Objective/Study Question To examine changes in uninsurance rates among U.S. adolescents ages 12‐17 and assess whether trends over time differed by citizenship status, Latino ethnicity, and household language. Data Sources/Study Setting 2007‐2016 National Health Insurance Survey (NHIS). Study Design Multivariable logistic regression and postestimation marginal effects were used to assess changes in the current uninsured rate. Logistic regression models were used to determine significant trends over time for each demographic group and compare them to trends in the broader adolescent population. Marginal effects were employed to calculate adjusted outcome probabilities for each year. Principal Findings Across all 12‐ to 17‐year‐olds, the unadjusted uninsured rate dropped significantly between 2007 and 2016, from 10.2 percent to 6.0 percent. For noncitizen youth, the probability of being uninsured increased from 26.6 percent in 2007 to 28.4 percent in 2016, after controlling for covariates. Latino youth and those in Spanish‐speaking households saw declines in their adjusted uninsurance rate that was proportional to non‐Latino and English‐speaking youth. Conclusions Most adolescents saw significant improvements in health insurance coverage between 2007 and 2016; however, disparities remain among Spanish‐speaking and Latino adolescents and no improvements were seen among noncitizen youth. This suggests a need for equity‐focused eligibility, outreach, and enrollment policies that expand insurance options for these populations.

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OBJECTIVE: The purpose of this study was to compare characteristics of youth who participate in the choking game alone versus those who participate in a group.METHODS: Lifetime prevalence estimates were obtained from the 2011 (n = 5682) and 2013 (n = 15 150) Oregon Healthy Teens survey. The 2011 and 2013 data sets were merged (N = 20 832) to compare youth who participate alone versus those who participate in a group in the choking game. Multivariate modeling was conducted to examine individual characteristics of young people who engaged in the choking game alone versus those who engaged in the game in a group. RESULTS:In 2011, 3.8% of eighth-grade participants reported a lifetime prevalence of choking game participation; 3.7% reported lifetime prevalence of participation in 2013. In the merged 2011/2013 data set, 17.6% (n = 93) of choking game participants indicated that they had participated alone. Compared with those who reported participating in a group, youth who participated alone had significantly higher rates of suicide contemplation (odds ratio: 4.58; P < .001) and poor mental health (odds ratio: 2.13; P < .05). CONCLUSIONS:Youth who participate alone in the choking game are a particularly high risk group, exhibiting substantially higher rates of suicidal ideation and poorer mental health compared with youth who participate in the choking game in a group. Adolescent health care providers should be aware of these associations, assess whether prevention messaging is appropriate, and be prepared to explain the high risks of morbidity and mortality associated with participation.a Hawaii State Department of Health, Honolulu, Hawaii; b Oregon Public Health Division, Portland, Oregon; c Western Kentucky University, Bowling Green, Kentucky; and d Cairn Guidance, Portland, Oregon Ms Ibrahim conducted the data analysis and drafted the initial manuscript; Ms Knipper conceptualized and designed the study, supervised the data analysis, and reviewed and revised the manuscript; Dr Brausch critically reviewed and revised the manuscript; and Ms Thorne helped conceptualize the study and reviewed and revised the manuscript; all authors approved the fi nal manuscript as submitted.

Objective: We describe provision of contraception to adolescents at Oregon school-based health centers (SBHCs). We examine trends over time, by race/ethnicity, and by Title X clinic status and test whether these factors are associated with provision of long-acting reversible contraception (LARC; intrauterine devices/IUDs and implants). Study design: We conducted a retrospective cohort study of 33 SBHCs participating in a shared electronic health record 2012-2016. We identified 20,339 contraception provision visits to 5,934 adolescent females ages 14-19 using diagnosis and procedure codes. We used logistic regression to evaluate the association of clinic Title X status, race/ethnicity, and year with receipt of LARC, controlling for individual-, clinic-, and residence-level factors. We calculated adjusted probabilities. Results: Provision of IUDs and implants increased at Oregon SBHCs between 2012 and 2016. IUD provision increased almost 5-fold, (from 0.9% to 4.4% of contraception provision visits), and implants increased approximately 6.5-fold (from 1.1% to 7.2%). More adolescent contraception provision visits occurred at Title X SBHCs, which had greater than twice the adjusted probability of providing LARCs than non-Title X SBHCs (4.4% versus 1.7%). After adjusting for adolescent-, clinic-, and residence-level covariates, nonwhite adolescents had lower probabilities of receiving LARC methods than white adolescents. Conclusions: SBHCs play an important role in providing access to contraceptive services to adolescents in Oregon. Access to IUDs and implants is increasing over time in SBHCs, particularly those that participate in the Title X program. Implications: Adolescents have expanding access to IUDs and implants in SBHCs over time in Oregon. Participation in the Title X program can help further increase access to effective contraception in SBHCs.

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