Journal of Adolescent Health - Articles in Press

HPV Vaccination Practices Among Juvenile Justice Facilities in the United States - Corrected Proof

Courtney E. Henderson, Josiah D. Rich, Michelle A. Lally — 2010-03-08

Abstract: The juvenile justice setting provides a unique opportunity to administer the human papillomavirus (HPV) vaccine to a high-risk, medically underserved population. We examined current HPV vaccination practices in the United States. Most states (39) offer the HPV vaccine to females committed to juvenile justice facilities.

Disordered Eating and Unhealthy Weight Loss Practices: Which Adolescents Are at Highest Risk? - Corrected Proof

Clinton C. Haley, Katrina Hedberg, Richard F. Leman — 2010-03-08

Abstract: Early diagnosis of unhealthy weight loss practices (UWLP) among adolescents improves treatment outcomes. Analysis of population-based school survey data in Oregon demonstrated that the 11.6% reporting UWLP were more likely to perceive themselves as overweight, depressed, and to have abused substances. Targeted screening of adolescents can help identify those with UWLP.

The Impact of Community-Based Sexually Transmitted Infection Screening Results on Sexual Risk Behaviors of African American Adolescents - Corrected Proof

2010-03-08

Abstract: Purpose: To examine the effect of a community-based sexually transmitted infection (STI) screening program on sexual risk behavior among African American adolescents. We hypothesized that adolescents testing positive for an STI and receiving post-test counseling would reduce risky sexual practices, whereas STI-negative adolescents would show little or no change in protective sexual behavior after screening.Methods: From August 2006 to January 2008, we recruited 636 sexually active African American adolescents (age, 14–17) from community-based organizations in two mid-sized U.S. cities with high STI prevalence. Participants were screened for three STIs (gonorrhea, chlamydia, and trichomoniasis) and completed an audio computer-assisted self-interview. Youth who tested positive for an STI (6.6%) received treatment and counseling. Youth testing negative received no further intervention. Approximately 85% of participants completed 3- and 6-month follow-up assessments. Generalized estimating equations determined the effects of STI screening on adolescents' number of sexual partners and occurrence of unprotected sex.Results: Adolescents who tested positive for an STI reduced their number of vaginal and oral sex partners and the probability of unprotected sex. STI-negative adolescents demonstrated no change for numbers of partners or unprotected sex.Conclusions: Community-based STI screening can help to reduce sexual risk behavior in youth who test positive for STIs. Alternative approaches will be needed to reduce risk behavior in youth who test negative but who are nevertheless at risk for acquiring an STI.

Health Disparities Among Different Ethnic and Racial Middle and High School Students in Sun Exposure Beliefs and Knowledge - Corrected Proof

2010-03-08

Abstract: Racial and ethnic differences may influence sun protection behavior. Adolescent students were administered a sun protection questionnaire and educational program. White people had the greatest pretest knowledge which resulted in the highest score, and blacks and Hispanics scored lower. White people who found tanned individuals attractive had greater score improvements. All groups improved after intervention.

Awareness of the Implications of Tattoo Removal among 4,277 Italian Secondary School Adolescents - Corrected Proof

2010-03-04

Abstract: Purpose: To investigate the awareness of the implications of tattoo removal among 4,277 secondary school adolescents.Methods: Students were recruited by a stratified convenience sample and surveyed by a self-administered questionnaire. Logistic regression analysis was performed, reporting adjusted odds ratios (OR) with 95% confidence interval (CI).Results: Only 40% of the respondents were aware of the issues related to tattoo removal. Males and pupils with younger fathers were less likely to be aware, whereas students satisfied with their physical appearance and those with a positive attitude toward body art were more likely to be aware.Conclusions: Health education programs should be informed accordingly.

Patterns and Consequences of Inadequate Sleep in College Students: Substance Use and Motor Vehicle Accidents - Corrected Proof

Daniel J. Taylor, Adam D. Bramoweth — 2010-02-25

Abstract: We examined college sleep patterns and consequences using a cross-sectional design. We found that students get insufficient sleep and frequently use medication and alcohol as sleep aids, use stimulants as alertness aids, and fall asleep at the wheel, or have motor vehicle accidents due to sleepiness. Future studies should focus on effective interventions for sleep in college students.

Family Factors Associated With Suicide Attempts Among Chinese Adolescent Students: A National Cross-Sectional Survey - Corrected Proof

2010-02-11

Abstract: Purpose: To determine the prevalence and associated family factors of suicide attempts among junior and/or senior high school students, so as to provide bases for preventive measures of suicide in China.Methods: A total of 13,512 students from 32 junior and/or senior high schools in grades 7 to 11 in eight cities of China participated in a self-administered anonymous survey to report their frequency of suicide attempts during the past year. Sociodemographic characteristics, tobacco, and alcohol use in the past 30 days were asked. Stressful family life events were used to evaluate the subjects' family characteristics.Results: Overall, 2.7% (338/12,470) in-school adolescents reported a suicide attempt during the past year, girls significantly more often than boys. Considered independently, all stressful family life events were strongly associated with increased risk for self-reported suicide attempts. When taking sociodemographic characteristics, life style, and all the five family factors selected from factor analysis into consideration, there was a significant independent impact of three family factors on increasing suicide attempts risk among adolescents. The most notable risks were derived from improper parental rearing behavior, separation from parents, and social problems of the family members. However, neither poor material conditions of family life nor family member's adversity contribute significantly to the risk.Conclusions: This study not only indicates that suicide attempt is a significant public health issue among in-school adolescents in China, but also confirms that adolescents with family problems commonly manifest suicide attempts, which highlights the importance of considering family environmental factors when assessing suicide risk.

Trajectories or Parental Monitoring and Communication and Effects on Drug Use Among Urban Young Adolescents - Corrected Proof

Amy L. Tobler, Kelli A. Komro — 2010-02-11

Abstract: Purpose: Identify the number and characteristics of heterogeneous trajectories of parental monitoring and communication among a sample of urban, racial/ethnic minority youth and examine the effects of these patterns on alcohol, cigarette and marijuana use.Methods: The study sample (n=2,621) was predominantly African American or Hispanic (38% and 32%, respectively) and low-income (67% received free, or reduced price, lunch). They completed classroom-based surveys when in 6th-8th grades. Multilevel general growth mixture modeling was used to identify the heterogeneous trajectories of parental monitoring and communication and estimate the effects of these distinct patterns on drug use in 8th grade.Results: Four trajectories of parental monitoring and communication were identified: (1) High (76.4%), (2) Medium (9.1%), (3) Decreasing (6.0%) and (4) Inconsistent (8.5%). Relative to those with high monitoring/communication, youth in the decreasing and inconsistent trajectories were at significantly greater risk for past year and past month alcohol and marijuana use and having ever smoked a cigarette. After controlling for family composition, only youth in the decreasing trajectory were significantly more likely to report substance use in 8th grade.Conclusions: Findings support the role of parents in preventing drug use during early adolescence and suggest that efforts to improve the level and consistency of parental monitoring and communication may be a fruitful target for prevention. Many youth initiate use of alcohol, tobacco or marijuana in this critical developmental period and considered with the health and social consequences of use, engaging parents in preventing drug use should remain a priority for prevention.

Examining Future Adolescent Human Papillomavirus Vaccine Uptake, With and Without a School Mandate - Corrected Proof

Amanda F. Dempsey, David Mendez — 2010-02-11

Abstract: Purpose: To develop a model of adolescent (HPV) human papillomavirus vaccine utilization that explored future HPV vaccination rates, with and without a school mandate, for the vaccine at middle school entry.Methods: A dynamic, population-based, compartmental model was developed that estimated over a 50-year time horizon HPV vaccine uptake among female adolescents living in the United States. The model incorporated data on parental attitudes about this vaccine and adolescent health care utilization levels.Results: Without a mandate, our model predicted that 70% coverage, a lower threshold value used in many previous modeling studies of HPV vaccination, would not be achieved until a mean of 23 years after vaccine availability. Maximal coverage of 79% was achieved after 50 years. With a school mandate in place, utilization increased substantially, with 70% vaccination coverage achieved by year 8 and maximal vaccination coverage, 90%, achieved by year 43.Conclusions: Our results suggest that vaccine utilization is likely to be low for several years, though strong school mandates might improve HPV vaccine uptake. These results affect the interpretation of previous modeling studies that estimated the potential clinical effects of HPV vaccination under assumptions of very high vaccine utilization rates.

The Experience of Siblings of Adolescents With Eating Disorders - Corrected Proof

Rosawan S. Areemit, Debra K. Katzman, Leora Pinhas, Miriam E. Kaufman — 2010-02-11

Abstract: Purpose: To qualitatively and quantitatively explore the experience and QOL of siblings of AEDs. To date, there is little research on the quality of life (QOL) and the effect an eating disorder (ED) has on the siblings of adolescents with an eating disorder (AEDs).Methods: Siblings were recruited between January 2008 and April 2008. Inclusion criteria included siblings aged 10–18 years old and living with a sibling with an ED. Exclusion criteria included having an ED, or major psychiatric disorder, or a communication problem that interfered with their participation. Siblings completed a general assessment questionnaire, the Pediatric Quality of Life inventory 4.0 Generic Core Scales and Eating Attitudes Test-26 (EAT-26). Focus group interviews were conducted until saturation was achieved and thematic analysis was employed.Results: Twenty siblings (14 females) of 17 AEDs (15 females) participated. All but one sibling scored within the normal range for the Eating Attitudes Test-26. Key themes identified included a desire to understand the ED, acute awareness of ED behaviors and thoughts, challenges in understanding noneating-related obsessive behaviors, increase in family conflict and arguments, compassion and concern for the AED, feelings of loss and sacrifice, overwhelming sense of responsibility for the AED, and a sense of pervasiveness of the ED in all aspects of their lives. The siblings' accounts of these themes were noted to be fraught with contradictions. Eighty percent reported that their QOL was negatively affected by the onset of their siblings' ED.Conclusion: Clinical attention and further research into the experience of siblings of adolescents with ED is needed.

Exposure To a Comprehensive School Intervention Increases Vegetable Consumption - Corrected Proof

2010-02-11

Purpose: The current epidemic of childhood overweight has launched a variety of school-based efforts to address the issue. This study reports on the first 2 years of a 3-year evaluation of one school district's comprehensive intervention to transform school foodservices and dining experiences, offer cooking and gardening programs, and integrate nutrition and food systems concepts into the academic curriculum.Methods: This 3-year prospective study enrolled 327 4th and 5th graders in a mid-sized school district in California, and followed them into middle school. Intervention exposure was determined through interviews with school staff and student surveys. Student knowledge and attitudes were assessed annually by questionnaire, and student behavior was assessed annually by 3-day food diary. Household information was gathered by parent questionnaire. Changes in knowledge, attitudes, and behavior were compared by level of intervention exposure using analysis of covariance; pairwise differences were evaluated using Bonferroni's test at a procedure-wise error rate of 5%.Results: After controlling for family sociodemographic background, students most exposed to the intervention increased their consumption of fruits and vegetables by nearly 0.5 cups (one standard serving), whereas students least exposed decreased their consumption by 0.3 cups (p < .05). Students most exposed to the programming also showed a significantly greater increase in preference for fruit and green leafy vegetables, compared to students least exposed to the programming (p < .05).Conclusions: Future research is needed to better understand the relative importance of the different components of such a program, and their cost-benefits as well as health impacts.

Exploring the Mechanisms of Physical Activity and Dietary Behavior Change in the Program X Intervention for Adolescents - Corrected Proof

2010-02-11

Purpose: The objective of this investigation was to examine the mechanisms of physical activity and dietary behavior change in the Program X intervention.Methods: Program X involved a clustered randomized controlled design with six schools (N=124 participants, mean age=14.1±0.8 years) randomized to intervention or control conditions for the 6-month study period. Physical activity and fruit and vegetable consumption were assessed using pedometers and questionnaires, respectively. The theoretical framework of the intervention was assessed using structural equation modeling, mediation, and moderation analyses.Results: The model explained 56% of the variance in physical activity at 6-months, but did not represent a good fit to the data, χ2=87.43, df=19, p < .001. The model explaining fruit and vegetable consumption explained 31% of the variance and provided a good fit to the data, χ2=12.40, df=10, p =.259. None of the variables satisfied the criteria for mediation or moderation in the physical activity model, but gender moderated the effects of intervention on fruit and vegetable consumption.Conclusions: None of the hypothesized mediators were responsible for behavior change in the Program X intervention. Future studies should address the limitations of existing psychosocial scales and continue to explore the mechanisms of behavior change using model testing, mediation, and moderation analyses.

Recreational Versus Nonrecreational Prescription Borrowing: Time for an expanded conceptualization? - Corrected Proof

Richard C. Goldsworthy — 2010-02-11

To the Editor: I read with interest and appreciation Dr. Johnston's discussion of the studies that my colleagues and I as well as Boyd et al. are carrying out regarding prescription medication sharing among adolescents. As both articles and the editorial point out, this is an important emerging problem that we are only beginning to understand and that appears to be on the increase for an array of social and personal reasons.

The Relative Importance of Different Measures of Peer Smoking on Adolescent Smoking Behavior: Cross-Sectional and Longitudinal Analyses of a Large British Cohort - Corrected Proof

Jo C. Holliday, Heather A. Rothwell, Laurence A.R. Moore — 2010-02-11

Abstract: Purpose: To examine the relative importance of smoking behavior of best friends, boyfriends/girlfriends, the wider friendship group, and school year group smoking prevalence as correlates and predictors of smoking behavior (peer influence). The article also aims to assess the relative extent to which smoking behavior is associated with changes in smoking among peers who are selected to be friends (selective association).Methods: Using two waves of data collected from 4,145 year 8 (12–13 years) and year 9 (13–14 years) students in 29 schools, logistic regression models estimated the cross-sectional association between four year 8 peer influence variables and weekly and occasional smoking, and the extent to which these peer influence variables and three selective association variables were predictors of weekly smoking in year 9.Results: The smoking behavior of best friend, boyfriend/girlfriend, the wider friendship group, and school year group prevalence were cross-sectionally associated with higher odds of weekly and occasional smoking. In longitudinal multivariate influence models, only the smoking behavior of boyfriend/girlfriend and the wider friendship group were associated with weekly smoking. Weekly smoking was associated with maintaining or changing to having smokers among best friends, boyfriends/girlfriends, and the wider friendship group. In models including all variables, only selective association effects were observed.Conclusions: Although univariate analyses indicate an association of friends', peer group, and year group smoking with current and subsequent smoking behavior, multivariate longitudinal analyses indicate that simple peer influence models do not completely explain adolescent smoking and that a more complex interrelationship exists between smoking, peer's smoking and peer socialization.

Compulsive Internet Use: The Role of Online Gaming and Other Internet Applications - Corrected Proof

2010-02-11

Abstract: Purpose: Increasing research on Internet addiction makes it necessary to distinguish between the medium of Internet and its specific applications. This study explores the relationship between time spent on various Internet applications (including online gaming) and Compulsive Internet Use in a large sample of adolescents.Methods: The 2007 (N=4,920) and 2008 (N=4,753) samples of a longitudinal survey study among adolescents were used, as well as the 2007–2008 cohort subsample (N=1421). Compulsive Internet Use was predicted from the time spent on the various Internet applications in two cross-sectional multiple linear regression models and one longitudinal regression model in which changes in behavior were related to changes in Compulsive Internet Use.Results: In both samples, downloading, social networking, MSN use, Habbo Hotel, chatting, blogging, online games, and casual games were shown to be associated with Compulsive Internet Use. Off these, online gaming was shown to have the strongest association with Compulsive Internet Use. Moreover, changes in online gaming were most strongly associated with changes in Compulsive Internet Use over time for the longitudinal cohort.Conclusions: A clear relationship was shown between online gaming and Compulsive Internet Use. It is further argued that a subgroup of compulsive Internet users should be classified as compulsive online gamers.

A Multisite Randomized Trial of a Motivational Intervention Targeting Multiple Risks in Youth Living With HIV: Initial Effects on Motivation, Self-Efficacy, and Depression - Corrected Proof

2010-02-04

Abstract: Purpose: Interventions targeting multiple risk behaviors are needed for youth living with HIV (YLH). A randomized clinical trial compared Healthy Choices, a four session motivational intervention targeting two of the three risk behaviors (HIV medication adherence, sexual risk behavior and substance use) to multidisciplinary specialty care alone. This article presents intermediary outcomes available at 3-month follow-up, variables proposed to be precursors to behavior change (motivation, self-efficacy, and depression).Methods: YLH (N=186) with at least one of the three problem behaviors were recruited from four sites in the Adolescent Trials Network and one non–Adolescent Trials Network site, and were assessed at baseline and 3 months.Results: Of the 94 youth randomly assigned to the treatment condition, 84% received at least one session, 67% received at least two sessions, 56% received at least three sessions, and 49% completed all four sessions. In intent-to-treat analysis, only depression was significantly improved in the treatment group as compared with controls. However, in per-protocol analysis, youth receiving at least two sessions of the intervention also showed significant improvements in motivational readiness to change as compared with youth in the control condition.Conclusion: Results suggest the potential benefits of clinic-based motivational interventions for YLH who access these interventions. Delivering interventions in the community using an outreach model may improve access. Analysis of subsequent time points will determine effects on actual behavior change.

Factors Related to Undiagnosed Asthma in Urban Adolescents: A Multilevel Approach - Corrected Proof

Sheryl Magzamen, Ira B. Tager — 2010-02-04

Abstract: Purpose: We report the results of a school-based asthma case-identification survey to determine the prevalence and predictors of possible undiagnosed asthma in a population of urban adolescents.Methods: During school years 2006–2008, middle school students in Oakland, California, completed a brief survey adapted from the International Study of Asthma and Allergy in Children. Students were classified into one of three categories: no asthma, current asthma, or possible undiagnosed asthma. Students reported demographic information and residential address, which was geocoded and matched tract-level data from the US Census 2000, Oakland land use designations, public and assisted housing locations, and distance from closed-access roadways. Logistic regression was used to examine factors associated with possible undiagnosed asthma.Results: Of the 4,017 students who completed the survey, 4.8% (95% confidence interval [CI]: 4.1, 5.5) were classified as possible undiagnosed asthma. Female students (odds ratio: 1.53, 95% CI: 1.07, 2.19) and students who resided in an urban residential area (odds ratio: 2.05, 95% CI: 1.05, 4.05) had significantly increased odds of classification as “possible undiagnosed asthma” compared to current asthma. Percentage of noncitizen recent immigrants in a census tract was related to increased odds of possible undiagnosed asthma. Residence in a census tract with older residential units was significantly associated with decreased odds of undiagnosed asthma.Conclusions: In urban settings, school-based asthma surveillance can aid in the identification of children with possible undiagnosed asthma. Implementation of a geographic information systems framework can enhance the identification of demographic and physical environmental factors associated with possible undiagnosed asthma.

Comparing Racial/Ethnic Differences in Mental Health Service Use Among High-Need Subpopulations Across Clinical and School-Based Settings - Corrected Proof

Janet R. Cummings, Ninez A. Ponce, Vickie M. Mays — 2010-02-04

Abstract: Racial/ethnic differences in mental health service use among adolescents in clinic and school settings for three high-need populations are examined. Results indicate no racial/ethnic differences in school-based use contrasted with significant differences in clinical settings. Schools may be critical avenues for reduction of unmet mental health need among racial/ethnic minorities.

Prevalence of Sexually Transmitted Infection/Human Immunodeficiency Virus Counseling Services Received by Teen Males, 1995–2002 - Corrected Proof

Arik V. Marcell, David L. Bell, Laura D. Lindberg, Adel Takruri — 2010-02-04

Abstract: Purpose: To examine whether improvements have been made in the delivery of sexually transmitted infection and/or human immunodeficiency virus (STI/HIV) counseling services to teen males.Methods: Analysis was performed using the 1995 National Survey of Adolescent Males (N = 1,729, response rate = 75%) and the 2002 National Survey of Family Growth (N = 1,121, response rate = 78%), which are two nationally representative surveys of 15–19-year-old males. Main outcome measure included discussion about STIs/HIV with a doctor/nurse. Weighted bivariate and multivariate Poisson regression analyses examined the association of outcome measures and survey year among males engaging in various types of sexual behaviors (e.g., varying partner numbers, higher risk sex) unadjusted and adjusted for sociodemographic and health care access factors.Results: In 2002, STI/HIV counseling receipt in the past year was reported by one-third of males who reported three or more female partners, anal sex with female partners, or oral/anal sex with male partners. Only 26% of males reporting high-risk sex (e.g., sex with prostitute, person with HIV or often/always high with sex) reported STI/HIV counseling receipt. Overall, no improvements were found between 1995 and 2002 in STI/HIV counseling, even after controlling for sociodemographic and health care access factors.Conclusions: Mechanisms are needed to raise the importance of STI/HIV counseling services among sexually active male teens as well as to improve health care providers' delivery of these services.

Family Experiences With Outpatient Care: Do Adolescents and Parents Have the Same Perceptions? - Corrected Proof

Terri L. Byczkowski, Linda M. Kollar, Maria T. Britto — 2010-02-04

Abstract: Purpose: Providing healthcare for adolescents involves balancing parents' and adolescents' needs, and little research addressing, measuring, and achieving this balance has been conducted. A first step for healthcare providers toward achieving this balance is to understand the differences between parents and adolescents regarding perceptions of outpatient care experiences. This study was to explore and compare the experiences of care between parents and adolescents in a primary care setting.Methods: As part of an institution-wide system to measure patient satisfaction, 170 pairs of adolescent patients aged 11–17.9 years and their parents/guardians who had an outpatient visit at a Teen Health Center located within a large pediatric hospital were interviewed by telephone using both closed- and open-ended questions.Results: Overall, perceptions of care between adolescents and parents were very similar. However, adolescents reported less involvement in decisions about medical care and were less likely to receive understandable answers to questions. A qualitative analysis of responses to open-ended questions indicated that aspects of care important to both adolescents and parents are communication followed by interpersonal skills and technical competence. Parents and adolescents did not always view confidentiality in the same way.Conclusions: These findings suggest that more time should be spent focusing on the adolescents' needs concerning communication. Healthcare providers should focus on the adolescents' needs by involving them in decisions and providing understandable answers to questions. Both parents and adolescents should be surveyed to measure their experience of care, especially with respect to involvement in care decisions, communication, and confidentiality.

Bullying Victimization Among Underweight and Overweight U.S. Youth: Differential Associations for Boys and Girls - Corrected Proof

Jing Wang, Ronald J. Iannotti, Jeremy W. Luk — 2010-02-04

Abstract: To examine the associations between body weight and physical, verbal, relational, and cyber victimization among U.S. boys and girls in grade 6 through 10. Underweight boys and girls were more likely to be physical and relational victims, respectively. Overweight boys and obese girls were more likely to be verbal victims.

Poly-Victimization and Risk of Posttraumatic, Depressive, and Substance Use Disorders and Involvement in Delinquency in a National Sample of Adolescents - Corrected Proof

Julian D. Ford, Jon D. Elhai, Daniel F. Connor, B. Christopher Frueh — 2010-01-28

Abstract: Purpose: Adolescents exposed to multiple forms of psychological trauma (“poly-victimization,” Finkelhor et al. Child Abuse Negl 2007;31:7–26) may be at high risk for psychiatric and behavioral problems. This study empirically identifies trauma profiles in a national sample of adolescents to ascertain correlates of poly-victimization.Methods: Latent Class analyses and logistic regression analyses were used with data from the National Survey of Adolescents to identify trauma profiles and each profile's risk of posttraumatic stress disorder, major depressive disorder, substance use disorders, and delinquency involvement and deviant peer group relationships. Poly-victimization classes were also compared to classes with trauma exposure of lesser complexity.Results: Six mutually exclusive trauma profiles (latent classes) were identified. Four classes were characterized by high likelihood of poly-victimization, including abuse victims (8%), physical assault victims (9%), and community violence victims (15.5%). Poly-victimization class members, especially abuse and assault victims, were more likely than do youth traumatized by witnessing violence or exposure to disaster/accident trauma to have psychiatric diagnosis and (independent of psychiatric diagnoses or demographics) to be involved in delinquency with delinquent peers.Conclusions: Poly-victimization is prevalent among adolescents and places youth at high risk for psychiatric impairment and for delinquency. Moreover, poly-victimized youths' risk of delinquency cannot be fully accounted for by posttraumatic stress disorder, depression, or substance use problems, suggesting that adolescent healthcare providers should consider poly-victimization as a risk for behavioral and legal problems even when PTSD, depression, or addiction symptoms are not clinically significant.

Community Violence and Health Risk Factors among Adolescents on Chicago's Southside: Does Gender Matter? - Corrected Proof

Dexter R. Voisin, Torsten B. Neilands — 2010-01-28

Abstract: We assessed community violence, school engagement, negative peer influences, mental health problems, and human immunodeficiency virus risk among 563 black adolescents. Boys reported higher rates of community violence exposures and gang involvement, while girls reported higher mental health distress. In the presence of multiple risk factors, negative peer norms were the strongest correlate of human immunodeficiency virus risk behaviors.

Sexual Orientation and Bullying Among Adolescents in the Growing Up Today Study - Corrected Proof

2010-01-28

Abstract: Purpose: To examine the relationship between sexual orientation and past-year reports of bullying victimization and perpetration in a large sample of American youth.Methods: Survey data from 7,559 adolescents aged 14–22 who responded to the 2001 wave questionnaire of the Growing Up Today Study were examined cross-sectionally. Multivariable generalized estimating equations regression was performed using the modified Poisson method. We examined associations between sexual orientation and past-year bully victimization and perpetration with heterosexuals as the referent group, stratifying by gender and controlling for age, race/ethnicity, and weight status.Results: Compared to heterosexual males, mostly heterosexual males (risk ratio [RR]: 1.45; 95% confidence interval [CI]: 1.13, 1.86) and gay males (RR 1.98; CI: 1.39, 2.82) were more likely to report being bullied. Similarly, mostly heterosexual females (RR: 1.72, 95% CI: 1.45, 2.03), bisexual females (RR: 1.63, 95% CI: 1.14, 2.31), and lesbians (RR: 3.36, 95% CI: 1.76, 6.41) were more likely to report being bullied than were heterosexual females. Gay males (RR: 0.34, 95% CI: 0.14, 0.84) were much less likely to report bullying others than were heterosexual males. Mostly heterosexual females (RR: 1.70, 95% CI: 1.42, 2.04) and bisexual females (RR: 2.41, 95% CI: 1.80, 3.24) were more likely to report bullying others than heterosexual females. No lesbian participants reported bullying others.Conclusions: There are significant differences in reports of bullying victimization and perpetration between heterosexual and sexual minority youth. Clinicians should inquire about sexual orientation and bullying, and coordinate care for youth who may need additional support.

Adolescents' Reports of Communication With Their Parents About Sexually Transmitted Diseases and Birth Control: 1988, 1995, and 2002 - Corrected Proof

Anna C. Robert, Freya L. Sonenstein — 2010-01-25

Abstract: Purpose: We examine trends in adolescents' reports of discussion with parents about sexually transmitted diseases (STDs) and birth control methods from 1988 to 2002.Methods: Data from the 1988 and 1995 National Survey of Adolescent Males, and the 1988, 1995, and 2002 National Survey of Family Growth were analyzed to evaluate changes in discussions of female adolescents with parents about birth control methods and STDs, and changes in male adolescent discussions with parents about birth control methods. The sample includes never married males and females aged 15–17 years.Results: In 2002, fewer female adolescents reported discussion with a parent about STD or birth control methods than in 1995. The share of female adolescents in 2002 reporting no discussion of either topic with their parents increased by almost half compared to 1995. Patterns across time in male adolescents' discussions of birth control methods with their parents appear stable.Conclusions: The recent decline in female adolescent reports of parent-communication about birth control and STDs, and the increase in female adolescent reports of no discussion of either topic suggest that public health officials, educators, and clinicians should invigorate their efforts to encourage parents to talk with their children about STDs and birth control.

Does Aggressive Refeeding in Hospitalized Adolescents With Anorexia Nervosa Result in Increased Hypophosphatemia? - Corrected Proof

Melissa Whitelaw, Heather Gilbertson, Adv.A.P.D., Pei-Yoong Lam, Susan M. Sawyer — 2010-01-25

Abstract: Purpose: Concerns about refeeding syndrome have led to relatively conservative nutritional rehabilitation in malnourished inpatients with anorexia nervosa (AN), which delays weight gain. Compared to other programs, we aggressively refed hospitalized adolescents. We sought to determine the incidence of hypophosphatemia (HP) in 12–18-year-old inpatients in order to inform nutritional guidelines in this group.Methods: A 1-year retrospective chart review was undertaken of 46 admissions (29 adolescents) with AN admitted to the adolescent ward of a tertiary children's hospital. Data collected over the initial 2 weeks included number of past admissions, nutritional intake, weight, height, body mass index, and weight change at 2 weeks. Serum phosphorus levels and oral phosphate supplementation was recorded.Results: The mean (SD) age was 15.7 years (1.4). The mean (SD) ideal body weight was 72.9% (9.1). Sixty-one percent of admissions were commenced on 1,900 kcal (8,000 kJ), 28% on 2,200 kcal (9,300 kJ). Four patients were deemed at high risk of refeeding syndrome; of these patients, three were commenced on rehydration therapy and one on 1,400 kcal (6,000 kJ). All patients were graded up to 2,700 kcal (11,400 kJ) with further increments of 300 kcal (1,260 kJ) as required. Thirty-seven percent developed mild HP; no patient developed moderate or severe HP. Percent ideal body weight at admission was significantly associated with the subsequent development of HP (p = .007).Conclusions: These data support more aggressive approaches to nutritional rehabilitation for hospitalized adolescents with AN compared to current recommendations and practice.

Evaluation of a Computer-Tailored Physical Activity Intervention in Adolescents in Six European Countries:The Activ-O-Meter in the HELENA Intervention Study - Corrected Proof

2010-01-13

Abstract: Purpose: The present study investigates the effect of the Activ-O-Meter, an internet-based computer-tailored physical activity intervention in adolescents in six European centers involved in the HELENA study.Methods: Adolescents (12–17 years old) from Vienna, Ghent, Heraklion, Dortmund, Athens, and Stockholm were randomized into intervention and control schools. Participants in the intervention condition received the computer-tailored advice at baseline and after 1 month. Participants in the control condition received a generic standard advice. Effects were evaluated after 1 (n = 675) and 3 months (n = 494) using multi-level modeling. Physical activity levels were measured using the International Physical Activity Questionnaire for adolescents (IPAQ-A).Results: After 1 month, the intervention group reported higher levels of moderate (β = −32.8, 95% CI (confidence interval): −64.2 to −1.4) and vigorous (β = −28.0, 95% CI: −50.7 to −5.3) physical activity in leisure time, as well as higher levels of cycling for transport (β = −19.1, 95% CI: −34.4 to −7.6) compared to the control group. After 3 months, when the intervention group had received the tailored feedback twice, intervention effects were even stronger. Favorable changes in physical activity levels of all intensities and in different contexts were found in the tailored group compared to the control group. Among adolescents not reaching the physical activity recommendations at baseline similar effects as in the total sample were found.Conclusions: The data indicated that the computer-tailored physical activity intervention had positive effects on physical activity levels among the adolescents. However, the implementation of the computer-tailored intervention in the schools was not feasible in all countries.

Relationship Between Health Literacy, Reading Comprehension, and Risk for Sexually Transmitted Infections in Young Women - Corrected Proof

Heather E. Needham, Constance M. Wiemann, Susan R. Tortolero, Mariam R. Chacko — 2010-01-12

Abstract: We investigated the relationship between health literacy, comprehension of sexually transmitted infection information, and sexual behavior in 127 women aged 16–21 years attending a reproductive health clinic. Women with lower health literacy scores demonstrated lower comprehension of written information related to sexually transmitted infections but did not have greater high-risk sexual behaviors.

Lower Lateral Orbitofrontal Cortex Density Associated With More Frequent Exposure to Television and Movie Violence in Male Adolescents - Corrected Proof

2010-01-12

Abstract: The relationship between cortical grey matter density and media violence exposure in healthy male adolescents was investigated using voxel-based morphometry and the Childrens' Report of Exposure to Violence. Adolescents with more frequent exposure have lower left lateral orbitofrontal cortex density—a possible risk factor for altered socioemotional functioning.

Adolescence Sleep Disturbances as Predictors of Adulthood Sleep Disturbamces—A Cohort Study - Corrected Proof

Alex Dregan, David Armstrong — 2010-01-12

Abstract: Purpose: The present study aimed to estimate whether sleep disturbances in adolescence predicted sleep disturbances in later years.Method: Our sample included 7,781 cohort members from the United Kingdom's National Child Development Study. Sleep disturbances at ages 16, 23, 33, and 42 were measured by asking whether cohort members had difficulties in falling/maintaining sleep or waking unnecessarily early in the morning.Results: Multivariate regression analyses indicated that sleep disturbance at age 16 was a significant predictor of sleep disturbances at ages 23, 33, and 42. Continuity of a number of risk factors, especially depression, accounted for some of the persistence of sleep disturbances over time but did not explain a significant part of ongoing sleep disturbance.Conclusions: Our findings suggest that many sleep disturbances start in adolescence and continue into later years.

A Prospective Study of Neck, Shoulder, and Upper Back Pain Among Technical School Students Entering Working Life - Corrected Proof

Therese N. Hanvold, Kaj B. Veiersted, Morten Wærsted — 2010-01-12

Abstract: Purpose: The aim of this prospective study was to relate the prevalence of neck, shoulder, and upper back pain to occupational and individual risk factors among a population of technical school students in their transition from school to working life. In addition, we wanted to assess the changes in pain prevalence during follow-up.Methods: A cohort consisting of 173 technical school students was followed up during a 3-year period, from their last year of school through their first years of working life. Data on self-reported neck, shoulder, and upper back pain and factors such as mechanical exposure, perceived stress, and physical activity in leisure time were collected.Results: A high prevalence of pain in the neck, shoulder, and upper back among the technical school students was found. There were however few students reporting severe pain. Reporting pain at baseline gave over three times higher risk of reporting it at follow-up. A high level of physical activity outside working hours gave a lower risk of reporting neck, shoulder, and upper back pain at follow-up. High and moderate levels of mechanical exposure and high stress level were not found to be risk factors for pain after entering working life.Conclusion: Neck, shoulder, and upper back pain are common among adolescents and may persist into working life. These results may give potential for preventive efforts at a young age. There is still much uncertainty about the factors leading to musculoskeletal pain, and more research is needed on this topic.

A Meta-Analysis of Obesity Interventions Among U.S. Minority Children - Corrected Proof

Dong-Chul Seo, Jaesin Sa — 2010-01-12

Abstract: Purpose: To quantitatively evaluate the efficacy of interventions designed to prevent or treat obesity among US minority children using meta-analytic techniques.Methods: A total of 40 intervention trials involving 10,725 children aged 6–19 years were examined.Results: Interventions with more components showed a higher mean effect size than those with fewer components: among 32 controlled trials, d = .07 for one-component (n = 6); d = .08 for two-component (n = 15); d = .33 for three-component (n = 10); and d = .71 for four-component (n = 1) interventions. Interventions with parental involvement (n = 22, d = .21) and lifestyle interventions (n = 14, d = .34) showed a greater mean effect size than those without parental involvement (n = 10, d = .05) or lifestyle interventions (n = 18, d = .04), despite the fact that their 90% confidence intervals overlapped. Among uncontrolled trials (n = 8), two-component interventions (n = 5) yielded d = .86 and three-component interventions (n = 3) yielded d = .96.Conclusions: Evidence indicates that, among US minority children, obesity interventions with three or more components might be more efficacious than those using fewer components. Parental involvement, lifestyle change, culturally-based adaptation, and interactive computer programs seem to show promise in the reduction of obese minority children.

Long-term Health and Economic Impact of Preventing and Reducing Overweight and Obesity in Adolescence - Corrected Proof

Li Y. Wang, Maxine Denniston, Sarah Lee, Deborah Galuska, Richard Lowry — 2010-01-12

Abstract: Purpose: Using data from the 2000 National Medical Expenditure Panel Survey and estimates from published studies, this study projected the long-term health and economic impacts of preventing and reducing overweight and obesity in today's adolescents.Methods: We developed a body mass index progression model to project the impact of a 1% point reduction in both overweight and obese adolescents aged 16–17 years at present on the number of nonoverweight, overweight, and obese adults at age 40 years. We then estimated its impact on the lifetime medical costs and quality-adjusted life years (QALYs) after age 40. Medical costs (in 2007 dollars) and QALYs were discounted to age 17 years.Results: A 1% point reduction in both overweight and obese adolescents ages 16–17 years at present could reduce the number of obese adults by 52,821 in the future. As a result, lifetime medical care costs after age 40 years would decrease by $586 million and lifetime QALYs would increase by 47,138. In the worst case scenario, the 1% point reduction would lower medical costs by $463 million and increase QALYs by 34,394; in the best case scenario, it would reduce medical costs by $691 million and increase QALYs by 57,149.Conclusions: Obesity prevention in adolescents goes beyond its immediate benefits; it can also reduce medical costs and increase QALYs substantially in later life. Therefore, it is important to include long-term health and economic benefits when quantifying the impact of obesity prevention in adolescents.

Changes in Suicide Rates by Hanging and/or Suffocation and Firearms Among Young Persons Aged 10–24 Years in the United States: 1992–2006 - Corrected Proof

2010-01-12

Abstract: We examined changes in suicide rates among 10–24-year-olds in the United States from 1992 to 2006. The overall suicide rate and the rate by firearms, poisoning, and other methods declined markedly, whereas the hanging/suffocation rate increased significantly from 1992 to 2006. This increase occurred across every major demographic subgroup, but was most dramatic for females.

Longitudinal Outcomes of an Alcohol Abuse Prevention Program for Urban Adolescents - Corrected Proof

Steven P. Schinke, Traci M. Schwinn, Lin Fang — 2010-01-12

Abstract: Purpose: This randomized clinical trial examined longitudinal outcomes from an alcohol abuse prevention program aimed at urban youths.Methods: Study participants were an ethnically and racially heterogeneous sample of early adolescents, recruited from community-based agencies in greater New York City and its environs. Once they assented to study participation and gained parental permission, youths were divided into three arms: youth intervention delivered by CD-ROM (CD), the same youth intervention plus parent intervention (CDP), and control. Once all youths completed baseline measures, those in CD and CDP arms received a computerized 10-session alcohol abuse prevention program. Parents of youths in the CDP arm received supplemental materials to support and strengthen their children's learning. All youths completed postintervention and annual follow-up measures, and CD- and CDP-arm participants received annual booster intervention sessions.Results: Seven years following postintervention testing and relative to control-arm youths, youths in CD and CDP arms reported less alcohol use, cigarette use, binge drinking, and peer pressure to drink; fewer drinking friends; greater refusal of alcohol use opportunities; and lower intentions to drink. No differences were observed between CD and CDP arms.Conclusions: Study findings lend support to the potential of computerized, skills-based prevention programs to help urban youth reduce their risks for underage drinking.

Understanding Adolescent Parenthood From a Multisystemic Perspective - Corrected Proof

2010-01-12

Abstract: Purpose: This study examined the associations between social, behavioral, and environmental factors and adolescent parenthood.Methods: We analyzed data from a subsample of participants, 18–30 years of age (n=7,937), who took part in the 2001–2002 National Epidemiologic Study on Alcohol and Related Conditions, a nationally representative survey of adults. An extended Cox proportional hazards model was used to model time until becoming an adolescent parent (i.e., age at which first child was born if ≤18 years). Predictor variables of interest included initiation of alcohol, marijuana, cocaine, and daily cigarette use, age of earliest conduct disorder symptom, having a parent with alcohol and/or drug problems, parental death, divorce and/or separation, race/ethnicity, and gender.Results: Several variables were associated with adolescent parenthood, including initiation of daily cigarette smoking, age of first antisocial/conduct disorder symptom, and race/ethnicity. Parental alcohol/drug problems and parental death were also associated with adolescent parenthood for women. A significant interaction between initiation of daily cigarette smoking and ethnicity was present for women. Daily cigarette smoking was associated with adolescent parenthood to a greater degree than nondaily cigarette smoking for white and Hispanic women but not African American women. No significant associations were found between adolescent parenthood and initiation of drinking, marijuana, or cocaine and parental divorce/separation.Conclusions: Prevention efforts should focus on adolescents who are at highest risk of adolescent parenthood.

The Causal Impact of Childhood-Limited Maltreatment and Adolescent Maltreatment on Early Adult Adjustment - Corrected Proof

Terence P. Thornberry, Kimberly L. Henry, Timothy O. Ireland, Carolyn A. Smith — 2010-01-04

Abstract: Purpose: We use full-matching propensity score models to test whether developmentally specific measures of maltreatment, in particular childhood-limited maltreatment versus adolescent maltreatment, are causally related to involvement in crime, substance use, health-risking sex behaviors, and internalizing problems during early adulthood.Methods: Our design includes 907 participants (72% male) in the Rochester Youth Development Study, a community sample followed from age 14 to age 31 with 14 assessments, including complete maltreatment histories from Child Protective Services records.Results: After balancing the data sets, childhood-limited maltreatment is significantly related to drug use, problem drug use, depressive symptoms, and suicidal thoughts. Maltreatment during adolescence has a significant effect on a broader range of outcomes: official arrest or incarceration, self-reported criminal offending, violent crime, alcohol use, problem alcohol use, drug use, problem drug use, risky sex behaviors, self-reported sexually transmitted disease diagnosis, and suicidal thoughts.Conclusions: The causal effect of childhood-limited maltreatment is focused on internalizing problems, whereas adolescent maltreatment has a stronger and more pervasive effect on later adjustment. Increased vigilance by mandated reporters, especially for adolescent victims of maltreatment, along with provision of appropriate services, may prevent a wide range of subsequent adjustment problems.

Obesity-Related Lipid Profile and Altered Insulin Incretion in Adolescent With Polycystic Ovary Syndrome - Corrected Proof

2010-01-04

Abstract: Purpose: The objective of this study was evaluate influence of body mass index (BMI), hyperinsulinemia and/or insulin resistance (IR), and androgens on the lipid profile of adolescent polycystic ovary syndrome (PCOS).Methods: A total of 71 PCOS and 94 healthy adolescent girls from a Southern Italian region were included in the study. At day 5-8 of menstrual cycle, patients underwent a 75-g oral glucose tolerance test to evaluate insulin levels; lipid and homocysteine levels were also assessed, baseline hormonal assays and ultrasound examination performed, and anthropometric characteristics measured.Result: No differences were observed in the incidence of overweight or obesity and total cholesterol, high-density lipoprotein (HDL) cholesterol level, low-density lipoprotein cholesterol level; triglycerides and homocysteine levels did not differ between PCOS and control groups. All fasting metabolic indexes were similar, whereas insulin secretion after glucose load (I-AUC) was significantly higher in PCOS subjects. Total cholesterol levels were significantly related to waist-hip ratio (WHR). Low-density lipoprotein level was positively correlated with BMI, waist, WHR, and homeostasis model assessment (HOMA) but not I-AUC. Findings obtained for HDL correlated negatively to the same parameters, being also negatively correlated to both fasting insulin and HOMA, but not I-AUC. Moreover, HDL was positively correlated to circulating androstenedione (A) and negatively to circulating testosterone (T) levels. Triglycerides seemed to correlate positively with body BMI, waist, and WHR, and negatively with A levels. Homocysteine levels correlated positively with plasma triglyceride content.Conclusion: In the adolescent population studied, no differences were revealed in lipid profile between PCOS and controls. The PCOS is not a discriminant factor. The anthropometric characteristics resulted in the primary factor influencing the lipid derangement, confirming the importance of treating obesity at an early age to reduce morbidity rates. Hyperinsulinemia and IR, peculiarities of PCOS capable of influencing long-term evolution into cardiovascular diseases and diabetes mellitus, are not associated with worse lipid profile. Young patients should be encouraged and motivated to change their lifestyle, with the aim of losing weight and thus reducing risk of onset of overt dyslipidemia.

Prevalence of Insufficient, Borderline, and Optimal Hours of Sleep Among High School Students – United States, 2007 - Corrected Proof

2010-01-04

Abstract: We describe the prevalence of insufficient, borderline, and optimal sleep hours among U.S. high school students on an average school night. Most students (68.9%) reported insufficient sleep, whereas few (7.6%) reported optimal sleep. The prevalence of insufficient sleep was highest among female and black students, and students in grades 11 and 12.

Young People: Taking Few Precautions Against Hearing Loss in Discotheques - Corrected Proof

Ineke Vogel, Johannes Brug, Catharina P.B. van der Ploeg, Hein Raat — 2010-01-04

Abstract: This study evaluated adolescents' music-listening risk and protective behaviors in discotheques. While frequently standing close to the loudspeakers, taking few breaks, and hardly using hearing-protection devices, many are at risk of developing permanent hearing loss. Assessing visiting mode may be a first and quick screener to identify adolescents at risk.

Assessing Youth Risk Behavior in a Clinical Trial Setting: Lessons From the Infant Health and Development Program - Corrected Proof

2009-12-25

Abstract: Purpose: The purpose of this article was to describe the use of the Youth Risk Behavior Surveillance System (YRBSS) with known 17–18-year-old patients in follow-up of a multisite randomized clinical trial, and to develop a new scoring algorithm indicating the degree of risk-taking behavior for between-group analyses.Methods: Seventy-five questions from the YRBSS were incorporated into the study questionnaire, with the development of safety plans to guide the disposition of participants. The YRBSS questions were grouped into two categories (with three subdomains each) named problem behaviors (conduct problems, sexual behavior, and suicide/hopelessness) and substance use (cigarettes, alcohol, and marijuana use), with scores for each subdomain indicating high, moderate, and low risk.Results: Of the 677 participants, the safety plan was activated 215 times for 199 (29.4%) of participants. Risk behaviors included binge drinking (149), alcohol/substance use and driving (41), depression (22), hopelessness (37), and suicidal ideation (13; all in the past). No emergency room evaluations were required. The subdomain scaling was analyzed by demographic characteristics, and findings were consistent with the literature; for example, higher rates of conduct problems in males, more suicidal ideation in females, greater sexual risk in African Americans, more substance use in males and whites, and more alcohol use in youth with mothers with higher levels of education.Conclusions: YRBSS can be administered in a research setting with appropriate safety precautions. These results should provide a useful guide to the application of the YRBSS to other adolescent populations in the future.

Everything's Better in Moderation: Young Women's Gender Role Attitudes and Risky Sexual Behavior - Corrected Proof

Tamara G.J. Leech — 2009-12-25

Abstract: Purpose: This study examines the association between gender role attitudes and risky sexual behavior among young women. Previous studies have posed seemingly contradictory arguments: that either traditional attitudes or egalitarian attitudes are associated with riskier behavior.Methods: Data are based on the children of the National Longitudinal Survey of Youth, representing 520 sexually active 18–19-year-old women. Propensity radius matching was used to assess differences in rates of multiple sexual partners and sex outside of a committed relationship.Results: Relative to moderate gender role attitudes, both egalitarian gender role attitudes and traditional gender role attitudes are associated with higher rates of risky sexual behavior. Both women with egalitarian role attitudes and those with traditional role attitudes have about a 10% higher prevalence of risky behavior compared to women with more moderate gender role attitudes.Conclusion: Existing, seemingly contradictory contentions about the relationship between gender role attitudes and risky sexual behavior may be more coherent than they seem. By shifting focus from risk to protection, the results suggest that moderate gender role attitudes are protective against risky sexual behavior. Future studies should investigate the causal mechanisms and intervention implications of this protective relationship.

Thriving in Stepfamilies: Exploring Competence and Well-being Among African American Youth - Corrected Proof

2009-12-25

Abstract: Although scholars conclude that children/adolescents in two-parent nuclear families have an advantage over those in stepfamilies, emerging evidence indicates that the experiences of African American youths have been overshadowed. In three replicated studies, we detected no differences on several important and commonly assessed well-being and competence indicators among samples of African American youth in two-parent nuclear and stepfamilies.

Peer Stressors and Gender Differences in Adolescents' Mental Health: The TRAILS Study - Corrected Proof

Martin P. Bakker, Johan Ormel, Frank C. Verhulst, Albertine J. Oldehinkel — 2009-12-10

Purpose: This study tested two hypotheses about gender-specific mental health effects of peer stressors during early adolescence: (1) boys and girls are sensitive to different types of peer stressors, and (2) peer stress is associated with different mental health problems in boys and girls.Methods: These two hypotheses were tested in a prospective large population cohort of 2,084 Dutch young adolescents. Internalizing and externalizing problems were measured at baseline and follow-up, whereas stressful life events in the period between baseline and follow-up were measured retrospectively at follow-up. We performed the analyses with two types of peer stressors; victimization at school and relationship losses.Results: Relationship losses were more strongly associated with internalizing and externalizing problems in girls than boys, supporting the first hypothesis. Peer victimization at school was also associated with both types of mental health problems, but equally strong in boys and girls.Conclusions: Peer stress is unlikely to be associated with different mental health problems in boys and girls. Instead, boys and girls are more likely to be susceptible to different types of peer stressors.

Utilization of Health Services in Physician Offices and Outpatient Clinics by Adolescents and Young Women in the United States: Implications for Improving Access to Reproductive Health Services - Corrected Proof

Karen W. Hoover, Guoyu Tao, Stuart Berman, Charlotte K. Kent — 2009-11-24

Abstract: Purpose: We examined utilization patterns of adolescents and young women as they seek general and reproductive health services in physician offices and hospital outpatient clinics.Methods: We analyzed physician office visits in the 2003–2006 National Ambulatory Medical Care Surveys, and hospital outpatient clinic visits in the National Hospital Ambulatory Medical Care Surveys, to examine utilization patterns of females aged 9–26 years by 2-year age intervals and other characteristics such as physician specialty or clinic type.Results: The number of visits to primary care physician offices increased with age, from 4.9 million for ages 9–10 years to 9.0 million for ages 25–26 years. The proportion of visits made to obstetrician-gynecologists and family practitioners increased with age, and by ages 15–16 years fewer than half of all visits to primary care providers were made to pediatricians. The proportion of visits to family practitioners increased from 25% at ages 9–10 years to 30% at ages 25–26 years. By ages 17–18 years, a larger proportion of visits were made to obstetrician-gynecologists (33% of 7.0 million visits) and to family practitioners (34%) than to pediatricians (23%). The proportion of visits for reproductive health services peaked at 53% of 7.5 million physician visits at ages 20–21 years. Similar utilization patterns were observed for the 11.0 million hospital outpatient visits to primary care providers.Conclusions: Because adolescents and young women most commonly utilize healthcare services provided by obstetrician-gynecologists and family practitioners, these specialties should be priority targets for interventions to improve the quality and availability of reproductive health services.

Changes in Ambulatory Health Care Use During the Transition to Young Adulthood - Corrected Proof

S. Todd Callahan, William O. Cooper — 2009-11-24

Abstract: Purpose: To identify changes in ambulatory health care use during the transition from adolescence to young adulthood.Methods: We analyzed data from health care encounters for adolescents (13–18 year olds) and young adults (19–24 year olds) in the National Ambulatory Medical Care Surveys or National Hospital Ambulatory Medical Care Surveys from 1997 through 2004. We present bivariate analysis of visit characteristics (including clinician specialty and health care setting, primary reason for the visit, and expected source of payment) for young adults as compared with those for adolescents, using weights provided by the National Center for Health Statistics to make national estimates.Results: Adolescents and young adults used similar number of health care visits annually; however, a greater proportion of ambulatory care for young adults was delivered in emergency departments as compared with adolescents (20% vs. 14%; p < .001), a smaller proportion was delivered to males (27% vs. 46%; p < .001), and a smaller proportion was covered by private health insurance (58% vs. 67%, respectively; p < .001). Among young adults, preventive care was listed as the reason for 40% of non–emergency department visits for females, whereas it accounted for only 10% of visits for males.Conclusions: Significant changes in ambulatory health care use occur during young adulthood. Improving health care during the transition to adulthood will necessitate attention to health care research and delivery agendas that are relevant to the young adult population.

Factors Associated With Intention-to-Recommend Human Papillomavirus Vaccination Among Physicians in Mysore, India - Corrected Proof

2009-11-24

Abstract: Purpose: This qualitative study investigated physician intention-to-recommend the human papillomavirus (HPV) vaccine to parents of adolescent girls in India. There are currently no data on attitudes to HPV vaccination among healthcare providers in India.Methods: Between June and August 2008, 20 semistructured qualitative in-depth interviews were conducted among physicians from a range of specialties and practice settings in Mysore District, India. Physicians were interviewed about their specialty and the types of patients they saw in their practice, attitudes toward recommending HPV vaccination to parents of adolescent girls, perceived subjective norms surrounding the promotion of vaccines in their work settings, and their perceptions regarding self-efficacy in recommending the HPV vaccine.Results: The study found that knowledge about HPV infection and its relationship to cervical cancer was low among physicians across specialties. While most physicians expressed positive attitudes toward vaccination in general, and HPV vaccination in particular, the overwhelming majority believed that few of their patients would react positively to a vaccine recommendation. Physicians were concerned about talking to parents about their adolescent daughters' reproductive lives. Certain specialties, particularly obstetrician/gynecologists, suggested that recommending immunization was not appropriate in their work setting.Conclusion: With the HPV vaccine recently being approved in India, there is a strong need to provide more education for physicians about the relationship of HPV infection and cervical cancer and the benefits of vaccinating adolescent girls to prevent cervical cancer in the future.

Does Resistance Training Improve the Functional Capacity and Well Being of Very Young Anorexic Patients? A Randomized Controlled Trial - Corrected Proof

2009-11-17

Abstract: Purpose: We determined the effects of a 3-month low–moderate-intensity strength training program (2 sessions/week) on functional capacity, muscular strength, body composition, and quality of life (QOL) in 22 young (12–16 yrs) anorexic outpatients.Methods: Patients were randomly assigned to a training or control group (n=11 [10 females] each). Training sessions were of low intensity (loads for large muscle groups ranging between 20%–30% and 50%–60% of six repetitions maximum [6RM] at the end of the program). We measured functional capacity by the time up and go and the timed up and down stairs tests. Muscular strength was assessed by 6RM measures for seated bench and leg presses. We estimated percent body fat and muscle mass. We assessed patients' QOL with the Short Form-36 items.Results: The intervention was well tolerated and did not have any deleterious effect on patients' health, and did not induce significant losses in their body mass. The only studied variable for which a significant interaction (group × time) effect was found (p=.009) was the 6RM seated lateral row test.Conclusions: Low–moderate-intensity strength training does not seem to add major benefits to conventional psychotherapy and refeeding treatments in young anorexic patients.

Who Gets Confidential Care? Disparities in a National Sample of Adolescents - Corrected Proof

Jennifer C. Edman, Sally H. Adams, M. Jane Park, Charles E. Irwin — 2009-11-17

Abstract: Using the 2001–2004 Medical Expenditures Panel Survey, we examined rates of past-year adolescent time alone with a clinician by visit type, and among youths with a preventive visit, examined age, gender, and race/ethnicity differences. Youths with a preventive visit have higher rates of time alone; rates for these youths increase with age, are higher for males (42%) versus females (37%), and are lowest among Hispanics. Time alone rates are low, especially for younger females and Hispanic youths. Special efforts are needed to increase time alone in these populations.

Randomized Controlled Clinical Trial of Yoga in the Treatment of Eating Disorders - Corrected Proof

T. Rain Carei, Amber L. Fyfe-Johnson, Cora C. Breuner, Margaret A. Brown — 2009-11-03

Abstract: Purpose: This was a pilot project designed to assess the effect of individualized yoga treatment on eating disorder outcomes among adolescents receiving outpatient care for diagnosed eating disorders (anorexia nervosa, bulimia nervosa, eating disorder not otherwise specified).Methods: A total of 50 girls and 4 boys aged 11–21 years were randomized to an 8-week trial of standard care vs. individualized yoga plus standard care. Of these, 27 were randomized to standard care and 26 to yoga plus standard care (attrition: n = 4). Standard care (every other week physician and/or dietician appointments) was required to meet ethical guidelines. The No Yoga group was offered yoga after study completion as an incentive to maintain participation. Outcomes evaluated at baseline, end of trial, and 1-month follow-up included Eating Disorder Examination (EDE), Body Mass Index (BMI), Beck Depression Inventory, State-Trait Anxiety Inventory, and Food Preoccupation questionnaire.Results: The Yoga group demonstrated greater decreases in eating disorder symptoms. Specifically, the EDE scores decreased over time in the Yoga group, whereas the No Yoga group showed some initial decline but then returned to baseline EDE levels at week 12. Food preoccupation was measured before and after each yoga session, and decreased significantly after all sessions. Both groups maintained current BMI levels and decreased in anxiety and depression over time.Conclusions: Individualized yoga treatment decreased EDE scores at 12 weeks, and significantly reduced food preoccupation immediately after yoga sessions. Yoga treatment did not have a negative effect on BMI. Results suggest that individualized yoga therapy holds promise as adjunctive therapy to standard care.