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PubMed2001

Serious injuries and deaths of adolescent girls resulting from interpersonal violence: characteristics and trends from the United States, 1989-1998.

BACKGROUND: Little published data are available concerning the death and disability of adolescent girls resulting from interpersonal violence (adolescents are defined as those aged 12-18 years in this study). OBJECTIVES: To determine whether there were sex differences in (a) the characteristics of those who were injured or died, (b) injury severity and outcomes, and (c) injury mechanism; and to describe time trends in these differences. DESIGN: Analysis of data concerning serious injuries due to assaults, recorded in the National Pediatric Trauma Registry (from January 1, 1989, through December 31, 1998), and homicides, recorded in the Web-Based Injury Statistics and Query Reporting System database (from January 1, 1990, through December 31, 1997). SETTING: Patient data from participating pediatric trauma centers (National Pediatric Trauma Registry) in 45 states and national death certificate data (Web-Based Injury Statistics and Query Reporting System). PATIENTS: Six hundred twelve adolescent girls who were seriously injured because of an assault were compared with 2656 adolescent boys who were seriously injured because of an assault. Three thousand four hundred eighty-seven adolescent girls who died due to a homicide were compared with 17 292 adolescent boys who died due to a homicide. RESULTS: Assaulted adolescent girls were more likely to have preexisting cognitive or psychosocial impairments than were adolescent boys (odds ratio, 1.68; 95% confidence interval, 1.12-2.51). Adolescent girls trended toward more injury-related impairments at discharge from the hospital (odds ratio, 1.16; 95% confidence interval, 0.92-1.47). Adolescent girls were more likely to have been stabbed, and less likely to have been shot. Also, adolescent girls were more likely to have been injured at a home or a residence. Compared with all National Pediatric Trauma Registry admissions, assaults declined at the same rate for adolescent girls and boys. The proportion resulting from penetrating trauma declined more slowly for adolescent girls. CONCLUSIONS: Interpersonal violence causes considerable morbidity and mortality for young women. Research and interventions should be developed to respond to adolescent girls who experience interpersonal violence.

Adolescent↗
PubMed1998

Comparison of responses to an asthma symptom questionnaire (ISAAC core questions) completed by adolescents and their parents. SCARPOL-Team. Swiss Study on Childhood Allergy and Respiratory Symptoms with respect to Air Pollution.

The primary objective of the study was to determine the impact of the identity of the respondent (parents versus adolescents) on prevalence estimates of asthma symptoms in Swiss adolescents. In addition, factors influencing agreement between parents' and adolescents' responses to the same questions were analysed. One thousand three hundred and seventy-four (78.4%) adolescents, aged 14 years, self-completed a questionnaire at school based on the International Study of Asthma and Allergy in Childhood (ISAAC) core questions on wheezing and asthma. The same questions were incorporated into a questionnaire to be completed by the parents at home. The adolescents' self-reported prevalence rates of current asthma symptoms and "asthma ever" were significantly higher than those obtained from the parental questionnaires. 856 (62.6%) parental questionnaires were filled in by parents without the help of the adolescents, 460 (37.4%) were completed by parents and adolescents and 51 (3.7%) were completed by the adolescents without the parents. Prevalence rates were higher when parents and adolescents completed the questionnaire jointly than when questionnaires were completed by parents alone. The level of agreement between parental and self-completed questionnaires was moderate to low (kappa coefficients 0.22-0.68). Agreement between parental and adolescents reports of asthma symptoms was best when questionnaires were completed jointly by parents and adolescents, when the adolescent was a girl, when a family history of asthma was recorded, when the adolescent was a non-smoker, and when the parental education was high. We conclude that the higher reporting of prevalence rates of current asthma symptoms by adolescents compared to reporting by their parents demonstrates the need to take the respondent to a questionnaire into account when comparisons are made between prevalence studies. The results also suggest that factors related to the family milieu influence symptom reporting.

Adolescent↗
PubMed2006

Neuroblastoma in adolescents: the Italian experience.

BACKGROUND: Neuroblastoma (NB) occurs rarely during adolescence, and information is scarce on its characteristics and clinical course in this age group. METHODS: Patients with NB who were included in the Italian Neuroblastoma Registry were considered for the current study. The clinical characteristics and survival of adolescents (age at diagnosis between 10 yrs and 18 yrs) were compared with those of children (ages 1-9 yrs). Infants (age < 1 yr) were excluded because of their well known favorable clinical course. RESULTS: Between 1116 children and 53 adolescents who were evaluated, no differences were documented with regard to the primary tumor site and the prevalence of advanced stage at diagnosis. If only patients with Stage IV NB were considered, then adolescents were less likely to be diagnosed with bone/bone marrow metastases (77%) compared with children (94%; P = 0.038), but adolescents were more likely to have metastases at unusual sites, such as the lung parenchyma or the central nervous system (23% vs. 7%, respectively; P = 0.005). With regard to biologic characteristics, adolescents did not differ significantly from children, although they always had a lower prevalence of unfavorable markers. In particular, MYCN amplification was documented in 21% of children and in 11% of adolescents (P = 0.173). At age 10 years, adolescents had a 20% overall survival rate and a 22% event-free survival rate. Adolescents who had resectable disease had a 73% overall survival rate, which was worse compared with the rate among children with the same disease stage (89%), although the difference did not reach statistical significance (P = 0.159). No differences in survival were observed among patients with Stage IV NB, and adolescents had a probability of survival almost identical to that among children (6% vs. 16%, respectively; P = 0.481). However, when the analysis was restricted to events that occurred after patients developed a recurrence, even if the final outcome was poor for both groups, the difference was statistically significant (P = 0.022) mostly because of the more indolent disease course observed among the adolescents. This effect was even more evident for patients with Stage IV NB. When the 6-year cut-off point was used to separate children from adolescents, a significantly worse overall survival rate (P = 0.036) was documented for adolescents who had resectable disease (81% vs. 93% in children). CONCLUSIONS: NB in adolescents had clinical and biologic characteristics similar to those observed among children. The clinical course of NB probably is correlated significantly with age at diagnosis, but information is scarce on the role of the biologic risk factors in this age group. The authors were able to identify a group of patients with a cut-off age between 6 years and 10 years that had a more indolent course but a worse prognosis.

Adolescent↗
PubMed1997

Anxiety and depression in adolescent cancer: findings in patients and parents at the time of diagnosis.

Adolescent cancer is uncommon and presents an exceptional stress for the young patient and their parents. The emotional needs of adolescents with cancer are a major factor in the recommendation for the establishment of adolescent cancer units in major cancer centres in the U.K. However, there have been no prospective, longitudinal studies assessing the psychological impact of a diagnosis of cancer on the adolescent patient and their family. In 1994 we began a longitudinal study of the emotional impact of the diagnosis of cancer in patients and their families presenting to an adolescent cancer unit and of the coping strategies they employ. This first report presents the results of the study at the time of diagnosis in 42 adolescents, 34 mothers and 27 fathers. The Beck Depression Inventory (BDI) was used to assess depression and anxiety levels were measured using Spielberger's State Trait Anxiety Inventory (STAI). Adolescents and their parents completed the questionnaires on first admission to the adolescent cancer unit. The median time since cancer diagnosis was approximately 3 weeks. To provide normative data for the U.K. adolescent population, control values were obtained from 173 pupils of the same age and background. The results showed that, contrary to expectation, adolescents with cancer were no more anxious or depressed than the control adolescent population. Nevertheless, a substantial minority of patients and controls had elevated anxiety or depression scores. Girls were significantly more anxious (P = 0.011) and depressed (P < 0.0001) than boys. Mothers were the most anxious family members and were significantly more anxious than fathers (P = 0.038). Parental anxiety scores, especially mothers, were much higher than reported norms. There was no significant difference between mothers' and fathers' depression scores. Although at the time of diagnosis adolescent cancer patients are not more anxious or depressed than their healthy peers, many adolescents without cancer are anxious or depressed. Staff on adolescent cancer units should therefore be aware of the frequency of emotional disturbance in this population. Mothers are the most anxious family members. Although the findings are relatively reassuring at the time of diagnosis, follow-up data from this cohort will show whether anxiety and depression change with treatment involving intensive chemotherapy, surgery and radiotherapy and will indicate the coping strategies which patients and their families adopt in dealing with both the disease and its treatment.

Adolescent↗
PubMed2002

Anthropometric assessment of nutritional status in adolescent populations in humanitarian emergencies.

OBJECTIVE: To outline the difficulties and suggest potential solutions in anthropometric assessment of adolescents during humanitarian emergencies. DESIGN: Literature review. SETTING: Multiple settings in which the nutritional status of adolescents has been assessed using anthropometric measurements. SUBJECTS: Adolescents in multiple populations. INTERVENTIONS: None. RESULTS: The use of anthropometry may be more difficult in adolescents than in other age groups because anthropometric indices in normally nourished adolescents change with age and sexual development. Moreover, survey and reference populations may differ in the age at which certain pubertal landmarks are attained, requiring adjustment for differences between survey and reference populations. Adolescent populations may also differ by ethnicity in various body proportions that affect anthropometric indices. Adjustment may be required when the body proportions of adolescents in the reference population differ from those in the population assessed. CONCLUSIONS: Although no definitive recommendation can be made regarding which anthropometric indices are the most appropriate for adolescents, some revisions may improve current practices. Weight-for-height could be used for prepubertal adolescents and body mass index could be used for postpubertal adolescents. Because cut-off points are age-specific, age should be collected as accurately as possible for all adolescents measured during screening or survey activities. The WHO-recommended reference population of US adolescents is inappropriate in most populations of adolescents. Adolescents should never undergo nutritional assessment in isolation; other population subgroups should be included, and other health, nutrition and food data should be collected at the same time. SPONSORSHIP: The United Nations Administrative Committee on Coordination/Sub-Committee on Nutrition.

Adolescent↗
PubMed2005

Brief report: psychosocial adjustment in adolescents with inflammatory bowel disease.

BACKGROUND: Inflammatory bowel disease (IBD) is an ideal disease for investigating adolescent adjustment to chronic illness, given its embarrassing, socially limiting, appearance-changing symptoms and adolescent onset. OBJECTIVE: To compare psychosocial adjustment among adolescents with a chronic illness to that of healthy adolescents and examine the role of adolescent disease onset. METHODS: Participants were 50 adolescents with IBD and their parents, and parents of 42 healthy comparison adolescents who completed questionnaires assessing behavioral, emotional, social, and family functioning. RESULTS: Adolescents with IBD were reported to have worse anxious and/or depressed and social problems than healthy adolescents. More adolescents with IBD were reported to have clinically significant social problems. Those diagnosed during adolescence were reported to have significantly worse social competence scores. CONCLUSIONS: Adolescents with a chronic illness such as IBD may be at higher risk for specific psychosocial difficulties than healthy adolescents. Diagnosis of a chronic illness during adolescence may have implications for social functioning.

Adaptation, Psychological↗
PubMed1998

Family environments of adolescents with lifetime depression: associations with maternal depression history.

OBJECTIVE: To assess family functioning of adolescents with a history of depression, taking into account maternal history of depression. METHOD: Lifetime major depression was assessed with standardized interviews in an epidemiological sample of adolescent twins and their parents. Family members completed questionnaires measuring family functioning. The families of three groups of adolescents were compared: ever-depressed adolescents with ever-depressed mothers (n = 37), ever-depressed adolescents with never-depressed mothers (n = 42), and never-depressed control adolescents (n = 82). RESULTS: A greater proportion of ever-depressed adolescents had ever-depressed mothers than did control adolescents (47% versus 18%); rates of paternal depression did not differ between the two groups. Ever-depressed adolescents with ever-depressed mothers described poorer family functioning than did ever-depressed adolescents with never-depressed mothers and controls. Relative to control mothers, mothers of both groups of ever-depressed adolescents reported family difficulties, particularly in the father-adolescent relationship. Fathers' descriptions of family relationships did not differ among the three groups. Ever-depressed adolescents came disproportionately from divorced families. CONCLUSIONS: These results highlight the importance of considering parental depression in the treatment of adolescent depression and underscore the need to understand the interactional patterns in families of depressed youth, particularly those with multiple depressed members.

Adolescent↗
PubMed2004

Challenges to conducting HIV preventative vaccine trials with adolescents.

It is estimated that 10.3 million people aged 15-24 are living with HIV infection/AIDS worldwide, with 7000 new infections occurring each day. Many of these infections occur during the adolescent years. These rates of infection make adolescents an important target for research in primary prevention. Currently, preparations are under way by the National Institutes of Health-supported HIV networks--the Adolescent Trials Network, the Pediatric AIDS Clinical Trials Group, and the HIV Vaccines Trials Network--for phase 1/2 HIV vaccine trials involving adolescents in the United States. Identifying the challenges to conducting HIV vaccine trials with this population is a crucial component of these preparations. Challenges to HIV vaccine trials with adolescents were identified by reviewing previous vaccine research for adolescents and HIV infection in adolescents and speaking with experts in HIV/AIDS and adolescent medicine. Adolescents (typically those younger than 18 years of age) are minors and fall under ethical and regulatory safeguards for their participation in clinical research including parental permission. Adolescents may not appropriately perceive personal risk, posing challenges for informed consent as well as prevention counseling during a trial. Safety and immunogenicity studies of adolescents are likely to be required by the US Food and Drug Administration before vaccine approval for this population. Early identification and subsequent follow-up of high-risk adolescents are problematic. Vaccine-induced seropositivity may present potential barriers to military service, employment, marriage, and acquiring health insurance. The age at optimal immunization, particularly for girls in some countries, may be during preadolescence. The successful completion of HIV vaccine trials with adolescents must address these challenges both in the United States and internationally. This report addresses relevant background information, identifies the issues surrounding HIV vaccine trials with adolescents, discusses what progress has been made, and addresses plans and implications for the implementation of these trials.

AIDS Vaccines↗
PubMed2006

Maternal perceptions of alcohol use by adolescents who drink alcohol.

OBJECTIVE: This research examines correlates of mothers' misperceptions of their adolescent children's regular alcohol consumption. Theories of adolescent autonomy, attribution processes, and stereotypes were used to make predictions about the biasing effects on attribution accuracy of maternal age, relationship satisfaction, and supervision of one's adolescent, as well as the adolescent's age, gender, physical development level, and peers. METHOD: The present research used a nationally representative sample of approximately 20,000 parent-adolescent dyads from the National Longitudinal Study of Adolescent Health (Add Health). Add Health is a school-based sample of 20,745 adolescents in Grades 7-12. Mothers indicated their perceptions of their adolescent children's alcohol use, and adolescents reported their actual use of alcohol. RESULTS: There was a tendency for mothers to underestimate alcohol use, sometimes substantially so. Maternal attributions followed a correlational pattern consistent with the scientific literature. There was evidence, however, that mothers may overgeneralize the applicability of these correlates, resulting in misattributions. CONCLUSIONS: Our analyses have important practical implications for parent-based intervention programs aimed at preventing adolescent alcohol use. First, programs should alert parents to the cues that signify adolescent alcohol consumption. Second, intervention programs should appropriately sensitize parents to identifying adolescent alcohol use in cases in which the child may not fit the stereotype of an adolescent drinker. Third, intervention messages should emphasize firm and consistent parental actions that minimize alcohol use independent of the particular cues that an adolescent is projecting.

Adolescent↗
PubMed1999

Physically abused adolescents: behavior problems, functional impairment, and comparison of informants' reports.

OBJECTIVE: This study, like earlier studies that focused on younger abused children, ascertained whether physically abused adolescents exhibited increased internalizing and externalizing behaviors. Relevance to pediatric practice is discussed. DESIGN: A cross-sectional design was used to compare the behavior of physically abused adolescents and comparison adolescents using self-reports, parent reports, and teacher reports. The level of agreement among raters was also examined. PARTICIPANTS: The subjects were 99 physically abused adolescents between the ages of 12 and 18 years, who were recruited from Child Protective Services. Comparison subjects were 99 community-recruited nonabused adolescents who were matched for age, gender, and income with the abused adolescents. MEASURES: The behavior of the adolescents was assessed using the Child Behavior Checklist, and the comparable Youth Self-Report and Teacher Report Form, which are widely used measures of behavioral and emotional problems. The Child Global Assessment Scale was also used as a measure of functional impairment and of the need for mental health services. RESULTS: Parents and teachers rated the problems of abused adolescents as significantly greater than the problems of nonabused adolescents on all checklist subscales. Abused adolescents reported significantly greater problems only on externalizing behavior subscales. In addition, based on interviewer ratings, physically abused adolescents exhibited significantly greater functional impairment. CONCLUSIONS: Similar to previous research on abused children, physically abused adolescents exhibit externalizing and internalizing behavior problems and experience greater functional impairment. Parent, teacher, and adolescent reports of externalizing behaviors were similar, but physically abused adolescents reported fewer internalizing behaviors than did the other informants.

Acting Out↗
PubMed2006

Reasons for testing and clinical and demographic profile of adolescents with non-perinatally acquired HIV infection.

OBJECTIVES: We sought to examine the demographic, clinical, and behavioral characteristics; reasons for HIV testing; and factors that contribute to delays in entry into specialized HIV care after diagnosis of HIV infection among adolescents in an urban clinic in Georgia. METHODS: All of the data for this study were obtained solely by medical chart review. Demographic, clinical, behavioral, and HIV testing data were abstracted from medical charts of 59 non-perinatally HIV-infected adolescents who were aged 13 to 18 years and entered care at the pediatric and adolescent HIV clinic of a Georgia hospital during 1999-2002. HIV-infected adolescents were compared by demographic, clinical, and behavioral characteristics as well as by circumstances surrounding HIV testing. Recent seroconversion was defined as having a documented negative or indeterminate HIV antibody test (confirmed) or a self-reported negative HIV test (probable) < or =6 months before HIV diagnosis. RESULTS: Of 59 HIV-infected adolescents, 35 (59%) were female and 56 (95%) were black/African American. Fifteen (25%) had > or =1 sexually transmitted infection when they entered care. All female (vs 38% male) adolescents were infected through heterosexual sexual intercourse; 9 (26%) were pregnant at the time of HIV diagnosis. Adolescents whose HIV was diagnosed at non-health care facilities entered HIV care much later than adolescents whose HIV was diagnosed at health care facilities (median: 108 vs 25 days). Approximately one half of adolescents had CD4+ T-cell counts <350 cells per microL and/or HIV-1 viral loads >55,000 copies per mL at entry into care. Twenty-seven (46%) adolescents had a previous negative HIV test; 7 had confirmed recent seroconversion, and 3 had probable recent seroconversion. Among adolescents with a documented reason for testing, routine medical screening was the most frequent reason for HIV testing; few adolescents were documented as having self-initiated HIV testing. CONCLUSIONS: Strategies are needed to implement timely linkage to medical services of adolescents who receive a diagnosis of HIV infection at non-health care facilities and to increase HIV testing, prevention efforts, and recognition of recent HIV infection among sexually active adolescents.

AIDS Serodiagnosis↗
PubMed2006

Can school income and racial/ethnic composition explain the racial/ethnic disparity in adolescent physical activity participation?

OBJECTIVE: Our goal was to determine if racial/ethnic disparities in adolescent boys' and girls' physical activity participation exist and persist once the school attended is considered. METHODS: We performed a cross-sectional analysis of 17,007 teens in the National Longitudinal Study of Adolescent Health. Using multivariate linear regression, we examined the association between adolescent self-reported physical activity and individual race/ethnicity stratified by gender, controlling for a wide range of sociodemographic, attitudinal, behavioral, and health factors. We used multilevel analyses to determine if the relationship between race/ethnicity and physical activity varied by the school attended. RESULTS: Participants attended racially segregated schools; approximately 80% of Hispanic and black adolescent boys and girls attended schools with student populations that were <66% white, whereas nearly 40% of the white adolescents attended schools that were >94% white. Black and Hispanic adolescent girls reported lower levels of physical activity than white adolescent girls. There were more similar levels of physical activity reported in adolescent boys, with black boys reporting slightly more activities. Although black and Hispanic adolescent girls were more likely to attend poorer schools with overall lower levels of physical activity in girls; there was no difference within schools between black, white, and Hispanic adolescent girls' physical activity levels. Within the same schools, both black and Hispanic adolescent boys had higher rates of physical activity when compared with white adolescent boys. CONCLUSIONS: In this nationally representative sample, lower physical activity levels in Hispanic and black adolescent girls were largely attributable to the schools they attended. In contrast, black and Hispanic males had higher activity levels than white males when attending the same schools. Future research is needed to determine the mechanisms through which school environments contribute to racial/ethnic disparities in adolescent physical activity and will need to consider gender differences in these racial/ethnic disparities.

Adolescent↗
PubMed2006

Diet of adolescents with and without diabetes: Trading candy for potato chips?

OBJECTIVE: To compare the dietary intake of adolescents with type 1 diabetes with that of adolescents without diabetes matched on age, sex, and year in school and to compare the diets of both groups with recommendations. RESEARCH DESIGN AND METHODS: Participants were 132 adolescents with type 1 diabetes, recruited from Children's Hospital of Pittsburgh, and 131 adolescents without diabetes ranging in age from 10.70 to 14.21 years. Dietary intake was assessed with three 24-h recall interviews with each participant and one parent. Percentage of calories from protein, carbohydrates, and total fat; amount of each type of fat; and amount of cholesterol, fiber, and sugar were calculated as averages across 3 days. RESULTS: Adolescents with diabetes took in less total energy than recommended. The percentage of calories from carbohydrates and protein were within recommendations for adolescents with and without diabetes, but adolescents with diabetes exceeded the recommended fat intake. The diet of adolescents with diabetes consisted of a greater percentage of fat and protein and a smaller percentage of carbohydrates relative to adolescents without diabetes. Adolescents without diabetes consumed more sugar, while adolescents with diabetes took in more of all components of fat than adolescents without diabetes. Male subjects with diabetes had an especially high intake of saturated fat. CONCLUSIONS: Adolescents with type 1 diabetes consume fewer calories from carbohydrates but more calories from fat than adolescents without diabetes and exceed the recommended levels of fat intake. These findings are of concern given the risk that type 1 diabetes poses for cardiovascular disease.

Adolescent↗
PubMed2002

[The changes in plasma leptin, insulin and proinsulin levels in obese adolescents].

OBJECTIVE: To investigate the metabolic changes in obese adolescents and the relationship between obese adolescents and metabolic syndrome. METHODS: 198 obese adolescents [body mass index (BMI) >/= 25 kg/m(2)] and 78 normal adolescents (BMI 18.5 approximately 23.0 kg/m(2)) were chosen from 2 217 middle school students of 14 approximately 16 years. The levels of serum leptin, insulin, proinsulin, glucose and lipids of these adolescents were measured and compared. RESULTS: (1) There was significant gender difference of serum leptin levels in adolescents of 14 approximately 16 years. The level of serum leptin was higher in female than that in male [(18.53 +/- 1.41) microgram/L vs (6.33 +/- 1.79) microgram/L]. (2) The levels of serum leptin, insulin and proinsulin of obese adolescents were significantly higher than those of normal adolescents [(19.94 +/- 1.91) microgram/L vs (11.27 +/- 2.04) microgram/L, (15.34 +/- 1.66) microIU/L vs (13.17 +/- 1.43) microIU/L and (16.19 +/- 1.64) pmol/L vs (11.79 +/- 1.70) pmol/L respectively]. (3) The levels of blood glucose and triglyceride of obese adolescents were significantly higher than those of normal adolescents [(4.63 +/- 0.50) mmol/L vs (4.13 +/- 0.33) mmol/L and (1.20 +/- 0.56) mmol/L vs (0.90 +/- 0.32) mmol/L respectively], but the levels of serum high-density lipoprotein cholesterol (HDL-C) of obese adolescents were significantly lower than those of normal adolescents [(1.14 +/- 0.24) mmol/L vs (1.38 +/- 0.26) mmol/L]. CONCLUSION: It is suggested that there are leptin resistance, insulin resistance and potential disorders of blood glucose and lipid metabolism in obese adolescents. Our study indicated that adolescent obesity would be related with early occurrence of type 2 diabetes.

Adolescent↗
PubMed1993

Adolescent pregnancy and parenting: controversies of the past and lessons for the future.

Recent research findings suggest that old ways of looking at adolescent sexuality, pregnancy, and parenting should be revised and that new approaches to service programs should be developed. This paper presents some new facts by examining the validity of nine beliefs about adolescent pregnancy: that nothing can reduce the rate of adolescent pregnancy; that pregnant adolescents experience poor pregnancy outcomes; that adolescent mothers do not complete their high school education; that pregnant adolescents have large families; that adolescent mothers remain on welfare for long periods; that pregnancy in adolescence is a mistake and, given a chance to overcome the immediate problems associated with it, young mothers can go on to lead normal lives; that welfare causes adolescent pregnancy and parenting; that adolescent mothers are poor parents; and that service programs can have a significant impact on adolescent pregnancy and parenting. Although programs aimed at the prevention and amelioration of the problems experienced by pregnant adolescents, young mothers, and their children and families have shown some success, relatively few are sufficiently powerful to bring about major changes--and even these are infrequently replicated because of high costs. Further progress in this area depends not only on new and expanded programs, but also on attacking the problem of poverty, which is an underlying cause of early sexual activity and childbearing.

Adolescent↗
PubMed1999

The application of Poisson random-effects regression models to the analyses of adolescents' current level of smoking.

BACKGROUND: In school-based smoking prevention research, it is still debatable whether parents or peers are most influential to maintained smoking among adolescents. As a result, this study examines the effects of parental and peer approval of smoking on adolescents' current levels of smoking. METHODS: Poisson random-effects regression models were used to assess the effects of parental and peer approval of smoking on adolescents' (n = 913) current level of smoking. RESULTS: Results of these analyses indicate that a stronger relationship between parental approval of smoking and current level of smoking was found for female adolescents than for male adolescents. Conversely, a stronger relationship between peer approval of smoking and current level of smoking was found for male adolescents than for female adolescents. With respect to race, the influence of parental approval of smoking on adolescents' current level of smoking was generally more pronounced for minority adolescents, relative to white adolescents. However, the influence of peer approval of smoking on current level of smoking was strongest for white adolescents and was less strong for black, Hispanic, and Asian adolescents. CONCLUSION: The findings of this study demonstrated that the effects of parental and peer approval of smoking on adolescents' current levels of smoking were varied by gender and race. These differential effects may have some implication for the development of future school-based smoking prevention and cessation programs.

Adolescent↗
PubMed1994

Pregnancy among American Indian adolescents: reactions and prenatal care.

PURPOSE: Adolescent childbearing is twice as common among Native Americans as among all US races combined. Despite this, little is written about the psychosocial context or prenatal care of pregnant Native American adolescents. The objective of this study was to explore the reactions and prenatal care of Navajo and Apache adolescents delivering infants at Shiprock Indian Hospital, New Mexico, between January and March 1991, and Whiteriver Indian Hospital, Arizona, between May and June 1991. METHODS: Of the 25 eligible adolescents aged 19 years and younger, 15 Navajo and 5 Apache participants were interviewed within 24 hours of delivery. The interview consisted of 121 questions divided into 5 areas: sociodemographics, personal and family reactions to the pregnancy, knowledge and attitudes toward prenatal care, barriers to care, and ways to improve access to care. RESULTS: The mean age was 17.4 +/- 1.1, 6 were married, and 13 were primiparous. According to the Maternal Health Services Index, 5 adolescents received adequate, 13 intermediate, and 2 inadequate prenatal care. During the pregnancy, 3 adolescents used tobacco, 3 used alcohol, and none admitted to other drugs. Although only 1 adolescent planned the pregnancy, 15 were not using contraception when they became pregnant. In exploring reactions to the pregnancy, 13 adolescents were afraid to tell their families and 4 concealed the pregnancy until confronted. During the pregnancy, 7 adolescents described loneliness and 6 expressed suicidal ideation. Although over half reported no barriers to obtaining prenatal care, barriers that were noted by the remainder included transportation, family problems, and missing school. CONCLUSION: We conclude that pregnancy among many American Indian adolescents is unplanned and characterized by uncertainty and fear of disclosure, resembling the reactions to pregnancy of other adolescent populations. Furthermore, despite universal access to health services, many American Indian adolescents continue to experience barriers to care and receive intermediate or inadequate prenatal care. These preliminary findings suggest further research may help clarify how adolescent reactions to pregnancy and knowledge of prenatal care affect health care utilization.

Adolescent↗
PubMed1995

Developmental issues influencing guidelines for adolescent health research: a review.

Adolescent development brings many opportunities to adolescents as research participants. They may be enthusiastic participants, especially if the focus of the research is of interest to the adolescents. Their increasing sense of self and development of autonomy may yield open, thoughtful responses less likely with older research participants. At the same time, the researcher must be aware of particular vulnerabilities of adolescents. Cognitive and reasoning capacity emerges gradually over the adolescent decade, making younger adolescents less capable than older adolescents of effective reasoning. The researcher can adjust materials to be understandable to the younger adolescent but should also recognize that inexperience could increase anxiety or emotionality about an issue not problematic to an older adolescent or adult. Making clear the right of the adolescent to refuse to discuss particular issues usually permits more honest responses, and increases the likelihood of consent to research or parts of research. Especially stressful circumstances may cause degradation of reasoning capacity suggesting that the researcher needs to assess whether the adolescent is able to make a wise decision about participation, as well as about particular responses. The researcher can usually identify ways to alleviate stress in the study situation and should take all steps necessary to obtain both informed consent and valid responses. Existing research provides clear evidence that most adolescents, at least past age 14 or 15 years, are able to function as well as adults research participants under most circumstances. With younger adolescents and under stressful situations, the researcher can find ways to minimize risk from research and increase the likelihood of valid responses.

Adolescent↗