Jennifer L. Marino

Background: Online information in Australia about abortion has not been assessed, despite its capacity to impact the trajectory of care without face‐to‐face medical expertise. Aim: To evaluate the online information that women in Australia can access for an unintended pregnancy. Study Design: Mixed methods were employed in four phases. A search identified abortion portals (defined as a webpage under a single domain, providing access to other abortion websites). DISCERN scores evaluated portals quality standard. A Student's t ‐test was employed to assess the difference in quality by type of organisation (portals ending in .gov.au vs. .org.au). A one‐way ANOVA compared portals according to the population size they targeted: ≤ 3 million, > 3 million to 8.2 million and > 8.2 million. Summative content analysis explored the framework of written words within portals associated with decision‐making. Results: Two hundred and thirty‐seven results were identified, with 24 selected. Portals were generally high quality (61.25 out of a possible 80). Quality standard did not significantly differ by type of organisation (.gov.au: 64.9, .org.au: 59.1; p = 0.28), nor by population size targeted (≤ 3 million: 64.2, > 3 million to 8.2 million: 58.3, > 8.2 million: 61.25; p = 0.59). Summative content analysis identified five categories associated with decision‐making: I am pregnant now what?, emotional support, facts that impact choices, practicalities and procedural knowledge. Conclusion: The rigorous methods employed to review the online abortion sites provided women with the information required to better prepare for and navigate abortion services and make decisions expeditiously. We now need to assess if women are using these resources to make decisions about their care.

Dysmenorrhea and heavy menstrual bleeding (HMB) are common gynecological conditions that substantially affect physical, emotional, and social well-being of young women (ACOG Committee on Practice B...

Menopausal symptoms are common in cancer survivors, often affecting their daily lives. Despite available treatments, few have access to adequate symptom management. Novel approaches, such as those incorporating symptom assessment and tailored or stepped approaches, are needed. This study explored perceived enablers and barriers to using an online patient-driven stepped-care platform to screen for and manage menopausal symptoms. Women with a history of cancer were invited through partner organisations by email or social media. Participants completed semi-structured interview based on a theoretical domain framework and the capability, opportunity, and motivation-behavior model. Transcripts were coded into the 14 theoretical domains. Belief statements were analysed into themes and categorised as enablers or barriers. Twenty participants (aged 30–75) were interviewed. Most were Australian-born ( n = 18), held vocational training or bachelor’s degree ( n = 12), and were employed ( n = 11). The most common cancer experienced was breast ( n = 6), most had received chemotherapy ( n = 16), were pre-menopausal before treatment ( n = 13) and reported hot flushes or vaginal dryness ( n = 14 each). Twenty-eight themes were identified. Enablers included high confidence in using mobile technologies, a user-friendly platform, and their role as “cancer survivor” to self-manage symptoms. Barriers included low awareness of the stepped-care concept, patient-related comorbidities, and time constraints. The platform’s concept was viewed positively and as important, with high intention to use and follow recommended pathways. This study provides insights into factors that could influence survivors’ engagement with the platform. Findings will guide the prototype development.

Background: Menstrual cups offer a cost‐effective and environmentally sustainable product for many young people. While clinical trials have shown their safety and effectiveness, no studies have investigated their performance in real‐world use.Aims: To describe the acceptability and functionality (continuation, discomforts, leakage, and adverse events) of menstrual cups and investigate the supportive role of product knowledge.Materials and Methods: A cross‐sectional online survey of 530 people aged 15–24 living in Australia who had ever used a menstrual cup, recruited via a menstrual cycle tracking application.Results: More than half of participants (55%) were still using their first menstrual cup at the time of the survey, 16% had switched to an alternative cup, and 29% had discontinued use. In their first cycle of use, 54% of participants reported leakage and 25% reported pain or discomfort with the cup in place. Many participants (45%) reported being unable to remove the cup on their first attempt, with subsequently 17% requiring help to remove it, and 2% reported displacement of an intra‐uterine device during removal. These figures decreased for subsequent cycles. Half of the participants were aware prior to using a cup that different cup models may offer a better fit for different individuals. This knowledge was associated with decreased odds of needing help to remove the cup (adjusted odds ratio 0.57, 95% CI 0.35–0.94) or discontinuing use (adjusted relative risk ratio 0.66, 95% CI 0.44–1.00).Conclusions: Difficulties using menstrual cups are common in real‐world use and higher than reported in clinical trials. Improved education provision may support more positive user experiences.

Purpose: Cancer and its treatments are known to compromise fertility in adolescents and young adults (AYAs). The emotional burden of possible infertility is reduced in those who receive supportive oncofertility care. In legal minors, provision of health care must consider the legal context and desire that AYAs have for autonomous decision-making, together with their competence to make health decisions. This has important implications for how oncofertility discussions may, or may not, involve parents. The aim of this study was to explore oncofertility decision-making and care experiences in a national Australian sample of AYA cancer patients and their parents. Methods: AYAs aged 15–25 years and parents were recruited from 17 cancer care sites and CanTeen Australia as part of a national AYA cancer care study. The cross-sectional survey included open-ended questions regarding oncofertility care experiences. We used reflexive thematic analysis to identify themes. Results: Data were available for 99 AYAs and 111 parents. Four themes were identified: emotional care needs; parent-AYA dynamics including AYA autonomy and agency; decision-making considerations including values and practicalities; and reflections on oncofertility care and follow-up. Both AYAs and parents placed importance on AYA autonomy in fertility decision-making, but many AYAs appreciated the role of parents in providing support and guidance throughout the process. Conclusion: Health care professionals are encouraged to autonomously engage AYAs around fertility decision-making, while concurrently offering opportunities that promote parental support. Better psychological support and follow-up oncofertility care are also needed.

Purpose: To understand how adolescents and young adults (AYAs) with cancer experience family and partner involvement in fertility preservation (FP) decision-making. Methods: As part of a nationally representative Australian cross-sectional study of 15–25-year olds with cancer, 196 participants (mean age 19.9 [standard deviation 3.2] years at diagnosis; 51% male) were surveyed regarding FP decision-making. Results: One hundred sixty-one (83%) participants reported discussion of potential effects of cancer and its treatment on fertility, of whom 57 (35%) did not undertake FP (51% of females; 19% of males). Parental involvement (mothers 62%, fathers 45%) in decision-making was considered helpful, including for 73% of 20–25-year olds with partners. Sisters and brothers were involved less often, yet rated helpful in 48% and 41% of cases, respectively. Older participants were more likely than younger ones to have involved partners (47% vs. 22%, p = 0.001) and less likely to have involved mothers (56% vs. 71%, p = 0.04) or fathers (39% vs. 55%, p = 0.04). Conclusion: This is the first quantitative study to explore family and partner involvement in AYA FP decision-making in both females and males in a nationally representative sample. Parents are important resources who commonly assist AYAs with these complex decisions. Although many AYAs will be the main decision-makers when it comes to FP, particularly as AYAs mature, these data suggest that resources and support should be available for and inclusive of parents, partners, and siblings.

There is limited evidence on heterogenous co-developmental trajectories of internalizing (INT) and externalizing (EXT) problems from childhood to adolescence and predictors of these joint trajectories. We utilized longitudinal data from Raine Study participants (n = 2393) to identify these joint trajectories from 5 to 17 years using parallel-process latent class growth analysis and analyze childhood individual and family risk factors predicting these joint trajectories using multinomial logistic regression. Five trajectory classes were identified: Low-problems (Low-INT/Low-EXT, 29%), Moderate Externalizing (Moderate-EXT/Low-INT, 26.5%), Primary Internalizing (Moderate High-INT/Low-EXT, 17.5%), Co-occurring (High-INT/High-EXT, 17%), High Co-occurring (Very High-EXT/High-INT, 10%). Children classified in Co-occurring and High Co-occurring trajectories (27% of the sample) exhibited clinically meaningful co-occurring problem behaviors and experienced more adverse childhood risk-factors than other three trajectories. Compared with Low-problems: parental marital problems, low family income, and absent father predicted Co-occurring and High Co-occurring trajectories; maternal mental health problems commonly predicted Primary Internalizing, Co-occurring, and High Co-occurring trajectories; male sex and parental tobacco-smoking uniquely predicted High Co-occurring membership; other substance smoking uniquely predicted Co-occurring membership; speech difficulty uniquely predicted Primary Internalizing membership; child’s temper-tantrums predicted all four trajectories, with increased odds ratios for High Co-occurring (OR = 8.95) and Co-occurring (OR = 6.07). Finding two co-occurring trajectories emphasizes the importance of early childhood interventions addressing comorbidity.

Sexuality- and gender-diverse young people experience disproportionate health and social adversity^1,2 and barriers to health care access.^3-5 Approximately 5% to 15% of adolescents are sexuality diverse,^6-9 and 0.5% to 2% are transgender or gender diverse,^6,7,10,11 with wide variance due to measurement differences and age, with most estimates in older adolescents (aged ≥15 years). Accurate measurement of sexual orientation and gender diversity in population research is important to better inform our understanding of the relative health and well-being of these minority groups. The Achenbach System of Empirically Based Assessment (ASEBA) Child Behavior Checklist/4-18 (CBCL),¹² Teacher Report Form (TRF),¹³ and Youth Self-Report (YSR)¹⁴ have been used to explore gender diversity in children and adolescents. In ASEBA items 110 and 5, respectively, the parent, child or adolescent, or teacher endorses degree of agreement with the statements that the child or adolescent “wishes to be of opposite sex” and “behaves like the opposite sex.” In recent research, these items have been used to measure relationships between gender diversity and autism^15-17 or psychiatric morbidity.^18,19 However, questions have been raised regarding whether item 110 is a valid indicator of gender diversity in clinical or population settings¹⁵ and therefore whether it should be used to infer diverse gender identity. These items may measure other dimensions of human experience, such as desire or ability to conform to stereotyped gender roles. Although a previous study found an association between these items in middle childhood and adult same-gender sexual identity, attraction, and behavior,²⁰ the association between these items in earlier childhood and adolescence and diverse sexual orientation in adulthood has not been considered. We sought to characterize sexual orientation and gender diversity in a longitudinal, general population birth cohort of Australian young people. We hypothesized that the ASEBA measures of gender role nonconformity in childhood and adolescence would be associated with diverse sexual orientation in young adulthood.

Purpose: Ovarian cancer is the third most common gynaecological cancer among women, yet remains under-researched. Past studies suggest that women who present with ovarian cancer have more supportive care needs compared to women experiencing other gynaecological cancers. This study explores the experiences and priorities of women with a diagnosis of ovarian cancer and whether age may influence these needs and experiences. Methods: Participants were recruited by a community organization, Ovarian Cancer Australia (OCA), via a social media campaign promoted on Facebook. Participants were asked to rank priorities around living with ovarian cancer, and to endorse which supports and resources they had used to address those priorities. Distributions of priority rankings and resource use were compared by age (19-49 vs. 50+ years). Results: Two hundred and eighty-eight people completed the consumer survey and most respondents were 60-69 years (33.7%). Priorities did not vary by age. Fear of cancer recurrence was identified by 51% respondents as the most challenging aspect of having ovarian cancer. Compared with older respondents, a higher proportion of young participants were more inclined to use a mobile app version of the OCA resilience kit (25.8% vs 45.1%, p=0.002) and expressed interest in using a fertility preservation decision aid (2.4% vs 25%, p<0.001). Conclusion: Fear of recurrence was participants’ primary concern, presenting an opportunity to develop interventions. Information delivery needs to consider age-specific preferences to better reach the target audience. Fertility is more important to younger women and a fertility preservation decision aid may address this need.

Background: Formative experiences in adolescence lay the foundation for healthy and pleasurable romantic and sexual relationships. Exposure to pornography may affect these experiences. Objective: We aimed to synthesize evidence published in the past decade on the relationship between exposure to pornography and sexual behavior (earlier age of first sex [1], lifetime multiple partners [>1], group sex, sexual aggression including forced sex, paid sex, teenage pregnancy, and history of sexually transmitted infection) in adolescents aged between 10 and 19 years. Methods: We identified 19 eligible studies by searching MEDLINE, PsycINFO, Cochrane, CINAHL, Embase, and Web of Science databases from January 2010 to November 2022. Results: Out of 8 studies that assessed earlier age of first sex, 5 studies, including 1 longitudinal study, found a statistically significant association with exposure to pornography. Given that most studies were cross-sectional or had substantial limitations, causal inference could not be made. Also, exposure to pornography was not measured consistently. The evidence was conflicting or insufficient to draw any conclusions regarding other outcomes. Conclusions: More quantitative research is needed to elucidate the association between pornography exposure and sexual behavior, and sex education should adopt evidence-based approaches to minimize the potential harms from pornography. Trial Registration: PROSPERO International Prospective Register of Systematic Reviews CRD42021227390; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=227390