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[Medical aspects of adolescent sexuality].

The increase of sexual activity among the adolescents has become a danger to their reproductive health. The goal of this study was to explore sexual behaviour of young people, to establish risks that endanger their reproductive health, and to find out the ways to reduce the consequences of adolescent sexuality. The study was conducted in the Mother and Child Health Care Institute of Serbia over a 2-year period. The sexual and reproductive behaviour, attitudes toward sexuality and contraception, as well as the prevalence rates of unintended pregnancy and Chlamydia trachomatis genital infections were analyzed in 300 sexually active adolescent females, aged 19 years. The first sexual intercourse was in 16.9 years, in average. Less than one-third of the total number (31.3%) of these persons had contraceptive protection at the first intercourse; condom was most frequently used (28.3%). Motives for the initiation of sexual activity were: love (45.7%), curiosity (35.7%), physical attraction and passion (8.3%), peer pressure (5.0%), on the boyfriend's insistence (4.7%), need for love (0.3%) and without answer (0.3%). Two-thirds of adolescent females (63.7%) reported more than one partner, 21.7% more than three and 10.2% more than five sexual partners. Almost half of girls (40.7%) experienced sexual intercourse in casual acquaintance, and 10.3% with a 10 or more years older partner. Use of contraceptive methods during each sexual encounter was inconsistent and sporadic. More than half of adolescent females (54.3%) relied on traditional forms of contraception, like withdrawal of the phallus. Condom was the method of contraceptive choice in one-third (34.3%) of girls, "birth-control pill" in 10.7% and spermicides in 0.7% of subjects. With a new sexual partner condom was used regularly by 55.6% of adolescents; and the remaining percentage of girls used condom irregularly (24.7%), or never (19.7%). The time interval between the initiation of sexual activity and the first gynaecological examination was more than 6 months in 56.7% of cases, and from one to three years in 31.0% of tested adolescent females. The reasons for the first gynaecological visit were as follows: fear of getting pregnant (22.0%), suspicion of contracting a sexually transmitted disease (22.0%) and symptoms indicating a pelvic inflammatory disease (18.3%). Only one-third of girls (37.7%) had their first gynaecological examination as a regular control examination or to get some contraceptive advice. During the adolescence unwanted pregnancy was noted in 16.0% of examined girls. One legal abortion had 14.4% of girls, two 1.3% and three 0.3% of adolescent females. Chlamydia trachomatis genital infection was found in 30.3% of girls. In the girls' opinion the improved knowledge about sexuality, reproduction and contraception is the best way of popularizing contraception among youth. This could be done by introduction of sexual education in school programmes (51.0%) or through mass media (33.3%). A successful health care service for young people should include: a gynaecologist who will have enough time and patience for an adolescent patient (91.3%); a female gynaecologist (36.7%); and a kind other health care workers (21.3%). In order to increase the number of adolescents who will use a condom, the following measures are necessary: a better quality of condoms (54.0%), installation of condom machines (15.6%), mass media education programmes on the significance of the condom role in the prevention of sexually transmitted diseases (10.0%), attractive design of condoms (7.0%), free condoms (6.7%), and universal accessibility of condoms (1.0%). The reproductive health of adolescent girls in Belgrade has been endangered by: their sexual behaviour, poor acceptance of healthy life styles, lack of responsibility in sexual relationships and high prevalence rates of unintended pregnancy and sexually transmitted diseases. Improvement of adolescent reproductive health could be achieved by: educational programmes for adolescents about sexuality, reproduction and contraception; appropriate adolescent advisory health care services; and a better condom quality.

Adolescent↗
PubMed2004

Comparison of self-reported emotional and behavioral problems in Turkish immigrant, Dutch and Turkish adolescents.

OBJECTIVE: The aim of this study was to compare self-reported emotional and behavioral problems for Turkish immigrant, native Dutch and native Turkish adolescents. METHOD: A total of 379 Turkish immigrant adolescents living in the Netherlands, and 1039 Dutch adolescents from the general population completed the Dutch translation of the Youth Self-Report (YSR); 2151 Turkish adolescents from the general population completed the Turkish translation of the YSR; parents of Turkish immigrant adolescents filled in the Turkish translation of the Child Behavior Checklist (CBCL/4-18). RESULTS: Turkish immigrant adolescents scored themselves significantly higher than Dutch adolescents on five of the 11 YSR syndromes, most markedly on the Anxious/Depressed, Withdrawn and Internalizing scales. Dutch adolescents scored themselves higher than immigrant adolescents on the Somatic Complaints and Delinquent Behavior scales. Turkish immigrant adolescents scored themselves higher than Turkish adolescents on five of the 11 scales, most markedly on the Delinquent Behavior scale. Total problems scores for Turkish immigrant adolescents were higher than for Dutch and Turkish adolescents. Turkish immigrant adolescents scored themselves higher than their parents assessed them on seven of the 11 scales. CONCLUSION: Turkish immigrant adolescents reported more problems in comparison to their Dutch and native Turkish peers. Different patterns of parent-child interaction, family values and delay of Dutch language skills are considered to be responsible for these differences in scores.

Adolescent↗
PubMed2002

Male adolescent use of health care services: where are the boys?

PURPOSE: To describe patterns of health care use by adolescent males in the United States and clinical practice characteristics associated with their use of adolescent-specific programs. METHODS: Secondary analysis of three national data sets to determine health care use by male adolescents: the National Ambulatory Medical Care Survey [NAMCS (1994): pediatric, family physician, internal medicine, and obstetric/gynecologic outpatient visits]; National Hospital Ambulatory Medical Care Survey [NHAMCS (1994): outpatient department (OPD) and emergency department (ED) visits]; and Comprehensive Adolescent Health Services Survey [CAHSS (1995)]. Both NAMCS and NHAMCS are representative national probability samples. Total visit estimates by adolescents in 1994 to NAMCS sites were 387,076,630, to OPD sites were 6,511,244, and to ED sites were 13,161,824. For CAHSS, 468 programs (60% of eligible) participated. Data analyses were performed using two-tailed Student's t-tests and correlation testing. RESULTS: Older male adolescents, aged 16-20 years, account for a lower percentage of total visits to NAMCS sites combined compared to younger males, aged 11-15 years (15.8% vs. 25.1%, p <.001), mainly owing to a significant decline in visits to pediatricians (3.2% vs. 14.9%, p <.001), despite significant increases in female health care use during the same time period. Younger males were seen at similar rates compared to females at NAMCS, NHAMCS-OPD and NHAMCS-ED sites, but older males account for a significantly lower percentage of total visits than females to all NAMCS sites combined (15.8% vs. 34.7%, p <.001), the NHAMCS-ED (26.4% vs. 31.5%, p <.05), and the NHAMCS-OPD (15.0% vs. 41.2%, p =.001). Among specialized adolescent sites (CAHSS), 13-19-year-old males account for fewer visits than females to all programs types: schools (40% vs. 60%), hospitals (33% vs. 67%), and community/health departments (25% vs. 75%) (all p's < or =.001). Clinical practice characteristics correlated with having a greater proportion of male adolescent visit varied depending on the types of adolescent program examined. CONCLUSIONS: Younger male adolescents make health care visits in relatively equal proportions to females at all NAMCS and NHAMCS locations and visits by older males are significantly reduced. Male adolescent visits are lower than females at all adolescent-specific programs; school-based clinics see the highest proportion of males. Greater understanding of male adolescents' transition between providers from adolescence to adulthood is needed to improve care to male adolescents who under-use health services.

Adolescent↗
PubMed2004

Adolescents' beliefs about the risks involved in smoking "light" cigarettes.

BACKGROUND: Light cigarettes have been marketed by the tobacco industry as being a healthier smoking choice, a safe alternative to cessation, and a first step toward quitting smoking altogether. Research, however, has failed to show a reduction in smoking-related health risks, an increase in rates of smoking cessation, a decrease in the amount of carbon monoxide or tar released, or a reduction in the rates of cardiovascular disease or lung cancer associated with light cigarette use, compared with regular cigarette use. Nevertheless, more than one-half of adolescent smokers in the United States smoke light cigarettes. This study is the first to investigate adolescents' perception of the risks associated with smoking light cigarettes, as well as adolescents' attitudes and knowledge about the delivery of tar and nicotine, health risks, social effects, addiction potential, and ease of cessation with light cigarettes, compared with regular cigarettes. DESIGN: Participants were 267 adolescents (mean age: 14.0 years) who completed a self-administered questionnaire during class time. After reading scenarios in which they imagined that they smoked regular or light cigarettes, participants estimated the chances that they would personally experience 7 smoking-related health risks and 3 addiction risks. Participants also responded to 14 items concerning their attitudes and knowledge about light cigarettes versus regular cigarettes. RESULTS: Participants thought that they would be significantly less likely to get lung cancer, have a heart attack, die from a smoking-related disease, get a bad cough, have trouble breathing, and get wrinkles when smoking light cigarettes, compared with regular cigarettes, for the rest of their lives. Furthermore, when participants were asked how long it would take to become addicted to the 2 cigarette types, they thought it would take significantly longer to become addicted to light versus regular cigarettes. Adolescents also thought that their chances of being able to quit smoking were higher with light versus regular cigarettes. Similarly, when participants were asked how easy it would be to quit smoking the 2 cigarette types, they thought it would be significantly easier for them to quit smoking light cigarettes than regular cigarettes. Adolescents agreed or strongly agreed that regular cigarettes deliver more tar than light cigarettes and that light cigarettes deliver less nicotine than regular cigarettes. CONCLUSIONS: Overall, the results of this study show that adolescents hold misperceptions in both their personal risk estimates and their general attitudes about the health risks, addictive properties, and ease of cessation associated with light cigarettes. With a variety of light and ultralight cigarettes on the market, adolescents are led to think that there is a progression of safety levels to choose from when deciding which cigarettes to smoke. This illusion of control over health outcomes contributes to an underestimation of risks associated with smoking light cigarettes and supports these misperceptions. These results are of concern, given evidence suggesting that, if adolescents think they are less vulnerable to smoking-related health risks (ie, lung cancer), then they are more likely to initiate smoking. Furthermore, there is evidence that adolescents are not fully aware of the addictive nature of cigarettes and therefore think that they can experiment with smoking during adolescence without becoming addicted or experiencing any health consequences. The data presented here support concerns regarding smoking addiction; adolescents might be even more inclined to smoke light cigarettes to delay addiction. Without correct information about light cigarettes, adolescents are unable to make informed decisions about their smoking behaviors. The findings presented here strongly suggest that health care practitioners need to talk to their adolescent clients not only about the overall risks of smoking but also about the specific risks associated with smoking light cigarettes and other tobacco varieties, including the potential for addiction and long-term health consequences. Information shared with adolescents about light cigarettes, both individually by health care practitioners and at the population level via counter-advertising campaigns, may be successful in changing current misperceptions, and ultimately light cigarette smoking patterns, among youth.

Adolescent↗
PubMed2005

Relationship between adolescent fitness and fatness and cardiovascular disease risk factors in adulthood: the Aerobics Center Longitudinal Study (ACLS).

PURPOSE: To examine the relationship between cardiorespiratory fitness and body fatness during adolescence and cardiovascular disease (CVD) risk factors in adulthood. METHODS: The sample was 48 participants from the Aerobics Center Longitudinal Study (ACLS) who had one clinical visit during adolescence (mean age = 15.8 years) and a follow-up visit during adulthood (mean age = 26.6 years). Values for treadmill time (TM), body fatness (body mass index [BMI], percent body fat [%BF], and waist circumference [WC]), traditional CVD risk factors (blood pressure [BP], fasting total cholesterol [TC], high-density lipoprotein cholesterol [HDL-C], triglycerides [TG], and glucose), and a composite metabolic syndrome risk factor score were adjusted for age and sex. The relationships between adolescent TM and body fatness variables and adult CVD risk factors were examined by partial correlations, controlling for length of follow-up (mean = 11 years). The correlation between changes in TM and body fatness (DeltaTM and Deltabody fatness, respectively) and changes in CVD risk factors between adolescence and adulthood (DeltaCVD risk factors) were also examined. Adolescent cardiorespiratory fitness and body fatness variables also were separated into 2 categories based on the median split: low (below median) and high (above median). RESULTS: TM and body fatness variables showed moderate stability between adolescence and adulthood ( r = 0.44-0.78). Adolescent TM and DeltaTM showed moderate correlations with adult body fatness indicators (BMI, WC, and %BF, r = -0.34 to -0.47) and Deltabody fatness ( r = -0.24 to -0.46), respectively. Adolescent TM was not significantly related to traditional CVD risk factors in adulthood. Adolescent WC was significantly related to adult BP ( r = 0.33 to 0.45), and body fatness variables during adolescence were significantly related to adult TM ( r = -0.32 to -0.44). The DeltaWC was significantly related to DeltaTM ( r = -0.46) and DeltaHDL-C ( r = -0.51), and DeltaBMI was significantly related to DeltaBP ( r = 0.45) and DeltaHDL-C ( r = -0.34). Subjects with a high TM during adolescence showed lower levels of body fatness as adults, and those with high levels of WC during adolescence showed higher BP during adulthood. CONCLUSIONS: The results indicate a significant relationship between adolescent cardiorespiratory fitness and adult body fatness and a lack of an association between adolescent cardiorespiratory fitness and adult cholesterol, BP, and glucose levels. Adolescent body fatness is moderately related to selected adult CVD risk factors.

Adolescent↗
PubMed2006

Agreement with satisfaction in adolescent body size between female caregivers and teens from a low-income African-American community.

OBJECTIVE: To describe body size satisfaction and agreement among low-income, urban, African-American adolescents, and female caregivers. METHODS: Two hundred and fifteen adolescent-caregiver pairs completed measures of demographics, anthropometrics, and body size satisfaction. RESULTS: Adolescent-caregiver agreement on body size satisfaction varied by body mass index (BMI) category. Among normal weight adolescents, 61% of adolescent-caregivers agreed that current body size was ideal. Among adolescents at risk for overweight, 38% of adolescent-caregivers agreed that current body size was ideal, and 38% were discordant with adolescents wanting to be thinner and caregivers satisfied with current body size. Among overweight adolescents, adolescent-caregiver agreement was 67%; 52% agreed the adolescent should be thinner and 15% agreed current body size was ideal. CONCLUSIONS: Body size satisfaction is related to BMI category for adolescents and caregivers, but adolescents have a lower threshold. Encouraging caregivers to elicit their adolescents' views on body size satisfaction may enable caregivers to support their adolescents in addressing weight-related issues.

Adolescent↗
PubMed1993

Family functioning and suicidal behavior in adolescent inpatients with mood disorders.

OBJECTIVE: This study was designed to identify family and parental characteristics associated with suicidal behavior (active intent, gesture, attempt) among adolescent inpatients with mood disorders. METHOD: Subjects were 32 suicidal adolescent inpatients with mood disorders, 32 nonsuicidal adolescent inpatients with mood disorders, and 38 normal comparison adolescents. A group comparison design was used. Adolescent measures were the Family Assessment Device and two semistructured interviews (Hamilton Rating Scale for Depression, Social Adjustment Inventory for Children and Adolescents). Parent measures were the Symptom Checklist-90 and the Social Adjustment Scale-Self Report. RESULTS: Fathers of suicidal adolescents reported more depression and family unit problems than did fathers of nonsuicidal and normal comparison adolescents, even after controlling for adolescents' depression severity. Suicidal adolescents, in turn, reported less active and communicative relationships with fathers. Differences among suicidal and nonsuicidal adolescents' perceptions of general family functioning were not significant after controlling for adolescents' depression severity. CONCLUSIONS: Findings highlight the importance of treating the depressed and potentially suicidal adolescent within the family system and attending to the nature and quality of adolescents' relationships with fathers as well as with mothers. Findings also highlight interactions between suicidal adolescents' depression severity and their negative perceptions of family functioning.

Adolescent↗
PubMed1998

Quality-of-life factors in adolescent inflammatory bowel disease.

Little is known about the specific psychosocial factors that influence quality of life in adolescents with newly diagnosed inflammatory bowel disease (IBD). We adapted a model by Garrett and Drossman to assess adolescent adjustment to recent-onset IBD. Thirty adolescent-parent pairs completed a set of standardized questionnaires. The inclusion criteria were adolescents 12-18 years of age with Crohn's disease or ulcerative colitis of < 5 years' duration. Adolescents' health-related quality-of-life scores significantly correlated with satisfaction and degree of closeness with their social support members, such as parents. An unexpected finding was that the adolescents included more extended family than peers in their social support networks. Also of note was that parental coping styles rather than adolescent coping styles significantly correlated with adolescents' quality-of-life health scores. Severity of illness did not correlate with adolescent quality-of-life health scores. There was significant agreement between adolescent and parental quality-of-life health scores and stressful event ratings. Adolescents with recent-onset IBD rely more on family members than their peers for emotional support, and they depend more on their parents' coping skills than their own. These findings may indicate lags in normal adolescent development. Adolescents and parents do communicate and share concerns with each other. Support programs for adolescents with IBD should reinforce existing coping skills and parent-adolescent communication while promoting normative development.

Adaptation, Psychological↗
PubMed2005

Influence of excess adiposity on exercise fitness and performance in overweight children and adolescents.

OBJECTIVE: Relatively little is known about how excess body mass affects adolescents' capacity to perform sustained exercise. We hypothesized that most of the difficulty that severely overweight adolescents have with sustained exercise occurs because the metabolic costs of moving excess mass result in use of a high proportion of their total oxygen reserve. METHODS: We compared results from a maximal cycle ergometry fitness test in 129 severely overweight adolescents who had BMIs of 41.5 +/- 9.7 kg/m2 and ages of 14.5 +/- 1.8 years (range: 12.1-17.8 years) and 34 nonoverweight adolescents who had BMIs of 20.1 +/- 2.9 kg/m2 and ages of 14.5 +/- 1.5 years (range: 12.0-18.1 years). Oxygen uptake (Vo2) was compared at 3 times: during a 4-minute period of unloaded cycling (ULVo2), at the lactate threshold estimated by gas exchange (LTVo2), and at maximal exertion (Vo2 max). Heart rate was obtained at rest and at Vo2 max. Participants also completed a 12-minute walk/run performance test to obtain distance traveled (D12) and heart rate. RESULTS: Absolute LTVo2 and Vo2 max and LTVo2 as a percentage of Vo2 max were not different in overweight and nonoverweight adolescents during the cycle test. However, absolute ULVo2 was significantly greater in overweight adolescents: ULVo2 accounted for 35 +/- 8% of Vo2 max (and 63 +/- 15% of LTVo2) in overweight adolescents but only 20 +/- 5% of Vo2 max (and 39 +/- 12% of LTVo2) in nonoverweight adolescents. Resting heart rate before initiating the cycle test was significantly greater in overweight than nonoverweight adolescents (94 +/- 14 vs 82 +/- 15 beats per minute). However, maximal heart rate during the cycle test was significantly lower in overweight adolescents (186 +/- 13 vs 196 +/- 11 beats per minute). During the walk/run test, mean D12 was significantly shorter for overweight than for nonoverweight adolescents (1983 +/- 323 vs 1159 +/- 194 m). D12 was negatively related to BMI SDS (r = -0.81) and to ULVo2 (r = -0.98). DISCUSSION: Overweight and nonoverweight adolescents had similar absolute Vo2 at the lactate threshold and at maximal exertion, suggesting that overweight adolescents are more limited by the increased cardiorespiratory effort required to move their larger body mass through space than by cardiorespiratory deconditioning. The higher percentage of oxygen consumed during submaximal exercise indicates that overweight adolescents are burdened by the metabolic cost of their excess mass. Their greater oxygen demand during an unloaded task predicted poorer performance during sustained exercise. Exercise prescriptions for overweight adolescents should account for the limited exercise tolerance imposed by excess body mass, focusing on activities that keep demands below lactate threshold so that exercise can be sustained.

Adipose Tissue↗
PubMed2026

Parents' Awareness of Their Adolescents' Sexual Behaviors and Experiences: A Concordance Analysis.

PURPOSE: Adolescence is a developmental period during which sexual exploration is normative. Parental awareness of adolescents' sexual behaviors can be protective during this stage; however, research suggests both parents and adolescents tend to avoid open conversations about these sensitive issues. This study aimed to examine concordance between parent proxy-reports and adolescent self-reports across three domains of adolescents' sexual behaviors and experiences. METHODS: Data were collected from a national sample of 522 parent-adolescent dyads (aged 15-17 years) from the AmeriSpeak panel (data collected May-September 2022). Prevalence-adjusted bias-adjusted kappa (PABAK) statistics were calculated to evaluate agreement. RESULTS: Findings revealed weak-to-moderate concordance regarding adolescents sending and receiving sexual photos (PABAKs = 0.54-0.79), whereas stronger concordance was observed for experiences related to nonconsensual sharing of sexual photos (PABAKs = 0.92-0.94), with high agreement largely driven by low reported prevalence of these experiences. Strong concordance regarding whether adolescents had ever had sex (PABAK = 0.80) was largely driven by both parents and adolescents reporting the adolescent had not had sex. Concordance regarding sexually transmitted infection and pregnancy prevention methods varied, ranging from weak to strong agreement across specific methods (or lack thereof; PABAKs = -0.07-0.79). DISCUSSION: Results highlight significant discrepancies in parents' knowledge about their adolescents' sexual behaviors and experiences. Interventions aimed at enhancing trust and open dialogue between parents and adolescents about sexuality-related topics, as well as ensuring adolescents have a variety of trusted sources to consult for sexual information, can help adolescents make informed sexual health decisions.

Humans↗
PubMed2006

Adolescent physical activity and health: a systematic review.

Physical activity in adolescence may contribute to the development of healthy adult lifestyles, helping reduce chronic disease incidence. However, definition of the optimal amount of physical activity in adolescence requires addressing a number of scientific challenges. This article reviews the evidence on short- and long-term health effects of adolescent physical activity. Systematic reviews of the literature were undertaken using a reference period between 2000 and 2004, based primarily on the MEDLINE/PubMed database. Relevant studies were identified by examination of titles, abstracts and full papers, according to inclusion criteria defined a priori. A conceptual framework is proposed to outline how adolescent physical activity may contribute to adult health, including the following pathways: (i) pathway A--tracking of physical activity from adolescence to adulthood; (ii) pathway B--direct influence of adolescent physical activity on adult morbidity; (iii) pathway C--role of physical activity in treating adolescent morbidity; and (iv) pathway D - short-term benefits of physical activity in adolescence on health. The literature reviews showed consistent evidence supporting pathway 'A', although the magnitude of the association appears to be moderate. Thus, there is an indirect effect on all health benefits resulting from adult physical activity. Regarding pathway 'B', adolescent physical activity seems to provide long-term benefits on bone health, breast cancer and sedentary behaviours. In terms of pathway 'C', water physical activities in adolescence are effective in the treatment of asthma, and exercise is recommended in the treatment of cystic fibrosis. Self-esteem is also positively affected by adolescent physical activity. Regarding pathway 'D', adolescent physical activity provides short-term benefits; the strongest evidence refers to bone and mental health. Appreciation of different mechanisms through which adolescent physical activity may influence adult health is essential for drawing recommendations; however, the amount of exercise needed for achieving different benefits may vary. Physical activity promotion must start in early life; although the 'how much' remains unknown and needs further research, the lifelong benefits of adolescent physical activity on adult health are unequivocal.

Adolescent↗
PubMed2005

Experiences of pregnant adolescents--voices from Wakiso district, Uganda.

BACKGROUND: In Uganda, morbidity and mortality among adolescent mothers and their children are high. Social factors behind this problem need to be better understood. OBJECTIVE: To explore problems that pregnant adolescents face in order to design appropriate policies and interventions. METHODS: This was a descriptive study that utilized qualitative methods for data collection. The study population comprised of pregnant adolescents, adolescent mothers, opinion leaders, In-charge of health unit, and Traditional Birth Attendants (TBAs) in Wakiso district, Uganda. Six Focus Group Discussions (FGDs) with adolescent mothers and pregnant adolescents, and six key informant interviews were conducted with leaders in-charge of health units and TBAs. A moderator and a note taker facilitated the FGDs, which were tape recorded with consent from participants. Qualitative content analysis was done. RESULTS: Discussions revealed that pregnant adolescents faced domestic physical violence. Furthermore, they were psychologically violated by parents and partners, and the community within which they lived. Pregnant adolescents were treated inhumanely and overworked with household chores and had inadequate food to eat. Adolescents experienced stigma and as a result some had carried out unsafe abortions. Key informant interviews and FGDs revealed that health workers were rude and unsympathetic to pregnant adolescents. This significantly contributed to delayed health care seeking when adolescents were ill. CONCLUSION: Pregnant adolescents lack basic needs like shelter, food and security. They also face relational problems with families, partners and the community. There is, therefore, a need to sensitize the community and school personnel about adolescent reproductive health issues. In addition, adolescent friendly services need to be established/strengthened. Continuous in-service training for health workers with emphasis on counseling skills for young people is urgently needed.

Adolescent↗
PubMed2001

Adolescent immunization practices: a national survey of US physicians.

BACKGROUND: Adolescent immunization rates remain low. Hence, a better understanding of the factors that influence adolescent immunization is needed. OBJECTIVE: To assess the adolescent immunization practices of US physicians. DESIGN AND SETTING: A 24-item survey mailed in 1997 to a national sample of 1480 pediatricians and family physicians living in the United States, randomly selected from the American Medical Association's Master List of Physicians. PARTICIPANTS: Of 1110 physicians (75%) who responded, 761 met inclusion criteria. OUTCOME MEASURES: Immunization practices and policies, use of tracking and recall, opinions about school-based immunizations, and reasons for not providing particular immunizations to eligible adolescents. RESULTS: Seventy-nine percent of physicians reported using protocols for adolescent immunization, and 82% recommended hepatitis B immunization for all eligible adolescents. Those who did not routinely immunize adolescents often cited insufficient insurance coverage for immunizations. While 42% of physicians reported that they review the immunization status of adolescent patients at acute illness visits, only 24% immunized eligible adolescents during such visits. Twenty-one percent used immunization tracking and recall systems. Though 84% preferred that immunizations be administered at their practice, 71% of physicians considered schools, and 63% considered teen clinics to be acceptable alternative adolescent immunization sites. However, many had concerns about continuity of care for adolescents receiving immunizations in school. CONCLUSIONS: Most physicians supported adolescent immunization efforts. Barriers preventing adolescent immunization included financial barriers, record scattering, lack of tracking and recall, and missed opportunities. School-based immunization programs were acceptable to most physicians, despite concerns about continuity of care. Further research is needed to determine whether interventions that have successfully increased infant immunization rates are also effective for adolescents.

Adolescent↗
PubMed2003

Pharmacists' attitudes toward and practices with adolescents.

BACKGROUND: Adolescents often face barriers to health care. As pharmacists' scope of practice expands, they may be in positions to decrease barriers to care for adolescents. OBJECTIVE: To describe pharmacists' attitudes toward and practices with adolescents. DESIGN: Cross-sectional self-administered survey of chief pharmacists at 1361 Indiana pharmacies. Survey items inquired about sociodemographic variables, adolescent-specific pharmacy practices, and training in adolescent health issues. SETTING: All active, licensed pharmacies in Indiana were surveyed. PARTICIPANTS: Nine hundred forty-eight surveys (70%) were returned. Sixty-five percent of responding pharmacists were male, 54% were younger than 45 years, and 58% had been practicing for more than 15 years; 47% practiced in areas with fewer than 30 000 people. MAIN OUTCOME MEASURES: Pharmacists' attitudes toward and practices with adolescents. RESULTS: The majority of pharmacists (94%) dispensed prescriptions for adolescents, but 57% felt inadequately trained in adolescent-specific issues. Forty-eight percent of pharmacies did not dispense emergency contraception. Pharmacists were more likely to report dispensing contraceptives directly to 17-year-olds than to 14-year-olds, and were more likely to report contacting a parent or provider before dispensing contraceptives to 14-year-olds. CONCLUSIONS: Adolescents often require pharmacy services, but many pharmacists feel inadequately trained in adolescent-specific issues. Confidentiality may not be maintained by all members of the health care team, and a prescription may be refused by the receiving pharmacist. Younger adolescents may face more barriers to care than older adolescents. Increasing pharmacists' knowledge and skills in adolescent issues, especially confidentiality, may decrease barriers to care and improve adolescent health outcomes.

Adolescent↗
PubMed2006

Anaemia, iron status and vitamin A deficiency among adolescent refugees in Kenya and Nepal.

OBJECTIVE: To investigate the prevalence of anaemia (haemoglobin<11.0 to 13.0 g dl(-1) depending on age and sex group), iron deficiency (transferrin receptor concentration>8.3 microg ml(-1)) and vitamin A deficiency (serum retinol <0.7 micromol l(-1)) in adolescent refugees. DESIGN: Cross-sectional surveys. SETTING: Kakuma refugee camp in Kenya and seven refugee camps in Nepal. SUBJECTS: Adolescent refugee residents in these camps. RESULTS: Anaemia was present in 46% (95% confidence interval (CI): 42-51) of adolescents in Kenya and in 24% (95% CI: 20-28) of adolescents in Nepal. The sensitivity of palmar pallor in detecting anaemia was 21%. In addition, 43% (95% CI: 36-50) and 53% (95% CI: 46-61) of adolescents in Kenya and Nepal, respectively, had iron deficiency. In both surveys, anaemia occurred more commonly among adolescents with iron deficiency. Vitamin A deficiency was found in 15% (95% CI: 10-20) of adolescents in Kenya and 30% (95% CI: 24-37) of adolescents in Nepal. Night blindness was not more common in adolescents with vitamin A deficiency than in those without vitamin A deficiency. In Kenya, one of the seven adolescents with Bitot's spots had vitamin A deficiency. CONCLUSIONS: Anaemia, iron deficiency and vitamin A deficiency are common among adolescents in refugee populations. Such adolescents need to increase intakes of these nutrients; however, the lack of routine access makes programmes targeting adolescents difficult. Adolescent refugees should be considered for assessment along with other at-risk groups in displaced populations.

Adolescent↗
PubMed1988

MMPI adolescent norms: patterns and trends across 4 decades.

This article examines central issues involving the accuracy of Minnesota Multiphasic Personality Inventory (MMPI) adolescent norms through examination of findings from eight investigations (n = 17,286), reporting MMPI mean values for samples of normal adolescents conducted between 1949 and 1964, and four studies (n = 1,758), based on adolescent samples collected since 1975. Issues related to sex and racial differences in adolescent samples are also examined. In addition, MMPI data from 1,315 normal adolescents, collected at the Mayo Foundation, and from 217 normal adolescents, collected in Norfolk, Virginia, are evaluated in relation to adult normative values on the Harris-Lingoes (Harris & Lingoes, 1955) content subscales to identify unique characteristics of adolescents' response patterns. Results support the adequacy of the adolescent norms, developed by Marks, Seeman, and Haller (1974), for evaluation of samples of normal adolescents collected between 1947 and 1965. MMPI patterns, produced by contemporary samples of adolescents collected since 1975, are elevated above the Marks et al. norms on most clinical scales. This latter finding indicated the need for the development of new adolescent norms that more precisely reflect current adolescent response frequencies and patterns. Finally, results from Harris-Lingoes subscales are reviewed to highlight unique aspects of adolescent developmental experience and to underscore the necessity of development of age appropriate adolescent norms for MMPI special scales.

Adolescent↗
PubMed1999

Adolescent health insurance coverage: recent changes and access to care.

OBJECTIVE: To assess the health insurance status of adolescents, the trends in adolescent health care coverage, the demographic and socioeconomic correlates of insurance coverage, and the role that insurance coverage plays in influencing access to and use of health care. Together, the results provide a current and comprehensive profile of adolescent health insurance coverage. METHODS: We analyzed data on 14 252 adolescents, ages 10 to 18 years, included in the 1995 National Health Interview Survey. The survey obtained information on insurance coverage and several measures of access and utilization, including usual source of care, site of the usual source of care, indications of missed or delayed care, and use of ambulatory physician services by adolescents. We conducted multivariate analyses to assess the independent association of age, sex, race, poverty status, family structure, family size, region of residence, metropolitan resident status, and health status on the likelihood of insurance coverage. We conducted bivariate and multivariate analyses to ascertain how insurance coverage was related to each of the access and utilization measures obtained in the survey. We also examined trends in health insurance coverage using the 1984, 1989, and 1995 editions of the National Health Interview Survey. RESULTS: An estimated 14.1% of adolescents were uninsured in 1995. Risk of being uninsured was higher for older adolescents, minorities, adolescents in low-income families, and adolescents in single parent households. Compared with their insured counterparts, uninsured adolescents were five times as likely to lack a usual source of care, four times as likely to have unmet health needs, and twice as likely to go without a physician contact during the course of a year. Between 1984 and 1995 the percentage of adolescents with some form of health insurance coverage remained essentially unchanged. During this period, the prevalence of private health insurance decreased, while the prevalence of public health insurance increased. CONCLUSIONS: This study demonstrates the critical importance of health insurance as a determinant of access to and use of health services among adolescents. It also shows that little progress has been made during the past 15 years in reducing the size of the uninsured adolescent population. The new State Children's Health Insurance Program could lead to substantial improvements in access to care for adolescents, but only if states implement effective outreach and enrollment strategies for uninsured adolescents.adolescents, health insurance, access, Medicaid, SCHIP.

Adolescent↗
PubMed2006

Emotional, behavioral, social, and academic outcomes in adolescents born with very low birth weight.

BACKGROUND: Very low birth weight survivors are at increased risk of developing emotional and behavioral problems and low social and academic competencies. Information on such problems in very low birth weight adolescents is still sparse. OBJECTIVES: Our purpose for this work was to study gender-specific emotional and behavioral problems and social and academic competencies in a cohort of very low birth weight adolescents in north Norway. METHODS: Families with very low birth weight adolescents aged 13 to 18 years, born between 1978 and 1989 (n = 162) were addressed by mail and asked to complete the Child Behavior Check List and the Youth Self-Report. Data were compared with 2 normative adolescent populations (Child Behavior Check List, n = 540; Youth Self-Report, n = 2522). Scores given by very low birth weight adolescents and their parents on identical items in Child Behavior Check List and Youth Self-Report (cross-informant syndrome constructs) were compared in pairs. To explore predictive effects, demographic and early medical characteristics were entered into a hierarchical multiple regression analysis. RESULTS: There were 156 eligible families, and 99 (63.5%) responded. All completed the Child Behavior Check List, and 82 (52.6%) completed the Youth Self-Report. Very low birth weight boys reported less externalizing and internalizing behaviors and thought and attention problems and higher activity score, whereas very low birth weight girls reported less externalizing behavior and less social, thought, and attention problems and higher activity score compared with normative adolescents. Very low birth weight parents, however, reported more social and attention problems and less social and school competence in boys and more internalizing behavior and social and attention problems and less school competence in girls compared with normative parents. They scored high proportions of both genders within the borderline/clinical range on all of the scales, except for externalizing behavior and social problems in girls. Female very low birth weight adolescents, in contrast to males, reported more problems than parents when compared in pairs, and externalizing problems in particular were not recognized by parents. CONCLUSIONS: From parents' point of view, significant proportions of very low birth weight adolescents experience more emotional and behavioral problems and less competence than normative adolescents. In contrast, very low birth weight adolescents state less problems and similar or higher competence than normative adolescents. Very low birth weight adolescent girls report more emotional and behavioral problems compared with their parents than very low birth weight adolescent boys do. Externalizing problems in very low birth weight adolescent girls are often not recognized by parents. To better understand these seemingly paradoxical findings and to develop adequate intervention programs, there is a need for prospective longitudinal studies.

Adolescent↗