Reproductive Health Complications Research Articles

'Every strategy needs to be contributing to erasing the stigma': Māori and Pacific young people talk about overcoming barriers to testing for sexually transmitted infections.

Māori and Pacific young people are disproportionately impacted by sexually transmitted infections (STIs). Access to STI screening is important to reduce transmission and reproductive health complications. Between November 2022 and May 2023, we held four wānanga (workshops) with Māori and Pacific participants (15-24years old) to find out what barriers they encounter to STI testing, and hear their ideas about how to overcome these. Participants were recruited via youth-focused community organisations in the Wellington region of Aotearoa New Zealand. Inductive thematic analysis was used to understand data generated from discussions, drawing on Māori and Pacific models of wellbeing to frame themes. Thirty-eight participants were involved in the wānanga. Barriers to STI testing related to five themes: (1) differences in cultural values and expression; (2) family/friends; (3) educational gaps; (4) psychological factors; and (5) structural obstacles. Suggested strategies to improve access to sexual health care included the need for free, flexible services, education and health promotion activities to reach young people in their spaces (e.g. church, marae, social media). Participants stressed the need for approaches to be community-based, delivered by trusted individuals using culturally appropriate messages, and saw participation in STI testing as beneficial for whānau/family and communities. To improve access to STI testing, participants described the need for free services, together with education and health promotion to improve inter-generational sexual health knowledge. Reframing messages around STIs to align with Māori and Pacific models of wellbeing was identified as a way to normalise conversations, in turn reducing the stigma surrounding STI testing.

Family Planning Knowledge and Attitudes of Childbearing Couples Regarding Reproductive Health with Husband's Participation

knowledge about reproductive health and actively participate in family planning. Couples can plan pregnancies according to their wishes, avoid unwanted pregnancies, reduce the risk of reproductive health complications, and create an environment that supports optimal development of children. This study aimed to determine the relationship between family planning knowledge and attitudes of reproductive health couples regarding reproductive health with the husband's participation. This study is an analytical observational research with a cross-sectional approach. This study uses primary data obtained from the research subject interview process. A total of 211 research subjects took part in this study. In conclusion, there is no relationship between family planning knowledge and attitudes of couples of childbearing age regarding reproductive health with the husband's participation.

Prevalence of Polycystic Ovarian Syndrome and Its Link to Obesity in Adolescent Girls.

Polycystic ovarian syndrome (PCOS), also referred to as Stein-Leventhal syndrome, happens to be one of most commonhormonal disorders found in females, causing large-sized ovaries with small cysts of non-ovulated oocytes in the outer medulla part of the ovary. Women suffering from PCOS often exhibit symptoms like oligomenorrhoea, elevated testosterone levels, acne, alopecia, hirsutism, sudden weight gain and many more. It can predispose a woman to developing infertility in future, and thus, difficulties in conceiving; due to the cystic changes in the ovaries, it results in anovulation and amenorrhea. The early symptoms of PCOS are being commonly observed nowadays in young women who are in their early 20s and those who are overweight or obese. The metabolic expression of PCOS increases with obesity. Obesity is a factor that is considered to contribute the most in the occurrence of various long-standing and non-transmissible illnessesapart from PCOS such as atherosclerosis, hypertension, diabetes, high blood cholesterol and even certain types of cancers. In obesity, there is an increase in the size and number of fat cells in the body. Obese and overweight young girls have a heightened likelihood of developing PCOS and its corresponding metabolic and reproductive health complications.

Environmentally relevant doses of endocrine disrupting chemicals affect male fertility by interfering with sertoli cell glucose metabolism in mice

The growing global deterioration in several aspects of human health has been partly attributed to hazardous effects of endocrine-disrupting chemicals (EDCs) exposure. Therefore, experts and government regulatory agencies have consistently advocated for studies on the combined effects of EDCs that model human exposure to multiple environmental chemicals in real life. Here, we investigated how low concentrations of bisphenol A (BPA), and phthalates compounds affect the Sertoli cell glucose uptake/lactate production in the testis and male fertility. An EDC mixture containing a detected amount of each chemical compound in humans, called daily exposure (DE), and DE increased in magnitude by 25 (DE25), 250 (DE250), and 2500 (DE2500), and corn oil (control) were administered for six weeks to male mice. We found that DE activated estrogen receptor beta (Erβ) and glucose-regulated protein 78 (Grp 78) and disrupted the estradiol (E2) balance. In addition, DE25, DE250, and DE2500 doses of the EDC mixture via binding with Sertoli cells’ estrogen receptors (ERs) inhibited the glucose uptake and lactate production processes by downregulating glucose transporters (GLUTs) and glycolytic enzymes. As a result, endoplasmic reticulum stress (ERS), marked by unfolded protein response (UPR) activation, was induced. The accompanying upregulation of activating transcription factor 4 (ATF4), inositol requiring enzyme-1 (IRE1), C/EBP homologous protein (CHOP), and mitogen-activated protein kinase (MAPK) signaling promoted antioxidant depletion, testicular cell apoptosis, abnormal regulation of the blood−testis barrier, and decreased sperm count. Therefore, these findings suggest that human and wildlife exposure to multiple environmental chemicals can produce a wide range of reproductive health complications in male mammals.

The Gynecological Sequelae of Sexual Violence in Adolescence: A Scoping Review (Web of Science).

Abstract Adolescent females who engage in sexual acts against their will, including sex trafficking, sex abuse, coercion, and molestation, may be at higher risk for sexual and reproductive health complications, including sexually transmitted infections (STIs), menstruation disturbance, infertility, abnormal uterine bleeding, reproductive cancers, dyspareunia, vaginismus, unplanned or unwanted pregnancies and chronic pelvic pain. Despite the high prevalence of sexual violence in the United States, a study reported in Women's Health Issues indicates three barriers to providing care for sexual assault (SA) survivors, from a physician's perspective, one of which includes provider discomfort addressing SA and another being provider-patient communication. This scoping review aimed to report the scope of the literature regarding gynecological outcomes in this population group.

The Gynecological Sequelae of Sexual Violence in Adolescence: A Scoping Review (CINAHL Complete).

Abstract Adolescent females who engage in sexual acts against their will, including sex trafficking, sex abuse, coercion, and molestation, may be at higher risk for sexual and reproductive health complications, including sexually transmitted infections (STIs), menstruation disturbance, infertility, abnormal uterine bleeding, reproductive cancers, dyspareunia, vaginismus, unplanned or unwanted pregnancies and chronic pelvic pain. Despite the high prevalence of sexual violence in the United States, a study reported in Women's Health Issues indicates three barriers to providing care for sexual assault (SA) survivors, from a physician's perspective, one of which includes provider discomfort addressing SA and another being provider-patient communication. This scoping review aimed to report the scope of the literature regarding gynecological outcomes in this population group.

The Gynecological Sequelae of Sexual Violence in Adolescence: A Scoping Review (MEDLINE/PubMed).

Abstract Adolescent females who engage in sexual acts against their will, including sex trafficking, sex abuse, coercion, and molestation, may be at higher risk for sexual and reproductive health complications, including sexually transmitted infections (STIs), menstruation disturbance, infertility, abnormal uterine bleeding, reproductive cancers, dyspareunia, vaginismus, unplanned or unwanted pregnancies and chronic pelvic pain. Despite the high prevalence of sexual violence in the United States, a study reported in Women's Health Issues indicates three barriers to providing care for sexual assault (SA) survivors, from a physician's perspective, one of which includes provider discomfort addressing SA and another being provider-patient communication. This scoping review aimed to report the scope of the literature regarding gynecological outcomes in this population group.

The Gynecological Sequelae of Sexual Violence in Adolescence: A Scoping Review (Embase).

Abstract Adolescent females who engage in sexual acts against their will, including sex trafficking, sex abuse, coercion, and molestation, may be at higher risk for sexual and reproductive health complications, including sexually transmitted infections (STIs), menstruation disturbance, infertility, abnormal uterine bleeding, reproductive cancers, dyspareunia, vaginismus, unplanned or unwanted pregnancies and chronic pelvic pain. Despite the high prevalence of sexual violence in the United States, a study reported in Women's Health Issues indicates three barriers to providing care for sexual assault (SA) survivors, from a physician's perspective, one of which includes provider discomfort addressing SA and another being provider-patient communication. This scoping review aimed to report the scope of the literature regarding gynecological outcomes in this population group.

Issue Highlights

Issue Highlights

“The most important thing when we arrive in New Zealand": Experiences of refugee women of reproductive age with interpreters

This study provides insight into the experiences of refugee women of reproductive age, who use interpreters while resettling in New Zealand. Understanding their experiences of using interpreters allows a deeper understanding for interpreting services and health professionals. It also enables more mindful and comprehensive language assistance approaches to migrant communities. Finally, refugee women will have the opportunity to voice their experiences. This research is the first of its kind in New Zealand. Women refugees are shown to be the most vulnerable refugee group, as they face many risks during their resettlement to their host country (UN Women Organisation, 2020). Refugee women often face family separation, psychosocial stress, trauma, violence, reproductive and sexual health complications while migrating (UN Women, 2020). Due to low literacy rates, they are less likely to understand or speak English, and therefore more likely to rely on interpreters to assist them with communication during the process of resettling in New Zealand. When women refugees arrive in New Zealand, they stay at the Mangere Refugee Resettlement Centre (MRRC). During their stay in the Centre, and after their resettlement to their new home, interpreters are hired to facilitate communication between refugees with numerous New Zealand services and health professionals (Ministry of Health, 2012). As this study focuses on human lived experience, it will use a qualitative approach and a methodology based on Heidegger’s hermeneutic phenomenology, to explore the lived experiences of refugee women and uncover their meaning through an interpretive analysis (Van Manen, 2016). 15-20 participants will be recruited during the first one to five years of resettlement in New Zealand and interviewed face to face or via Zoom when Covid-19 restrictions apply. Ultimately the intention of this study is to improve the experiences of refugee women as they settle into New Zealand life and into their new homes.

Maternal erythrocyte fatty acid composition as a predictive marker for pregnancy health.

Pregnancy is accompanied by a surge in demand for fatty acids (FAs) in order to support maternal health, as well as fetal growth and development. Of particular demand is essential for long-chain polyunsaturated FAs. FAs are primarily obtained from dietary sources and are distributed in the body. In comparison with the use of self-reporting approaches, measuring the FA levels within different blood compartments can present a more accurate image of nutritional, and thus tissue, FA composition. Hence, the FA profile of plasma or serum is commonly used for physiological analyses. Nevertheless, plasma and serum FAs are not yet incorporated into cell membranes, and consequently may not be a suitable reflection of the FA status of body tissues. The evaluation of erythrocyte FA levels offers a superior possibility for the following reasons: the biological fluctuation of erythrocyte FA composition is low, phospholipids account for almost all the lipid content of erythrocytes, and the FA profiles of erythrocytes represent those of tissues. Here, we elaborate on whether the status of maternal erythrocyte FAs can serve as a prognostic biomarker for reproductive health and fetomaternal complications, including embryonic and fetoplacental development, gestational length, and preeclampsia. In addition, factors with the potential of altering the maternal erythrocyte FAs such as maternal diet, lifestyle habits, genetics, and body composition are discussed.

Prevalence and Demographic, Socioeconomic, and Behavioral Risk Factors of Self-Reported Symptoms of Sexually Transmitted Infections (STIs) among Ever-Married Women: Evidence from Nationally Representative Surveys in Bangladesh.

Sexually transmitted infections (STI) symptoms (e.g., abnormal genital discharge and genital sores/ulcers) are a major public health concern in Bangladesh because the symptoms can indicate an STI and cause sexual and reproductive health complications in women of reproductive age. To our knowledge, no study examined the prevalence and risk factors of STI symptoms using a nationally representative sample. This study investigates the prevalence of STI symptoms among ever-married women in Bangladesh and the associations of STI symptoms with various demographic, socioeconomic, and behavioral risk factors using the most recent available data (2007, 2011, and 2014) of the Bangladesh Demographic and Health Surveys (BDHS). The BDHS employs a two-stage stratified sampling technique. The analytic sample comprised 41,777 women of reproductive age (15–49 years). Outcome variables included STI symptoms: abnormal genital discharge and genital sores/ulcers. Multivariate logistic regression was employed to find the adjusted odds ratio with a 95% confidence interval to assess the associations of outcome measures with explanatory variables. The study found that the prevalence of abnormal genital discharge and genital sores/ulcers among ever-married women aged 15–49 years was 10% and 6%, respectively. Multivariable analysis revealed that for women aged 25–34 years, those who used contraceptives and married earlier had an increased likelihood of STI symptoms. Furthermore, women from the wealthiest wealth quintile and couple’s joint decision-making were less likely to have STI symptoms. Findings have implications for interventions efforts aiming to improve women’s sexual and reproductive health in Bangladesh.

Addressing a silent and neglected scourge in sexual and reproductive health in Sub-Saharan Africa by development of training competencies to improve prevention, diagnosis, and treatment of female genital schistosomiasis (FGS) for health workers

BackgroundSchistosomiasis is an acute and chronic disease caused by parasitic worms, that can take two main forms: intestinal or urogenital. If left untreated, the urogenital form can lead to female genital schistosomiasis (FGS) in women and girls; frequently resulting in severe reproductive health complications which are often misdiagnosed as sexually-transmitted infections (STIs) or can be confused with cervical cancer. Despite its impact on women’s reproductive health, FGS is typically overlooked in medical training and remains poorly recognized with low awareness both in affected communities and in health professionals. FGS has been described as the one of the most neglected sexual and reproductive health issues in sub-Saharan Africa (Swai in BMC Infect Dis 6:134, 2006; Kukula in PLoS Negl Trop Dis 13:e0007207; Joint United Nations Programme on HIV/AIDS (UNAIDS) 2019). Increased knowledge and awareness of FGS is required to end this neglect, improve women’s reproductive health, and decrease the burden of this preventable and treatable neglected tropical disease.MethodsWe conducted interactive virtual workshops, in collaboration with the World Health Organization (WHO), engaging 64 participants with medical and public health backgrounds from around the world to establish standardized skills (or competencies) for prevention, diagnosis, and treatment of FGS at all levels of the health system. The competencies were drafted in small groups, peer-reviewed, and finalized by participants.ResultsThis participatory process led to identification of 27 skills needed for FGS prevention, diagnosis, and management for two categories of health workers; those working in a clinical setting, and those working in a community setting. Among them, ten relate to the diagnosis of FGS including three that involve a pelvic exam and seven that do not. Six constitute the appropriate behaviors required to treat FGS in a clinical setting. Eleven address the community setting, with six relating to the identification of women at risk and five relating to prevention.ConclusionDefining the skills necessary for FGS management is a critical step to prepare for proper diagnosis and treatment of women and girls in sub-Saharan Africa by trained health professionals. The suggested competencies can now serve as the foundation to create educative tools and curricula to better train health care workers on the prevention, diagnosis, and management of FGS.

A review of sexual and reproductive health outcomes of female genital mutilation and with the context of covid-19 pandemic

Female Genital Mutilation (FGM) is commonly known as female genital cutting or female circumcision. This traditional practice is harmful and practiced in many countries without any fear of worse health outcomes. FGM is linked with worse sexual and reproductive health outcomes and complications through which young girls and women have to go through earlier in the incidence and later in life. These complications include sexual dysfunction, menstrual issues, difficulties with labor and delivery, infections, and infertility. The role of healthcare providers, community stakeholders, and young people is very significant in fighting FGM.

Diagnosis and treatment of polycystic ovary syndrome in adolescents.

Polycystic ovary syndrome (PCOS), characterized by ovulatory dysfunction and hyperandrogenism, is one of the most common endocrine disorders in women of reproductive age. Early diagnosis can help clinicians address associated long-term metabolic and reproductive health complications and mitigate the negative effects of PCOS on a patient's mental health and quality of life. Clinicians often are challenged by the diagnosis and management of PCOS because of controversies around diagnostic criteria, especially for adolescents. The International Consortium of Paediatric Endocrinology 2017 Consensus Statement provides practical guidance for clinicians to implement best practices for the identification, diagnosis, and management of PCOS in adolescents.

Legal Perspective of Female Circumcision: Study of Woman Rights to access Information of Sexual Health in Indonesian and Somalia

Female circumcision is a controversial practice in some countries, including Indonesia. The female circumcision also occurs in Somalia and has impact of medical complication. This study aims to know the implication of female circumcision in Indonesia, especially in Situbondo, Surabaya and Bangkalan with implication of female circumcision in Somalia. Quantitative methodology is used as the methodology, while the samples are taken through random sampling and given questionnaire, interview and comparison with Somalia. The finding showed that most women are still does not know about the function of female circumcision in Indonesia and Somalia, they only following the tradition within their community. The patriarchy culture that view woman as a lower creature makes woman cannot get her right in asking about reproductive health. In Somalia, there are impact of circumcision with reproductive health and many complications with health. It even considered as taboo and unnecessary. Female circumcision that firstly legalized by the Health Minister is now prohibited due to health problem. Therefore, female circumcision is no longer legal in Indonesia meanwhile in Somalia is legal in their government. In Indonesia, female as a part of society did not have any rights on their own self. Their life is depend on the tradition which sustain until present and will be continued for next generation. The tradition is often spread within the religious belief and vice versa. Therefore, the practice of female circumcision is still happening in three regions, including Surabaya, Bangkalan and Situbondo. Meanwhile In Somalia, female as a part of society who has any rights on their own self. In Somalia, female circumcision was supported by society and government in Somalia.

Adolescent Latinas' with Diabetes and Their Mothers' Understanding of Diabetes and Reproductive Health: Converging Themes to Inform a Culturally Sensitive Preconception Counseling Program.

Latinas are at an increased risk for diabetes and reproductive health (RH) complications with sexuality and pregnancy. This study explored the understanding of diabetes related to RH, pregnancy, unplanned pregnancies, preconceptioncounseling, tight-control, and family planning among Latina adolescents with diabetes and their mothers and explored converging themes. The qualitative descriptive study used written open-ended questions (English or Spanish) with Latina mothers (n = 13) and daughters (n = 21). Responses were transcribed. Content analysis was used by four researchers who coded and discussed themes and reached consensus. Converging themes were confirmed using Atlas.ti software. Seven themes emerged from the mother-daughter dyad: communication (awkwardness, ambivalence, styles); control (being controlled vs. controlling); consequences (fertility, complications); planning (pregnancy, being healthy, life plan, RH); support; danger, risk, and safety; and stigma. Many mother-daughter dyads were not ready to discuss RH among themselves. Cultural and familial perspectives should be considered when providing care and preconception counseling to this population.

Detection of maternal X chromosome abnormalities using single nucleotide polymorphism–based noninvasive prenatal testing

Maternal X chromosome abnormalities may cause discordant results between noninvasive prenatal screening tests and diagnostic evaluation of the fetus/newborn, leading to unnecessary invasive testing. Women with X chromosome abnormalities are at increased risk for reproductive, pregnancy, or other health complications, which may be reduced or ameliorated by early diagnosis, monitoring, and intervention. This study aimed to validate a single nucleotide polymorphism-based noninvasive prenatal test to identify X chromosome abnormalities of maternal origin. All tests unable to evaluate fetal risk for aneuploidy because of uninformative algorithm results were eligible for inclusion. Two groups of cases were prospectively identified: Group A (n=106) where a maternal X chromosome abnormality was suspected and Group B (control group, n=107) where a fetal chromosome abnormality involving chromosome 13, 18, 21, or X was suspected but did not meet criteria for reporting. Maternal DNA was isolated from the plasma-depleted cellular pellet and sent to a reference laboratory for blinded analysis using chromosomal microarray. A chromosome abnormality involving chromosomes 13, 18, 21, or X was reported by the reference laboratory if ≥5 Mb in size and present in ≥20% of the DNA. A maternal X chromosome abnormality was suspected in 1/1305 tests (149/194,385; 0.08%). In Group A, a maternal X chromosome abnormality was confirmed in 100/106 cases (94.3% positive predictive value, 1-sided 97.5% confidence interval, 88.1%-100.0%). Turner syndrome was the most commonly suspected maternal abnormality (58/106, 54.7%), with confirmation of mosaic or nonmosaic 45,X by microarray in 38/58 (65.5%) cases. Noninvasive prenatal screening tests suspected the presence of maternal 47,XXX with or without mosaicism in 40/106 (37.7%) cases, confirmed by microarray in 38/40 (95.0%). In Group B (n=107), no maternal microarray abnormalities were reported, providing a negative predictive value of 100% (1-sided 97.5% confidence interval, 96.6%-100.0%). When noninvasive prenatal testing suspected a maternal X chromosome abnormality, maternal microarray confirmed an X chromosome abnormality with 94.3% positive predictive value. Of the maternal X chromosome abnormalities detected by array, >50% were 45,X. When fetal chromosome abnormalities involving chromosomes 13, 18, 21, or X were suspected, no maternal chromosome abnormalities were reported, yielding a negative predictive value of 100%. Women with maternal X abnormalities suspected with noninvasive prenatal testing may be at increased risk for reproductive and health complications; early evaluation and treatment may prevent long-term consequences or disability.

1300-P: Empowering Youth with Diabetes (DM): Characteristics and Initial Outcomes of a Novel Diabetes Transition Program (DTP)

Adolescents and young adults (AYA) with DM have increased risk of poor outcomes. The DTP was created to equip AYA with knowledge, support, and skills to foster successful lifelong DM self-management. This 1-year (4 visits) program pairs clinical care with peer-group discussions led by a multidisciplinary team focused on informed decision making of issues relevant to AYA with DM. The purpose of this study was to characterize the population referred to DTP and evaluate concerns, program adherence and outcomes. Medical records were reviewed and surveys administered. To date 153 AYA were referred (51% females, 99% T1DM, age at 1st visit 18.8±1.4 yrs, age at onset 9.7±4.7 yrs, HbA1c 9±2%). In ranking concerns of 5 complications (retinopathy, neuropathy, reproductive health complications, nephropathy and hypertension) at the 1st DTP visit, 60% of males and 57% of females who completed the survey rated retinopathy as their number 1 or 2 concern. Reproductive health and hypertension were listed as their least concern by 43% of males and 42% of females respectively. In terms of program adherence, the majority (60%, n=92) completed DTP on schedule (1 year). Of these, 42% transferred to adult care, 52% continued care at the institution and 6% were lost to follow up. Of those who did not complete DTP over 1 year (40%), 25% transferred to adult care before DTP completion, 60% are completing DTP in more than 1 year, and 15% were lost to follow up. Those who transferred to adult care (irrespective of program completion time), versus those who did not, had lower HbA1c at all DTP visits (e.g., 1st visit: 8.1 ± 1.4% vs. 9.4 ± 1.7%, p=0.01). In terms of outcomes for those that completed the program, no differences were found in HbA1c from the 1st to 4th visit. In conclusion, AYA referred to DTP appear to be a high-risk population based on their HbA1c and suboptimal program adherence. This highlights the need for methods (e.g., telehealth) to continue to engage this population and ongoing self-management support. Disclosure I. Libman: Consultant; Self; Novo Nordisk A/S. J.T. Krall: Research Support; Self; Becton, Dickinson and Company. A.F. Fischl: None. J. Finney: None. A.M. Diaz: None. L.M. Siminerio: Research Support; Self; Becton, Dickinson and Company. D. Charron-Prochownik: None. D.J. Becker: None. Funding David Paul Diabetes Transition Care Research Initiative Fund

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