Purpose-To examine the relationship between sexual orientation and past-year reports of bullying victimization and perpetration in a large sample of American youth.Methods-Survey data from 7,559 adolescents aged 14 to 22 who responded to the 2001 wave questionnaire of the Growing Up Today Study were examined cross-sectionally. Multivariable generalized estimating equations regression was performed using the modified Poisson method. We examined associations between sexual orientation and past-year bully victimization and perpetration with heterosexuals as the referent group, stratifying by gender and controlling for age, race/ethnicity, and weight status.Results-Compared to heterosexual males, mostly heterosexual males (risk ratio (RR): 1.45; 95% confidence interval (CI): 1.13, 1.86) and gay males (RR 1.98; CI 1.39, 2.82) were more likely to report being bullied. Similarly, mostly heterosexual females (RR 1.72, 95% CI 1.45, 2.03), bisexual females (RR 1.63, 95% CI 1.14, 2.31), and lesbians (RR 3.36, 95% CI 1.76, 6.41) were more likely to report being bullied than were heterosexual females. Gay males (RR 0.34, 95% CI 0.14, 0.84) were much less likely to report bullying others than were heterosexual males. Mostly heterosexual females (RR 1.70, 95% CI 1.42, 2.04) and bisexual females (RR 2.41, 95% CI 1.80, 3.24) were more likely to report bullying others than heterosexual females. No lesbian participants reported bullying others.Conclusions-There are significant differences in reports of bullying victimization and perpetration between heterosexual and sexual minority youth. Clinicians should inquire about sexual orientation and bullying, and coordinate care for youth who may need additional support.

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Confidentiality for adolescents has important implications for the quality provision of healthcare for this vulnerable population. Physicians and other healthcare providers must be aware of these health implications, as well as federal policies, common law, and their individual state's laws pertaining to this important topic.

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Iron deficiency and fatigue are common problems in adolescent females. Heavy menstrual bleeding (HMB) is associated with both iron deficiency and fatigue. The aim of this study was to define baseline ferritin values and fatigue symptoms in a population of young females with excessive menstrual blood loss, as compared to healthy controls. The study population included 11 to 17-year-old menstruating females presenting to an Adolescent Gynaecology Clinic, Menorrhagia Clinic or Sports Medicine clinic. To evaluate the degree and effects of menstrual blood loss, we utilized the Ruta Menorrhagia Severity Score. We investigated the symptoms of fatigue using the Fatigue Severity Scale. We evaluated possible predictors of ferritin level (age, body mass index, fatigue scores and Menorrhagia Severity Score) using generalized linear models. A total of 48 adolescents with HMB and 102 healthy adolescents completed the study. Iron deficiency and elevated fatigue scores were common findings in young women with HMB. Both fatigue severity scores and menorrhagia severity scores were significantly higher in young women with HMB as compared to healthy controls. In adolescents with HMB, 87.5% had ferritin levels ≤40 ng mL(-1), and 29.2% had ferritin levels ≤15 ng mL(-1). Our generalized linear models did not identify any significant univariate relationships between ferritin levels and patient age, body mass index, fatigue score or menorrhagia score. Iron deficiency and symptoms of fatigue are common findings in young women with HMB. Fatigue severity scores are significantly higher in young women with HMB as compared to healthy controls.

Adolescent and young adult reproductive health care needs are not diminished during pandemics. Needs for family planning services may be heightened because of various environmental changes in response to the pandemic, including amount of parental supervision, daily structure, and usual ways of accessing contraception and condoms. Health care professionals (HCPs) caring for adolescent and young adult patients need to acknowledge that contraception is an essential need and adopt new approaches to providing this crucial care.In response to the coronavirus disease 2019 (COVID-19) pandemic, HCPs are exploring ways to ensure delivery of essential health care services and minimize exposure risks to personnel and patients, including virtual care. Fortunately, both telephone and video platforms are well suited to providing contraceptive care. While an in-person encounter may be ideal, many reproductive health care services can be performed virtually, including contraception counseling, provision and maintenance of regular and emergencycontraception,andsexualrisk-reductioncounseling. We propose the following approach for providing contraception to adolescents during COVID-19 that leverages virtual care and minimizes the need for in-person visits (Figure). This approach can be used by many HCPs and across telehealth and in-person settings.Safe provision of contraception relies largely on history and rarely requires a physical examination, pelvic or breast examinations, sexually transmitted infection, or cervical cancer screenings. 1 Much of the information needed can be obtained from the patient history, including patient-reported or previously recorded blood pressure. The US Medical Eligibility Criteria for Contraceptive Use provides guidance on contraindications to contraceptives based on the patient history and is available in many forms, including a smartphone application. 1 A challenge in conducting telehealth with adolescents is patient privacy; adolescents may not have a private space and HCPs may not be able to reliably assess whether an adolescent's verbal communication is actually private. It is important to explore who is in the room and if the patient can speak freely. We recommend using clinical judgement to guide whether you can safely ask about sensitive content and how much you need to obtain. It is not necessary to obtain a complete sexual history to prescribe contraceptives. Consider using yes/no questions for sensitive topics, such as interest in contraception, sexual history, and pregnancy screening.Fortunately, a healthy young person with no active or previous medical conditions who takes no medications or supplements can safely use any reversible contraceptive method. Using contraception is very safe and is safer than pregnancy. HCPs can ask questions to be reasonably certain a person is not pregnant. If there are no signs or

The Seventeen Days program shows promise to improve perceived self-efficacy to acquire condoms among sexually active female adolescents-an important precursor to behavior change.

4215 Introduction Adolescent females are one of two pediatric populations at greatest risk for iron deficiency. An important risk factor for iron deficiency in adolescent females is excessive menstrual blood loss. Due in part to changes in circadian rhythms and poor sleep hygiene, fatigue is also a pervasive problem in adolescence, and may be exacerbated by iron deficiency secondary to menorrhagia. Clinical trials have shown that non-anemic adult women with low serum ferritin (≤15„30 ng/ml) and unexplained fatigue demonstrate improvement in fatigue with iron supplementation. Similar studies have not been performed in women <18 years of age. Our primary objective was to define baseline ferritin values and fatigue symptoms in a population of young females with a history of heavy menstrual bleeding. Methods The study population included 11,Ÿ17 year old females presenting to an Adolescent Gynecology Clinic or Menorrhagia Clinic for initial evaluation or follow-up of heavy menstrual bleeding. To mirror our clinical practice, the study population included patients who did and did not take iron supplements, as well as those who did and did not use hormonal contraception. To evaluate the degree and effects of menstrual blood loss, we utilized the Ruta Menorraghia Scale (RMS), a subjective measurement of menstrual blood loss and health-related quality of life. Possible responses to each multiple choice question were assigned ordinal scores to produce a total menorrhagia severity score (MSS). We investigated symptoms of fatigue using the Fatigue Severity Scale (FSS), a Likert scale measurement of fatigue's effects, symptoms, and severity (possible responses range from 1 to 7). Hemoglobin and ferritin levels were obtained by venipuncture after the completion of survey instruments. A control population of 12,Ÿ17 year old menstruating females was recruited from a Sports Medicine clinic. These patients completed the RMS and FSS instruments but did not undergo venipuncture. We compared FSS and MSS between the two populations using the Kruskal Wallis test. We evaluated possible predictors of ferritin level (age, body mass index, fatigue scores, and MSS) using generalized linear models. Results A total of 31 adolescents diagnosed with heavy menstrual bleeding and 37 healthy adolescents completed the study. Mean MSS was 39.3 (±17.4) in those with a history of heavy menstrual bleeding, compared to 17.9 (±10.0) in controls (p<.0001). When completing the menorrhagia scale, over two-thirds (71%) of adolescents with heavy menstrual bleeding reported that menses mildly to moderately affected their ability to participate in physical education class or sports, compared to 27% of controls. Thirteen (41.9%) of those with heavy bleeding reported missing at least one day of school with each menses, compared to 8.1% of controls. Mean fatigue score was 4.2 (±1.5) in patients with heavy menstrual bleeding, similar to values reported in adults with sleep-wake disorders. In contrast, the mean fatigue score was 2.98 (±1.1, p=.001) in the control population, similar to values reported in normal healthy adults. Twenty-five of 31 (80.6%) adolescents with heavy menstrual bleeding had ferritin levels ≤30 ng/ml, and ten (32.2%) had ferritin levels ≤15 ng/ml. Our generalized linear models did not identify any significant univariate relationships between ferritin levels and patient age, body mass index, fatigue score, or menorrhagia score. This finding may be due to our small sample size, or the narrow range of ferritin levels in our study population (87% had a ferritin level <40 ng/ml). Discussion Iron deficiency and symptoms of fatigue were common findings in a small population of young women with heavy menstrual bleeding. Fatigue severity scores were significantly higher in our study population as compared to healthy controls. Larger studies are needed to delineate the relationship between menstrual blood loss, fatigue, and ferritin values in adolescents, in order to plan for future intervention trials of iron supplementation. We also identified a high frequency of physical activity limitations and school absence in young women with heavy menstrual bleeding, highlighting the importance of including these types of patient-reported outcomes in the design of clinical trials for this patient population. Disclosures: No relevant conflicts of interest to declare.