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PubMed2006

[Adolescents as research subjects and free informed consent: knowledge and opinion of researchers and adolescents].

This article presents the results of a study that evaluated the knowledge and opinions of researchers and adolescents that served as their research subjects on the legal norms that regulate the participation of the latter as research subjects, the capacity of adolescents to make autonomous decisions regarding participation, and the adolescent experience after agreeing to take part in a study. This was a qualitative study with a convenience sample, the size of which was defined by the criteria of informational redundancy. Interviews were conducted with three researchers who had used adolescents as research subjects and nine of these subjects. This number of interviews was sufficient to reach informational redundancy. Data was collected through recorded semi-structured interviews, with open questions. All the researchers were familiar with some legal document related to the participation of adolescents as subjects of research. On the other hand, the adolescents were surprised because they were not aware of the existence of such documents. However, they considered them necessary for their own protection. In general, researchers and adolescents believe that adolescents have the capacity to decide autonomously to participate as research subjects. The adolescents affirmed that they had decided to volunteer conscientiously.

Adolescent↗
PubMed1999

The risks for late adolescence of early adolescent marijuana use.

OBJECTIVES: The purpose of this study was to assess the relation of early adolescent marijuana use to late adolescent problem behaviors, drug-related attitudes, drug problems, and sibling and peer problem behavior. METHODS: African American (n = 627) and Puerto Rican (n = 555) youths completed questionnaires in their classrooms initially and were individually interviewed 5 years later. Logistic regression analysis estimated increases in the risk of behaviors or attitudes in late adolescence associated with more frequent marijuana use in early adolescence. RESULTS: Early adolescent marijuana use increased the risk in late adolescence of not graduating from high school; delinquency; having multiple sexual partners; not always using condoms; perceiving drugs as not harmful; having problems with cigarettes, alcohol, and marijuana; and having more friends who exhibit deviant behavior. These relations were maintained with controls for age, sex, ethnicity, and, when available, earlier psychosocial measures. CONCLUSIONS: Early adolescent marijuana use is related to later adolescent problems that limit the acquisition of skills necessary for employment and heighten the risks of contracting HIV and abusing legal and illegal substances. Hence, assessments of and treatments for adolescent marijuana use need to be incorporated in clinical practice.

Adolescent↗
PubMed2004

Health-related quality of life in Swiss adolescents with asthma. Validation of the AAQOL-D and comparison with Australian adolescents.

PRINCIPLES: The Adolescent Asthma Quality of Life Questionnaire (AAQOL) is the only asthma-specific quality-of-life questionnaire to date for use specifically in adolescents. The aim of this study was translation of the AAQOL into German, revalidation of the German version (AAQOL-D) and comparison of health-related quality of life (HRQOL) in Swiss and Australian adolescents. METHODS: 60 adolescents with frequent episodic or persistent asthma aged 12-17 years were recruited. The standardised method consisted of (1) translation of the AAQOL; (2) additional item selection via semistructured interviews (n = 11); (3) item reduction and re-validation (n = 56). For item reduction the clinical impact method was applied. RESULTS: The same 32 items were identified as relevant for the AAQOL-D as in the original version (AAQOL). Internal consistency for the 6 dimensions and the total score was high (alpha = 0.76-0.87). Despite consideration of psychosocial aspects relevant to adolescents, high correlation with the Pediatric Asthma Quality of Life Questionnaire was confirmed for the AAQOL-D (rho = 0.85; p <0.0001). Correlation with a health status thermometer consisted in rho = 0.74 (p <0.0001). There was moderate correlation with clinical parameters of asthma severity (rho = 0.51-0.73; p < or = 0.0002), not however with frequency of medication (rho = 0.22; p = 0.13). Comparison of Swiss and Australian adolescents showed that Swiss adolescents were more bothered by cigarette smoke and the need to avoid places where cigarettes were smoked. CONCLUSIONS: The AAQOL-D is a valid multidimensional instrument in German for assessing HRQOL of adolescents with asthma. HRQOL of Swiss adolescents with asthma may be enhanced by implementing non-smoking policies promoting smoke-free environments.

Adolescent↗
PubMed1998

Significant individuals in adolescence: adolescent and adult perspectives.

This study examines the ways in which 360 Israeli adolescents, and 395 midlife adults looking retrospectively perceive significant individuals from their adolescence. Following the methodology developed by Hendry et al. (Journal of Adolescence 1992, 15, 255-270), participants were asked to chose the most significant family and non-family individuals in their adolescent lives, and to indicate which of a number of characteristics applied or did not apply to their chosen significant persons. Our results indicate that most of the adults and the adolescents chose a parent as the most significant relative in their adolescence and that females in both samples chose their mothers more than did males. Compared with adolescents, adults attributed, retrospectively, more negative characteristics to their parents (e.g. as being mollycoddlers and rejectors). Adults were more likely to mention their teachers as significant non-family individuals in their lives and to characterize them in terms of their future impact as teachers and role models. Adolescents referred more positively to their parents, they also chose more friends of the same or opposite sex as significant others, and characterized them in terms of present-oriented features as being supporters and challengers.

Adolescent↗
PubMed1995

Guidelines for adolescent health research: a position paper of the society for adolescent medicine.

Their ambiguous legal and ethical status has become a barrier to adolescents' appropriate involvement in research from which they may benefit and which is needed to improve adolescent health care and to inform health policy. Involvement of adolescents in research should be based on a scientific and empathetic understanding of their developing capabilities and a careful assessment of risks and benefits. The important role of parents and communities as protectors of adolescents should be respected and enhanced as we acknowledge and respect developing adolescent autonomy. These guidelines provide a framework to interpret the federal regulations for protection of human subjects in light of the unique legal, ethical, developmental, contextual, and racial issues that affect adolescents. The guidelines are designed to protect individual adolescent research subjects and to facilitate important youth research that would promote the health of adolescents.

Adolescent↗
PubMed2006

Neuropsychological performance in first-episode adolescents with schizophrenia: a comparison with first-episode adults and adolescent control subjects.

BACKGROUND: The goal of this study was to compare the extent of cognitive deficits between adolescents and adults early in the course of schizophrenia. METHODS: A comprehensive neuropsychological battery was performed on 49 adolescents with childhood- or adolescent-onset schizophrenia, 139 adults with adult-onset schizophrenia, 32 healthy adolescent volunteers, and 240 healthy adult volunteers. Both patient groups were assessed early in the course of their illness and were matched to their respective control groups on age and parental education. RESULTS: The adolescent patients performed significantly worse than the adult patients on tasks of working memory, language, and motor function. The healthy adolescents also performed significantly worse than the healthy adults in working memory and language tasks but were significantly better than the adults in motor function. When accounting for developmental differences in the control group, only motor performance was worse in the adolescent patients compared with the adult patients. CONCLUSIONS: These findings, when coupled with published retrospective studies reporting greater cognitive deficits in earlier onset schizophrenia, implicate a cessation in development in specific cognitive domains following the onset of schizophrenia in adolescent patients.

Adolescent↗
PubMed2004

Adolescent units-an evidence-based approach to quality nursing in adolescent care.

Adolescence is a complex and critical period in psychosocial development. The interruptive process of hospitalisation may adversely affect the developmental period of adolescence and impact on psychological well being. As a result of increased attention to adolescents with cancer, the psychosocial management of this client group has become an integral component of cancer care. The unique needs of adolescents and the need to provide dedicated hospital facilities have been documented over the past four decades. However, despite the availability of policies and guidelines that stress the need for specific Adolescent Units, the vast majority of adolescents continue to be nursed inappropriately in adult or paediatric environments. Twenty-seven research articles are reviewed and the psychosocial factors that affect the quality of the hospital experience of the adolescent with cancer are identified. Relevant literature is reviewed and critiqued in order to provide an evidence-based approach to quality nursing in adolescent care.

Adaptation, Psychological↗
PubMed2006

Adolescents referred to specialty mental health care from local services and adolescents who remain in local treatment: what differs?

BACKGROUND: The study investigates whether adolescents referred to specialty mental health services from local services differ from adolescents who only have received help for psychiatric problems locally. If so, which factors associate strongest with referral? METHOD: Adolescents (n = 76) from an adolescent population sample (N = 2,538) who had received help during the last year for mental problems from local services were compared to a clinical sample of adolescents (N = 129) referred to specialty mental health services from such local services. Comparisons were made according to scores on the Youth Self-Report (YSR); depressive symptoms; family functioning; attachment to parents; self-concept; coping styles; response styles; dysfunctional attitudes; negative life events; daily hassles; socio-demographics. RESULTS: As compared to adolescents receiving help locally, adolescents in specialty mental health care scored higher on YSR internalising syndrome; YSR attention problems; YSR thought problems; suicidality; psychosocial stressors; knowing someone who had attempted suicide; parental divorce; substance use; recent moves; living in lodgings; lost a pal or boy/girlfriend; and lower on attachment to parents. Multivariate logistic regression analysis identified four factors associated with receiving specialty mental health care: low family functioning; moved previous year; knowing someone who had attempted suicide; own suicidality. CONCLUSIONS: Family functioning as reported by the adolescents, and not mental health problems except for suicidality, was found to be the strongest associated with referral to specialty mental health services. Contrary to findings from many other studies, referral was associated with internalising problems, not externalising ones.

Adolescent↗
PubMed2006

Comparative multifactorial analysis of the effects of idiopathic adolescent scoliosis and Scheuermann kyphosis on the self-perceived health status of adolescents treated with brace.

Bracing is the most effective non-operative treatment for mild progressive spinal deformities in adolescence but it has shown a considerable impact on several aspects of adolescents' functioning. This cross-sectional study investigated the self-perceived health status of adolescents with the two most common deformities, treated with body orthosis. Seventy-nine adolescents with spinal deformities (idiopathic adolescent scoliosis, thoracic Scheuermann kyphosis) and 62 adolescents without spinal deformities were asked to complete the Quality of Life profile for Spine Deformities Instrument. This study showed that adolescents with deformities are significantly less likely to have back pain in training than controls, but more likely to have difficulty in forward bending, and in the most common daily activities while in brace. These individuals claim they wake up because of back pain and feel quite nervous with the external appearance of their body. These patients face often problems with their relations with friends, while they reported difficulties in getting up from bed and sleep at night more often than their counterparts without deformities. As they grow older, patients feel increasing ashamed of their body, as they are more concerned about the future effect of the deformity on their body. As the bracing time increases, patients have much more probability than controls to get low back pain. Girls with deformity have a higher probability than boys to get low back pain while working in the house and while training. Individuals with larger spinal curvatures have more difficulties in bending and increased incidence of back pain than their counterparts with smaller curvatures. Psychological reasons associated mainly with relations at school and back pain are the main causes for low compliance in adolescents with spinal deformities treated with body orthosis. Careful instructions for all individuals who will undergo brace therapy, psychological support for all patients who develop psychological reactions and physical training particularly for older girls should be recommended to increase bracing compliance.

Adolescent↗
PubMed2005

Does perceived parental rejection make adolescents sad and mad? The association of perceived parental rejection with adolescent depression and aggression.

PURPOSE: To research the association of perceived parental rejection to adolescent depression and aggression. METHODS: This study focused on 1329 Dutch junior high and high school students (47.9% males and 52.1% females; age range 10-19 years) that completed depression, aggression and perceived parental rejection questionnaires. The data were analyzed by structural equation modeling that assumed a relationship between perceived parental rejection and adolescent aggression, as mediated by adolescent depression. RESULTS: Perceived parental rejection, mediated through adolescent depression, explains aggressive behaviors of adolescents, as tested by a mediation model. Additionally, the fit of this mediation model is somewhat enhanced when direct paths from perceived parental rejection to aggression are included. Further analysis demonstrates that these effects are also somewhat dependent on the gender and the age of the adolescents, as would be expected in light of previous studies of these cohorts. CONCLUSIONS: The study of perceived parental rejection should receive the same attention in the research of the development of both adolescent depression and aggression, as has been the case for adolescent peer rejection.

Adolescent↗
PubMed2001

Parent-adolescent communication and sexual risk behaviors among African American adolescent females.

OBJECTIVE: To examine associations between parent-adolescent communication about sex-related topics and the sex-related communication and practices of African American adolescent females with partners, as well as their perceived ability to negotiate safer sex. DESIGN: A theory-guided survey and structured interview were administered to 522 sexually active African American females 14 to 18 years old. Recruitment sites were neighborhoods with high rates of unemployment, substance abuse, violence, and sexually transmitted diseases. Multivariate analyses, controlling for observed covariates, were used to identify the association of less frequent parent-adolescent communication with multiple assessed outcomes. RESULTS: Less frequent parent-adolescent communication (scores below the median) was associated with adolescents' non-use of contraceptives in the past 6 months (adjusted odds ratio [AOR] = 1.7) and non-use of contraceptives during the last 5 sexual encounters (AOR = 1.6). Less communication increased the odds of never using condoms in the past month (AOR = 1.6), during the last 5 sexual encounters (AOR = 1.7), and at last intercourse (AOR = 1.7). Less communication was also associated with less communication between adolescents and their sex partners (AOR = 3.3) and lower self-efficacy to negotiate safer sex (AOR = 1.8). CONCLUSIONS: The findings demonstrate the importance of involving parents in human immunodeficiency virus/sexually transmitted disease and pregnancy prevention efforts directed at female adolescents. Pediatricians and other clinicians can play an important role in facilitating parent-adolescent communication about sexual activity.

Adolescent↗
PubMed2004

Gundhu Adolescent Wing: providing adolescent beds in a rural acute mental health unit.

OBJECTIVE: To describe the evolution, structure and outcomes of Gundhu Adolescent Wing, Toowoomba, Queensland, which comprises six dedicated beds set aside during development of a new rural acute mental health unit. METHODS: All adolescents discharged from Gundhu in its first 7 months were included in the study. Data pertaining to patient characteristics, model of service delivery, length of inpatient stay and outcome at 7 months were obtained. RESULTS: Thirty-three adolescents with mental illness living in the rural area were discharged from Gundhu in the first 7 months. For the 23 adolescents who stayed on the unit <14 days, outcome at 7 months after discharge was generally favourable. Six adolescents with length of stay of >or=30 days did less well, but made similar progress to patients in tertiary units. CONCLUSIONS: From the authors' experience, designating a small number of beds as adolescent within a rural acute mental health unit is an effective intervention for short-stay patients and is valued by adolescents and their families. Keeping the adolescent unit separate is beneficial even at the expense of foregoing access to space and facilities enjoyed by adult patients. Involving families early to provide off-ward fun, exercise and socialization with peers is important. Rural services tend to have high staff turnover. Involving rural general practitioners in follow-up plans may ensure better continuity of care after discharge.

Adolescent↗
PubMed2002

Use of a routine, self-report outcome measure (HoNOSCA-SR) in two adolescent mental health services. Health of the Nation Outcome Scale for Children and Adolescents.

BACKGROUND: The Health of the Nation Outcome Scale for Children and Adolescents (HoNOSCA) is an established outcome measure for child and adolescent mental health. Little is known of adolescent views on outcome. AIMS: To develop and test the properties of an adolescent, self-rated version of the scale (HoNOSCA-SR) against the established clinician-rated version. METHOD: A comparison was made of 6-weekly clinician-rated and self-rated assessments of adolescents attending two services, using HoNOSCA and other mental health measures. RESULTS: Adolescents found HoNOSCA-SR acceptable and easy to rate. They rated fewer difficulties than the clinicians and these difficulties were felt to improve less during treatment, although this varied with diagnosis and length of treatment. Although HoNOSCA-SR showed satisfactory reliability and validity, agreement between clinicians and users in individual cases was poor. CONCLUSIONS: Routine outcome measurement can include adolescent self-rating with modest additional resources. The discrepancy between staff and adolescent views requires further evaluation.

Adolescent↗
PubMed2005

Quality of life: how do adolescents with facial differences compare with other adolescents?

OBJECTIVE: Compare the quality of life (QOL) of youth living with visible facial differences (FDs) with youth living with a visible nonfacial difference (i.e., mobility limitations), an invisible difference (i.e., attention deficit/hyperactivity disorder), or no known difference. DESIGN: An observational study of perceived QOL among adolescents with FDs (n = 56), adolescents with no diagnosed chronic condition (NCC, n = 116), adolescents with mobility limitations (ML, n = 52), and adolescents with attention deficit/hyperactivity disorder (ADHD, n = 68). PARTICIPANTS: Adolescents ages 11-18 years with FDs recruited through Children's Hospital, Seattle, Washington, participated in this study. Comparison groups were from a previous study of QOL among youth with and without chronic conditions. MAIN OUTCOME MEASURES: The main outcome measure was the Youth Quality of Life Instrument-Research Version, a generic instrument that assesses both perceptual and contextual aspects of QOL in four domains: Sense of Self, Relationships, Environment/Culture, and General Quality of Life. RESULTS: A MANCOVA adjusting for age, gender, and depressive symptomatology revealed that adolescents with FDs, on average, reported significantly lower overall QOL than did the NCC group. Their domain scores were similar to those of the other chronic conditions groups on all but the relationship domain. Reviewing the constituent items of the relationship domain revealed that adolescents in the ML and FDs groups reported higher scores than either the NCC group or the ADHD group on the relationship variables concerning family. CONCLUSIONS: Adolescents with facial differences confront significant challenges to their own self-identity while experiencing higher QOL from relationships, possibly from their need to negotiate and maintain close family support.

Adolescent↗
PubMed2003

Central American adolescent acculturation and parental distress: relationship to ratings of adolescent behavior problems.

This study examined the relationship of acculturation and Central American adolescents' behavioral problems as reported by their parents. Cross-sectional survey data regarding demography, acculturation, and psychosocial functioning was examined among 112 urban adolescent immigrants, aged 12 to 17 years. Analysis indicated that, when parents and adolescents differed in acculturation, parents most frequently rated their adolescent with internalizing symptoms at a clinically elevated level. Parents' education and distress predicted parents' reports of adolescents' psychosocial problems beyond demographic factors, respondents' characteristics, and parents' and adolescents' acculturation. Higher relative acculturation among adolescents, but not parents, was the most robust predictor of parental distress scores, indicating that parental distress mediates the relationship between high relative acculturation of the adolescents and their psychosocial problems as reported by parents. Implications for research and clinicians conducting mental health interventions with Central American populations are briefly discussed.

Acculturation↗
PubMed1999

Developing quality measures for adolescent care: validity of adolescents' self-reported receipt of preventive services.

OBJECTIVE: To demonstrate the feasibility of directly surveying adolescents about the content of preventive health services they have received and to assess the validity of adolescent self-reported recall. DATA SOURCES/SETTING: Audiotaped encounters, telephone interviews, and chart reviews with 14-21 year olds being seen for preventive care visits at 15 pediatric and family medicine private practices, teaching hospital clinics, and health centers. DESIGN: 537 adolescents presenting for well visits were approached, 400 (75 percent) consented, 374 (94 percent) were audiotaped, and 354 (89 percent) completed telephone interviews either two to four weeks or five to seven months after their visits. Audiotapes were coded for screening and counseling across 34 preventive service content areas. Intraobserver reliability (Cohen's kappa) ranged from 0.45 for talking about peers to 0.94 for discussing tobacco. The sensitivity and specificity of the adolescent self-reports were assessed using the audiotape coding as the gold standard. RESULTS: Almost all adolescents surveyed (94 percent) remembered having had a preventive care visit, 93 percent identified the site of care, and most (84 percent) identified the clinician they had seen. There was wide variation in the prevalence of screening, based on the tape coding. Adolescent self-report was moderately or highly sensitive and specific at two weeks and six months for 24 of 34 screening and counseling items, including having discussed: weight, diet, body image, exercise, seatbelts, bike helmet use, cigarettes/smoking, smokeless tobacco, alcohol, drugs, steroids, sex, sexual orientation, birth control, condoms, HIV, STDs, school, family, future plans, emotions, suicidality, and abuse. Self-report was least accurate for blood pressure/cholesterol screening, immunizations, or for having discussed fighting, violence, weapon carrying, sleep, dental care, friends, or over-the-counter drug use. CONCLUSION: Adolescents' self-report of the care they have received is a valid method of determining the content of preventive health service delivery. Although recall of screening and counseling is more accurate within two to four weeks after preventive care visits, adolescents can report accurately on the care they had received five to seven months after the preventive health care visits occurred.

Adolescent↗