Introduction: The on-road behind-the-wheel “practical” license test is the gate by which aspiring drivers must pass in order to drive independently in many jurisdictions. Evidence linking practical test performance and future driving outcomes is mixed. In the United States, license tests are characterized by high pass rates. A more rigorous test might dissuade applicants who are not ready from attempting the test, encourage better preparation, and also sensitize aspirational drivers to their areas of strengths and weaknesses; this is especially important for young, novice drivers. Methods: The purpose of this analysis was to detail the validation and implementation of the Drivingly On-Road Driver Assessment (DORA) to inform the debate on adopting a more challenging license test for young drivers and to describe the frequency of critical errors committed. Dyads randomized to the intervention arm of the Drivingly trial and who participated in the DORA were analyzed (n = 453 adolescents). The DORA was administered in live-traffic by a certified instructor at the end of the state learner’s permit holding period. Critical errors were assessed. Drivers self-reported practice hours and number of license test attempts following the DORA. Driver licenses were authenticated by the study team. Enrollment ran from 8/18/2021 to 12/15/2023. Results: Learner drivers passing the practical test the first-time had fewer critical errors on the DORA than those who took 3 + attempts or who delayed license-testing (p < 0.0001). Practice was inversely associated with errors (p < 0.001). Commission of critical errors was common, yet 317(70%) of learner drivers were licensed in one practical test attempt. Conclusions: The DORA validly assesses driving performance. Practical Implications: Changing state practical driver licensing examinations to be more comprehensive and rigorous could enhance traffic safety.

Introduction Motor vehicle crashes (MVCs) are a leading cause of injury and death of adolescents world-wide. There is no consensus on the most efficacious individual-level behavioral interventions for reducing young drivers’ risk for MVCs. The purpose of this systematic review was to evaluate evidence of effectiveness of such interventions. We were interested in only fully randomized-controlled trials (RCT) owing to the superior quality of evidence they provide. Methods Eligible studies needed to have all of the following attributes: 1) random assignment, 2) concern individual-level behavioural interventions, 3) target young drivers (16–24 years of age), young drivers and their carer (dyads), or carers of young drivers, and 4) report young drivers’ post-license MVC outcomes. The Risk-of-Bias 2 assessment tool was used. Fourteen databases were searched from May-to-June 2023 and re-checked in April 2024. The protocol was pre-registered with Prospero: CRD42023425135. Results Sixteen papers corresponding to 12 distinct RCTs of individual-level behavioural interventions were identified as meeting all criteria for inclusion. Of these, none were found to be effective in reducing risk for MVC. Conclusion We propose that the limited amount of success thus far is caused by: 1) the quality of research evidence coupled with a lack of individual-level interventions mature enough to evaluate; 2) the small number of randomised controlled trials conducted; 3) the low statistical power of these trials; and related to this 4) the practice of combining MVCs with other outcomes. A more rigorous and collaborative approach is necessary to move the field forward in order to prevent MVCs in this vulnerable group.

BACKGROUND AND OBJECTIVES:Adolescent strengths and risks are not routinely captured in systematized and actionable ways in pediatric primary care. To address this problem, we developed a comprehensive adolescent health questionnaire (AHQ) integrated within the electronic health record and evaluated the AHQ's impact on collection of information on prioritized health-related domains. METHODS:We developed and pilot tested the AHQ. We then scaled and assessed the AHQ's impact on data collection. AHQ development used innovation methods and measured feasibility and acceptability outcomes. Scaling and postscaling outcomes included Reach, Effectiveness, Adoption, Implementation, Maintenance and Sustainability measures: Reach (total questionnaires completed), Effectiveness (capture of key information across health domains pre- vs post-AHQ scaling), Adoption (proportion of practices that adopted the AHQ), Implementation (proportion of eligible adolescents who completed the AHQ), and Maintenance (monthly completion rates). RESULTS:AHQ development led to a tool that was feasible and acceptable for use. During scaling (October 2020-December 2021), 22 147 questionnaires were completed by 20 749 unique adolescents aged 13 to 21 years at their preventive visit. Comparing pre- versus post-AHQ scaling data, use of the AHQ increased collection of information across domains, especially for strengths, gun safety, substance use, sexual activity, sexual orientation, and gender identity, from ranges of 0%-25% to 92%-95%. All 31 practices adopted the AHQ with completion at 88.7% of visits (n = 24 968). Two years postscaling, completion rates were >91% per month. CONCLUSIONS:We successfully developed, scaled, and maintained an AHQ in a widely-used electronic health record system, a model for improving adolescent care and foundation for developing future interventions.

Purpose: To further elucidate the various aspects of the triadic relationship between health-care providers (HCP), adolescents, and caregivers during adolescent health-care visits, with the goal of helping HCPs better understand how they can best support adolescents to choose healthy behaviors. Methods: Adolescents (ages 13-18 years) and caregivers of adolescents were recruited to participate in qualitative interviews regarding preferences for provider interactions around health behavior change. Data analysis was conducted using inductive thematic analysis to identify and describe patterns of themes across the dataset. Results: Thirty one adolescents and 30 caregivers participated. Fourteen themes emerged in the analysis regarding adolescent and caregiver preferences for direct and indirect relationships between adolescents, caregivers, and HCPs in promoting healthy behavior. These themes were organized into a triadic collaboration framework to promote healthy behavior using an adolescentcentered and caregiver -involved approach. Discussion: This study supports findings of previous research on triadic interactions between HCPs, adolescents, and caregivers while deepening our understanding of the HCP's role in helping adolescents to choose healthy behaviors. These themes are representative of the continuing shift toward an adolescent -centered and caregiver -involved approach to adolescent health care and provide further guidance to HCPs on how to work collaboratively with both adolescents and caregivers to promote healthy behaviors and improve health outcomes. (c) 2023 Society for Adolescent Health and Medicine. All rights reserved.

The Journal of Adolescent Health (JAH) is the multidisciplinary scientific journal of the Society for Adolescent Health and Medicine (SAHM), a professional society dedicated to improving the health and wellbeing of all adolescents and young adults (AYA). JAH is committed to publishing articles that help to increase AYA health equity, decrease AYA health disparity, and promote respect for all young people. To do this effectively, we depend on high-quality submissions, followed by a review process that is based on diversity, equity, and inclusion (DEI) principles. There is an emerging discussion about the importance of DEI within the field of scholarly publishing. The Committee on Publication Ethics is an organization committed to educating and supporting editors, publishers, and authors with the aim of normalizing ethical practices in publishing culture [https://publicationethics.org/about/our-organisation]. Committee on Publication Ethics has produced a comprehensive discussion paper on diversity and inclusivity that attempts to accomplish five goals: (1) Identify subjects of discrimination in scholarly research; (2) Identify representational issues related to workforce discrimination and marginalization in employment; (3) Identify impact of discriminatory practices in peer review and editorial decision-making; (4) Identify marginalization of topics of research study, including through citation lexicons and algorithmics; and (5) Provide initial recommendations for the promotion of social justice and equity within scholarly publishing [[1]COPE Council. COPE discussion document: diversity and inclusivity — English. Available at: https://publicationethics.org/node/52156. https://doi.org/10.24318/RLqSoVsZ. Accessed November 4, 2022.Google Scholar]. Elsevier, the company with whom SAHM contracts to publish JAH, has an active Inclusion and Diversity Advisory Board (https://www.elsevier.com/about/inclusion-diversity-board). Elsevier is committed to enhancing inclusion and diversity in academic research and to ensuring that research is conducted and reported in the most equitable and inclusive manner possible [[2]Elsevier inclusion and diversity advisory board, 2020- 2021 report.https://www.elsevier.com/__data/assets/pdf_file/0008/1243673/ID-BOARD-REPORT_20220321.pdfDate accessed: November 4, 2022Google Scholar]. Individual journals have published editorials, communications, and reports specific to this topic [3Fontanarosa P.B. Flanagin A. Ayanian J.Z. et al.Equity in the JAMA network.JAMA Cardiol. 2021; 6: 876-879Crossref PubMed Scopus (3) Google Scholar, 4Fisher P.G. Cole S.S. Cochran C.R. et al.Diversity, equity, and inclusion in the journal of pediatrics.J Pediatr. 2021; 236: 4Abstract Full Text Full Text PDF PubMed Scopus (3) Google Scholar, 5Shah S.S. Shaughnessy E.E. Spector N.D. Promoting gender equity at the journal of hospital medicine.J Hosp Med. 2020; 15: 517Crossref PubMed Scopus (7) Google Scholar, 6Williams W.A. Garvey K.L. Goodman D.M. et al.Role of gender and publication at the journal of pediatrics 20 15-20 16: Equal reviews, unequal opportunities.J Pediatr. 2018; 200: 254-260.e1Abstract Full Text Full Text PDF PubMed Scopus (26) Google Scholar, 7Merriman R. Galizia I. Tanaka S. et al.The gender and geography of publishing: Review of sex/gender reporting and author representation in leading general medical and global health journals.BMJ Glob Health. 2021; 6: e005672Crossref PubMed Scopus (22) Google Scholar, 8Buffone B. Djuana I. Yang K. et al.Diversity and health professional education scholarship: A document analysis of international authors representation in leading journals.BMJ Open. 2020; 10: e043970Crossref PubMed Scopus (13) Google Scholar]. Yet, there has been no consensus on how best to incorporate DEI principles into scholarly publishing practices. Over the past two years, JAH's leadership has engaged in a series of discussions about the importance of being more intentional about integrating DEI principles in our scholarly journal's role in promoting AYA health equity and reducing AYA health disparities. JAH recently published a commentary authored by the SAHM DEI Ad Hoc Committee that was focused on the role of professional organizations in advancing DEI [[9]Barkley L. Kelley M.A. Mihaly L. Chulani V.L. Advancing diversity, equity, and inclusion in professional organizations: Lessons from the society for adolescent health and medicine.J Adolesc Health. 2022; 71: 523-525Abstract Full Text Full Text PDF PubMed Scopus (3) Google Scholar]. This commentary highlighted the 2002 Institute of Medicine seminal publication titled "Unequal Treatment," which underscored the need to increase the proportion of health professionals from under-represented backgrounds to address health inequities experienced by members of historically marginalized groups [[10]Institute of Medicine (US)Smedley B.D. Stith A.Y. Nelson A.R. Committee on understanding and eliminating racial and ethnic disparities in health care. Unequal treatment: Confronting racial and ethnic disparities in health care. National Academies Press (US), Washington (DC)2003Google Scholar]. In addition, professional medical organizations have been charged with promoting DEI in their memberships and providing leadership to address health inequities in clinical practice [[11]Institute of Medicine (US)Committee on institutional and policy-level strategies for increasing the diversity of the U.S. Healthcare workforce.in: Smedley B.D. Stith Butler A. Bristow L.R. The Nation's compelling interest: Ensuring diversity in the health-care workforce. National Academies Press (US), Washington (DC)2004Google Scholar]. Noting the lack of consensus on how professional organizations can advance DEI efforts, the SAHM's DEI Ad Hoc Committee described efforts undertaken by SAHM to respond to the calls to action, current efforts to codify DEI values into SAHM's operations, and lessons learned applicable to other organizations [[9]Barkley L. Kelley M.A. Mihaly L. Chulani V.L. Advancing diversity, equity, and inclusion in professional organizations: Lessons from the society for adolescent health and medicine.J Adolesc Health. 2022; 71: 523-525Abstract Full Text Full Text PDF PubMed Scopus (3) Google Scholar]. The Committee proposed focusing on specific SAHM activities to address opportunities for more inclusion, with activities including SAHM membership, leadership, conference presentations, awards, training, and JAH. We agree that JAH has opportunities for more inclusion and we take this opportunity to summarize the Journal's recent and current DEI-related activities. Consistent with SAHM's history and recommendations of the SAHM Ad Hoc Committee, we consider multiple dimensions of diversity [[9]Barkley L. Kelley M.A. Mihaly L. Chulani V.L. Advancing diversity, equity, and inclusion in professional organizations: Lessons from the society for adolescent health and medicine.J Adolesc Health. 2022; 71: 523-525Abstract Full Text Full Text PDF PubMed Scopus (3) Google Scholar]. JAH acknowledges the importance of increasing health equity and reducing health disparities among AYA populations based on the dimensions of race, ethnicity, language, gender, sexuality, culture, geography, income, disability, illness, and body size and shape. JAH considers similar dimensions of diversity when creating its Editorial Board, with the addition of professional discipline, areas of content expertise, and stage of career. Furthermore, JAH leadership recognizes the importance of acknowledging that individuals may have more than one identity, considering intersectionality and conducting research on overlapping dimensions of diversity. JAH leadership has developed a framework to help guide our efforts to support DEI principles and promote AYA health equity (Figure 1). This framework is grounded in JAH's dedication to publishing articles that help to improve the health and wellbeing of all AYAs, increase AYA health equity, decrease AYA health disparities, and promote respect for all young people. We accomplish this by publishing and disseminating high-quality evidence-based original research, reviews, editorials, commentaries, case reports, infographics, letters, and JAH intersection items. To do this effectively, we depend on an equitable review process that is based on DEI principles, which minimize risks of discrimination and bias. Content published in JAH is contingent upon the types and quality of articles that are submitted for our consideration. Within the context of this framework, we first reflect upon recent work within three core domains. This is followed by a description of areas of ongoing work and priorities for future improvements.(1)Encourage more high-quality submissions in a manner that is consistent with strong DEI principles and informs efforts to improve health equity. We aim to attract high-quality original research and other submissions that align with JAH's aims and scope. We have revised our aims and scope explicitly to include a description of our commitment to improving health equity and reducing health disparities among AYAs (https://www.jahonline.org/content/aims). Submissions from diverse groups of multidisciplinary authors are strongly encouraged. We urge JAH Editorial Board members to serve as ambassadors to encourage high-quality submissions to the Journal. We expanded and diversified our Board in 2019 and again this year, with the goal of increasing diversity in areas of professional discipline, content expertise, stage of career, race, ethnicity, gender, and geography. This will help to extend our reach to a more diverse group of authors who are focused on increasing health equity and decreasing health disparities in AYAs. To support authors, we have added information about Elsevier's Author Support Services to our author guidelines (https://www.jahonline.org/content/authorinfo). Our guidelines encourage authors to use inclusive, nonstigmatizing language, consistent with the style guides of the American Medical Association and the American Psychological Association [12American Medical Association and Association of American Medical CollegesAdvancing health equity: Guide on language, narrative and concepts.https://www.ama-assn.org/about/ama-center-health-equity/advancing-health-equity-guide-language-narrative-and-concepts-0Date: 2021Date accessed: November 4, 2022Google Scholar, 13American Psychological AssociationInclusive language guidelines.https://www.apa.org/about/apa/equity-diversity-inclusion/language-guidelines.pdfDate: 2021Date accessed: November 4, 2022Google Scholar, 14Flanagin A. Frey T. Christiansen S.L. et al.Updated guidance on the reporting of race and ethnicity and medical and science journals.JAMA. 2021; 326: 621-627Crossref PubMed Scopus (554) Google Scholar]. This includes a strong preference for use of person-first language (e.g., "a person living with HIV" rather than "an HIV-positive person"). JAH's Editor-in-Chief and Managing Editor offer workshops at annual SAHM meetings and meetings of the International Association of Adolescent Health to encourage and support authors interested in submitting their work to our Journal.(2)Improve processes to ensure that all submissions receive a fair review and minimize risks of unintended discrimination, exclusion, or bias. The initial review of submitted manuscripts involves collaboration among the Editor-in-Chief, Associate Editors, and the Editorial Board. We have developed the following four specific criteria to guide decisions about whether a submission is referred for a full peer review versus "desk-rejected" without a full peer review:•Topic/Content. Is the content new, innovative, and/or important to the field of AYA health?•Science. Is the scientific design and execution strong and are the conclusions very likely to be valid?•Presentation. Is the study (rationale, methods, results, and discussion) presented in an organized and easily understandable manner? Given JAH's very limited capacity to assist authors in editing their manuscripts, submissions must be written in clear scientific English. Collaboration with an English-speaking colleague is recommended. Elsevier provides language services for a fee.•Alignment with JAH's Aims and Scope. Does the study align well with the aims and scope of SAHM's professional journal? JAH prioritizes publication of information that will be of interest to people working on AYA health in multiple geographical areas. For example, for JAH to publish an article, its results should be of interest to those working in the field of AYA health in more than one U.S. state or more than one other country. When submissions are sent for full peer review, the editorial office aims to invite peer reviewers with expertise related to the submissions' content, methodology, potential contribution to the field, and/or familiarity with the content's broader context. To the extent possible, peer reviewers with context expertise and/or relevant life experience are invited to review submissions on topics related to health equity or disparities or when submissions focus on highly sensitive or politically charged topics. Given the breadth and depth of topics considered for publication, JAH maintains a large and diverse pool of volunteer peer reviewers who are willing and able to conduct timely reviews. Our current reviewer database contains 10,500 potential reviewers. Our Editorial Analyst identifies and invites peer reviewers based upon the content of a submitted abstract and the subject-area classifications indicated by the authors. Reviewers are also nominated by the Editorial Board members who desk-reviewed the submission and we strongly consider author-suggested reviewers. Typically, JAH invites an initial group of eight potential reviewers to each submission. The editors generally rely on three completed peer reviews to inform final editorial decisions. In 2020, 29% of invited reviewers completed reviews. JAH has a standard appeal process available to authors who do not agree with initial decisions and the appeal process always involves a second independent desk review. Ensuring fair and unbiased peer review requires the involvement of a diverse JAH leadership team, Editorial Board, and pool of peer reviewers. We are engaged in ongoing efforts to diversify the membership of all groups. For example, 11 Board members volunteered to be part of the JAH International Working Group focused on issues related to extending the Journal's reach to more diverse international geographic and resource-limited regions. More details on this workgroup's efforts will be described in an upcoming editorial by Dr. David Ross, our JAH Associate Editor for international health.(3)Ensure that JAH is publishing content that increases our understanding of and informs practices, programs, and policies that improve health equity and reduce health disparities. Our methodology for tracking specific JAH content over time has historically focused on categorizing the main subject content of articles (e.g., mental health, substance use, reproductive health) rather than the article's contributions to understanding and improving health equity. Nonetheless, a scan of JAH tables of contents and article content reveals a range of topics important to understanding AYA health equity and health disparities along multiple diversity dimensions. Table 1 provides examples of recently published articles related to AYA health disparities, including topics on race, ethnicity, gender, gender identity, sexuality, culture, geography, income, disability, illness, and body size and shape. In addition, we include the direct perspective of youth who contribute information based on their lived experiences in publications that use qualitative methodologies and through use of creative expressions such as photographs, poems, and essays within JAH intersection [15Harness J. Fitzgerald K. Sullivan H. m Selkie E. Youth insight about social media effects on well/ill being and self-modulation efforts.J Adolesc Health. 2022; 71: 324-333Abstract Full Text Full Text PDF PubMed Scopus (3) Google Scholar, 16Wilkerson T.A. Hawryluk B. Moore C. et al.Developing a youth contraception navigator program: A human centered design approach.J Adolesc Health. 2022; 71: 217-225Abstract Full Text Full Text PDF PubMed Scopus (3) Google Scholar, 17Davies S.H. Langer M.D. Klein A. et al.Adolescent perceptions of menstruation on Twitter: Opportunities for advocacy and education.J Adolesc Health. 2022; 71: 94-104Abstract Full Text Full Text PDF PubMed Scopus (7) Google Scholar, 18Chang C. Ceci C. Uberoi M. et al.Youth perspectives on the medical team's role in screening for and addressing social determinants of health.J Adolesc Health. 2022; 70: 928-933Abstract Full Text Full Text PDF PubMed Scopus (6) Google Scholar, 19Quinn S.M. Parva B. COVID9TEEN virtues: Help, hope, and holding space. Editorial.J Adolesc Health. 2022; 71: 844-845Abstract Full Text Full Text PDF Scopus (2) Google Scholar]. JAH also publishes influential SAHM Position Papers, which address racism, health equality, and discrimination [[20]Society for Adolescent Health and MedicinePromoting equity and reducing health disparities among racially/ethnically diverse adolescents: A position paper of the society for adolescent health and medicine.J Adolesc Health. 2013; 52: 804-807Abstract Full Text Full Text PDF PubMed Scopus (13) Google Scholar,[21]Society for Adolescent Health and MedicineRacism and its harmful effects on nondominant racial–ethnic youth and youth-serving providers: A call to action for organizational change.J Adolesc Health. 2018; 63: 257-261Abstract Full Text Full Text PDF PubMed Scopus (31) Google Scholar,[22]Society for Adolescent Health and MedicinePromoting health equality and nondiscrimination for transgender and gender-diverse youth.J Adolesc Health. 2020; 66: 761-765Abstract Full Text Full Text PDF PubMed Scopus (20) Google Scholar] The important theme of intersectionality is now beginning to be discussed and studied [[23]Krause K.H. Mpofu J.J. Underwood J.M. et al.The CDC's adolescent behaviors and experiences survey – using intersectionality and school connectedness to understand health disparities during the COVID-19 pandemic.J Adolesc Health. 2022; 70: 703-705Abstract Full Text Full Text PDF PubMed Scopus (5) Google Scholar,[24]Krause K.H. Mpofu J.J. Brown M. et al.At the intersections: Examining trends in experiences of violence, mental health status, and suicidal risk behaviors among US high school students using intersectionality, national youth risk behavior survey, 2015–2019.J Adolesc Health. 2022; 71: 293-300Abstract Full Text Full Text PDF PubMed Scopus (5) Google Scholar].Table 1Examples of JAH publications informing areas of AYA health disparities related to race, ethnicity, gender, sexuality, culture, geography, income, disability/illness/other limitations, and body size/shape (August–October 2022)Publication title (type)DiversityDimensionsOctober 2022 Adolescent-Adult Social Networks and Experiences of Violence Among Black Youth in Neighborhoods With High Levels of Community Violence (Research)Race Racial Discrimination and Conduct Problems Among Black American Youth: The Moderating Effect of Ethnic Racial Socialization (Research)Race, Ethnicity, Culture Binary and Nonbinary Transgender Adolescents' Healthcare Experiences, Avoidance, and Well Visits (Research)Gender Same but Different? Comparing Attitudes Regarding Gender, Gender Diversity, and Sexual Diversity Among Early Adolescents in South Africa and Belgium (Research)Gender, Sexuality, Geography Obesity in Adolescents: Understanding the Combined Role of Food Security and Emotional and Behavioral Disorders (Research)Body size/shape The Role of Critical Consciousness and Inclusive Curricula in Adolescents and Young Adults' Wellbeing: A Call for Critical Multicultural Education. (Commentary)RaceSeptember 2022 Substance Use Behaviors Among LGBTQ + Youth of Color: Identification of the Populations Bearing the Greatest Burden in Three Large Samples (Research)Race, Ethnicity, Sexuality, Gender Males' Awareness of Female and Male Contraception Methods, Information, Outreach, and Acquisition Locations in Abidjan, Côte d'Ivoire, Nairobi, Kenya, and Lagos, Nigeria (Research)Gender, Geography Two-Year Follow-Up of a Transition-Specific Education Program for Young People With Chronic Conditions (Research)Illness At the Intersections: Examining Trends in Experiences of Violence, Mental Health Status, and Suicidal Risk Behaviors Among US High School Students Using Intersectionality, National Youth Risk Behavior Survey, 2015–2019 (Research)Race, Ethnicity, Sex/Gender How Do Psychosocial Interventions for Adolescents and Young People Living With HIV Improve Adherence and Viral Load? A Realist Review (Review)Illness Scientific Misinformation and Gender Affirming Care: Tools for Providers on the Front Lines (Commentary)GenderAugust 2022 Police Stops and the Erosion of Positive Future Orientation Among Urban Adolescents (Research)Race, Ethnicity Weight Status and Mental Well-Being Among Adolescents: The Mediating Role of Self-Perceived Body Weight. A Cross-National Survey (Research)Body shape/size Preventing, but Not Caring for, Adolescent Pregnancies? Disparities in the Quality of Reproductive Health Care in Sub-Saharan Africa (Research)Gender Geography Flavored Tobacco Product Use Among Young Adults by Race and Ethnicity: Evidence From the Population Assessment of Tobacco and Health Study (Research)Race, Ethnicity The Impact of Monetary Poverty Alleviation Programs on Children's and Adolescents' Mental Health: A Systematic Review and Meta-Analysis Across Low-, Middle-, and High-Income Countries (Review)Geography, Income Availability and Components of National Adolescent Health Programs, by World Bank Income Group (Infographic)Geography, Income Open table in a new tab In 2021, we realized that the way in which we collected data on manuscripts' geographic origin was ambiguous: the corresponding author's parent institution did not necessarily correlate with site of the actual research or data collection. This limited our ability to understand geographic diversity in submitted and published research. We have since modified this measure and new, more accurate location data will be emerging in 2023. During the process of discussing and developing JAH's framework to support DEI principles and promote AYA health equity, we identified areas of needed improvement and potential opportunities for the future. JAH recognizes that this is an evolving process as we learn, monitor, and progress. Addressing areas of needed improvement will require complex, effective, and multi-year sustained efforts along with multipronged and multilevel approaches. Informed by our discussions over the past two years, and placed within the context of our framework, JAH's leadership has initially prioritized the following activities. Currently, we do not have adequate data systems in place to help us to monitor or improve diversity within our publishing process, including information to identify or track submissions based on authors' identity, populations of research focus, or Editorial Board members' identities (i.e., demographic data such as sex/gender, racial and ethnic diversity, geography). Furthermore, we do not have data systems in place to describe potential peer reviewers based on diversity dimensions or context domains for which they are willing to contribute their expertise. We consider this data deficit to be a major limitation to current efforts to advance DEI in the scholarly publishing process. This need has been widely acknowledged among scholarly publishers. There are now international efforts to standardize how self-reported data on gender identity and race and ethnicity are collected [[25]Royal Society of ChemistryDiversity data collection in scholarly publishing.https://www.rsc.org/new-perspectives/talent/diversity-data-collection-in-scholarly-publishing/Date accessed: November 4, 2022Google Scholar,[26]Else H. Perkel J.M. The giant plan to track diversity and research journals.Nature. 2002; 602: 566-570Crossref Scopus (38) Google Scholar]. Elsevier is participating in these efforts and JAH has volunteered to be a part of its early efforts. While recognizing the multidimensional aspects of diversity, Elsevier is initially focusing on standardizing data collection of self-reported gender identity, race, and ethnicity through its Electronic Manager system. Authors, reviewers, and editors will be asked to self-report their identity data during login. Guiding principles for this process are as follows:•Users are in full control of their data.•Users have the option not to disclose.•User data are collected, stored, and safeguarded appropriately.•User data may be used to further diversity but will otherwise be analyzed and reported at aggregate levels.•User self-reported data cannot and will not be used during manuscript review processes.•Only capture data intended to be converted to an actionable output.•Level of aggregation and number of options for each schema parallel the scale of diversity they can practically accommodate (e.g., diversity on the Editorial Board).•Schemas will be periodically reviewed and updated as necessary. These processes will begin to provide JAH with self-identified data to describe dimensions of diversity among our authors, peer reviewers, and Editorial Board. Although we understand that there are challenges and differences of opinion about schemas for best collecting these data, and response rates will be less than 100%, we fully support Elsevier's activities. As data pertinent to JAH become available, they will become a part of our Annual Reports and discussed at the annual Editorial Board meeting. Our current classification system for describing the content of submissions should be updated. At this time, there is no effective system to describe and monitor submissions or publications based on content specifically related to health equity or health disparities. Authors and reviewers are given the opportunity to select from the same large list of classifications to describe their manuscript topic area or area of expertise, and JAH Editorial Office can run reports on these classifications to describe and match manuscripts and reviewers. This a voluntary selection process and it is subject to differences in selection/classification (that is, it lacks reliability). We will explore strategies to add the option of selecting categories aligned with health equity along multiple diversity dimensions. This editorial is intended to provide a broad overview of our thoughts related to JAH's DEI policies and practices. We recognize that there can be an added value to focusing on specific diversity dimensions. In this issue, we have published an important editorial focused on JAH and DEI within the dimensions of race and ethnicity [[27]Boyer C.B. Halpern C.T. Katzman D.K. et al.The journal of adolescent health's current practices and future opportunities for promoting and sustaining racially and ethnically diverse, equitable, and inclusive scholarly publishing policies and practices.J Adolesc Health. 2023; 72: 171-172Abstract Full Text Full Text PDF PubMed Scopus (2) Google Scholar]. Next month, we will publish another focused on JAH and DEI within the dimensions of geography and country income. Next month's editorial includes a summary of work done in collaboration with the JAH Editorial Board's International Working Group. We acknowledge that there may be a value in focusing on JAH and other DEI dimensions in the future. Although the numbers of submissions that are focused on health equity and health disparities are strongly influenced by funding priorities, we recognize that JAH could intentionally encourage more submissions through notices of our interest in publishing research in this area. JAH leadership is actively discussing a series of "Notices of Special Interest" for submission of articles related to relatively neglected health topics or specifically related to DEI, AYA health equity, or AYA health disparities. Submissions from diverse groups of multidisciplinary authors and research teams will be explicitly encouraged. Submissions will go through standard JAH peer-review process and if accepted will be published in regular JAH issues. JAH regularly publishes theme-driven supplements that are dedicated to specific topics. These are funded by external agencies or organizations. Manuscripts submitted to supplements undergo a standard peer review. JAH's leadership will explore funding agency interests in sponsoring a specific supplement dedicated to DEI, AYA health equity, and/or AYA health disparities. In addition, JAH's leadership will explore funding agency interests in sponsoring a supplement linked to mentorship support, with the goal of helping early career researchers from historically marginalized backgrounds to develop the knowledge and skills to successfully submit and publish an article in JAH. Watch for an upcoming supplement in mid-2023 that describes just such a series of collaborative interventions in sub-Saharan Africa. In summary, JAH's leadership is wholly committed and looks forward to continuing our journey toward implementing more intentional strategies to promote AYA health equity, reduce AYA disparities, and incorporate DEI principles throughout the editorial processes. Table 2 summarizes activities described in this editorial, which are parts of an ongoing active and interactive process. Our strategies will be guided by a framework placed within the context of publication of an academic journal. Collectively, these activities align with suggestions for JAH proposed by the SAHM DEI Ad Hoc Committee. We expect that consistent, sustained efforts will be required to produce a meaningful long-term change and look forward to actively setting priorities with ongoing evaluation. Regular updates will be provided to the JAH Editorial Board, SAHM Board of Directors, and to the broad JAH audience through future Journal editorials.Table 2JAH activities to support diversity, equity, and inclusion principles and promote adolescent and young adult health equityDiversifying Editorial BoardRevised Aims and Scope to include commitment to improving health equity and to DEI principlesRevised Guidelines for Authors to include information about Elsevier Author Support ServicesRevised Guidelines for Authors to encourage use of person-first, inclusive, non-stigmatizing language as defined by American Medical Association or American Psychological Association recommendationsJAH Workshops offered at SAHM and International Association of Adolescent Health (IAAH) meetings to support diverse researchers interested in submitting work to JAHDeveloped more specific transparent criteria to guide decisions about initial submission reviewClarified three completed peer-reviews typically required to inform final editorial decisionsJAH International Working GroupModified measure to increase validity of data collected for geographic location of researchElsevier standardizing voluntary data collection of self-reported gender identity, race, and ethnicity for editorial board members, authors, and reviewersAdded "health disparities" as potential submission classificationUpcoming "Notices of Special Interest"JAH Supplement opportunities Open table in a new tab

The Journal of Adolescent Health (JAH) remains committed to publishing high-quality science that can be used to improve the health and well-being of all adolescents and young adults 10–25 years of age. JAH publishes editorials, commentaries, and letters to help place this science within a broad context and to inform broad audiences. Reflecting upon the past year, I find myself embracing the importance of JAH and science within a politically volatile environment. I also find myself reflecting on the importance of compassion for young people, their parents, and the professionals dedicated to adolescents and young adults.

Background The impact of young drivers’ motor vehicle crashes (MVC) is substantial, with young drivers constituting only 14% of the US population, but contributing to 30% of all fatal and nonfatal injuries due to MVCs and 35% ($25 billion) of the all medical and lost productivity costs. The current best-practice policy approach, Graduated Driver Licensing (GDL) programs, are effective primarily by delaying licensure and restricting crash opportunity. There is a critical need for interventions that target families to complement GDL. Consequently, we will determine if a comprehensive parent-teen intervention, the Drivingly Program, reduces teens’ risk for a police-reported MVC in the first 12 months of licensure. Drivingly is based on strong preliminary data and targets multiple risk and protective factors by delivering intervention content to teens, and their parents, at the learner and early independent licensing phases. Methods Eligible participants are aged 16-17.33 years of age, have a learner’s permit in Pennsylvania, have practiced no more than 10 h, and have at least one parent/caregiver supervising. Participants are recruited from the general community and through the Children’s Hospital of Philadelphia’s Recruitment Enhancement Core. Teen-parent dyads are randomized 1:1 to Drivingly or usual practice control group. Drivingly participants receive access to an online curriculum which has 16 lessons for parents and 13 for teens and an online logbook; website usage is tracked. Parents receive two, brief, psychoeducational sessions with a trained health coach and teens receive an on-road driving intervention and feedback session after 4.5 months in the study and access to DriverZed, the AAA Foundation’s online hazard training program. Teens complete surveys at baseline, 3 months post-baseline, at licensure, 3months post-licensure, 6 months post-licensure, and 12 months post-licensure. Parents complete surveys at baseline, 3 months post-baseline, and at teen licensure. The primary end-point is police-reported MVCs within the first 12 months of licensure; crash data are provided by the Pennsylvania Department of Transportation. Discussion Most evaluations of teen driver safety programs have significant methodological limitations including lack of random assignment, insufficient statistical power, and reliance on self-reported MVCs instead of police reports. Results will identify pragmatic and sustainable solutions for MVC prevention in adolescence. Trial Registration ClinicalTrials.gov # NCT03639753.

In this issue of the Journal of Adolescent Health (JAH), we pay tribute to Dr. Charles (Charlie) E. Irwin, Jr., who was JAH's Editor-in-Chief from 2004 to 2019 and the Supplements Editor from 2019 to 2023. In July 2023, Dr. Irwin stepped down from his role as Supplements Editor of JAH after many years of outstanding service. We celebrate Dr. Irwin's contributions to JAH over the years. We recognize the many positive changes he has made during his tenure, his devotion to JAH, and his commitment to the JAH associate editors, editors, staff, contributors, reviewers, and readers. Dr. Irwin is a Distinguished Professor of Pediatrics and Director of the Division of Adolescent and Young Adult Medicine at the University of California, San Francisco, School of Medicine and the University of California, San Francisco, Benioff Children's Hospital. He is a graduate of Hobart College, Dartmouth Medical School, and University of California, San Francisco. He heads the National Adolescent Health Information and Innovation Center and the Public Policy Analysis and Education Center for Adolescent and Young Adult Health. Dr. Irwin was also a President of the Society for Adolescent Health and Medicine (SAHM) in 2002–2003. Dr. Irwin first assumed the role of Editor-in-Chief of JAH in 2004. Inspired by his commitment to the care of adolescents and young adults and scientific excellence, Dr. Irwin took on his new responsibilities with great vitality. During Dr. Irwin's tenure, the journal flourished as a multidisciplinary scientific journal dedicated to improving the health and well-being of adolescents and young adults. Dr. Irwin revitalized the organization and administrative structure of JAH. In particular, he built a strong editorial office that included Tor Berg, Managing Editor, and Teresa Dal Santo, Editorial Analyst. This dynamic team attracted high-quality manuscripts, administered rigorous peer review, promoted JAH, and increased its overall quality. In addition, Dr. Irwin established a core group of 5 associate editors who were senior researchers and subject experts on various adolescent and young adult health topics. This core group of associate editors played a key role in supporting Dr. Irwin and the success of the journal. Dr. Irwin had a clear vision for JAH. One of his early transformations of JAH was changing the cover of the journal. Beginning in January 2005, JAH began printing a comprehensive table of contents on the cover, making the topics of each volume clear and easy to review. A little over a year later, JAH was given a more modern look, replacing the original solid blue cover with the blue gradient that we see today. Dr. Irwin was also committed to making JAH an international journal. Under his leadership, the editorial board became truly international in its composition, consisting of 57 experts in the field, with 26 members from international communities representing each continent. In addition, JAH became a journal where more international and interdisciplinary professionals could disseminate their scholarly work on global health issues relevant to adolescent and young adult health. His commitment to excellence was evident in all aspects of producing JAH, from transitioning the journal from the paper-based system of peer review to the Editorial Manager (formerly Elsevier Editorial System) online submission and review system, revamping the journal's website, improving acceptance-to-publication timelines to 2 or 3 months, increasing the number of submissions 3.5 fold from 2004 to 2017, and creating a fast-tracking process for timely public policy content. Furthermore, Dr. Irwin's commitment to scientific rigor is one of the many contributing factors that propelled JAH to rank fifth among all pediatric journals. During Dr. Irwin's tenure, the impact factor steadily rose from 1.67 (2004) to an impressive 4.0984 (2017). Under Dr. Irwin's leadership, JAH has strengthened our field and moved adolescent and young adult health to the forefront of pediatrics. Dr. Irwin also launched a new section in the Journal entitled, Perspectives on Adolescence & Young Adulthood. Perspectives was an opportunity to share short essays, poetry, and stories by and about young people. The goal of this section was to inspire new insights and encourage authors and readers to be curious about the lived experiences of adolescents and young adults while broadening their perspective on this important period of the life cycle. Perspectives has evolved into our current successful JAH Intersection initiative. One of Dr. Irwin's greatest accomplishments was the introduction and oversight of supplements to JAH in 2005. In 2019, after completing his tenure as Editor-In-Chief, Dr. Irwin became JAH's inaugural Supplements Editor. Over the past 18 years, Dr. Irwin oversaw the publication of 45 JAH Supplements, approximately 2–3 per year. The Supplement volumes were dedicated to focused themes on important global adolescent and young adult health issues. The articles in each supplement underwent the same peer review process and met the same ethical and editorial standards as other manuscripts published in JAH. In addition, the supplement volumes broadened JAH's readership and played a critical role in disseminating new scientific information to a larger audience. Dr. Irwin's steadfast commitment to ensuring excellence in the supplements enhanced JAH's stature and reputation. In recognition of Dr. Irwin's commitment to research, training, and mentoring, SAHM established the Charles E. Irwin New Investigator Award to recognize professionals who, through excellence in research, have furthered SAHM's mission. Many of the Charles E. Irwin award recipients have published their original research in JAH. Dr. Irwin has been described as having "a steady hand steering the ship." He is regarded as a strong leader who guided the editorial team, set high standards, and fostered a collaborative working environment. Dr. Irwin's dedication to adolescent and young adult health coupled with his outstanding editorial skills, rigor, and attention to detail ensured the excellent scientific quality and content of the manuscripts published in JAH. Furthermore, Dr. Irwin always kept a vigilant eye on anticipated opportunities and challenges facing the scientific publishing community and the extent to which these changes could shape JAH in the future. Dr. Irwin made certain that the scientific quality and the accessibility of JAH was uncompromised as JAH continued to embark on new changes. In addition to his unwavering commitment to JAH and the field of adolescent and young adult health, Dr. Irwin is an adoring husband to Nancie Kester and father to Seth. He enjoys listening to music, particularly opera, good food and wine, and swimming. These are just some of the highlights of the incredible accomplishments during Dr. Irwin's tenure as Editor-in-Chief and Supplements Editor of JAH. Dr. Irwin's passion and commitment to JAH will be missed by Dr. Carol A. Ford, current Editor-in-Chief of JAH, the Associate Editors, the Editorial Board and JAH staff. He has left an indelible legacy of innovation and scientific excellence that will have an enduring impact on JAH and the field of adolescent and young adult health. On behalf of all of us at JAH, we wish to express our sincere gratitude to our friend Charlie for his years of service and dedication to JAH. We wish him all the best in the next phase of his illustrious career.

OBJECTIVE: To describe adolescent and young adult (AYA) perspectives on defining quality and value in health care and to gain understanding of their knowledge of value-based payment. METHODS: A text message-based survey was sent to a conve-nience sample of AYAs aged 14 to 24 in 2019. Participants were asked 4 open-ended questions: 1) how they would define "good health care," 2) what factors to consider in rating doc-tors, 3) whose opinions should matter most when rating doc-tors, and 4) the best ways to collect AYA opinions on doctors, and one yes/no question on their awareness of value-based payment. Analyses included descriptive demographic statistics and an inductive thematic approach with multivariable models comparing adolescent (14-18) and young adult (19-24) responses.RESULTS: Response rate was 61.0% (782/1283). Most partici-pants were White (63.3%), female (53.3%), and adolescents (55.6%). Common themes from the first 2 questions included accessibility (specifically affordability), coverage benefits, and care experience (including compassion, respect, and clinical competence). Young adults more commonly mentioned affordability than adolescents (54.4% vs 43.3%, P = .001) and more commonly felt their opinion should matter more than their parents when rating doctors (80.6% vs 62.0%, P < .001). Only 21.0% of AYAs were familiar with the potential value-based link between physician payment and care quality.CONCLUSIONS: When considering quality and value in health care, AYAs expressed their desired agency in rating the quality of their care and clinicians. AYAs' perspectives on health care quality, including the importance of care accessibility and affordability, should be considered when designing youth-cen-tered care delivery and value-based payment models.

Importance Studies linking the quality of parent-adolescent relationships with young adult health outcomes could inform investments to support these complex relationships. Objective To evaluate whether consistently measured, modifiable characteristics of parent-adolescent relationships are associated with young adult health across multiple domains. Design, Setting, and Participants This cohort study used data from waves I (1994-1995; ages 12-17 years) and IV (2008-2009; ages 24-32 years) of the US National Longitudinal Study of Adolescent to Adult Health. Of 20 745 adolescents enrolled in wave I, 15 701 of 19 560 who were eligible completed wave IV (response rate, 80.3%). Data analyses were conducted from February 2019 to November 2020. Exposures Parental warmth, parent-adolescent communication, time together, relationship and communication satisfaction, academic expectations, and maternal inductive discipline as reported at wave I by adolescent participants. Main Outcomes and Measures Wave IV participant-reported self-rated health, depression, stress, optimism, nicotine dependence, substance abuse symptoms (alcohol, cannabis, or other drugs), unintended pregnancy, romantic relationship quality, physical violence, and alcohol-related injury. Separate regression models were run for mother-adolescent and father-adolescent relationships while controlling for age, biological sex, race and ethnicity, parental educational level, family structure, and child maltreatment experiences. Results A total of 10 744 participants (mean [SD] age at wave IV, 28.2 [1.8] years; 52.0% female; 67.3% non-Hispanic White) and 8214 participants (mean [SD] age at wave IV, 28.2 [1.8] years; 50.8% female; 71.9% non-Hispanic White) had valid sampling weights and complete data for mother-adolescent and father-adolescent relationship characteristics, respectively. Adolescents who reported higher levels of mother-adolescent warmth (β = 0.11 [95% CI, 0.06-0.15]), communication (β = 0.02 [95% CI, 0.00-0.04]), time together (β = 0.07 [95% CI, 0.05-0.09]), academic expectations (β = 0.05 [95% CI, 0.02-0.08]), relationship or communication satisfaction (β = 0.07 [95% CI, 0.04-0.10]), and inductive discipline (β = 0.03 [95% CI, 0.01-0.05]) reported significantly higher levels of self-rated general health in young adulthood. Adolescents who reported higher levels of father-adolescent warmth (β = 0.07 [95% CI, 0.03-0.11]), communication (β = 0.03 [95% CI, 0.01-0.05]), time together (β = 0.06 [95% CI, 0.03-0.08]), academic expectations (β = 0.04 [95% CI, 0.01-0.06]), and relationship satisfaction (β = 0.07 [95% CI, 0.04-0.10]) also reported significantly higher levels of self-rated general health in young adulthood. Adolescents reporting higher levels of all exposures also reported significantly higher levels of optimism and romantic relationship quality in young adulthood (β coefficient range, 0.02 [95% CI, 0.00-0.04] to 0.24 [95% CI, 0.15-0.34]) and lower levels of stress and depressive symptoms (β coefficient range, −0.07 [95% CI, –0.12 to –0.02] to −0.48 [95% CI, –0.61 to –0.35]). Higher levels of parental warmth, time together, and relationship or communication satisfaction were significantly associated with lower levels of nicotine dependence (odds ratio range, 0.78 [95% CI, 0.72-0.85] to 0.89 [95% CI, 0.81-0.98]) and substance abuse symptoms (incidence rate ratio range, 0.60 [95% CI, 0.50-0.73] to 0.94 [95% CI, 0.89-0.99]), as well as lower odds of unintended pregnancy (odds ratio range, 0.81 [95% CI, 0.74-0.88] to 0.93 [95% CI, 0.86-0.99]). Patterns were less consistent for physical violence and alcohol-related injury. Characteristics of mother-adolescent and father-adolescent relationships were similarly associated with young adult outcomes. Conclusions and Relevance The findings of this cohort study suggest that adolescents’ positive perceptions of their relationships with their mothers and fathers are associated with a wide range of favorable outcomes in young adulthood. Investments in improving parent-adolescent relationships may have substantial benefits for young adult population health.

Our supplement this month, “Lessons Learned in Providing Pre-Exposure Prophylaxis (PrEP) for HIV for Young People at Scale,” addresses the critical issue of HIV prevention among adolescents and young adults. In particular, this supplement focuses on key populations in low- and middle-income countries who are disproportionately affected by the HIV/AIDS epidemic: adolescent men who have sex with men, adolescent transgender women, and adolescent girls and young women [[1]Felds E.L. Realizing the promise of PrEP globally for vulnerable adolescent and young adult populations.J Adolesc Health. 2023; 73: S1-S3Abstract Full Text Full Text PDF PubMed Scopus (1) Google Scholar,[2]Dourado I. Mullick S. Magno L. Grangeiro A. Implementing differentiated and integrated PrEP services for adolescent key populations: What works and what is the way forward?.J Adolesc Health. 2023; 73: S4-S7Abstract Full Text Full Text PDF Scopus (2) Google Scholar]. The 11 scientific papers in this supplement report from two projects, one in Brazil and the other in South Africa. PrEP1519 targeted adolescent men who have sex with men and adolescent transgender women between the ages of 15 and 19 in three large capital cities in Brazil: Salvador, São Paulo, and Belo Horizonte [3Zucchi E. Ferguson L. Magno L. et al.When ethics and the law collide: A multicenter demonstration cohort study of preexposure prophylaxis provision to adolescent men who have sex with men and transgender women in Brazil.J Adolesc Health. 2023; 73: S11-S18Abstract Full Text Full Text PDF Scopus (2) Google Scholar, 4Medeiros D.S. Magno L. Crosland Guimarães M.D. et al.Violence, discrimination and high levels of symptoms of depression among adolescent men who have sex with men and transgender women in Brazil.J Adolesc Health. 2023; 73: S19-S25Abstract Full Text Full Text PDF Scopus (2) Google Scholar, 5Soares F. Magno L. Pinto Junior J.A. et al.Same-day initiation of oral pre-exposure prophylaxis is high among adolescent men who have sex with men and transgender women in Brazil.J Adolesc Health. 2023; 73: S26-S32Abstract Full Text Full Text PDF Scopus (2) Google Scholar, 6Dourado I. Soares F. Magno L. et al.Adherence, safety and feasibility of HIV pre-exposure prophylaxis among adolescent men who have sex with men and transgender women in Brazil (PrEP1519 Study).J Adolesc Health. 2023; 73: S33-S42Abstract Full Text Full Text PDF PubMed Scopus (2) Google Scholar, 7Zeballos D. Magno L. Soares F. et al.Oral PrEP discontinuation in a large cohort of adolescent men who have sex with men and transgender women in Brazil.J Adolesc Health. 2023; 73: S43-S49Abstract Full Text Full Text PDF PubMed Scopus (2) Google Scholar]. Project PrEP in South Africa aimed to introduce PrEP into comprehensive sexual and reproductive health services for adolescent girls and young women [8Briedenhann E. Rosenberg P.S. Sheobalak N. et al.Eita! Reaching communities and young people to drive demand for oral PrEP in South Africa.J Adolesc Health. 2023; 73: S50-S57Abstract Full Text Full Text PDF Scopus (3) Google Scholar, 9Butler V. Kutwayo A. Martin C. et al.Implementing differentiated and integrated HIV prevention services for adolescent girls and young women: Experiences from oral PrEP rollout in primary care services in South Africa.J Adolesc Health. 2023; 73: S58-S66Abstract Full Text Full Text PDF Scopus (3) Google Scholar, 10Mullick S. Cox L. Martin C. et al.Comparing the integration of syndromic versus aetiological management of sexually transmitted infections into HIV pre-exposure prophylaxis services for adolescent girls and young women in South Africa.J Adolesc Health. 2023; 73: S67-S72Abstract Full Text Full Text PDF Scopus (3) Google Scholar, 11Gordon K.J. Martin C. Kutywayo A. et al.Mental health needs of adolescent and young adult PrEP users in South Africa: Implications for sexual and reproductive health programming.J Adolesc Health. 2023; 73: S73-S80Abstract Full Text Full Text PDF Scopus (3) Google Scholar, 12Martin C. Cox L. Nongena P. et al.Patterns of HIV pre-exposure prophylaxis use among adolescent girls and young women accessing routine sexual and reproductive health services in South Africa.J Adolesc Health. 2023; 73: S81-S91Abstract Full Text Full Text PDF Scopus (3) Google Scholar, 13Cox L. Martin C. Nongena P. et al.The use of HIV pre-exposure prophylaxis among men accessing routine sexual and reproductive health services in South Africa.J Adolesc Health. 2023; 73: S92-S100Abstract Full Text Full Text PDF Scopus (4) Google Scholar]. The projects were planned, funded, and undertaken simultaneously, with both tnational teams communicating and collaborating throughout the process. What emerges from the supplement as a whole is a blueprint for the development of culturally appropriate interventions to promote PrEP uptake and adherence among key populations in other low- and middle-income countries. In a commentary, representatives from the World Health Organization and Pan American Health Organization reinforce the desperate need for HIV prevention targeted at vulnerable young people and the particular barriers they face [[14]Schaefer R. Peralta H. Radebe M. Baggaley R. Young people need more HIV prevention options, delivered in an acceptable way.J Adolesc Health. 2023; 73: S8-S10Abstract Full Text Full Text PDF PubMed Scopus (2) Google Scholar]. Carefully targeted interventions like those described in this supplement, as well as new PrEP options like long-acting injectable cabotegravir and the dapivirine vaginal ring, hold great promise in finally addressing and overcoming these barriers.

“To ensure that scholarly publications reach their widest possible audience and provide scholars a transparent and equitable path to publication, unimpeded by bias, it is essential that our industry address the systemic role that racism plays” (Coalition for Diversity & Inclusion in Scholarly Communications, 2020)

The proliferation of electronic health records (EHRs),1 an advent of the nearly instantaneous sharing of clinical information and notes with patients and parents,2 and efforts to comply with the 21st Century Cures Act Information Blocking Rule3 have together forced professionals who deliver health care to adolescent patients to focus intense attention on frameworks that guide the provision of adolescent health care.4,5 Ethical and professional frameworks emphasize that meeting the health care needs of adolescents is the professional responsibility of health care systems and clinicians who provide their health care. Parents are typically involved in health care and aligned with clinicians on the goal of achieving optimal health for their adolescent children. However, it is well-documented that some adolescents will only seek health care or openly communicate with a health professional if their parents are not involved, and ethical and professional frameworks support the provision of confidential adolescent health care when needed.6–8Understanding the legal framework and legal protections that exist for adolescent privacy (and their relationship to consent requirements) is the other key element in finding the most appropriate ways to share adolescents’ health information while also considering privacy protection, both for developmental reasons and to encourage them to seek needed care.9 Thus, health care providers’ professional responsibilities include adhering to ethical and professional guidelines and their legal obligation to protect the confidential health information of their adolescent patients.10 This has become increasingly challenging within EHRs and in the context of OpenNotes and the 21st Century Cures Act ban on information blocking.11,12One of the realities underlying the challenge is the variability in the laws that protect adolescent privacy and the ways that some of these laws differ from professional guidelines. The variability in the laws is the subject of the article in this issue of Pediatrics by Sharko et al,13 in which their analysis of state laws clearly reveals significant differences among states in how and when they allow adolescent minors to consent to their own care and protect the confidentiality of the information associated with their care. Their analysis also examines the extent to which states’ laws conform to or depart from evidence-based professional guidelines on protecting adolescent privacy and finds significant inconsistencies in that realm as well.Currently, the legal protections for adolescents’ confidential health information are derived from a complex patchwork of both state and federal laws. At the state level, they include laws that allow minors to consent to their own care, some of which also specify privacy protections, as well as an array of medical privacy and health records laws.14 At the federal level, the Health Insurance Portability and Accountability Act Privacy Rule includes specific protections for adolescent minors in ways that refer to both state laws and other federal laws, such as family planning regulations and substance use disorder confidentiality rules, for determining who has access and control over an individual’s health information.15 Sometimes, but not always, the laws support the approaches set forth in professional and ethical guidelines. Of note, ethical guidelines and many laws require disclosure of confidential information in cases of suspected abuse, suicide risk, or homicidal threats. When laws and ethical guidelines diverge, health care professionals wrestle with balancing their ethical obligations with what the law requires.The complexity of the legal framework does present challenges for health care providers who must decide what information to enter in an adolescent patient’s EHR, for information technology administrators who are responsible for the implementation and modification of EHRs and web portals, for EHR designers and vendors who are responsible for ensuring their product is compliant with legal requirements, and for policymakers who craft new legal requirements. Against this backdrop, Sharko et al13 issue a “call to action” to harmonize state laws to provide consistent privacy protection for adolescents in line with professional guidance. This is a laudable goal that, if achievable, would simplify the task of adolescent health care providers, information technology administrators, EHR vendors, and the legal counsel who advise them. Nevertheless, the pursuit of this goal at the present time entails substantial risk.The state minor consent laws, as well as the privacy protections in the minor consent laws and other laws, have been enacted over decades in different states during varying political climates. Many of the minor consent laws have been in place for 4 decades or longer, sometimes with more recent minor additions or expansions to address specific services or vulnerable groups. Nonetheless, in recent years, attempts have been made in some states to repeal in their entirety the laws allowing minors to consent for their own health care and providing protection for the confidentiality of the information associated with that care in their specific state. Although these attempts have, so far, not been successful, some have come close and have required extraordinary advocacy by the community of health care professionals to defeat them. Most recently, attempts are being made in some states to disallow minor consent for health care under the guise of “parents’ rights.”16 At the same time, intense controversies around issues such as abortion17 and transgender care for young people18,19 make the current climate less than hospitable to efforts that might entail expansion of minor consent laws and confidentiality protection in some states.At the present time, we suggest 2 strategies that might prove useful now and in the future. The first is that health care professionals support ongoing efforts to develop technical methodologies for granular segmentation of digital health information in EHRs so that sensitive information can, when ethically or legally necessary, be protected from sharing while as much other information as possible can be shared via OpenNotes or patient portals in ways that promote adolescent and young adult health. The second is for the health care community to work on developing recommendations for what would optimally be included in laws that protect adolescent minors’ privacy consistent with ethical standards and best practice professional guidelines, while allowing advocates in each state to decide whether and when it would make sense, without undue risk, to move forward with efforts to bring the laws in their state in line with the professional recommendations. We believe these 2 strategies are consistent with the goals of the call to action issued by Sharko et al.13