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PubMed1999

Utilization of physician offices by adolescents in the United States.

UNLABELLED: Recent guidelines for adolescent primary care call for the specification of clinical services by three adolescent age subgroups. Yet analyses of office visits have either merged adolescence into one stage or divided it at age 15 years. OBJECTIVE: To explore the utilization of physician offices in the United States by early (11-14 years), middle (15-17 years), and late (18-21 years) adolescents. DESIGN: Secondary analysis of the 1994 National Ambulatory Medical Care Survey, focusing on visits made by the three adolescent age groups. SETTING: Nationally representative sample of 2426 physicians in nonfederal, nonhospital offices. SUBJECTS: A total of 33 598 visits by patients of all ages, representing 681.5 million visits in 1994. MAIN OUTCOME MEASURES: Number of visits, health insurance, providers seen, duration of visits, reasons for visits, resulting diagnoses, and counseling provided. RESULTS: Adolescents aged 11 to 21 years made 9.1% (61.8 million) of the total office visits and represented 15.4% of the total US population in 1994. This underrepresentation in visits held across all three adolescent age subgroups. Within the adolescent cohort, whites were overrepresented relative to their population proportion (78.5% of visits, 67.6% of population) and blacks and Hispanic adolescents were underrepresented (8.3% and 9.3% of visits, 15.5% and 13.1% of population). Middle adolescence signaled a life turning point from male to female predominance in office visits. Peak lifetime uninsurance rates occurred at middle adolescence for females (18.7%) and late adolescence for males (24.0%). Between childhood and early adolescence, public insurance decreased from 24.7% to 15.7% and uninsurance increased from 12.7% to 19.7%. Pediatricians accounted for the highest proportion of early adolescent visits (41.2%), family physicians for middle adolescent visits (35.3%), obstetrician-gynecologists for late adolescent female visits (37.3%), and family physicians for late adolescent male visits (34.8%). Mean visit duration during adolescence was 16 minutes, did not differ by age subgroup or sex, exceeded that of children (14.6 minutes), and was shorter than that of adults (19.3 minutes). Obstetrician-gynecologists spent more time with adolescents than did other physicians. Education or counseling was included in 50.4% of adolescent visits, ranging from 65.1% for obstetrician-gynecologists to 34.8% for internists. During early adolescence, the leading reasons for both male and female visits were respiratory (19.4%), dermatological (10.0%), and musculoskeletal (9.7%). A similar profile was found for middle and late adolescent males. For middle and late adolescent females, the leading reason for visits was special obstetrical-gynecological examination (12.8% and 21.1%), and the leading diagnosis resulting from visits was pregnancy (9.5% and 20.4%). CONCLUSIONS: Adolescents underutilize physician offices and are more likely to be uninsured than any other age group. Visits are short, and counseling is not a uniform component of care. As adolescents mature, their providers, presenting problems, and resulting diagnoses change. The data from the National Ambulatory Medical Care Survey support a staged approach to adolescent preventive services, targeted to the needs of three age subgroups.

Adolescent↗
PubMed1996

Adolescent suicide.

In the introduction to this report our committee, with its focus on adolescent development, expressed its concern that adolescent suicidal behavior represented a grave crisis in the adolescent, a crisis not only in the development of the adolescent but one that endangers the existence of the adolescent. The possibility of a fatal outcome is abhorrent to us as physicians and psychiatrists, as it is to all those entrusted with the care and development of our fellow human beings. Consequently, we explored the ways in which developmental and other forces lead to adolescent suicide and the measures that can be taken to prevent it. We first considered the historical and cross-cultural aspects of suicidal behaviors. Societal and cultural stresses arise from parental attitudes, beliefs, expectations, and childrearing practices that evolve from the social and economic needs in each culture. If unbalanced by growth-sustaining supports, they may compromise or constrict the existential adaptive ability of the developing adolescent and place the adolescent at risk for suicide. Research into vulnerability in adolescence has revealed gender, ethnic, and geographic differences in the dimension of the problem and has indicated the social, psychological, and biological conditions that increase the likelihood that adolescents will resort to suicidal behaviors. Research is still needed to distinguish those adolescents who commit suicide from those adolescents with similar conditions who do not. Research has only begun to explore the ways in which the interaction of specific individual dynamics, precipitating events, and personal characteristics result in an adolescent's attempt of suicide. We discussed the strengths that adolescents acquire, but we emphasized the weaknesses that ensue as adolescents are faced with the impact of the thrust of their own biological, psychological, and social development with the forces inherent in their cultures. Adolescents progress through this period in their lives with varying and varied attempts to master, or cope with, the inevitable change in their existential status. Some try but fail and some fail to try, with resulting despair that can lead those adolescents to believe that suicide is the only choice they have to end their suffering. We described how psychodynamics can influence motivation, relationships, and behaviors, and how these may contribute to an outcome of suicide. Existing psychopathological conditions contribute. These include anxiety, dysthymia, posttraumatic stress disorders, acute reactive disorders, major affective disorders, severe conduct disorders, and psychotic disorders. We considered the possible lethal interplay between psychodynamic and psychopathological factors. This led to the crux of this report, a full discussion of prevention and treatment. The first and most important aspect of suicide prevention is early recognition of the adolescent at risk. It is of high priority to detect and treat those psychiatric disorders accompanied by greatest suicidal risk; depression, conduct disorders, substance abuse disorders, borderline conditions, and schizoaffective disorders. With all adolescents, threats of suicide must be taken seriously. There should be an immediate, complete psychiatric workup preferably before specific treatment begins. If crisis intervention must precede diagnostic study, the workup should not be delayed longer than necessary. Education of health care professionals, educators, families, and peers about warning signs can emphasize early intervention and thereby enable a skilled psychiatrist to assess suicidal thoughts, plans, means, and previous attempts, past and current life stresses, and available family and environmental support. All of this information will lead to a decision regarding hospitalization and treatment for the adolescent.(ABSTRACT TRUNCATED)

Adolescent↗
PubMed2003

Health-related quality of life of severely obese children and adolescents.

CONTEXT: One in 7 US children and adolescents is obese, yet little is known about their health-related quality of life (QOL). OBJECTIVE: To examine the health-related QOL of obese children and adolescents compared with children and adolescents who are healthy or those diagnosed as having cancer. DESIGN, SETTING, AND PARTICIPANTS: Cross-sectional study of 106 children and adolescents (57 males) between the ages of 5 and 18 years (mean [SD], 12.1 [3] years), who had been referred to an academic children's hospital for evaluation of obesity between January and June 2002. Children and adolescents had a mean (SD) body mass index (BMI) of 34.7 (9.3) and BMI z score of 2.6 (0.5). MAIN OUTCOME MEASURES: Child self-report and parent proxy report using a pediatric QOL inventory generic core scale (range, 0-100). The inventory was administered by an interviewer for children aged 5 through 7 years. Scores were compared with previously published scores for healthy children and adolescents and children and adolescents diagnosed as having cancer. RESULTS: Compared with healthy children and adolescents, obese children and adolescents reported significantly (P<.001) lower health-related QOL in all domains (mean [SD] total score, 67 [16.3] for obese children and adolescents; 83 [14.8] for healthy children and adolescents). Obese children and adolescents were more likely to have impaired health-related QOL than healthy children and adolescents (odds ratio [OR], 5.5; 95% confidence interval [CI], 3.4-8.7) and were similar to children and adolescents diagnosed as having cancer (OR, 1.3; 95% CI, 0.8-2.3). Children and adolescents with obstructive sleep apnea reported a significantly lower health-related QOL total score (mean [SD], 53.8 [13.3]) than obese children and adolescents without obstructive sleep apnea (mean [SD], 67.9 [16.2]). For parent proxy report, the child or adolescent's BMI z score was significantly inversely correlated with total score (r = -0.246; P =.01), physical functioning (r = -0.263; P<.01), social functioning (r = -0.347; P<.001), and psychosocial functioning (r = -0.209; P =.03). CONCLUSIONS: Severely obese children and adolescents have lower health-related QOL than children and adolescents who are healthy and similar QOL as those diagnosed as having cancer. Physicians, parents, and teachers need to be informed of the risk for impaired health-related QOL among obese children and adolescents to target interventions that could enhance health outcomes.

Adolescent↗
PubMed2000

Adolescents' perceptions of maternal disapproval of sex: relationship to sexual outcomes.

PURPOSE: To examine the relationship between adolescents' perceptions of maternal abstinence attitudes, adolescent-maternal relationship satisfaction, and the occurrence in the ensuing 12 months of: (a) sexual intercourse, (b) the use of birth control at intercourse, and (c) the occurrence of pregnancy. We also examined the accuracy of adolescents in perceiving the attitudes of their mothers as well as factors that predicted underestimations of these attitudes. Finally, the study evaluated the relative predictive power of adolescent perceptions of maternal abstinence attitudes and the actual maternal abstinence attitudes. METHODS: This was a prospective study using a subsample of the Longitudinal Study of Adolescent Health database, which is a nationally representative school-based sample. The sample for the present study was approximately 10,000 adolescents in grades 7 to 11 who completed 2 interviews in their homes at a 1-year interval. Mothers of the adolescents were interviewed only during Wave 1. Interviews covered a variety of topics, including adolescent risk behaviors and family relationships. Measures at Wave 1 were used to predict outcomes at Wave 2, employing logistic and multiple regression techniques. RESULTS: Adolescents' perceptions of maternal attitudes toward the adolescents' engaging in sexual intercourse, and adolescent satisfaction with the maternal relationship were predictive of the occurrence of sexual intercourse between Wave 1 and Wave 2, as well as the occurrence of pregnancy. The more disapproving adolescents perceived their mothers to be toward their engaging in sexual intercourse and the more satisfied adolescents were with their relationship with their mothers, the less likely adolescents were to initiate sexual activity or to become pregnant. Only relationship satisfaction was predictive of the use of birth control, such that more satisfied adolescents were more likely to use birth control at their most recent intercourse. The correlation between adolescent perceptions of maternal abstinence attitudes and actual maternal attitudes was .26. Adolescent perceptions of maternal attitudes tended to be a more consistent predictor of outcomes than actual maternal attitudes. CONCLUSIONS: The results are consistent with a growing body of literature that suggests the importance of adolescents' perceptions of maternal attitudes in determining sexual risk behaviors. Adolescents may misperceive the attitudes of parents, suggesting the need for communication between parent and teen.

Adolescent↗
PubMed2006

Parental awareness of adolescent risk involvement: implications of overestimates and underestimates.

PURPOSE: To explore: 1) parent-adolescent discrepancies on adolescent risk involvement; 2) factors related to parental overestimates and/or underestimates of specific adolescent risk behaviors; and 3) the association of parental overestimates and/or underestimates at baseline with subsequent adolescent risk involvement. METHODS: 754 African American parent-adolescent dyads were recruited from 35 low-income urban communities in Baltimore, Maryland. Parent-adolescent discordance (overestimates and underestimates) regarding adolescent involvement in risk behaviors in three areas (sex, substance use, and violence) were assessed. Multiple logistic regression models were performed to examine the association of parental overestimates or underestimates with subsequent adolescent risk involvement, and to explore potential factors related to parental overestimates and underestimates of each behavior. RESULTS: Percentage of parental overestimation and underestimation ranged from 3% to 24% and 53% to 86%, respectively, for targeted behaviors. Parents reporting higher levels of parental monitoring and open communication were less likely to overestimate, and more likely to underestimate adolescent risk involvement. Parents of adolescents who perceived themselves as better than average in school performance and who participated in religious services were more likely to underestimate adolescents' substance use and sex. Parents of older adolescents overestimated adolescents' sexual experience. Parental overestimation at baseline generally predicted subsequent increased risk of adolescents engaging in these behaviors. Conversely, parental underestimation was associated with subsequent decreased adolescent risk involvement. CONCLUSIONS: Parental underestimation and overestimation of adolescent risk involvement have implications for subsequent adolescent risk involvement. The protective association of parental underestimation and the adverse association of parental overestimation on subsequent adolescent risk involvement indicate that parenting interventions should advance beyond simply improving parent-adolescent concordance on risk behavior.

Adolescent↗
PubMed2000

Patterns of adolescent smoking initiation rates by ethnicity and sex.

OBJECTIVE: To define US national sex specific rates of smoking initiation among Hispanic, non-Hispanic white, and African American adolescents aged 12-17 years for each calendar year from 1940 through 1992. METHODS: Adult survey data from the tobacco use supplement of the Current Population Survey in 1992-93 and 1995-96 were used to reconstruct the age at which individuals began to smoke and the calendar year in which they were that age. From these data, the number of individuals who began a calendar year as never smokers and who were aged 12-17 years during that year could be estimated and formed the denominator of the initiation rate. The number of these individuals who reported taking up smoking during that year formed the numerator of the initiation rate. RESULTS: Initiation rates among male adolescents in each of the three racial/ethnic groups have declined since 1945. However, since 1983, initiation rates among male adolescents overall have increased. Non-Hispanic white male adolescents generally initiated cigarette smoking at higher rates than Hispanic or African American male adolescents. Initiation rates among Hispanic male adolescents have not been statistically different from initiation rates among African American male adolescents. From 1978 to 1982, initiation rates among Hispanic and African American male adolescents experienced a sharp decline, and the rate of decline was steeper than that experienced by non-Hispanic white male adolescents. Initiation rates among female adolescents have increased since 1940, catching up to male adolescent initiation rates by the mid 1970s. Initiation rates among female adolescents appeared to level off or increased slightly again from the mid 1980s to 1990. Non-Hispanic white female adolescents generally initiate cigarette smoking at higher rates than Hispanic or African American female adolescents. Initiation rates among non-Hispanic white and African American female adolescents equalled the initiation rates of their male counterparts by the mid 1970s, but initiation rates among Hispanic female adolescents did not overlap with initiation rates of Hispanic male adolescents until 1990. From 1975 to 1980, initiation rates among African American female adolescents decreased sharply, but, unlike initiation rates among the two other ethnic groups, rates continued to decline from 1984 to 1990. CONCLUSIONS: Different patterns of increasing and decreasing smoking initiation among sex and ethnic adolescent groups suggest the effect of varying social and cultural influences. These findings support the importance of including ethnic factors in studies of smoking behaviour.

Adolescent↗
PubMedDate not supplied

[Risk factors for Clamydia infections of the genital organs in adolescent females].

INTRODUCTION: Chlamydia trachomatis (Ct) infections are the most common bacterial sexually transmitted diseases (STDs). The highest age-specific rates for chlamydia are found in adolescents. Female adolescents are more susceptible to STDs than older women because their cervical anatomic development is incomplete and especially sensitive to infection by certain sexually transmitted pathogens, and for some other features that characterize sexual behavior and health care behavior of the young people. The aim of this study was to identify risk factors and risk indicators statistically associated with the presence of Ct genital infection in adolescent females. METHOD: The study group comprised 300 sexually active 19 years old girls who were attending the Mother and Child Health Care Institute of Serbia in the period from 1995 to 1997. The participants of this study were interviewed about their sexual behavior, health care behavior and their responsibility level in sexual relationships. Physical examination included microbiological and colposcopic findings. Vaginal and cervical microbiological examinations included the analysis of collected specimens for microscopic and culture analyses. Ct infection of the cervix was identified by direct immunofluorescence staining of smears using monoclonal antibodies. Colposcopic findings were divided in two groups: cervical ectopy and other findings. Data were statistically analyzed using step-wise linear regression. RESULTS: The prevalence of Ct genital infection in the study group was 30.3%. Characteristics in adolescent girls with this infection were mostly as follows: first sexual intercourse was before the age of 17, first sexual partner was older, a great number of sexual partners, (more than 3-25.3% vs 20.1%; more than 4-16.5% vs 10.5%), sexual intercourse during casual contact (44.0% vs 34.4%) and high coital frequency (83.5% vs 72.7%). Among these characteristics, only the coital frequency was significantly associated with the probability of chlamydial genital infection (p < 0.05). Statistical findings about the use of contraceptives among the adolescents indicated that the level of safe sexual practice was low in the majority of girls, despite the presence of chlamydial genital infection. Nevertheless, the girls without Ct genital infection more frequently reported the condom as the method of contraception used for the longest adolescence period (41.6%) in comparison with the adolescent females infected by Ct (17.6%). This difference was statistically significantly associated with the possible manifestation of Ct genital infection (p < 0.05). Healthy adolescent females used condom more frequently at the last intercourse (37.3%) than girls with Ct genital infection (18.2%). Adolescent females often experienced only 0-2 methods of contraception (70.3% of girls infected with Ct and 59.8% of healthy girls). Health care behavior was poor in the examined girls. The suspicion of getting a STD was the reason for their first gynaecological examination in 25.3% of adolescent women with Ct genital infection and in 20.6% of healthy girls. Unwanted pregnancy during adolescence reported 16.5% of girls with Ct cervicitis and 15.8% of healthy girls. The existence of STD previous to examination was noted in 7.9% of infected girls and 7.7% of healthy subjects. Drug abuse reported 23.1% of studied adolescent females with Ct genital infection and 23.0% without it. A large proportion of both the adolescent females and their partners had negative attitudes toward the condom use (54.9% of infected girls and 57.1% of their partners; 32.1% of healthy girls and 35.9% of their partners). The difference between the attitudes toward the condom use among infected and healthy adolescent women and their partners was statistically significant (p < 0.001). Clinical findings of cervical ectopy were more frequent in girls infected with Ct (60.4%) in comparison to healthy girls (15.8%). These differences were also statistically significant (p < 0.001). Associated genital infections (vaginal and/or cervical) were more frequent in adolescent women with Ct cervicitis (56.0%) than in healthy girls (36.8%). The observed differences were statistically significant (p < 0.01). CONCLUSION: Predictors of Ct genital infection in adolescent women, according to the step-wise linear regression analysis, were as follows: the presence of cervical ectopy, negative attitudes of adolescent girls and their partners toward the condom use; associated genital infections; frequent coitus; experience in causal sexual relations and older age of the first sexual partner. However, the possibility that this criterion provides imprecise identification of uninfected adolescent women and separation of only Ct infected women, is limited. Therefore, screening of the presence of Ct genital infections in all sexually active adolescent women is necessary.

Adolescent↗
PubMedDate not supplied

Disease and health seeking patterns among adolescents in Uganda.

UNLABELLED: Adolescents in Uganda have a heavy burden of disease mainly from STD's, HIV and effects of unwanted pregnancy. Currently there are initiatives to address this problem. This paper presents results of a project which piloted a package of adolescent health services with the aim of identifying the best approach for providing quality, accessible, and affordable adolescent friendly services. OBJECTIVE: The main objective of the study was to evaluate the impact of adolescent-friendly health services piloted in the Jinja district Uganda. The specific objectives were to assess adolescents' knowledge, attitudes, and practices related to access and utilization of adolescent friendly services; to assess the perceptions and skills of health workers; and to identify options for scaling up services and sustainability of such services. METHODS: A KAP (Knowledge, Attitude and Practice) study was conducted among adolescents and service providers at eight health units. Four of the health units had implemented a package of adolescent friendly services, while four other health units had not implemented the package, but were comparable in terms of level of service delivery, catchment size and population characteristics. A structured questionnaire and in-depth interviews were used to collect data. RESULTS: A total of 128 adolescents and 42 health workers were interviewed, and focus group discussions were used to collect data. More adolescents utilized routine services at four pilot health units as follows: antenatal care (72.8% vs. 53.7%, p = 0.000), maternity care (70.6% vs. 53.1%, p = 0.005), family planning (69.4% vs. 21.1%, p = 0.000), management of STD's (65.5% vs. 31.9%, p = 0.000) and access to laboratory services (49.8% vs. 4.4%, p = 0.000). Adolescents at pilot sites were more knowledgeable on adolescent health problems (74.8% vs. 48.9%, p = 0.000), factors predisposing adolescents to health problems (73.4% vs. 52.5%, p = 0.003), family planning methods (84.5% vs. 68.7%, p = 0.000), HIV as a problem to adolescents (84.5% vs. 68.7%, p = 0.011), and STD's as a problem to adolescents (76.3 vs. 50.2%, p = 0.004). One of the main constraints to the pilot project was an erratic supply of contraceptives and STD drugs mainly from inadequacies in the national health system. CONCLUSION: Implementation of adolescent friendly services improved access and use of services among adolescents; this lead to reduced morbidity from STD's, HIV, and unwanted pregnancies. In order to reach more adolescents, services have to be scaled to lower health units up to the community level. Training of health workers, ensuring a constant supply of contraceptives, STD drugs, and availing voluntary HIV testing and counseling services are key program issues to consider.

Adolescent↗
PubMed2005

Pain among children and adolescents: restrictions in daily living and triggering factors.

OBJECTIVES: Pain among children and adolescents has been identified as an important public health problem. Most studies evaluating recurrent or chronic pain conditions among children have been limited to descriptions of pain intensity and duration. The effects of pain states and their impact on daily living have rarely been studied. The objective of this study was to investigate the impact of perceived pain on the daily lives and activities of children and adolescents. In addition, we sought to delineate self-perceived triggers of pain among children and adolescents. In this study, we (1) document the 3-month prevalence of painful conditions among children and adolescents, (2) delineate their features (location, intensity, frequency, and duration), (3) describe their consequences (restrictions and health care utilization), and (4) elucidate factors that contribute to the occurrence of pain episodes among young subjects. METHODS: The study was conducted in 1 elementary school and 2 secondary schools in the district of Ostholstein, Germany. Children and adolescents, as well as their parents/guardians, were contacted through their school administrators. The teachers distributed an information leaflet, explaining the conduct and aim of the study, to the parents a few days before the official enrollment of the youths in the study. Parents of children in grades 1 to 4 of elementary school were asked to complete the pain questionnaire for their children at home, whereas children from grade 5 upward completed the questionnaire on their own during class, under the supervision of their teachers. The response rate was 80.3%. As previously stated, chronic pain was defined as any prolonged pain that lasted a minimum of 3 months or any pain that recurred throughout a minimal period of 3 months. The children and adolescents were surveyed with the Luebeck Pain-Screening Questionnaire, which was specifically designed for an epidemiologic study of the characteristics and consequences of pain among children and adolescents. The questionnaire evaluates the prevalence of pain in the preceding 3 months. The body area, frequency, intensity, and duration of pain are addressed by the questionnaire. In addition, the questionnaire inquires about the private and public consequences of pain among young subjects. Specifically, the questionnaire aims to delineate the self-perceived factors for the development and maintenance of pain and the impact of these conditions on daily life. RESULTS: Of the 749 children and adolescents, 622 (83%) had experienced pain during the preceding 3 months. A total of 30.8% of the children and adolescents stated that the pain had been present for >6 months. Headache (60.5%), abdominal pain (43.3%), limb pain (33.6%), and back pain (30.2) were the most prevalent pain types among the respondents. Children and adolescents with pain reported that their pain caused the following sequelae: sleep problems (53.6%), inability to pursue hobbies (53.3%), eating problems (51.1%), school absence (48.8%), and inability to meet friends (46.7%). The prevalence of restrictions in daily living attributable to pain increased with age. A total of 50.9% of children and adolescents with pain sought professional help for their conditions, and 51.5% reported the use of pain medications. The prevalence of doctor visits and medication use increased with age. Weather conditions (33%), illness (30.7%), and physical exertion (21.9%) were the most frequent self-perceived triggers for pain noted by the respondents. A total of 30.4% of study participants registered headache as the most bothersome pain, whereas 12.3% cited abdominal pain, 10.7% pain in the extremities, 8.9% back pain, and 3.9% sore throat as being most bothersome. A total of 35.2% of children and adolescents reported pain episodes occurring > or =1 time per week or even more often. Health care utilization because of pain differed among children and adolescents according to the location of pain. Children and adolescents with back pain (56.7%), limb pain (55.0%), and abdominal pain (53.3%) visited a doctor more often than did those with headache (32.5%). In contrast, children and adolescents with headache (59.2%) reported taking medication because of pain more often than did those with back pain (16.4%), limb pain (22.5%), and abdominal pain (38.0%). The prevalence of self-reported medication use and doctor visits because of pain increased significantly with age (chi2 test). The prevalence of self-reported medication use was significantly higher among girls than among boys of the same age, except between the ages of 4 and 9 years (chi2 test). The prevalence of restrictions in daily activities varied among children and adolescents with different pain locations; 51.1% of children and adolescents with abdominal pain and 43.0% with headache but only 19.4% with back pain reported having been absent from school because of pain. The prevalence of restrictions attributable to pain was significantly higher among girls than among boys of the same age, except between the ages of 4 and 9 years (chi2 test). The self-reported triggers for pain varied between girls and boys. Girls stated more often than boys that their pain was triggered by weather conditions (39% vs 25%), illness (eg, common cold or injury) (35.9% vs 23.9%), anger/disputes (20.9% vs 11.9%), family conditions (12.1% vs 5.2%), and sadness (11.9% vs 3.4%). In contrast, boys stated more often than girls that their pain was triggered by physical exertion (28% vs 17.2%). We used a logistic regression model to predict the likelihood of a child paying a visit to the doctor and/or using pain medication. Health care utilization was predicted by increasing age, greater intensity of pain, and longer duration of pain but not by the frequency of pain. We used a logistic regression model to predict restrictions in daily activities. Only the intensity of pain was predictive of the degree of restrictions in daily life attributable to pain; the duration of pain and the frequency of pain episodes had no bearing on the degree to which the daily lives of the children were restricted because of pain. CONCLUSIONS: More than two thirds of the respondents reported restrictions in daily living activities attributable to pain. However, 30 to 40% of children and adolescents with pain reported moderate effects of their pain on school attendance, participation in hobbies, maintenance of social contacts, appetite, and sleep, as well as increased utilization of health services because of their pain. Restrictions in daily activities in general and health care utilization because of pain increased with age. Girls > or =10 years of age reported more restrictions in daily living and used more medications for their pain than did boys of the same age. We found gender-specific differences in self-perceived triggers for pain. Pain intensity was the most robust variable for predicting functional impairment in > or =1 areas of daily life. Increasing age of the child and increasing intensity and duration of pain had effects in predicting health care utilization (visiting a doctor and/or taking medication), whereas restrictions in daily activities were predicted only by the intensity of pain. Our results underscore the relevance of pediatric pain for public health policy. Additional studies are necessary and may enhance our knowledge about pediatric pain, to enable parents, teachers, and health care professionals to assist young people with pain management, allowing the young people to intervene positively in their conditions before they become recurrent or persistent.

Activities of Daily Living↗
PubMed2003

Effect of patient priming and primary care provider prompting on adolescent-provider communication about alcohol.

OBJECTIVE: To determine whether priming adolescent patients to discuss alcohol with their primary care providers and prompting providers to discuss alcohol increases adolescent-provider communication about alcohol. DESIGN: Randomized controlled trial. SETTING: Five managed care group practices in Washington, DC. PARTICIPANTS: Consecutive patients aged 12 to 17 years who were seeing primary care providers (n = 26) for health checkups. Of 892 eligible adolescents, 444 (50%) were randomized and completed data collection. Most adolescents (80%) were African American, 55% were male, and 17% currently drank alcohol. INTERVENTION: Usual care (group 1) vs adolescent priming with alcohol self-assessment and education just before their health checkups (group 2) vs adolescent priming and provider prompting with the adolescent's self-assessment and a patient education brochure (group 3). MAIN OUTCOME MEASURES: This exploratory substudy of a longitudinal study on adolescent alcohol behaviors examined adolescent-provider communication by adolescent exit survey, researcher observation, and audiotapes of a subsample of visits. RESULTS: More adolescents in group 3 (96%) than group 1 (87%) reported that their provider talked about alcohol (adjusted odds ratio [OR], 1.10; 95% confidence interval [CI], 1.04-1.17). More adolescents in group 3 (18%) than group 1 (10%) reported asking about alcohol (adjusted OR, 1.08; 95% CI, 1.00-1.16). The mean +/- SD number of minutes adolescents were with their providers without parents being present was greater for group 3 (10.8 +/- 7.6) than group 1 (8.8 +/- 8.0). Adolescents in group 2 spent more time with their provider and reported initiating more discussion not specific to alcohol than did group 1 adolescents. CONCLUSION: Adolescent priming and provider prompting increases adolescent-provider communication about alcohol.

Adolescent↗
PubMed1991

Sexual concerns of adolescents with cancer.

The sexually related concerns of adolescents with cancer were compared with those of healthy adolescents. Forty-one adolescents age 12 to 19 years participated. A sexual concerns questionnaire was used. The study had three primary objectives: (1) to identify concerns related to physical, emotional, and behavioral aspects of sexuality present among all adolescents in the study; (2) to determine if there were differences between sexual concerns of adolescents with cancer and those of healthy adolescents; and (3) to determine whether a relationship existed between age and the concerns adolescents had about sexuality. Results of the study indicate that although no age-linked trends in sexually related concerns existed for the adolescents studied, adolescents had concerns regarding sexuality. Adolescents with cancer did not seem to be any more concerned about common developmental aspects of sexuality than healthy adolescents. However, adolescents with cancer had numerous sexually related concerns not identified by healthy adolescents. These concerns seem to relate to being treated for cancer. They included worries about hair loss, feeling isolated, ability to have children, and children having genetic or congenital defects. Nurses who care for adolescents with cancer can provide education and support regarding sexual concerns to help adolescents cope with and resolve some of these treatment-related anxieties. Further research that includes in-depth, narrative interviews could give better insight into the concerns that both adolescents with cancer and healthy adolescents have about sexual issues.

Adaptation, Psychological↗
PubMed2002

Outcome of renal transplantation in adolescents with focal segmental glomerulosclerosis.

Using the NAPRTCS database from January 1987 to January 2001, we examined 2687 adolescent (age 13-17 yr) index renal transplants to analyze differences in demographic treatment, and outcomes in adolescents with FSGS compared to other renal disease. 338 (12.6%) of adolescents had a primary diagnosis of FSGS. Adolescents with FSGS were more likely to be black and less likely to receive pre-emptive transplants (p < 0.001). No differences existed in HLA matching or immunosuppression regimens. Acute tubular necrosis occurred in more FSGS adolescents compared to non-FSGS adolescents following LD (11% vs. 4.7%) or CD (25.1% vs. 17.8%) transplants (p < 0.001). There were no significant differences in acute rejection rates between adolescents with FSGS and other adolescents. Graft survival was worse for LD FSGS adolescents (6 yr, 56%) compared to non-FSGS adolescents (77%) (p < 0.001) and was not significantly different from CD graft survival in FSGS (51%) or non-FSGS groups (61%). The relative risk (RR) of graft failure was greatest in LD transplant with FSGS (RR = 1.75; p < 0.001), compared to LD transplants without FSGS (RR = 1.0). Recurrent primary disease accounted for 15.2% of all graft failures in adolescents transplanted for FSGS with no difference between LD (17%) or CD (13.8%) grafts. Recurrent disease accounted for 3.2% of graft failures in adolescents without FSGS. Recurrent disease was the only cause of graft failure that differed between groups (p < 0.001). When compared to patients up to age 12 yr with FSGS, graft survival in both LD and CD transplants was worse in adolescents with FSGS (LD p = 0.035, CD p < 0.001). In conclusion, FSGS has a negative impact on graft survival in adolescents. Recurrence of FSGS results in a loss of the expected LD graft survival advantage in adolescents. Furthermore, adolescents with FSGS have decreased graft survival compared to younger children with FSGS. These data suggest that the rationale for LD transplantation in adolescents with FSGS should be based on factors other than the increased graft survival typically seen with LD transplantation.

Adolescent↗
PubMed2006

Adolescent and parent perceptions on youth participation in risk behavior research.

OBJECTIVES: To assess and compare parent and adolescent views on the importance of risk behavior research and the need for parental consent and to identify predictors of views. DESIGN: Confidential survey. SETTING: Adolescent, general pediatrics clinics. PARTICIPANTS: Adolescents aged 14 to 17 years presenting alone (solo) or with a parent or guardian (paired) and parents or guardians. Of 265 eligible pairs (199 solo adolescents), 134 (93) had useable surveys. The proportion of females in the parent or guardian, paired adolescent, and solo adolescent groups was 92%, 59%, and 75%, respectively; and the proportion of African Americans in these groups was 67%, 69%, and 91%, respectively. MAIN OUTCOME MEASURES: Views on the importance of and requirement of parental consent for confidential risk behavior research. RESULTS: Most parents (98%), paired adolescents (99%), and solo adolescents (100%) believed confidential risk behavior research surveys with teenagers were important; greater than 90% of all groups believed surveys should be conducted. The proportion of parents, paired adolescents, and solo adolescents that endorsed requiring parental permission was 84%, 53%, and 19%, respectively. Parents were less likely to endorse requiring permission if they had confidential health concerns as teenagers and were more likely to endorse requiring permission if their child was younger or female, if they believed their child had sex, and if they were a parent vs a guardian. Adolescents were more likely to endorse requiring permission if they were younger, not African American, and had more educated parents. Adolescents presenting with parents were more likely to endorse requiring permission. CONCLUSIONS: Parents and adolescents believed risk behavior research with adolescents was important. Most parents believed parental permission is needed for participation. Compared with parents, fewer adolescents believed parental consent was necessary. It is not clear what effect requirement of parental permission would have on participation or validity. Further research is needed to elucidate views on adolescent risk behavior research.

Adolescent↗
PubMed2002

Teaching medical residents about teenagers: an introductory curriculum in adolescent medicine.

OBJECTIVE: Adolescents in the United States have high morbidity rates, which are attributable to injuries, behavioral disorders, sexually transmitted diseases, and unplanned pregnancies. This has led to a call to action for health care educators to better prepare future practitioners to meet adolescent health care needs. Although pediatrics residency programs have required one-month curricula dedicated to adolescent medicine, many internal medicine (IM) residency programs do not have such requirements despite an American College of Physicians position paper recognizing the importance of internists' providing health care to adolescents. Thus, an introductory curriculum in adolescent medicine was developed for a community hospital IM residency program. The curriculum was designed to train IM residents to effectively interview, provide preventive care for, and evaluate common medical problems of older adolescents (ages 16-21) in an outpatient setting. DESCRIPTION: The curriculum was based on the results of an extensive needs assessment, which included surveys sent to practicing internists and current IM residents. It included three units, each a series of one-hour lessons delivered via morning report or grand rounds sessions. The first unit was interviewing, which covered specific interviewing questions, communication methods, and confidentiality issues. The second unit was preventive medicine care, which addressed immunizations, injury prevention, and adolescent drug and alcohol use. The third unit was diagnosis and management of common problems, which focused on topics frequently encountered during adolescent outpatient visits, including acne, sexually transmitted diseases, reproductive health care needs, and menstrual abnormalities. Other topics pertinent to the care of adolescents, notably depression, eating disorders, and sports medicine, were covered by previously established curricula, and thus omitted. This curriculum was created through the support of the Michigan State University Primary Care Faculty Development Fellowship Program, and was reviewed by curricular and adolescent medicine content experts. The residency program director supported its implementation over the course of two academic years. The pilot unit interviewing was conducted in February 2001, during two one-hour morning report sessions. In the first session, a short lecture outlining interviewing concepts and principles was given, followed by several case-based studies describing office presentations of adolescent patients. In the second session, an actual office visit was simulated; the residents observed adolescent volunteers being interviewed, and were then given an opportunity to ask the patients further questions. Residents completed a brief quiz and evaluation survey at the end of the pilot unit. DISCUSSION: Twenty-one of 40 residents participated in the pilot unit. Evaluations were overall very positive. Quiz scores confirmed that the residents achieved the desired learning objectives. Given these results from the pilot unit, the remaining two units of the curriculum have been integrated into the residency curriculum. Additional faculty members have been selected to deliver future sessions and support this important educational activity. The adolescent medicine curriculum can be used as an model by other IM residency programs for teaching adolescent health care, with an emphasis on both the knowledge base of adolescent issues and awareness of the unique skills necessary for the establishment of a physician-patient relationship between internists and older adolescents.

Adolescent↗
PubMed1993

Adolescents and access to health care.

The developmental characteristics and health behaviors of adolescents make the availability of certain services--including reproductive health services, diagnosis and treatment of sexually transmitted disease, mental health and substance abuse counseling and treatment--critically important. Furthermore, to serve adolescents appropriately, services must be available in a wide range of health care settings, including community-based adolescent health, family planning and public health clinics, school-based and school-linked health clinics, physicians' offices, HMOs, and hospitals. National, authoritative content standards (for example, the American Medical Association's Guidelines for Adolescent Preventive Services (GAPS), a multispecialty, interdisciplinary guideline for a package of clinical preventive services for adolescents may increase the possibility that insurers will cover adolescent preventive services, and that these services will become part of health professionals' curricula and thus part of routine practice. However, additional and specific guidelines mandating specific services that must be available to adolescents in clinical settings (whether in schools or in communities) are also needed. Although local government, parents, providers, and schools must assume responsibility for ensuring that health services are available and accessible to adolescents, federal and state financing mandates are also needed to assist communities and providers in achieving these goals. The limitations in what even comprehensive programs currently are able to provide, and the dismally low rates of preventive service delivery to adolescents, suggests that adolescents require multiple points of access to comprehensive, coordinated services, and that preventive health interventions must be actively and increasingly integrated across health care, school, and community settings. Unless access issues are dealt with in a rational, coordinated fashion, America's adolescents will not have access to appropriate health services. Current efforts to minimize current health care expenditures through managed care programs inevitably conflict with efforts to deliver comprehensive preventive services to all adolescents. Use of multiple sites may not represent inadequate access to care. However, as managed care reimbursement continues to expand, school-based clinics and free-standing adolescent health programs increasingly report decreases in reimbursement without a change in demand for services. The Office of Technology Assessment study called for explicit funding and expansion of services for America's youth; since then, a federal Office of Adolescent Health has been authorized, and, by the time this reaches print, should have received appropriations and been staffed. Dryfoos has called for expansion to nearly 5000 comprehensive programs in the coming years. 76 Additionally, The Robert Wood Johnson Foundation has just announced a $23.2 million state-community partnership grant program to increase availability of school-based health services for children and youth with unmet health needs.77 As health care reform efforts move forward,both careful definition of the services adolescents need and adequate financing for these services are essential to ensure access to care for all adolescents.

Adolescent↗
PubMed2005

Trends in adolescent suicide in Hong Kong for the period 1980 to 2003.

This paper utilizes existing statistics on adolescent suicide to examine adolescent suicide trends and patterns in Hong Kong for the period 1980 to 2003. Several trends and patterns could be revealed from the analyses. First, there was a gradual rising trend where adolescent suicide rates in the 1990s and the early 2000s were higher than those in the 1980s. Second, suicide rates for adolescents aged 10-24 years were lower than those of other adult age groups. Third, although adolescent suicide rates in Hong Kong were lower than those reported in some English-speaking countries and Mainland China, the figures were higher than those reported in Taiwan. Fourth, suicide rates among teenagers in early adolescence were lower than those among adolescents in late adolescence. Fifth, although male adolescent suicide rates were in general higher than female adolescent suicide rates (10-24 age group), gender differences in suicide rates appeared to be moderated by age. Sixth, there was a gradual rising trend in adolescent proportional mortality rates for suicide since the 1990s. Seventh, proportional mortality rates for suicide among teenagers in early adolescence were lower than those among adolescents in late adolescence. Finally, although jumping from a height was a common method of adolescent suicide, there was a rising trend of using other methods, such as taking drugs, hanging and charcoal burning. The observed adolescent suicide phenomena are discussed in this study with reference to the socio-cultural context of Hong Kong.

Adolescent↗
PubMedDate not supplied

Adolescent suicide in Hong Kong during 1980-2000.

Analyses of adolescent suicide statistics in Hong Kong for the period 1980 to 2000 revealed several phenomena. First, while adolescent suicide rates (10-24 age group) in Hong Kong were relatively stable for the period under study, there was a gradual rising trend where adolescent suicide rates in the 1990s were higher than those in the 1980s. Second, suicide rates for adolescents aged 10-24 were lower than those of other adult age groups. Third, while adolescent suicide rates in Hong Kong were lower than those reported in some English-speaking countries and Mainland China, the figures were higher than those reported in Taiwan. Fourth, suicide rates among teenagers in early adolescence were lower than those among adolescents in late adolescence. Fifth, although male adolescent suicide rates were in general higher than female adolescent suicide rates (10-24 age group), gender differences in suicide rates appeared to be moderated by age. Sixth, there was a gradual rising trend in adolescent proportional mortality rates for suicide in the 1990s. Seventh, proportional mortality rates for suicide among teenagers in early adolescence were lower than those among adolescents in late adolescence. Finally, while jumping from a height was a common method of adolescent suicide, there was a rising trend of using other methods such as taking drugs, hanging and charcoal burning. The observed adolescent suicide phenomena are discussed with reference to the socio-cultural context of Hong Kong.

Adolescent↗
PubMed1998

Emergency department utilization by adolescents in the United States.

BACKGROUND: Adolescents in the United States have been shown to underutilize primary care services and therefore may rely heavily on emergency service. Although several small studies have explored local emergency services for youth, there are no published reports of adolescent utilization of emergency services on a national scale. Furthermore, emergency services data have not been aggregated according to the age subgroups used by the current guidelines for adolescent care. OBJECTIVE: To explore the utilization of emergency departments in the United States by early (11 to 14 years), middle (15 to 17 years), and late (18 to 21 years) adolescent subgroups. DESIGN: Secondary analysis of the emergency department component of the 1994 National Hospital Ambulatory Medical Care Survey. SETTING: Nationally representative sample of 418 emergency departments in the United States. PATIENTS: Approximately 26,547 visits by patients of all ages, representing 93.4 million total visits in 1994 and 14.8 million adolescent visits. OUTCOME MEASURES: Number of visits, health insurance, reasons for visits, urgency of visits, resulting diagnoses, and hospitalization rates. RESULTS: Adolescents accounted for 15.4% of the population and 15.8% of emergency department visits in 1994. Late adolescents were overrepresented in emergency department visits relative to their population proportion (6.8% of visits, 5.3% of population), whereas early adolescents were underrepresented (4.6% of visits, 5.9% of population). Lack of health insurance was more common among 11- to 21-year-olds (26.2%) than either children (13.6%) or adults (22.7%). By ages 18 to 21 years, 40.5% of male visits and 27.6% of female visits were uninsured. Injury-related visits were more common among adolescents (28.6%) than either children (23.1%) or adults (18.2%). Injury was the leading reason for visits among all adolescent age-sex subgroups (36.6% to 42.0% of male visits and 14.1% to 27.2% of female visits) except females aged 18 to 21 years for whom digestive reasons ranked first (18.8%). Injury was the leading diagnosis for all adolescent age-sex subgroups, with peaks at early adolescence of 61.6% for males and 45.8% for females. Across all adolescent age-sex subgroups, 3.1% to 5.3% of visits resulted in hospitalization, and 41.0% to 52.5% of visits were urgent. These rates did not differ from those of children but were lower than those of adults. CONCLUSIONS: Utilization of emergency departments increases and health insurance decreases during adolescence, suggesting that adolescents with inadequate health insurance may rely heavily on emergency departments for their health care needs. Most adolescent visits to emergency departments are not urgent and might be better treated through nonemergency, primary care sites.

Adolescent↗