunity to promote smoking cessation interventions. Future interventions to address cancer risk perception profiles among physically active, AYA women should tailor approaches that are inclusive of these unique characteristics.

Abstract P4-06-06: Neoadjuvant B27 protocol in Triple-Negative Breast Cancer: Evaluation response rate, pathological complete response rates,toxicity,and the prognosis of Adolescent and Young Adult (AYA) age group compared to older population

Abstract Background: Neoadjuvant chemotherapy (NACT) is the standard early-stage triple-negative breast cancer (TNBC) treatment. Achieving pathological complete response (pCR) is considered an essential prognostic factor with favorable long-term outcomes. Younger patients have with poorer prognosis in breast cancer. To date, few studies are comparing the prognosis of AYA and older women (≥40) with breast cancer subtypes, specifically Triple-negative breast cancer (TNBC), as AYAs had higher proportions of this subtype. Method: Retrospective review was performed on female patients who received NACT at a King Hussien Cancer Center from January 2014 to June 2020. Data were collected from patients’ electronic medical records. TNBC was histopathologically confirmed. Logistic regression analysis of predictors of pathologic complete response (pCR). Survival curves were estimated with the Kaplan-Meier method. Multivariate analysis for EFS was performed using Cox’s proportional hazards regression model, covariates included age at diagnosis (AYA vs. ≥40), tumor size, nodal status LVI and pCR Result: We analyzed 211 women with stage I-III TNBC, including 62 (29.4%) women aged 18 to 39 years (AYA) and 149 (70.6%) ≥40 years. 138 (68.3%) were node positive, and 71 (34.8%) were T3/4 disease. Median follow-up was 28.1 months, median number of ER visit during NAC is 1 (0-11), 23 (10.9 %) patients had admission during neoadjuvant chemotherapy, most commonly due to febrile neutropenia 13 (56.9%). 37 (17.5%) patients did not complete NAC, due to disease progression in 22 (10.4%), and toxicity in 15 (7.1%) patients. 195 (92.4%) patients had surgery, including 75 (35.5%) had breast-conserving surgery (BCS). 166 (76.3%) patients had objective response, and 64 (30.3%) had pCR. 170 (80.6%) received adjuvant radiotherapy, and 38 (18%) received adjuvant capecitabine. No significant differences between the AYA and the ≥40 group in terms of clinicopathological, toxicity, pCR rate, and the rate of BCS. In univariate analysis, the LVI, nodal status, pCR, and age group were significant predictors of DFS. In multivariate analysis, only PCR and age are the only independent predictor of DFS. The median DFS was worse in the AYA population 47.8 (31.21-64.39) months vs. NR in ≥40 (p-value 0.013). In patients who achieved pCR, the estimated 5-years DFS for the AYA group was 56.1% versus 86.8% for the ≥40 group, (p-value 0.71). In patients with residual disease, PFS for AYA was 34.2 (95%CI 11.5-57) months vs. 59.5 months in the ≥40 group, (p 0.009). Conclusion: Although there is no difference in pCR between the AYA age group patient treated with NACT for TNBC and the older age group, the DFS is significantly worse in the AYA than the ≥40 age group in patients with residual disease. As well, DFS is numerically worse in the AYA age vs. the ≥40 age group in patients who achieved pCR. Citation Format: Faris Tamimi, Baha’ Sharaf, Suhaib Khater, Suhaib Al-Sawajneh, Malek Horani, Khalid M. Elrabii, Anas Zayed, Hikmat Abdel-Razeq. Neoadjuvant B27 protocol in Triple-Negative Breast Cancer: Evaluation response rate, pathological complete response rates,toxicity,and the prognosis of Adolescent and Young Adult (AYA) age group compared to older population [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P4-06-06.

Levels, Trends, and Causes of Adolescent and Young Adult Maternal Mortality in Nigeria During 1990–2017: Analysis of the 2017 Global Burden of Disease Study Database

Background: Despite the global progress made in reducing maternal mortality in the past two decades, the health of adolescents and young adult women (10-24 years) has been neglected based on the wrong assumption that they are healthy, especially in a developing country like Nigeria; this is despite the fact that adolescents and young adults (AYA) constitute over 16% of Nigeria’s population. Thus, this study aimed to determine the levels, trends, and causes of maternal mortality among AYA women aged 10-24 years in Nigeria. Methods: This was a cross-sectional study that utilized secondary data sets running from 1990 to 2017 from the Global Burden of Disease Study’s (GBD) online interactive tool downloaded from the Global Health Data Exchange (GHDx) platform. From the database, we extracted the numbers of maternal deaths (10-49 years), adolescent and young adults’ maternal deaths (10-24 years), the proportion of maternal deaths (10-24 years), and both maternal mortality ratio and rate for 15-49 years old and 10-24 years old in the form of Comma separated values (CSV) and converted into XLS file in Microsoft (MS) Excel format for the analysis. Frequencies, proportions, and charts were generated using MS Excel. Result: A total of 122,107 maternal deaths occurred among adolescents and young adults (AYA), which is 26% of all deaths occurring among 10-49 years old. Year-to-year changes in the absolute numbers of maternal deaths among AYA showed that it ranged from 3,866 (1990) to 4,451 (2017), showing a slight upward increase over the period; however, both AYA maternal mortality ratio and rate show consistent declines over the period. AYA maternal mortality ratio (MMR) for adolescents aged 15-19 years was 17% higher than for young adults aged 20-24 years. Sepsis was the leading cause of adolescent maternal death (MMR of 168), followed by maternal hypertensive disorder, obstructed labor, maternal hemorrhage, ectopic pregnancy, and abortion. A total of 460,155 maternal deaths occurred in women aged 10-49 years during the study period. Maternal deaths in the age group 10-24 years ranged from 3,866 (29.8%) in 1990 to 4,451 (25.1%) in 2017. The maternal mortality ratio in women aged 10-49 years declined by about 30% for the 1990 – 2017 period. Conclusion and Implications for Translation: The study showed that adolescents and young adults are at increased risk of maternal deaths in Nigeria. Therefore, multi-faceted maternal health programs in the country need to target this age group to prevent maternal deaths. Copyright © 2022 Dahiru et al. Published by Global Health and Education Projects, Inc. This is an open-access article distributed under the terms of the Creative Commons Attribution License CC BY 4.0.

Cancer incidence in U.S. adolescent and young adult (AYA) women stratified by race/ethnicity and region.

e18529 Background: Cancer incidence is higher in AYA women compared to men and is increasing. National trends by race/ethnicity and region for AYA women in the U.S. are needed to improve health care outcomes. Methods: Data about the top ten cancers 2001-2017, race/ethnicity, and 9 CDC divisions were extracted from US Cancer Statistics Public databases encompassing 99% of US population. Age-adjusted incidence and its annual percent change (APC) were generated using SEER*Stat and trends analyzed via joinpoint regression. All statistical tests were two sided. Results: The top ten cancers in AYA women were: breast (incidence of 26.7 per 100,000), thyroid (16.0), melanoma (11.5), cervical (8.8), colorectal (4.1), uterine (3.5), non-Hodgkin lymphoma (3.6), Hodgkin lymphoma (4.0), and leukemia (3.1). Hispanic women had the highest incidence of uterine and cervical cancer and leukemia. Incidence of breast and colorectal cancer and non-Hodgkin lymphoma was highest in NH Black. Thyroid and colorectal cancer, melanoma, and Hodgkin lymphoma incidences were highest in NH White. Incidence trends included: 1) rise in breast (APC 0.5%), uterine (2.9%) in 2001-2017, and colorectal cancer (2.2% 2001-2013; 6.7% 2013-2017); 2) thyroid cancer (APC 2.1-7.2%) 2001-2015; (-5.7%) 2015-2017; 3) melanoma (-1%) 2005-2017; 4) cervical cancer (-1.4%) 2001-2013; 5) non-Hodgkin lymphoma (-0.5%) in 2007-2017; 5) Hodgkin lymphoma (-0.9%) 2007-2017; 6) leukemia (2.4%) 2001-2012 (p &lt; 0.05). Incidence trends by race/ethnicity included: 1) breast cancer rise in all groups except for NH Black; 2) thyroid cancer rise in all 2001-2015; fall in NH White 2015-2017; 3) melanoma fall in Hispanic and NH Other, rise in NH White 2001-2005); 4) cervical cancer decline in all, Hispanic 2001-2013; 5) colorectal and uterine cancer rise in all; 6) fall in non-Hodgkin lymphoma in NH Black 2005-2017; rise in NH Other; 8) fall in Hodgkin lymphoma in NH White; 7) ovarian cancer rise in Hispanic; 8) leukemia rise in all, NH black 2001-2015 (p &lt; 0.05). Division incidence trends included: 1) breast cancer rise in New England and Middle Atlantic (APC 0.7%); 2) colorectal cancer rise in New England (3.5%) and Mountain (4%); 3) melanoma fall in West South Central (-1.1%); 4) cervix cancer fall in West South Central (-0.3%) and South Atlantic (-0.7%); 5) uterine cancer rise in East North Central (2.3%), South Atlantic (3.0%), and West South Central (4.3%); 6) non-Hodgkin lymphoma rise (0.54%) in Pacific; 7) leukemia rise in South Atlantic (2.4%) and West South Central (0.9%) (p &lt; 0.05). Conclusions: Breast, colorectal, uterine cancer, and leukemia incidence rose in AYA women, while thyroid and cervical (2001-2013) cancer, melanoma and lymphoma incidence fell, with variation by race/ethnicity and division. Research to describe environmental, lifestyle, and healthcare/policy factors and correlate them with outcomes is an urgent unmet need to improve equity in cancer outcomes.

Fertility Preservation and Financial Hardship among Adolescent and Young Adult Women with Cancer.

Financial hardship among adolescents and young adults (AYA) with cancer who receive gonadotoxic treatments may be exacerbated by the use of fertility services. This study examined whether AYA women with cancer who used fertility preservation had increased financial hardship. AYA women with cancer in North Carolina and California completed a survey in 2018-2019. Cancer-related financial hardship was compared between women who cryopreserved oocytes or embryos for fertility preservation after cancer diagnosis (n = 65) and women who received gonadotoxic treatment and reported discussing fertility with their provider, but did not use fertility preservation (n = 491). Multivariable log-binomial regression was used to estimate prevalence ratios and 95% confidence intervals (CI). Women were a median age of 33 years at diagnosis and 7 years from diagnosis at the time of survey. Women who used fertility preservation were primarily ages 25 to 34 years at diagnosis (65%), non-Hispanic White (72%), and had at least a Bachelor's degree (85%). In adjusted analysis, use of fertility preservation was associated with 1.50 times the prevalence of material financial hardship (95% CI: 1.08-2.09). The magnitude of hardship was also substantially higher among women who used fertility preservation: 12% reported debt of ≥$25,000 versus 5% in the referent group. This study provides new evidence that cryopreserving oocytes or embryos after cancer diagnosis for future family building is associated with increased financial vulnerability. More legislation that mandates insurance coverage to mitigate hardships stemming from iatrogenic infertility could improve access to fertility preservation for young women with cancer.

A Survey of Healthcare Providers About Reproductive Healthcare for Adolescent Women With Epilepsy.

To evaluate knowledge, attitudes, and practices about sexual and reproductive health (SRH) for adolescent and young adult (AYA) women with epilepsy among general pediatricians, adolescent medicine specialists, and pediatric gynecologists. Survey comprising previously validated and novel items that underwent content validity testing and was distributed through specialty listservs. Categorical variables analyzed with χ2 or Fisher exact tests, and continuous variables with Kruskal-Wallis tests. Online. Physicians and Advanced practice providers. Online survey. Questions testing SRH knowledge, assessing confidence in SRH counseling practices and frequency of intended SRH counseling, and identifying barriers and facilitators to SRH provision for AYA women with epilepsy. Of 329 participants, 57% were general pediatricians, 27% were adolescent medicine specialists, and 16% were pediatric gynecologists. On 15 items assessing knowledge, general pediatricians scored significantly lower than respondents in the other specialties (P < .01). Among 11 items about confidence in SRH skills, general pediatricians were significantly less confident than respondents in the other specialties (P < .01). General pediatricians reported that they would perform annual counseling less often on 7 SRH counseling topics compared with respondents in the other specialties (P < .01). In all, 54% of the respondents reported that barriers to SRH provision include limited time during visits and lack of epilepsy knowledge. Respondents identified facilitators including guidelines/algorithms for managing SRH (83%), provider education (61%), and electronic health record alerts (60%). Responses suggest suboptimal knowledge, confidence, and care provision regarding SRH for AYA women with epilepsy, particularly among general pediatricians. Identified barriers and facilitators may serve as targets for interventions to improve SRH provision.

Adolescent Women with Congenital Heart Disease: Self-Reported Reproductive Health Discussions with Health Care Providers

Study ObjectiveThis study evaluated self-reported discussions with health care providers (HCPs) among adolescent and young adult (AYA) women with congenital heart disease (CHD). DesignData were collected through a one-time survey of AYA women. SettingParticipants were recruited from pediatric cardiology clinics. ParticipantsAYA women with CHD, ages 14-21 (N = 107) InterventionsNone Main Outcome MeasuresQuestionnaires assessed adolescent characteristics and specific HCP discussions regarding transmissibility of a cardiac condition to the infant, risk of pregnancy, and hormonal contraception. Outcome measures were self-reported discussions with HCPs about these reproductive health topics. ResultsMean age was 16.8 years (SD = 2.1). Self-reported reproductive health discussions were infrequent, including discussions on transmissibility of a heart condition to their offspring (37%), risk of pregnancy to their offspring (34%), risks of pregnancy to their health (46%), and risks of hormonal contraception given their heart condition (21%). Reported discussions were most commonly with a cardiologist. ConclusionsAYA women with CHD reported limited discussions about reproductive health topics important to those with CHD. Lack of appropriate and timely counseling could lead to poor maternal and child health outcomes. Targeted interventions that improve reproductive health discussions between HCPs and AYA women with CHD are needed to close critical information and service gaps.

Provider Attitudes, Preferences, and Practices Regarding Sexual and Reproductive Health for Adolescents and Young Adults With Sickle Cell Disease

PurposeWith improvements in life expectancy, adolescents and young adults (AYAs) with sickle cell disease (SCD) increasingly face sexual and reproductive health (SRH) concerns. As subspecialists often serve as primary care providers for those with chronic disease, this study examines pediatric SCD providers' practices and attitudes related to SRH of AYA women with SCD. MethodsWe developed an adapted survey to identify SCD provider attitudes and practices in addressing menses, sexual activity, contraception, and pregnancy for their female patients. We electronically distributed this survey to the American Society of Pediatric Hematology/Oncology SCD interest group. We used descriptive statistics to analyze results. ResultsA total of 78 pediatric SCD providers completed the survey. A majority (95%) rated SRH discussions as moderately important or higher, with 89% agreeing this care should be standardized. Most respondents reported discussing SRH, such as menses (78%), teratogenic medications (61%), and contraception (90%), with their female patients with SCD at least annually. Although most refer AYAs with SCD for birth control (83%), 39% endorsed a preferred method, with 33% of these favoring levonorgestrel intrauterine devices in this population and 40% injectable contraception. Approximately half of respondents (57%) reported that the use of combined hormonal contraceptives was unacceptable despite published guidelines that support potential benefits outweighing theoretical risk in AYAs with SCD. ConclusionsThe range of SRH conversations and contraceptive recommendations for AYAs from pediatric SCD providers is broad. SCD providers and AYAs with SCD would benefit from improved evidence and educational resources related to contraception as well as coordinated SRH counseling.

Breast Cancer in Adolescent and Young Adult Women Under the Age of 40 Years.

In the United States, one in 196 women is diagnosed with breast cancer under the age of 40 years. Adolescents and young adults (AYAs), of age 15-39 years at diagnosis, experience a number of unique challenges when confronting breast cancer. The incidence of invasive breast cancer has increased among AYA women in the United States since 2004, and most of this change is due to an increase in young women diagnosed with distant disease. AYAs are more likely than older women to present with aggressive subtypes and advanced disease, and they often require systemic staging at diagnosis. Clinical trials should be considered whenever possible, particularly in AYAs with locally advanced or metastatic disease at diagnosis and those with disease progression or recurrence. A significant proportion of AYAs carry germline cancer predisposition mutations, which necessitates prompt genetic testing for all AYAs at diagnosis and may influence choice of local therapy. Suppression of ovarian function, as an adjunct to chemotherapy, may improve breast cancer survival in AYAs. To provide optimal care for AYAs with breast cancer, clinicians should engage multidisciplinary teams that offer fertility preservation, genetic counseling, physical and occupational therapy, nutrition, and psychosocial support, along with medical expertise in tailoring cancer-directed therapy and symptom management toward young women.

Changes in cannabis, tobacco, and alcohol use among sexually active female adolescents and young adults over a twelve-year period ending in 2019

BackgroundThe United States has experienced an increasing divergence in cannabis, tobacco, and alcohol use among adolescents and young adults (AYA). We assessed the changes in cannabis, tobacco and alcohol use in an inner-city population of predominantly minority AYA females attending a large adolescent-specific health center in New York City. MethodsThis was a longitudinal study of AYA women recruited and followed over a twelve-year period between 2007 and 2019. Lifetime and past 30-day use were assessed by self-administered questionnaire every six months. In addition, we assessed associations with race, ethnicity, sexual behaviors, receipt of social services, living situation at home (e.g., with or without parents), and use of other drugs. ResultsParticipants included 1549 AYA females aged 13–21 at baseline, 95% of whom were youth of color. Use of cannabis increased significantly over the twelve-year period, with frequent cannabis use (≥20 times in 30-days) increasing almost 18% per year (OR = 1.18; 95%CI:1.13–1.23). In contrast, past 30-day tobacco use declined over the same period (OR = 0.86; 95%CI:0.83–0.89). Past 30-day cannabis use was more likely among African Americans (OR = 1.33; 95%CI:1.08–1.63), women who had sex with both men and women compared to with men only (OR = 1.44; 95%CI:1.18–1.75), recent users of tobacco (OR = 2.20; 95%CI:1.92–2.52) and alcohol (OR = 2.84; 95%CI:2.52–3.20), and ever users of other drugs (OR = 1.69; 95%CI:1.44–1.99), independent of age, time and living situation. ConclusionsIncreasing rates of cannabis use and the association with concurrent tobacco and alcohol use in AYA females underscore the need to screen for unhealthy cannabis use, in addition to tobacco and alcohol, especially among inner-city AYA.

Using Reproductive Health as a Strategy to Engage Youth in Preventive Care

PurposeThis research examined differences in receipt of recommended preventive services by contraceptive use in adolescent and young adult (AYA) women. MethodsData are from a retrospective chart review of 408 AYA women who received sexual health risk reduction counseling in an urban academic AYA clinic. Descriptive, bivariate, and logistic regression analyses were used to examine relationships between contraception use and receipt of care. ResultsAYA women aged 12–24 years using hormonal contraception were more likely to receive recommended preventive care, including an annual preventive visit and sexually transmitted infection screening, compared with those using condoms or no contraception. Women using medium-acting reversible contraception were more likely to have an annual visit compared with those not using hormonal contraception. ConclusionsAYA women using contraception are more likely to receive recommended preventive health services, suggesting reproductive health visits may be used to promote engagement around preventive care.

55. Assessing Reproductive Health Among Adolescents and Young Adults Undergoing Cancer Treatment: A Pilot Study

<h3>Background</h3> Adolescent and young adult (AYA) women undergoing cancer treatment face unique reproductive health risks. This study sought to determine sexual health practices and communication with oncology providers among female AYA cancer patients. <h3>Methods</h3> After IRB approval, actively treated cancer patients were offered participation if they were female, age 15-39 years, and English-speaking. Excluded were pregnant patients and those with a history of hysterectomy or removal of both ovaries and/or fallopian tubes. Participants completed an online survey regarding demographics, cancer history, sexual history, and communication with their oncologists. The main outcome measures assessed included rates of contraception, condom use, and sexual activity. Communications about sexual health with oncologists was also assessed. <h3>Results</h3> The 8 participants were a median of 24 years (range 16-37) with a history of breast cancer (50%), hematologic malignancies (25%), and other malignancies (25%). Treatment exposures in patients included chemotherapy (75%), radiation (62.5%), and surgery (50%); no one received only surgery. Lifetime history of heterosexual vaginal intercourse was reported in 62% of patients and other sexual activity such as oral or anal sex in 75%. Since cancer diagnosis, 50% reported having heterosexual vaginal intercourse, of which 50% reported using any contraception at last intercourse and no one reported using condoms. Overall, 62.5% had never discussed pregnancy prevention with their oncologists, and none recalled discussing STIs. Only 37.5% stated that they were told that sexual health discussions were confidential. <h3>Conclusions</h3> AYA women undergoing cancer treatment face unique sexual and reproductive health risks. This study demonstrates that there may a sizeable portion of these patients not taking precautions against pregnancy or STIs, and that there may be a need to increase discussions and counseling about these topics. Further research is needed to determine whether these findings persist in a broader population of AYA female cancer patients.

Contraception Counseling and Use Among Adolescent and Young Adult Female Patients Undergoing Cancer Treatment: A Retrospective Analysis.

Study ObjectiveAdolescent and young adult (AYA) women undergoing cancer treatment face unique reproductive health risks. This study aimed to assess the prevalence of sexual health counseling and contraception use in the oncology setting, and to identify patient factors associated with these outcomes.DesignRetrospective chart review.SettingYale New Haven Hospital from 2013 to 2018.ParticipantsFemale patients 15-25 years of age receiving cancer treatment, excluding those treated with surgery only.InterventionsNone.Main Outcome MeasuresOutcomes of documented sexual health counseling and contraception use were assessed for frequency. Associations between patient factors and these outcomes were assessed using Pearson χ2 and Fisher exact tests, and multivariate logistic regression was used to identify predictors of these outcomes.ResultsIn this cohort (n = 157), the median age was 20.5 years, and the most common diagnoses were hematologic (40.8%) and thyroid (31.2%) malignancies. Of the patients, 33.1% were documented as receiving sexual health counseling, and 48.4% used contraception. Younger patients (15-20 years of age) were less likely to receive counseling (OR 0.31, 95% CI 0.14-0.70, P = .005). Receiving counseling (OR 3.36, 95% CI 1.35-8.34, P = .009) and sexual activity (OR 4.18, 95% CI 1.80-9.68, P = .001) were significantly associated with contraception use.ConclusionsSexual health counseling was documented infrequently during oncologic care for AYA women, especially for younger patients. However, such conversations were associated with a higher likelihood of contraception use. There is a need to improve rates of counseling in this high-risk setting, in which adolescents may be more vulnerable with regard to sexual health.

781-P: Exploring Concerns and Preventative Behaviors Regarding Reproductive Health (RH) Complications in Female Adolescents and Young Adults (AYA) with T1D

Background: AYA women with T1D are vulnerable to poor glycemic control which could increase their risks of RH complications. ADA recommends starting preconception counseling (PC) at puberty. Purpose to explore concerns for and preventative behaviors regarding RH complications in AYA females with T1D. Methods: New AYA patients attending a diabetes transition clinic at a pediatric teaching hospital completed a short survey on concerns for diabetes-related complications and preventative actions taken: ranking their concerns on a scale 1=most important to 5=least important from a list of five complications. They identified any actions ever taken to prevent complications by a list of items and an open-ended response. This reports on female participant (n=49; ages 17-22) responses regarding RH complications at baseline prior to any peer-group information sessions. Descriptive analyses were used for quantitative and qualitative data. Open-ended data were clustered and analyzed to identify themes with 2 researchers reaching agreement. Results: Only 29% of AYA female participants (n=14) ranked RH complications as most important concern (rank of 1) and 12% (n=6) ranked it as important (rank of 2); while 20% (n=10) ranked RH complications as least important (rank of 5). Several participants (n=33) checked off one or more behaviors they have taken to prevent RH complications (e.g., control glucose, discussed family planning with health provider). Themes for ’other preventative actions’ remained broad, “healthy lifestyle” and “self-management.” Almost all (88%; n=29/33) believe RH complications can be prevented. Conclusion: Less than half of AYA females ranked RH complications as an important concern, which could reflect unawareness. Although most have taken some general preventive actions, enhancing other more specific behaviors to decrease their risks that were not identified could be targeted for future interventions through PC. Disclosure D. Charron-Prochownik: None. A.F. Fischl: None. J.T. Krall: Research Support; Self; Becton, Dickinson and Company. J. Finney: None. H. Abujaradeh: None. D.J. Becker: None. A.M. Diaz: None. I. Libman: Consultant; Self; Novo Nordisk A/S. Funding David Paul Diabetes Transition Care Research Initiative Fund

Experiences with Menses and Menstrual Suppression of Young Women with a History of Cancer.

Background: Adolescent and young adult (AYA) women undergoing multiagent chemotherapy are at risk for heavy menstrual bleeding (HMB). There is a paucity of data on the experiences with menses of AYA women with cancer, their risk for HMB, and how they perceive menstrual suppression. Objective: This study aimed to (1) describe the attitudes and experiences of AYA women with a history of cancer regarding their menses and menstrual suppression and to (2) investigate facilitators and barriers to improve this aspect of oncologic care. Design/Methods: AYA women with a history of cancer completed individual semistructured interviews regarding their experiences, attitudes, and preferences around menstrual health. Two independent reviewers conducted a thematic analysis of transcribed interviews to elicit major themes. Results: We interviewed 20 young women with a history of cancer (mean age 19.9 years) who were treated with chemotherapy within the past 5 years. Themes included the following: (1) negative feelings and worry about menstrual bleeding; (2) positive attitudes toward menstrual suppression; (3) misconceptions about menstrual health; and (4) desire for tailored discussions about menstrual suppression. Conclusions: AYA women with a cancer history elucidate clear opinions regarding menstruation during chemotherapy, and many hold misconceptions regarding menses and menstrual suppression. Enhanced patient-provider communication and patient educational resources around menstrual health and menstrual suppression are needed to improve comprehensive oncologic care during chemotherapy.