Journal of Adolescent Health

Support for Adolescents Who Experience Parental Military Deployment

Mona P. Ternus — 2010-03-01

See Related Article p. 218

The Generalizability and Specificity of Theory

Melbourne F. Hovell, Ding Ding — 2010-03-01

See Related Article p. 224

Social and Emotional Impairment in Children and Adolescents with ADHD and the Impact on Quality of Life

Peter M. Wehmeier, Alexander Schacht, Russell A. Barkley — 2010-01-04

Abstract: This review provides an overview as to how the social and emotional impairments involved in Attention-Deficit/Hyperactivity Disorder affect the quality of life of patients and their families. A model of three categories into which the emotional difficulties fall, and how they impair quality of life, is also presented.

The Impact of Parental Deployment on Child Social and Emotional Functioning: Perspectives of School Staff

Anita Chandra, Laurie T. Martin, Stacy Ann Hawkins, Amy Richardson — 2009-12-25

Abstract: Purpose: Since 2001, many military families have experienced multiple and extended deployments. Little is known about the effect of parental deployment on the well-being of children, and few, if any, studies to date have engaged school staff to understand whether and how parental deployments affect the behavioral, social, and emotional outcomes of youth in the school setting.Methods: Focus groups and semi-structured interviews were conducted with teachers, counselors, and administrative staff at schools serving children from U.S. Army families (N=148 staff). Participants were queried about the academic, behavioral, and emotional issues faced by children of deployed soldiers. Data were analyzed for themes in these areas, with attention to differences by service component (Active Component vs. Army Reserve and National Guard).Results: Although some children seem to be coping well with deployment, school staff felt that children's anxiety related to parental absence, increased responsibilities at home, poor mental health of some nondeployed parents, and difficulty accessing mental health services affected the ability of other students to function well in school.Conclusions: School staff felt that parental deployment negatively affected social and emotional functioning for some children and youth, although they felt others were coping well. Future research should examine factors related to youth outcomes during parental deployment (e.g., mental health of the non-deployed parent) and assess the effects of deployment on other measures of behavior such as school engagement and academic performance.

A Longitudinal Study of Sexual Risk Behavior Among the Adolescent Children of HIV-Positive and HIV-Negative Drug-Abusing Fathers

2009-08-21

Abstract: Purpose: This is a longitudinal study of the precursors of sexual risk behavior among a cohort of adolescent children of HIV-positive and HIV-negative drug-abusing or drug-dependent fathers.Methods: Individual structured interviews were administered to 296 drug-abusing or drug-dependent fathers, 43% of whom were HIV positive, and an adolescent child of each father (mean age = 16.3 years; SD = 2.8). Adolescents were reinterviewed approximately 1 year later, at Time 2.Results: Structural equation modeling showed multiple direct and indirect pathways from psychosocial factors to adolescent sexual risk behavior (sexually active, number of sexual partners, and frequency of condom use). Greater paternal drug addiction and infection with HIV/AIDS, and the youth's perception of environmental hostility (discrimination and victimization), were both related to increased adolescent maladjustment and substance use. Greater paternal drug addiction and infection with HIV/AIDS also were associated with a weaker father–child mutual attachment, which was linked with increased adolescent maladjustment and substance use. Greater perceived environmental hostility (discrimination and victimization), a weak father–child relationship, and greater adolescent maladjustment and substance use had direct pathways to adolescent sexual risk behavior.Conclusions: Findings suggest complex interrelationships among paternal, environmental, social, personal, and substance use factors as longitudinal predictors of sexual risk behavior in children whose fathers abuse or are dependent upon drugs. The importance of perceived environmental hostility, the father–child relationship, and adolescent maladjustment and substance use may have implications for public policy as well as prevention and treatment programs.

Factors Associated with Event Level Anal Sex and Condom Use During Anal Sex Among Adolescent Women

Devon J. Hensel, J. Dennis Fortenberry, Donald P. Orr — 2009-08-28

Abstract: Purpose: To examine the distribution of and factors associated with event-level heterosexual anal sex and of event-level condom use during anal sex among adolescent women.Methods: Adolescent women (N=387; age 14–17 years at enrollment) were recruited from primary care clinics for a longitudinal cohort study of sexually transmitted infections and sexual behavior. Data were taken from daily sexual diaries; generalized estimating equation logistic regression assessed the likelihood of anal sex or condom use during anal sex on a given day.Results: Heterosexual anal intercourse is a small but nonrandom event-level component in adolescent women's sexual behavior. About 30% of anal sex events were condom protected. Mood, partner, and situational factors predicted anal sex, but not condom use during anal sex; within-day and recent behavior factors were the strongest influences on both outcomes.Conclusions: Our findings suggest the importance of providers' screening adolescent women patients during office visits about anal sex and about condom use during anal sex, as well as asking questions about the context of these behaviors to appropriately tailor risk reduction counseling.

Update on Age at Menarche in Italy: Toward the Leveling Off of the Secular Trend

2009-10-13

Abstract: Purpose: To update the information on age at menarche in the Italian population and to verify the influence of genetic, nutritional, and socioeconomic factors on menarcheal age. Recent studies suggest that the magnitude of the secular trend toward an earlier age at menarche is slackening in industrialized countries.Methods: This multicenter study was conducted on a large, population-based sample of Italian high school girls (n = 3,783), using a self-administered questionnaire. The questionnaire was used to gather information on the girls, including demography, anthropometry, menarcheal date, regularity of menses, behavioral habits, and physical activity. The questionnaire was also used to gather information on parents, including demography and mothers' and sisters' menarcheal ages. The median age at menarche and its 95% confidence interval were estimated by means of Kaplan-Meier survival analysis. To identify the independent predictive factors of age at menarche, multivariate mixed-effects models were applied.Results: The median age at menarche of the subjects was 12.4 years (95% confidence interval: 12.34–12.46). The girls had their first menses approximately one-quarter of a year (median–0.13) earlier than did their mothers (p < .0001). Among all variables, parents' birth area, body mass index, family size, and the mother's menarcheal age were significantly and independently associated with age at menarche.Conclusions: This study confirmed the reduction in the trend toward earlier menarche in Italy. The results also confirmed that genetic and nutritional factors are strong markers for early menarche. Currently, socioeconomic factors do not seem to play as significant a role as in the past.

Body Mass Index and Waist-to-Height Changes During Teen Years in Girls Are Influenced by Childhood Body Mass Index

Frank M. Biro, Bin Huang, John A. Morrison, Paul S. Horn, Steven R. Daniels — 2009-08-18

Abstract: Purpose: This study examined longitudinal changes in waist-to-height ratio and components of body mass index (BMI) among young and adolescent girls of black and white race/ethnicity.Methods: Girls were recruited at age 9 years through the National Heart, Lung, and Blood Institute Growth and Health Study (NGHS) and were followed annually over 10 years. Girls were grouped into low (<20th percentile), middle, and high (>80th percentile) BMI on the basis of race-specific BMI percentile rankings at age 9, and low, middle, and high waist-to-height ratio, on the basis of waist-to-height ratio at age 11. BMI was partitioned into fat mass index (FM) and fat-free mass index (FMI).Results: Girls accrued fat mass at a greater rate than fat-free mass, and the ratio of fat mass to fat-free mass increased from ages 9 through 18. There was a significant increase in this ratio after age at peak height velocity. Participants with elevated BMI and waist-to-height ratios at age 18 tended to have been elevated at ages 9 and 11, respectively. There were strong correlations between BMI at age 9 with several outcomes at age 18: BMI (.76) and FMI (.72), weaker but significant with FFMI (.37), and ratio of fat mass to fat-free mass (.53). In addition, there was significant tracking of elevated BMI from ages 9 through 18.Conclusions: In girls, higher BMI levels during childhood lead to greater waist-to-height ratios and greater than expected changes in BMI by age 18, with disproportionate increases in fat mass. These changes are especially evident in adolescent girls of black race/ethnicity and after the pubertal growth spurt.

Impact of School-Based Health Center Use on Academic Outcomes

2009-08-28

Abstract: Purpose: The purpose of this study was twofold: (1) to examine the effects of School-Based Health Center (SBHC) use on academic outcomes for high school students, using a well-controlled, longitudinal model, and (2) to examine whether SBHC medical and mental health service use differentially impacts academic outcomes.Methods: Analyses used a latent variable growth curve modeling approach to examine longitudinal outcomes over five school semesters for ninth grade SBHC users and nonusers from Fall 2005 to Fall 2007 (n = 2,306). Propensity score analysis was used to control for self-selection factors in the SBHC user and nonuser groups.Results: Results indicated a significant increase in attendance for SBHC medical users compared to nonusers. Grade point average increases over time were observed for mental health users compared to nonusers. Discipline incidents were not found to be associated with SBHC use.Conclusions: SBHC use was associated with academic improvements over time for a high-risk group of users. The moderating effect of type of use (medical and mental health) reinforces the importance of looking at subgroups when determining the impact of SBHC use on outcomes.

Discrepant Trends in Mental Health Complaints Among Younger and Older Adolescents in Sweden: An Analysis of WHO Data 1985–2005

Curt Hagquist — 2009-10-06

Abstract: Purpose: To elucidate the time trends in self-reported mental health complaints (internalizing problems) among school children in Sweden during a time characterized by economic downturns and upturns, with a focus on possible differences across grades and genders.Methods: The study uses nationwide and repeated cross-sectional data collected five times during 1985–2005 among students in Sweden in grades 5, 7, and 9. The number of participating students each year varied between 2,933 and 4,421. The attrition rates varied between 10% and 15% in the participating schools. Data were subjected to descriptive analysis and multinomial logistic regression using a composite measure of self-reported mental health complaints.Results: The study results show significantly higher rates of mental health complaints in 2005/2006 compared with 1985/1986 among older adolescents, in particular girls, whereas the rates are almost unchanged among younger boys and girls. Only among girls in grade 9 has there been a successively (linear) increase of mental health complaints across years of investigations.Conclusions: The increasing rates of mental health complaints among older adolescents, in particular girls, are a cause for concern and a challenge for public health work. By showing discrepant time trends among younger and older adolescents, the results of the study nuance the predominant and unambiguous notions about continuously deteriorating mental health among children and adolescents in Sweden. To address hypotheses concerning the causes of the discrepant time trends, suggestions are made for comparative cross-country analyses based on data from Sweden and other European countries.

Adolescents' Perceived Risk of Dying

2009-08-28

Abstract: Purpose: Although adolescents' expectations are accurate or moderately optimistic for many significant life events, they greatly overestimate their chances of dying soon. We examine here whether adolescents' mortality judgments are correlated with their perceptions of direct threats to their survival. Such sensitivity would indicate the importance of ensuring that adolescents have accurate information about those threats, as well as the psychological support needed to deal with them.Methods: Data from two separate studies were used: a national sample of 3,436 14–18-year-old adolescents and a regional sample of 124 seventh graders and 132 ninth graders, 12–16 years old. Participants were asked about their chance of dying in the next year and before age 20, and about the extent of various threats to their physical well-being.Results: Adolescents in both samples greatly overestimated their chance of dying. Those mortality estimates were higher for adolescents who reported direct threats (e.g., an unsafe neighborhood). Thus, adolescents were sensitive to the relative size of threats to their survival, but not to the implications for absolute risk levels.Conclusions: Contrary to the folk wisdom that adolescents have a unique sense of invulnerability, the individuals studied here reported an exaggerated sense of mortality, which was highest among those reporting greater threats in their lives. Such fears could affect adolescents' short-term well-being and future planning.

Point-of-Care Testing for Sexually Transmitted Infections Increases Awareness and Short-Term Abstinence in Adolescent Women

2009-10-12

Abstract: Purpose: To evaluate the effect of point-of-care (POC) testing for sexually transmitted infections (STIs) on reported awareness of test results and STI risk-reduction behaviors in adolescents.Methods: Adolescent and young adult women aged 14–21 years were recruited from the Emergency Department or Teen Health Clinic for this longitudinal study and were tested for STIs. Baseline demographics, risk behaviors, treatment, POC tests (wet mount and rapid antigen tests for Trichomonas vaginalis), and other STI test results (available 24–48 hours postvisit) were measured. These were compared to subject's report of test results, abstinence, partner discussion, and partner testing during a postvisit telephone contact.Results: Of 294 subjects, 155 (53%) were contacted: 65 (42%) had a positive STI test result; 28 (43%) were POC positive; and 52 (33.5%) believed their STI results were positive. A positive POC test result increased the proportion of subjects aware of being positive for an STI (89 vs 21%, p < .01). Postvisit, 62% reported abstinence, 82% discussed testing with her partner, and 48% reported partner testing. Predictors of abstinence included a positive POC test result (adjusted odds ratio (AOR) = 4.6, confidence interval (CI) = 1.5–13.6, prior abstinence of >14 days (AOR = 3.9, CI = 1.7–9.0), and black race (AOR = 3.5, CI = 1.2–9.7). Women who believed their STI results were positive were more likely to report partner discussion (odds ratio [OR] = 3.0, CI = 1.0–8.8) and partner testing (OR = 5.1, CI = 2.4–11.2).Conclusions: Awareness of STI results increases with POC testing. Effective communication of results can increase patient understanding and compliance with risk reduction strategies, which may affect the STI epidemic.

Adherence to Scheduled Appointments Among HIV-Infected Female Youth in Five U.S. Cities

2009-07-23

Abstract: Objective: Identify factors associated with appointment-keeping among HIV-infected adolescents and young adults.Methods: HIV-infected adolescent and young adult females in five U.S. cities were followed for a period of 18 months to examine adherence to scheduled clinic visits with their HIV care provider. Psychosocial and behavioral factors that have been shown in other populations to influence appointment adherence were measured at baseline and follow-up visits using an audio computer-assisted self-interview questionnaire. These factors included mood disorder, depressive symptoms, social network support, healthcare satisfaction, disease acceptance, HIV stigma, alcohol use, and marijuana use. CD4 count and prescription of antiretroviral therapy medication were also monitored to understand the influence of health status on appointment- keeping.Results: Participants included 178 youth with a mean age of 20.6 years. Forty-two percent had clinically significant depressive symptoms, 10% had a diagnosable mood disorder, 37% reported marijuana use in the last 90 days, and 47% reported alcohol use. Overall, participants attended 67.3% of their scheduled visits. Controlling for age and health status, marijuana use was the only variable that was associated with appointment-keeping behavior.Conclusions: Considering the importance of appointment-keeping for maintaining personal health and preventing further transmission, screening HIV-infected adolescents for marijuana use could help alert providers of this specific barrier to visit compliance.

Adolescent Offspring of Mothers With Chronic Fatigue Syndrome

2009-10-13

Abstract: Purpose: The goal of this study was to determine whether adolescent offspring of mothers with chronic fatigue syndrome (CFS) have higher prevalence of CFS and report more fatigue, greater pain sensitivity, more sleep problems, and poorer cardiopulmonary fitness in comparison with offspring with no exposure to maternal CFS.Methods: A total of 26 adolescent offspring of 20 mothers diagnosed with CFS were compared with 45 adolescent offspring of 30 age-matched healthy control mothers. Study measures included structured interviews and medical and laboratory examinations for CFS; tender point examination; maximum oxygen uptake and perceived exertion; dolorimetry pain ratings; and questionnaires on fatigue severity and sleepiness.Results: In comparison with offspring of healthy mothers, those exposed to mothers with CFS reported higher prevalence of fatigue of at least 1-month duration (23% vs. 4%), fatigue of 6 months or longer (15% vs. 2%), and met criteria for CFS (12% vs. 2%), although these differences only approached statistical significance. CFS and healthy mothers differed on almost all study outcomes, but offspring groups did not differ on measures of current fatigue severity, pain sensitivity, sleep, mean number of tender points, and cardiopulmonary fitness.Conclusions: The higher prevalence of fatiguing states in offspring of CFS mothers, despite the lack of statistical significance, suggests that familial factors may potentially play a role in developing chronically fatiguing states. Alternately, perturbations in pain sensitivity and cardiopulmonary fitness may be consequences of CFS. Future studies should focus on examining the impact of maternal CFS and associated disability on psychosocial functioning of offspring.

The Future Adolescent Medicine Workforce: A Survey of Current Adolescent Medicine Fellows

Erin C. Kish, Constance M. Wiemann, Albert C. Hergenroeder — 2010-01-25

Abstract: Purpose: To ensure a workforce of board-certified adolescent medicine (AM) specialists, the reasons why physicians choose this specialty must be understood. This study sought to develop a profile of AM fellows and to delineate common experiences that influenced them to seek AM training.Methods: In April 2008, all AM fellows in Accreditation Council of Graduate Medical Education-accredited fellowships and those committed to begin training in July 2008 or after were electronically surveyed. Survey links were e-mailed to fellowship program directors who forwarded them to current and incoming fellows. The survey included questions regarding demographics, training experiences, career expectations, and attitudes and beliefs about AM. Open-ended questions allowed fellows to describe influential experiences. Means, medians, and percentages were calculated. Three independent reviewers identified themes in open-ended questions.Results: Fifty-two respondents completed the survey: 42 of 59 (71%) current fellows, 10 incoming fellows (approximately 35%). Sixty-seven percent reported first exposure to AM before or during medical school and 31% decided to pursue AM before starting residency. Qualitative responses revealed the importance of interactions with those established in the field, the intrinsic appeal of adolescents and their clinical issues, and the inherent personal qualities of the respondents. Many spoke of multiple exposures to AM or adolescents through high school activities, volunteer work, personal experiences, or during medical training.Conclusions: A variety of experiences with AM and/or adolescents is important in establishing interest in AM as a career. Serving as mentors and capitalizing on brief role modeling opportunities could promote further interest in AM fellowship training.

Does the “Healthy Immigrant Effect” Extend to Smoking in Immigrant Children?

Jennifer O'Loughlin, Katerina Maximova, Keely Fraser, Katherine Gray-Donald — 2009-10-12

The “healthy immigrant effect” may apply to lifestyle-related behaviors in immigrant children. In a cross-sectional study of 1,959 children aged 9–12 years, the number of years lived in Canada was related to an increased risk of smoking among immigrant children. Interventions may be needed for immigrant children to prevent the adoption of unhealthy behaviors prevalent in their new host environments.

Using Mobile Phones for Adolescent Research in Low and Middle Income Countries: Preliminary Findings From the Birth to Twenty Cohort, South Africa

Alastair C. van Heerden, Shane A. Norris, Linda M. Richter — 2010-01-04

Abstract: Mobile phones enable engagement with adolescents through a familiar medium. Survey data are presented from 2,023 South African adolescents who were asked about phone ownership, usage, and their willingness to divulge sensitive information in short message service surveys. Barriers to participation are addressed as are recommendations for follow-up research.

2010-03-01