Journal of Adolescent Health - Articles in Press

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.

The Future Adolescent Medicine Workforce: A Survey of Current Adolescent Medicine Fellows - Corrected Proof

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.

Connectedness as a Predictor of Sexual and Reproductive Health Outcomes for Youth - Corrected Proof

2010-01-22

Abstract: To review research examining the influence of “connectedness” on adolescent sexual and reproductive health (ASRH). Connectedness, or bonding, refers to the emotional attachment and commitment a child makes to social relationships in the family, peer group, school, community, or culture. A systematic review of behavioral research (1985–2007) was conducted. Inclusion criteria included examination of the association between a connectedness sub-construct and an ASRH outcome, use of multivariate analyses, sample size of ≥100, and publication in a peer-reviewed journal. Results were coded as protective, risk, or no association, and as longitudinal, or cross sectional. Findings from at least two longitudinal studies for a given outcome with consistent associations were considered sufficient evidence for a protective or risk association. Eight connectedness sub-constructs were reviewed: family connectedness (90 studies), parent–adolescent general communication (16 studies), parent–adolescent sexuality communication (58 studies), parental monitoring (61 studies), peer connectedness (nine studies), partner connectedness (12 studies), school connectedness (18 studies), and community connectedness (four studies). There was sufficient evidence to support a protective association with ASRH outcomes for family connectedness, general and sexuality-specific parent–adolescent communication, parental monitoring, partner connectedness, and school connectedness. Sufficient evidence of a risk association was identified for the parent overcontrol sub-construct of parental monitoring. Connectedness can be a protective factor for ASRH outcomes, and efforts to strengthen young people's pro-social relationships are a promising target for approaches to promote ASRH. Further study regarding specific sub-constructs as well as their combined influence is needed.

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.

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

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.

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

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 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.

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

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.

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.

Parenting Style as a Predictor of Adolescent Weight and Weight-Related Behaviors - Corrected Proof

Jerica M. Berge, Melanie Wall, Katie Loth, Dianne Neumark-Sztainer — 2009-10-16

Abstract: Purpose: Current research indicates that specific parenting styles are associated with adolescent overweight, dietary intake, and physical activity; but most of the research has been cross-sectional, making it difficult to determine the temporal order of these associations. The current study adds to the previous research by examining 5-year longitudinal associations between parenting style and adolescent weight and weight-related behaviors.Methods: Data from Project EAT, a population-based study with adolescents from diverse ethnic and socioeconomic backgrounds, were used. Adolescents (N = 2,516) from 31 Minnesota schools completed in-class assessments in 1999 (Time 1) and mailed surveys in 2004 (Time 2). Multiple linear regression models were used to predict mean levels of adolescent outcomes at Time 2 from parenting style at Time 1.Results: Time 1 maternal authoritative parenting style predicted lower body mass index in adolescent sons and daughters at Time 2. Time 1 paternal permissive parenting style predicted more fruits and vegetables intake in daughters at Time 2. Significant associations were not found between parenting style and adolescent physical activity.Conclusions: Findings suggest that authoritative parenting style may play a protective role related to adolescent overweight and that the dimension of warmth and/or caring in the parent–adolescent relationship may be important in relation to female adolescent healthy dietary intake. Further exploration of opposite sex parent–adolescent dyad patterns related to parenting style and adolescent weight and weight-related behaviors is warranted.

Gender and the Effects of an Economic Empowerment Program on Attitudes Toward Sexual Risk-Taking Among AIDS-Orphaned Adolescent Youth in Uganda - Corrected Proof

2009-10-16

Abstract: Purpose: This article examines gender differences in attitudes toward sexual risk–taking behaviors of acquired immune deficiency syndrome (AIDS)–orphaned youth participating in a randomized control trial testing an economic empowerment intervention in rural Uganda.Methods: Adolescents (average age 13.7 years) who had lost one or both parents to AIDS from 15 comparable schools were randomly assigned to either an experimental (n=135) or a control condition (n=142). Adolescents in the experimental condition, in addition to usual care, also received support and incentives to save money toward secondary education.Results: Findings indicate that although adolescent boys and girls within the experimental condition saved comparable amounts, the intervention appears to have benefited girls, in regard to the attitudes toward sexual risk–taking behavior, in a different way and to a lesser extent than boys.Conclusions: Future research should investigate the possibility that adolescent girls might be able to develop equally large improvements in protective attitudes toward sexual risk taking through additional components that address gendered social norms.

Adolescents' Perceptions of Cigarette Brand Image: Does Plain Packaging Make a Difference? - Corrected Proof

Daniella Germain, B. Psych. Hons, Melanie A. Wakefield, Sarah J. Durkin — 2009-10-14

Abstract: Purpose: To examine the effect of plain packaging on adolescents' perceptions of cigarette packs, attributes of smokers, and expectations of cigarette taste, and to identify the effect of increasing the size of pictorial health warnings on appraisal of plain packs.Methods: We used a 5 (degree of plain packaging and graphic health warning)× 3 (brand type) between-subjects experimental design, using a Web-based methodology to expose adolescents to one randomly selected cigarette pack, during which respondents completed ratings.Results: When brand elements such as color, branded fonts, and imagery were progressively removed from cigarette packs, adolescents perceived packs to be less appealing, rated attributes of a typical smoker of the pack less positively, and had more negative expectations of cigarette taste. Pack appeal was reduced even further when the size of the pictorial health warning on the most plain pack was increased from 30% to 80% of the pack face, with this effect apparent among susceptible nonsmokers, experimenters, and established smokers.Conclusions: Removing as much brand information from cigarette packs as possible is likely to reduce positive cigarette brand image associations among adolescents. By additionally increasing the size of pictorial health warnings, positive pack perceptions of those who are at greater risk of becoming regular addicted adult smokers are most likely to be reduced.

Adolescent Offspring of Mothers With Chronic Fatigue Syndrome - Corrected Proof

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.

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

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.

Television Use and Snacking Behaviors Among Children and Adolescents in China - Corrected Proof

2009-10-12

Abstract: Purpose: Television (TV) use has been linked with poor eating behaviors and obesity in young people. This study examines the association between TV watching and paying attention to TV commercials with buying and requesting snacks seen on commercials, and eating snacks while watching TV among youth in China.Methods: Data from 1,552 participants (ages 6–17.99) in the 2004 China Health and Nutrition Survey were analyzed cross-sectionally. The 2004 China Health and Nutrition Survey was conducted in nine Chinese provinces.Results: Most respondents (92.2%) reported watching TV; on average children (6–11.99 years old) and adolescents (12–17.99 years old) watched TV for 9–10 hours per week. Nearly half (42.9%) of all the respondents said they “sometimes” or “often” paid attention to TV commercials. Respondents who reported paying attention to commercials had higher odds of requesting snacks (odds ratio [OR]=3.43; 95% confidence interval [CI]=2.55–4.60) and buying snacks (OR=2.73; 95% CI=2.17–3.43) seen on TV, and eating snacks while watching TV (OR=1.60; 95% CI=1.23–2.07) than those who did not pay attention. However, frequency of watching TV was not significantly related to snacking.Conclusion: Attention to TV commercials for snack foods may be one of the factors affecting the increase in obesity among children and adolescents in China.

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

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.

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

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.

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

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.

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

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.