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MNAAP Newsletter

Addressing Adolescent Sexual Health Amid Rising STI Rates

karischneiderKari Schneider, MD, FAAP, University of Minnesota Medical School

The 2018 Minnesota Adolescent Sexual Health Report, released in June by the Healthy Youth Development Prevention Research Center (HYD•PRC) at the University of MN, provides a great look at the sexual health of Minnesota’s youth. Most notably, adolescent pregnancy and birth rates are at “historic lows” with a 65 percent decline in the adolescent birth rate between 1990 and 2016. Unfortunately, however, sexually transmitted infections (STIs) continue to increase in the young people of our state. The rates of chlamydia and gonorrhea in MN reached all-time highs in 2017. Chlamydia at 440/100,000 (an increase of 4 percent from 2016) and gonorrhea at 123/100,000 (an increase of 28 percent) illustrate the disproportionate effect that these infections have on Minnesota’s adolescents and young adults.

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Promoting Adolescent Health: Partnerships Between Pediatricians, Parents and Adolescents

ReneeSieving AnnieMcReeBy Renee Sieving PhD, RN, FAAN, FSAHM & Annie-Laurie McRee DrPH, University of Minnesota

Guidelines from the AAP and other professional organizations highlight provision of confidential care and time alone with a clinician as critical elements of adolescent preventive services. However, recent research highlights a gap between professional guidelines around confidential services and practice.

A nationwide study with parents of teens found that of adolescents who had a clinic visit in the past year, only 30 percent reported time alone with their health care provider. In another study examining confidential services and private teen-clinician discussions, adolescents, parents, and clinicians all expressed strong support for confidential adolescent services but also voiced ambivalent attitudes about these services. This ambivalence often reflected the desire to promote adolescents’ independence as health care consumers, while also wanting to continue to protect them from harm. Our current research–involving Minnesota-based clinicians, parents and teens—explores the balance between confidential services and parent engagement.

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The Nitty Gritty of Providing Adolescent Confidential Services

DaveAugheyDave Aughey, MD, FAAP, Children’s Minnesota

Minnesota’s “Minor Consent” statute allows adolescents to receive confidential sexual health services. The statute does not mandate that clinicians need to provide confidential care. But if services are provided confidentially, the clinician is obligated to do everything possible to ensure 100 percent privacy for the patient.

This is an implied contract between the clinician and the patient and is consistent with “Do no harm.” When confidentiality is broken, not only is the patient’s trust violated, but a variety of harms may occur.

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Endocannabinoids and Autism Spectrum Disorder: Facts, Not Hype

LucienGonzalezLucien Gonzalez, MD, MS, FAAP, Diplomate of ABAM, University of Minnesota

Autism spectrum disorder (ASD) has been added to the list of qualifying medical conditions for Minnesota Medical Cannabis. Patients certified to have ASD will be eligible to enroll in the program on July 1, 2018 and receive cannabis extracts from the state’s approved vendors beginning August 1, 2018.

Minnesota joins only Pennsylvania and Georgia in specifically including autism among their lists of qualifying conditions for young people. In Delaware, autism is a qualifying condition for adults only.

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Gender Nonconformity: Understanding Steps and Care

By Rhamy Magid, MD, FAAP, HCMC

Increasingly, primary care pediatricians, as well as pediatric subspecialists, are caring for youth who identify as transgender or gender nonconforming (GNC). Rather than an increase in prevalence, this phenomenon is more likely a testament to a gradually improving cultural environment, both nationally and in the state of Minnesota.

In the 2016 Minnesota Student Survey, 3 percent of 9th graders and 2 percent of 11th graders considered themselves transgender, genderqueer, genderfluid, or were unsure about their gender identity. We have a responsibility and an opportunity to lift the health and the spirits of one of our most vulnerable patient subpopulations.

In the AAP’s July 2017 Statement in Support of Transgender Children, Adolescents and Young Adults, Drs. Stein and Remley affirm that the Academy “stands in support of transgender children and adults, and condemns attempts to stigmatize or marginalize them…As pediatricians, we know that transgender children fare much better when they feel supported by their family, school and larger community…The AAP supports policies that are gender-affirming for children.”

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