Melissa K Miller

• MD
• Professor at Children’s Mercy Kansas City

Introduction Hospitalisation represents an opportunity to identify and treat e-cigarette use among adolescents and young adults (AYAs). Knowledge on how to provide this care is lacking. We aim to fill this gap by developing an e-cigarette use intervention and evaluating preliminary efficacy and implementation outcomes among hospitalised AYAs. Meth...

Background This study assessed feasibility constructs of adolescent contraceptive care in the pediatric emergency department (PED), including contraception initiation. Methods We conducted a randomized trial in two PEDs with pregnancy‐capable adolescents aged 15–18 years who were assigned to enhanced usual care (usual) or same‐day initiation (same...

Background Pediatric hospitalization represents a valuable opportunity to identify and treat e-cigarette use among adolescents and young adults (AYAs). Knowledge on how best to provide this care is lacking. We aim to fill this gap by developing an e-cigarette use intervention and evaluating preliminary efficacy and implementation outcomes among hos...

Background Little is known about healthcare providers’ (HCPs) contraceptive views for adolescents in Haiti, who experience high rates of unintended pregnancy. We sought to describe HCPs’ perspectives on barriers and facilitators to contraceptive care delivery in rural Haiti. Methods We conducted a cross-sectional survey and qualitative interviews...

Purpose: Adolescents have limited access to sexual healthcare services, and the emergency department (ED) may be the only place some will seek care. We implemented an ED-based contraception counseling intervention to assess intervention feasibility, and adolescent intention to initiate contraception, contraception initiation, and follow-up visit c...

Background Adolescents and young adults (AYAs) in Haiti experience a high unintended pregnancy rate, in part due to unmet contraception needs. Little is known about AYA opinions of and experiences with contraception that may explain remaining gaps in coverage. We aimed to describe barriers and facilitators to contraception use among AYAs in Haiti....

Objectives: Unintended pregnancy in adolescents and young adults (AYAs) is linked with negative outcomes. We sought to evaluate the feasibility, acceptability, and preliminary efficacy of a contraception intervention in the pediatric hospital. Methods: We conducted a pilot study of hospitalized AYA females aged 14 to 21 years who reported past o...

Background Individuals with substance use disorders (SUD) have disproportionately high rates of unintended pregnancy. Reducing harm associated with this risk and its biopsychosocial consequences requires evidence-based, non-coercive interventions that ensure access to contraception for individuals who choose to prevent pregnancy. We examined feasib...

Many adolescents use the emergency department (ED) as their primary source of health care. As a result, the ED serves as a unique opportunity to reach adolescents. Although many adolescent visits to the ED are related to reproductive health, ED providers report barriers to providing this care, including lack of training. Nurse practitioners (NPs) a...

Plain language summary Adolescents and young adult (AYA) females in low- and middle-income countries can often lack adequate access to materials to manage their menstruation, in addition to safe spaces to change those materials. This lack of access, in addition to low levels of reproductive health education, can cause AYAs to miss school, leading t...

Background Individuals with substance use disorders (SUD) have disproportionately high rates of unintended pregnancy. Reducing harm associated with this risk and its biopsychosocial consequences requires evidence-based, non-coercive interventions that ensure access to contraception for individuals who choose to prevent pregnancy. We aimed to examin...

OBJECTIVES To describe sexual behaviors and acceptability of receiving sexual and reproductive health (SRH) services among hospitalized adolescent males. METHODS We performed a cross-sectional survey of hospitalized adolescents. Eligible participants were males aged 14 to 20 years admitted at 2 academic medical centers. Outcome measures included r...

Objectives: To describe sexual health behaviors, contraceptive use, and pregnancy risk among hospitalized female adolescents. Methods: We conducted a cross-sectional survey of hospitalized female patients aged 14 to 21 years at 2 academic medical centers to assess sexual health behaviors, contraceptive use, contraceptive counseling receipt, and...

Background The sharp rise in opioid use disorder (OUD) among women coupled with disproportionally high rates of unintended pregnancy have led to a four-fold increase in the number of pregnant women with OUD in the United States over the past decade. Supporting intentional family planning can have multiple health benefits and reduce harms related to...

Objective To test the hypothesis that our motivational sexual health intervention (SexHealth) would increase health service uptake when compared with control. Study design In a randomized controlled trial at a pediatric emergency department (ED), sexually active adolescents received either the SexHealth intervention or printed materials (control)....

Background and objectives: Adolescent substance use is associated with numerous adverse health outcomes. A hospitalization represents an opportunity to identify and address substance use. We sought to describe self-reported and documented substance use among hospitalized adolescents. Methods: We conducted a cross-sectional survey of adolescents...

Objective To assess justice system involvement among adolescents in the pediatric emergency department (ED) and identify associations with risk and protective factors. Study design We conducted a cross-sectional computerized survey of adolescents to assess for personal , JSI, and non-household JSI (ie, important people outside of household). We as...

Aims During the early months of the U.S. COVID-19 outbreak, women suffered disproportionate burdens of pandemic-related psychological and economic distress. We aimed to describe the experiences of women in substance use disorder (SUD) recovery programs by (1) exploring the pandemic's impact on their lives, sobriety, and recovery capital and (2) tra...

Purpose This study aimed to assess adolescent and parent perspectives on parent notification after disclosure of adolescent relationship abuse (ARA) to a health care provider. Methods A computerized survey was administered to a convenience sample of adolescents aged 14–18 years and their parents presenting to three Midwestern pediatric emergency d...

Objectives: To describe current trends in filled opioid prescriptions for Medicaid-enrolled children, adolescents and young adults (AYAs) from 2012 to 2016, and to identify patient characteristics and clinical settings associated with a higher probability of filled opioid prescriptions. Design: Retrospective cohort study of children and young ad...

Objectives To assess the impact of a 90-second animated video on parents’ interest in receiving an antibiotic for their child. Study design This pre-post test study enrolled English and Spanish speaking parents (n=1051) of children ages 1-5 years presenting with acute respiratory tract infection symptoms. Before meeting with their provider, parent...

Purpose As almost nine in ten pregnancies among women with opioid use disorder (OUD) are unintended, expanding access to contraception is an underutilized but potentially effective strategy in increasing reproductive agency and reducing the overall burden of neonatal abstinence syndrome. We aimed to identify where and how contraceptive services cou...

Objectives: Prescription of opioids to treat pediatric migraine is explicitly discouraged by treatment guidelines but persists in some clinical settings. We sought to describe rates of opioid administration in pediatric migraine hospitalizations. Methods: Using data from the Pediatric Health Information System, we performed a cross-sectional stu...

Objective: The aim of this study was to evaluate a novel educational intervention for physician trainees to improve sexual health care provision, including condom distribution, in the pediatric emergency department. Methods: Resident physicians and medical students in an urban pediatric emergency department viewed an evidence-based educational v...

Objective To identify key questions for emergency medicine (EM)‐based adolescent sexual and reproductive health and to develop an evidence‐based research agenda. Methods We recruited national content experts to serve as advisory group members and used a modified Delphi technique to develop consensus around actionable research questions related to...

Background and objectives: Many hospitalized adolescents are at increased risk for pregnancy complications due to an underlying medical condition, however sexual risk assessment is not consistently performed in this setting. While adolescents and their parents are supportive of sexual health discussion in the inpatient setting, a thorough understa...

Objective: The aim of this study was to examine universal intimate-partner violence (IPV) assessment in the pediatric acute care setting. Methods: We reviewed universal IPV assessment over 1 year in 2 emergency departments and 3 urgent care centers within a children's hospital system. Written IPV assessment used 2 questions (ie, safety concerns...

Objective To develop an acceptable clinical decision support (CDS) system to facilitate evidence‐based sexual health care for adolescents in the emergency department (ED). Methods In this multi‐phased iterative process, we engaged an expert group to synthesize evidence on a wide range of sexual health services (e.g., contraception, condoms, identi...

Objective: The aims of this study were to assess trust in the medical profession among adolescents in an urban pediatric emergency department (ED) and explore factors associated with trust. Methods: We used a computerized survey to assess personal trust, perceived trust among family/friends, health care use, general and genital examination prefe...

Becoming a Responsible Teen (BART) is a community-based, HIV risk reduction curriculum shown to increase safer sex behaviors among African American adolescents. However, BART does not address common barriers to sexual health care access, which may limit program efficacy. We used a community-engaged adaptation process to maximize program relevance a...

Objectives: There is limited literature about physicians' adherence to 2010 Centers for Disease Control and Prevention (CDC) Sexually Transmitted Diseases Treatment Guidelines specific to specimen collection testing methods in adolescent females in the emergency setting is limited. The objectives are to (1) determine physician adherence to CDC gui...

Purpose: The purposes were to describe interest in hormonal contraception initiation among female adolescent in the emergency department (ED) and to assess for associations with factors known to increase pregnancy risk such as violence victimization. Methods: We used a computerized survey to assess sexual and dating practices, pregnancy history/...

Background and objectives: Rates of adult women receiving contraceptive provision when simultaneously prescribed a known teratogen are alarmingly low. The prevalence of this behavior among pediatric providers and their adolescent patients is unknown. The objective of this study was to describe pediatric provider behaviors for prescribing teratogen...

Motivational interviewing (MI) is defined as a collaborative, patient centered counseling style used to strengthen motivation for behavioral change by evoking an individuals’ own reasons for change. It has been extensively used to address substance use and has shown effectiveness in facilitating a variety of healthy behaviors among a wide range of...

Adolescent relationship abuse is common among adolescents seeking care in the emergency department (ED). Adolescent relationship abuse is a health issue; adolescents experiencing relationship abuse are at increased risk for multiple, severe short and long-term consequences. Adolescents endorse providers screening for adolescent relationship abuse....

This study aimed to determine the prevalence of Chlamydia trachomatis, Neisseria gonorrheae, and Trichomonas vaginalis and to describe factors associated with sexually transmitted infection (STI) in a pediatric emergency department (ED). Adolescents aged 14 to 19 years presenting to a Midwestern pediatric ED were asked to provide urine for STI test...

The evaluation for children with bruising may be affected by the specialty to which they are referred. We conducted a 3-year retrospective review of subjects referred for bruising to Child Abuse Pediatrics (CAP) or Pediatric Hematology to identify characteristics associated with referral to each specialty and to compare the diagnostic evaluations a...

Objective: Although emergency department (ED) visits offer an opportunity to deliver brief behavioral interventions to improve health, provision of ED-based interventions targeting adolescent sexual health is uncommon. The objectives for this study were to evaluate the feasibility and preliminary effects of a novel sexual health service interventi...

Urban adolescents face many barriers to health care that contribute to health disparities in rates of sexually transmitted infections (STIs) and unintended pregnancy. Designing interventions to increase access to health care is a complex process that requires understanding the perspectives of adolescents. We conducted six focus groups to explore th...

Motivational Interviewing is a collaborative style of communication designed to strengthen a person's own motivation and commitment to change. We report on our ongoing efforts to implement motivational interviewing to address health behavior change among several patient populations in our pediatric hospital, including sexual risk reduction among ad...

While the human papillomavirus (HPV) vaccine has potential to protect against the majority of HPV-associated cancers, vaccination rates in the United States remain low. Racial/ethnic and economic disparities exist for HPV vaccination completion rates. We conducted a mixed-methods study using the theory of planned behavior framework to explore attit...

The purpose of this study was to explore health care providers' (HCPs') attitudes and beliefs about adolescent sexual health care provision in the emergency department (ED) and to identify barriers to a health educator-based intervention. We conducted focused, semistructured interviews of HCPs from the ED and adolescent clinic of a children's hospi...

The objective was to identify adolescent preferences for emergency department (ED)-based education about emergency contraception. This was a cross-sectional computerized survey, using adaptive conjoint analysis (ACA). Patients were eligible if they were females ages 14 through 19 years old and were seeking care in one of two urban EDs. Patients wer...

The objective of this study was to describe sexual health behaviors, as well as prior use of and preferences for sexual health services among adolescents in the pediatric emergency department (ED). In this cross-sectional study, subjects aged 14 to 19 years who presented to an urban or suburban ED from a single Midwestern hospital system completed...

Objective: The objective of this study was to determine acceptability of sexual health discussion and testing among adolescents, parents, and health care providers (HCPs). Methods: We conducted a cross-sectional study of acute care patients (aged 14-19 years), parents, nurses, and physicians/nurse practitioners. Subjects rated sexual health disc...

Objectives: This study aimed to assess urban adolescents' knowledge of and attitudes about emergency contraception (EC) and to assess the intention to use EC in particular hypothetical situations. We hypothesized that knowledge about EC would be limited, but that adolescents would support using EC in certain situations. Methods: A cross-sectiona...

This study aimed to compare efficacy of enema versus polyethylene glycol (PEG) 3350 for pediatric fecal impaction treatment. We conducted a prospective, randomized comparison of treatments of fecal impaction in children in a pediatric emergency department (ED). Treatment arms were a single milk and molasses enema in the ED or PEG 3350 for 3 days ou...

The objective was to describe knowledge, attitudes, and experiences regarding emergency contraception (EC) among pediatric emergency health care providers (HCPs). This multicenter, focus group study elicited thoughts and experiences from pediatric emergency HCPs about EC. Participants were physicians, nurse practitioners (NPs), and nurses in one of...

To describe epidemiologic and clinical characteristics of patients receiving emergency contraception (EC) in a pediatric emergency department (ED), practice variations for EC, and ED return visits after EC. This single-site study describes all patients who received oral EC (1.5-mg levonorgestrel) in the ED from January 1, 2003 to December 31, 2007....

The Increased Flow Utilizing Subcutaneously-Enabled (INFUSE)-Pediatric Rehydration Study was designed to assess efficacy, safety, and clinical utility of recombinant human hyaluronidase (rHuPH20)-facilitated subcutaneous rehydration in children 2 months to 10 years of age. Patients with mild/moderate dehydration requiring parenteral treatment in US...

The objective was to describe epidemiologic features and usage patterns of pediatric emergency medical services (EMS) transports in Kansas City, Missouri. The study consisted of a retrospective analysis of transports from January 1, 2002, to December 31, 2004, for Kansas City, Missouri, residents younger than 15 years of age (excluding interfacilit...

Constipation is a common diagnosis made in the pediatric emergency department (ED). Specific evidence-based standards for evaluation and treatment are lacking. To describe variation in evaluation and treatment of constipation and characteristics and treatments associated with improvement. This single-site descriptive study examined constipated chil...