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PubMed2003

The impact of anxiety disorders on educational achievement.

Anxiety disorders typically have an age of onset in childhood and adolescence, resulting in significant disability in social and occupational functioning. Epidemiological evidence suggests that persons with psychiatric disorders and perhaps especially social phobia are at increased risk for premature withdrawal from school [Am. J. Psychiatry 157 (2000) 1606]. In order to further determine the impact of anxiety disorders on school functioning and/or premature withdrawal from school, 201 patients meeting DSM-IV criteria for a primary anxiety disorder completed a school leaving questionnaire as well as self-report measures of anxiety, depression, and social adjustment. About 49% (n = 98) reported leaving school prematurely and 24% of those indicated that anxiety was the primary reason for this decision. Patients who had left school prematurely were significantly more likely to have a lifetime diagnosis of generalized social phobia, a past history of alcohol abuse/dependence and a greater number of lifetime diagnoses than those who completed their desired level of education. This study suggests that anxiety disorders, and perhaps especially generalized social phobia, are associated with premature withdrawal from school. Further studies are required to determine methods for early identification and treatment of anxiety disorders in school aged children to enable these students to reach their full potential.

Adolescent↗
PubMedDate not supplied

Family dimensions in anxious-depressed school refusers.

The Family Adaptability and Cohesion Evaluation Scale II (FACES II) was administered to 46 adolescents with comorbid anxiety and major depressive disorders and to their parents in a treatment study of school refusal. FACES II measures cohesion and adaptability dimensions, as well as family type (balanced to extreme). Generally, adolescents and parents reported low cohesion (i.e.. disengagement) and low adaptability (i.e.. rigidity) on FACES II. Adolescents and parents described their ideal families as significantly less disengaged and less rigid than their own families. Fifty percent of adolescents, 38% of fathers, and 24% of mothers classified their families as the extreme type. Adolescents in extreme families, when compared with adolescents in more balanced families, reported significantly higher scores on two of three depression instruments and on a measure of somatic symptoms. Family therapy to improve cohesion and adaptability and treatments focused on improving depression and somatic symptoms may improve family functioning and decrease the severity and course of school refusal.

Adolescent↗
PubMed2001

High-risk behaviors associated with early smoking: results from a 5-year follow-up.

PURPOSE: To compare grade 7 nonsmokers, experimenters, and smokers on the basis of prevalence of other problem behaviors at both grade 7 and grade 12. METHODS: Based on longitudinal self-report data from 4327 California and Oregon students, we used logistic regression to develop weighted estimates of the prevalence of academic difficulties, substance use, and delinquent behavior within the three smoking status groups at grades 7 and 12. Huber variance estimates, which adjust for weighting and clustering of observations, were used to assess the statistical significance of differences across groups. RESULTS: Compared with nonsmokers, early smokers were at least 3 times more likely by grade 12 to regularly use tobacco and marijuana, use hard drugs, sell drugs, have multiple drug problems, drop out of school, and experience early pregnancy and parenthood. These adolescents were also at higher risk for low academic achievement and behavioral problems at school, stealing and other delinquent behaviors, and use of predatory and relational violence. Early experimenters were at significantly greater risk for these problems as well, although to a lesser extent than smokers. Importantly, the higher risk among experimenters and smokers of experiencing many of these problems was evident as early as grade 7. CONCLUSIONS: Early experimenters and smokers are more likely than nonsmokers to experience various problem behaviors by grade 12, with many of these problems evident as early as grade 7. Results suggest that substance use programs that target multiple problems in addition to smoking may be most effective for these high-risk adolescents.

Adolescent↗
PubMed2001

Douching practices among HIV infected and uninfected adolescents in the United States.

PURPOSE: To characterize sexual behaviors and sociodemographic factors that are associated with douching among geographically diverse adolescent women with and without HIV infection. METHODS: HIV infected subjects recruited preferentially and behaviorally comparable high-risk HIV uninfected subjects were enrolled in a prospective HIV study from 15 sites in 13 U.S. cities. Baseline interview data from 1996 to 1999 for females aged 12 to 19 years were analyzed using one-way analysis of variance and multiple logistic regression. RESULTS: Among the 342 females/young women, 74.9% were black (non-Hispanic), 11.1% Hispanic/Latina, and 14.0% white or other race/ethnicity; 63.5% were HIV infected. Young women who had dropped out of high school comprised 23.4% of subjects. In the 3 months before the interview, 179 (52.3%) adolescents had douched at least once. In a multivariable logistic regression model, recent douching was more common among sexually active females (OR = 2.2; 95% CI: 1.2-4.2), Blacks (OR = 2.2; 95% CI: 1.2-4.1 vs. Hispanics/Whites/others), females who dropped out of high school (OR = 2.1; 95% CI: 1.2-3.7), and HIV infected females (OR = 1.7; 95% CI: 1.04-2.7). CONCLUSIONS: In this nationwide study, adolescents who are sexually active, African-American, dropped out of high school, and HIV infected were most likely to douche. Interventions to discourage douching should pay special attention to these populations.

Adolescent↗
PubMed1999

Ten years after: examination of adolescent screening questions that predict future violence-related injury.

PURPOSE: To determine which screening questions used in routine adolescent health care maintenance visits correlate with subsequent violence-related injury. METHODS: A prospective cohort study was undertaken of adolescents initially seen at the East Boston Neighborhood Health Center (EBNHC) in 1986. Risk factor data were collected based on the adolescent health intake form in the medical records. The primary outcome measure, time until first violence-related injury was determined through identification on chart review of the treatment of any such injuries at the urgent care center at EBNHC in the subsequent 10 years. Kaplan-Meier survival statistics and Cox proportional hazards models were used to account for loss of patients to follow-up. RESULTS: Median follow-up for this sample was >5 five years. Male gender, cigarette smoking, alcohol use, other drug use, poor relationships with parents, not being in school or failing school, and history of fighting in the past year, predicted violence-related injury within the follow-up period. The number of fights in the past year appeared to have a dose-response effect on risk of subsequent violence-related injury. A simple screening instrument consisting of items concerning school status, drug use, and fighting history was used to stratify youth into low, moderate, and high risk of violence-related injury during the follow-up period. CONCLUSIONS: These results suggest that a simple three-item screening instrument may be used to stratify the risk of future injury at the time of adolescent health maintenance visits. Further research is indicated to validate this finding in other populations. Interventions designed to assist adolescents who are not in school or who have drug use problems should also incorporate violence prevention strategies.

Adolescent↗
PubMed2003

Voluntary changes in surgery career paths: a survey of the program directors in surgery.

BACKGROUND: This article attempts to quantify the current scope of attrition, identify the reasons why categorical residents are leaving general surgery residency programs voluntarily, and correlate the program directors' and residents' perspectives. STUDY DESIGN: A questionnaire asked the Program Directors of general surgery residency programs how many categorical residents left voluntarily in the 2000-2001 academic year, their postgraduate (PGY) levels, why they left, and where they went. Another questionnaire asked the residents why they entered surgery and why they left. The surveys' responses were compared. RESULTS: A total of 206 programs (81%) responded. One hundred ten programs (53%) reported voluntarily attrition of 167 categorical residents (mean: 0.8 residents per program for all responders and 1.5 residents per program for programs that reported attrition). Seventy-three programs (66%) lost one resident; 23 programs (21%), 2 residents; 9 programs (8%), 3 residents; 4 programs (4%), 4 residents; and 1 program (<1%), 5 residents. Eighty-five PGY-1 residents (51%), 42 PGY-2 residents (25%), 27 PGY-3 residents (16%), and 13 PGY-4 residents (8%) left. The most common reasons for attrition cited by the program directors were personal and work hours/lifestyle in 40% and 35%, respectively. One hundred five residents (63%) entered other fields of medicine; 40 residents transferred to other general surgery programs. Net voluntary attrition, defined as the number of residents who left general surgery voluntarily (127) divided by the resident population at risk, was 3%, indicating that 97% of the residents at risk in the responding programs remained in general surgery. CONCLUSIONS: Most surgery programs that responded were affected by attrition in 2000-2001, with approximately one-third losing more than one resident. Attrition tends to occur early in training. Most residents enter other specialties, primarily for quality-of-life reasons. But many stay in general surgery.

Career Choice↗
PubMed1999

Attrition in graduate surgical education: an analysis of the 1993 entering cohort of surgical residents.

BACKGROUND: Pyramidal surgical residency programs, in which more residents are enrolled than can complete the program, have gradually declined in number in recent years. In 1996, the Residency Review Committee for Surgery established a policy that the number of residents appointed to a program must be consistent with the number who will complete the program. Even so, there is still attrition in the ranks of surgical residents, some of whom hold undesignated preliminary positions and have no guarantee of a position that will lead to completion of the program. This study examined the 1993 entering cohort of surgical residents to determine the rate of attrition as of 1998. STUDY DESIGN: Data were collected from the AMA's Medical Education Research Information Database, the American College of Surgeons Resident Masterfile, and the Association of American Medical Colleges GME Tracking Census database. The data were examined by specialty, gender, ethnic background, and type of medical school attended. RESULTS: The overall attrition rate from surgical GME was 12%; the rate for international medical graduates was 33%; and the rate for osteopathic residents was 28%. African-American United States and Canadian graduates had attrition rates of 16% for men and 8% for women, and Hispanic United States and Canadian graduates had attrition rates of 14% for men and 15% for women. General surgery residents had an attrition rate of 26%, which included residents in undesignated preliminary positions. Gender was not a risk factor except for the significantly higher attrition rate of African-American men. Most (81%) of the residents who dropped out of surgical GME enrolled in GME in other specialties. CONCLUSIONS: The attrition rate from surgical GME is low, and most residents who drop out reenter GME in another specialty. Of concern is the high rate of attrition of African-American men who are United States or Canadian graduates. The highest rate of attrition, by far, is in the group of international medical graduates, many of whom are likely to have held undesignated preliminary positions.

Career Choice↗
PubMedDate not supplied

Rethinking race and attrition in nursing programs: a hermeneutic inquiry.

This hermeneutic study examined the lived experience of four self-identified African-American students enrolled in predominantly white baccalaureate nursing programs. An understanding of the following concerns was sought: (1) Does being black matter in an educational program that is predominantly white? (2) Does being black in a predominantly white nursing program hinder a student's ability or desire to continue toward his or her educational goal? These concerns were guided by the major research question: What is the meaning of being black in a predominantly white nursing program? Critical hermeneutic inquiry, as explicated by Jurgen Habermas, was used as the philosophical framework. Audiotaped interviews were transcribed and subsequently analyzed by a team of researchers. Three constitutive patterns emerged from the analysis of the texts: Being Different/Being the Same, Student As Teacher: Toward a Surrogate Pedagogy, and Resoluteness: I'll See You at Graduation. Findings suggest that empirical research concerning the attrition of blacks from predominantly white nursing programs must include a description of what it means to be black or different in these settings.

Adult↗
PubMed1997

The effects of unemployment on psychiatric illness during young adulthood.

BACKGROUND: The aims of this study were to examine the associations between exposure to unemployment following school leaving and rates of psychiatric disorder using data gathered on a birth cohort of New Zealand young people studied up to the age of 18. METHODS: At age 18 cohort members were assessed on: (a) duration of exposure to unemployment from age 16; (b) DSM-IV diagnostic criteria for major depression, anxiety disorders, conduct disorder, nicotine dependence, other substance abuse/dependence and attempted suicide. This information was integrated into longitudinal data gathered on the social circumstances, family background and adjustment of the cohort up to the age of 18. RESULTS: Increasing exposure to unemployment was associated with increasing risks of psychiatric disorder in adolescence. Those exposed to 6 months or more unemployment had rates of disorder that were 1.5 to 5.4 times higher than those not exposed to unemployment. However, most of the elevated risk of disorder among those unemployed was explained by family and personal factors that were present prior to school leaving age. Nonetheless, even after control for these factors those exposed to unemployment had significantly higher rates of anxiety disorder and substance use disorders. CONCLUSIONS: To a large extent the relationships between unemployment and psychiatric disorder seen in this cohort were explained by social, family and personal factors that were present before school leaving age. Nonetheless, young people exposed to unemployment had higher rates of substance use and anxiety disorder.

Adolescent↗
PubMed2001

Resilience among abused and neglected children grown up.

Although an extensive literature has accumulated documenting the maladaptive outcomes associated with childhood victimization, a limited body of knowledge addresses resilience. This paper sought to operationalize the construct of resilience across a number of domains of functioning and time periods and to determine the extent to which abused and neglected children grown up demonstrate resilience. Substantiated cases of child abuse and neglect from 1967 to 1971 were matched on gender, age, race, and approximate family social class with nonabused and nonneglected children and followed prospectively into young adulthood. Between 1989 and 1995. 1,196 participants (676 abused and neglected and 520 controls) were administered a 2-hr in-person interview, including a psychiatric assessment. Resilience requires meeting the criteria for success across six of eight domains of functioning: employment, homelessness, education, social activity, psychiatric disorder, substance abuse, and two domains assessing criminal behavior (official arrest and self-reports of violence). Results indicate that 22% of abused and neglected individuals meet the criteria for resilience. More females met the criteria for resilience and females were successful across a greater number of domains than males. We speculate on the meaning of these findings and discuss implications for the child maltreatment field. Limitations of the study are also acknowledged.

Adaptation, Psychological↗
PubMed1999

Specification tests for random-effects transition models: an application to a model of the British youth training scheme.

We develop diagnostic tests for random-effects multi-spell multi-state models focusing on: independence between the unobserved heterogeneity and observed covariates; mutual independence of heterogeneity terms; and distributional form. They are applied to a transition model of the British youth labor market, revealing significant mis-specifications in our initial model, and allowing us to develop a considerably better-fitting specification that would have been difficult to reach by other means. The improved specification implies reduced estimates of the effectiveness of the youth training scheme (YTS), but we nevertheless retain the conclusion of significant positive effects of YTS on employment prospects.

Adolescent↗
PubMed2002

Natural mentors and adolescent resiliency: a study with urban youth.

Natural mentors may play an important role in the lives of adolescents. We interviewed 770 adolescents from a large Midwestern city. Fifty-two percent reported having a natural mentor. Those with natural mentors were less likely to smoke marijuana or be involved in nonviolent delinquency, and had more positive attitudes toward school. Natural mentors had no apparent effect on anxiety or depression. Using the resiliency theory framework, natural mentors were found to have compensatory but not protective effects on problem behaviors, and both compensatory and protective effects on school attitudes. Direct and indirect (mediated) effects of natural mentors are explored for problem behaviors and school attitudes. The potential importance of natural mentors is supported, and implications for future research are considered.

Adolescent↗
PubMed1999

The EARLY ALLIANCE prevention trial: an integrated set of interventions to promote competence and reduce risk for conduct disorder, substance abuse, and school failure.

Describes the EARLY ALLIANCE interventions, an integrated set of four programs designed to promote competence and reduce risk for early-onset conduct disorder, substance abuse, and school failure. These interventions are evaluated as part of a prevention trial that begins at school entry and targets child functioning and socializing practices across multiple contexts (school, peer group, family) and multiple domains (affective, social, and achievement coping-competence). The paper presents the conceptual foundation of the four interventions, including a synopsis of the risk and protective factors associated with conduct disorder and related outcomes, and of the coping-competence model driving EARLY ALLIANCE. The developmental rationale, intended impact, and procedures are described for each intervention: a universally administered classroom program and indicated, peer, reading-mentoring, and family programs. Interventions are currently being tested in a prevention trial, which is briefly summarized.

Adolescent↗
PubMed1999

A developmental approach to prevention research: configural antecedents of early parenthood.

A developmental framework emphasizing the combined impact of correlated constraints within and without the individual was applied to a prospective longitudinal study of early parenthood. The purpose was to use a person-approach to the analysis of longitudinal data to clarify risk for early parenthood and to generate hypotheses about potentially useful intervention strategies. Respondents were 475 youth who were assessed annually from seventh grade through the end of high school and, again, at ages 20 and 24. The risk patterns associated with parenthood were the same for both sexes. Individuals with a middle-school configuration of low socioeconomic status, high aggression, low academic skills, low popularity, and prior grade failure were most likely to become parents by early adulthood. Risk for early parenthood increased substantially for respondents who dropped out of school early, regardless of their initial risk status.

Adolescent↗