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PubMed2002

Family transitions during the adolescent transition: implications for parenting.

This study explored how family transitions affect parenting practices in a sample of 7,000 ethnically diverse students in 9th, 10th, or 11th grade over a period of 2 years. Adolescent perceptions of parental control and parental responsiveness were assessed in three groups: (1) adolescents moving into mother-custody households following a marital separation or divorce, (2) adolescents from stable never-divorced households, and (3) adolescents from stable mother-custody households. The study examined pre- and posttransition data to determine whether adolescents in newly formed single-parent families experienced a larger drop in parental control and responsiveness than did adolescents in stable nondivorced and stable mother-custody households. Adolescents from all family types reported significant declines in behavioral control, but not parental responsiveness. However, the lack of family-type differences contrasts sharply with findings from the childhood-divorce literature. Findings suggest that adolescent individuation may overshadow family-type differences during middle adolescence. As expected, boys reported lower parental control than did girls. Ethnic differences revealed that European American adolescents reported the highest levels of parental responsiveness, and African American adolescents reported the highest levels of parental control. Contextual and individual pathways in adolescence are discussed.

Adolescent↗
PubMed2006

Perceptions and practices of private medical practitioners to adolescent reproductive health in Lagos State, Nigeria.

INTRODUCTION AND OBJECTIVES: Adolescent sexual and reproductive ill health is a major global public health issue, contributing to high levels of morbidity and mortality in adolescents. Although adolescents are known to have low levels of doctor consultations, private medical practitioners remain the preferred health care providers. This study was carried out to document the attitudes and experiences of private medical practitioners to adolescent reproductive health issues and to assess the factors that may influence their attitudes. METHODS: Information was obtained from a random sample of 187 out of 352 (53% ) registered private medical practitioners in 5 of the 20 Local Government Areas in Lagos State using a self-administered structured questionnaire. RESULTS: Sixty-two per cent of the doctors claimed they saw adolescents regularly, mainly for the treatment of sexually transmitted infections (STIs). Many (86% ) believed that adolescents should use contraception and suggested that parents, teachers and health workers provide sexuality information to adolescents. Sixty one percent of the practitioners believed that abortion should be legalised, though with restrictions. Many of them admitted to providing post abortion care to adolescents. The religious affiliation of the private medical practitioners influenced their perception and practices. CONCLUSION AND RECOMMENDATIONS: Improving the reproductive health care of adolescents is key to improving the world's future economic and social well being. It is recommended that appropriate sexuality education be made widely available to adolescents. In addition, private medical practitioners should strengthen their skills and be more actively involved in the care of adolescents by making their facilities more adolescent friendly.

Abortion, Induced↗
PubMed1993

Patient satisfaction and side effects with levonorgestrel implant (Norplant) use in adolescents 18 years of age or younger.

OBJECTIVES: Levonorgestrel implants (Norplant) have recently been approved for use in the United States. Adolescents may be especially suited for this method of contraception because of its long duration of action and lack of dependence on patient compliance for efficacy. To date, however, its use in young patients has not been investigated. This study was undertaken to compare side effects and satisfaction with this new method during the first 6 months of use among adolescents and adults. METHODS: Twenty-one adolescents 18 years of age or younger and 30 adults 19 years or older participated in this study. Information on side effects and satisfaction was obtained from clinic records and a structured interview conducted 6 months after insertion. RESULTS: The most frequent reason adolescents gave for selecting Norplant was convenience. None of the adolescents were upset by the insertion process or by its appearance in the arm, although 10 (48%) reported that it was visible. The most frequent side effect reported by both adolescents (71%) and adults (53%) was abnormal menstrual bleeding. Weight gain was reported by 8 adolescents (38%), 3 of whom attributed it to an increase in their appetite. Other side effects commonly reported by adolescents included emotional disturbances (33%) and headaches (38%), whereas adults reported acne (27%) and mastalgia (37%). Only 1 adolescent (5%) and 1 adult (3%) reported experiencing no side effects. A similar percentage of adolescents (8%) compared with adults (6%) requested removal of the implant because of side effects during the 6-month period. Overall, satisfaction was expressed by 86% (18/21) of adolescents, all of whom stated that they preferred Norplant to their previous contraceptive method. CONCLUSIONS: This investigation demonstrates that levonorgestrel implants are well tolerated by most young patients. Clinicians involved in the care of adolescents should consider Norplant as an appropriate option of birth control for this population.

Adolescent↗
PubMedDate not supplied

Family communication about sex: what are parents saying and are their adolescents listening?

CONTEXT: Communication between parents and adolescents about sex, particularly in minority families, has been understudied; more information is needed both on which sex-related topics are discussed and on how their content is transmitted. METHODS: Parent-adolescent communication about 10 sex-related topics was examined in a sample of 907 Hispanic and black 14-16-year-olds. Chi-square analyses were performed to test for significant differences across the 10 topics in discussions reported by the adolescents (with either parent) and by the mothers. The openness of communication, parent-adolescent agreement about communication of topics and differences by gender and ethnicity were also examined. RESULTS: Significantly higher proportions of mothers and adolescents reported discussions of HIV or AIDS (92% by mothers and 71% by adolescents, respectively) and STDs (85% and 70%, respectively) than of issues surrounding sexual behavior, contraceptive use and physical development (27-74% for these other eight topics as reported by mothers vs. 15-66% as reported by adolescents). The gender of the adolescent and of the parent holding the discussion, but not the family's ethnicity, significantly influenced findings, with adolescents of both sexes more likely to report discussions with mothers than with fathers, and with parents more likely to discuss any of the 10 topics with an adolescent of the same gender than of the opposite gender. The likelihood of a topic being discussed and of mother-adolescent agreement that a topic was discussed both increased with an increasing degree of openness in the communication process. CONCLUSIONS: Consistent with research among white samples, mothers of black and Hispanic adolescents are the primary parental communicators about sexual topics. To facilitate communication, educational programs for parents should cover not only what is discussed, but how the information is conveyed.

Adolescent↗
PubMed1999

Abortion: knowledge and perceptions of adolescents in two districts in Kenya.

BACKGROUND: Pregnancy among adolescents is unplanned in many instances. Although some pregnant adolescents carry the pregnancy to term, abortion, in many instances unsafely induced, is a commonly sought solution in Kenya. OBJECTIVE: To determine adolescents' perceptions of induced abortion. DESIGN: A cross-sectional descriptive study carried out between July 1995 and June 1996. SETTING: An urban and a rural district in Kenya. PARTICIPANTS: Adolescents aged 10-19 years in schools in Nairobi and Kiambu districts, and a group of immediate post-abortion adolescent girls in some health facilities in Nairobi. MAIN OUTCOME MEASURES: The number of health programmes formulated and put into use, which are adolescent-friendly and providing information, education and communication on abortion issues. DATA COLLECTION: One thousand eight hundred and twenty adolescents were subjected to a self-administered questionnaire that collected demographic and health data as well as perceptions of induced abortion. Focus group discussions on perceptions of abortion were held with 12 groups of adolescents in schools and the information obtained recorded on paper and in a tape-recorder. RESULTS: One thousand nine hundred and fifty two adolescents, comprising of 1048 school girls (SG), 580 boys (SB), 192 post-abortion girls (PA) and 132 adolescents in the focus group discussions, formed the study sample. More than 90% were aware of induced abortion (IA). Knowledge of IA correlated positively with level of education (P < 0.01). Seventy one per cent of SG, 84% of PA and 40% of SB were aware of abortion-related complications, the most common being infections, death and infertility. Eighty three per cent of PA felt that complications were preventable by seeking care from a qualified doctor compared to one quarter each for the SB and SG. 56% PA, 69% SB and 72% SG felt that abortions were preventable. However, less than 40% proposed abstinence as a primary strategy. The most important source of information on abortion was the media followed by friends and teachers. CONCLUSION: Adolescents are aware of abortion and the related complications, but there is more variability in their knowledge and preventive measures.

Abortion, Illegal↗
PubMed2002

Weight-related concerns and behaviors among overweight and nonoverweight adolescents: implications for preventing weight-related disorders.

OBJECTIVES: To assess weight-related concerns and behaviors in a population-based sample of adolescents and to compare these concerns and behaviors across sex and weight status. DESIGN: The study population included 4746 adolescents from St Paul or Minneapolis, Minn, public schools who completed surveys and anthropometric measurements as part of Project EAT (Eating Among Teens), a population-based study focusing on eating patterns and weight concerns among teenagers. MAIN OUTCOME MEASURES: Measured weight status, weight-related concerns (perceived weight status, weight disparity, body satisfaction, and care about controlling weight), and weight-related behaviors (general and specific weight control behaviors and binge eating). RESULTS: Weight-related concerns and behaviors were prevalent among the study population. Although adolescents were most likely to report healthy weight control behaviors (adolescent girls, 85%; and adolescent boys, 70%), also prevalent were weight control behaviors considered to be unhealthy (adolescent girls, 57%; and adolescent boys, 33%) or extreme (adolescent girls, 12%; and adolescent boys, 5%). Most overweight youth perceived themselves as overweight and reported the use of healthy weight control behaviors during the past year. However, the use of unhealthy and extreme weight control behaviors and binge eating were alarmingly high among overweight youth, particularly adolescent girls. Extreme weight control practices (taking diet pills, laxatives, or diuretics or vomiting) were reported by 18% of very overweight adolescent girls, compared with 6% of very overweight adolescent boys (body mass index, > OR = 95th percentile). CONCLUSION: Prevention interventions that address the broad spectrum of weight-related disorders, enhance skill development for behavioral change, and provide support for dealing with potentially harmful social norms are warranted in light of the high prevalence and co-occurrence of obesity and unhealthy weight-related behaviors.

Adolescent↗
PubMed2000

Association between household and workplace smoking restrictions and adolescent smoking.

CONTEXT: Recent marked increases in adolescent smoking indicate a need for new prevention approaches. Whether workplace and home smoking restrictions play a role in such prevention is unknown. OBJECTIVE: To assess the association between workplace and home smoking restrictions and adolescent smoking. DESIGN, SETTING, AND SUBJECTS: Data were analyzed from 2 large national population-based surveys, the Current Population Surveys of 1992-1993 and 1995-1996, which included 17,185 adolescents aged 15 to 17 years. MAIN OUTCOME MEASURES: Smoking status of the adolescents surveyed, compared by presence of home and workplace smoking restrictions. RESULTS: After adjusting for demographics and other smokers in the household, adolescents who lived in smoke-free households were 74% (95% confidence interval [CI], 62%-88%) as likely to be smokers as adolescents who lived in households with no smoking restrictions. Similarly, adolescents who worked in smoke-free workplaces were 68% (95% CI, 51%-90%) as likely to be smokers as adolescents who worked in a workplace with no smoking restrictions. Adolescent smokers were 1.80 (95% CI, 1.23-2.65) times more likely to be former smokers if they lived in smoke-free homes. The most marked relationship of home smoking restrictions to current adolescent smoking occurred in households where all other members were never-smokers. Current smoking prevalence among adolescents in homes without smoking restrictions approached that among adolescents in homes with a current smoker but with smoking restrictions. CONCLUSIONS: Parents with minor children should be encouraged to adopt smoke-free homes. Smoke-free workplaces can also augment smoking prevention. These findings emphasize the importance of tobacco control strategies aimed at the entire population rather than at youth alone. JAMA. 2000;284:717-722

Adolescent↗
PubMed2002

Clinical characteristics of adolescents later hospitalized for schizophrenia.

Intellectual and behavioral abnormalities, non-psychotic psychiatric disorders, and drug abuse are sometimes present in adolescents who later develop schizophrenia. We followed a population-based cohort of adolescents with baseline assessments of intellectual and behavioral functioning, non-psychotic psychiatric disorders and drug abuse, and ascertained future hospitalization for schizophrenia. Results of the medical and mental health assessments on 16- to 17-year-old male adolescents screened by the Israeli Draft Board, were cross-linked with the National Psychiatric Hospitalization Case Registry, which contains data on all psychiatric hospitalizations in the country. Male adolescents who were later hospitalized for schizophrenia had significantly poorer test scores on all measures in comparison with adolescents not reported to the Psychiatric Registry, the magnitude of the differences was 0.3-0.5 standard deviation (SD). Adolescents (1.03%) of assigned a non-psychotic psychiatric diagnosis, compared to of the adolescents without any psychiatric diagnosis (0.23%), were later hospitalized for schizophrenia. Patients with schizophrenia (26.8%), compared to only 7.4% in the general population of adolescents, had been assigned a non-psychotic psychiatric diagnosis in adolescence (overall OR = 4.5, 95% CI = 3.6-5.6), ranging from OR = 21.5, (<2 >95% CI = 12.6-36.6) for schizophrenia-spectrum personality disorders to OR = 3.6 (<2 >95% CI = 2.1-6.2) for neurosis. The prevalence of self-reported drug abuse was higher in adolescents later hospitalized for schizophrenia (12.4%), compared to the prevalence of drug abuse in adolescents not later hospitalized (5.9%); adjusted RR = 2.033, 95% CI = 1.322-3.126. These results reflect the relatively common finding of impaired intellectual and behavioral functioning, the presence of non-psychotic psychiatric disorders, and drug abuse, in adolescents later hospitalized for schizophrenia, together with the relatively low power of these disorders in predicting schizophrenia.

Adolescent↗
PubMed2004

Determination of dietary habits as a risk factor of cardiovascular heart disease in Turkish adolescents.

BACKGROUND: To investigate dietary habits and evaluate these with regard to cardiovascular risk status in Turkish adolescents aged 12-19 years. METHODS: A total of 300 adolescents, 135 males and 165 females aged between 12 and 19, were included in the study. Dietary intake was determined by using 3-day food records (including 1 weekend day). Adolescents' smoking habits and familial chronic diseases were recorded. The values obtained for energy and nutrient intakes were compared with RDA and DRI and recommendations given by AHA. RESULTS: The mean energy intakes of male and female subjects were 1964 +/- 723 kcal and 1804 +/- 486 kcal respectively. According to NHANES III, age-standardized (CDC: Centers for Disease Control and Prevention) prevalence of overweight indicated that 20.7% among male and 17.5% among female adolescents were at risk for becoming overweight. The prevalence of premature CHD family history was found to be 9.6% for males and 11.5 % for females. The prevalence of current smoking was found to be 22.2 % for males and 18.2 % for females. In addition, 29.6% of the males and 37.6% of the females were physically inactive (p < 0.05); however, male adolescents (48.2%) were significantly more likely than female adolescents (52.1 %) to report sufficient moderate physical activity (p < 0.05). The dietary fiber intake was slightly below the recommended intake of 10 g per 1000 kcal. Compared to the AHA averages, these adolescents had significantly higher intake of total fat, saturated fat, sodium and dietary cholesterol and lower intake of polyunsaturated fat, monounsaturated fat and dietary fiber. The Turkish adolescents also had higher amounts of energy from fat. The mean percentage of energy from fat was 34.2 +/- 6% TE for males and 35.2 +/- 6.8 % TE for females; saturated fat was 11.8 +/- 6.8 % TE for males and 12.1 +/- 8.9 for females. The intake of fat and saturated fat was higher than the AHA recommendations. The polyunsaturated to saturated fat ratio was 0.4 +/- 0.2 and reflected a high saturated fat (12.0 +/- 7.7% TE) and low polyunsaturated fat (5.5 +/- 3.9 % TE) diet. In addition, the percentage of adolescents who did not meet 66% of RDA for vitamin E, B6, and folates and the recommendation for RDA dietary fiber is presented. Approximately, 80% of adolescents failed to meet the dietary recommendation of the AHA for polyunsaturated fatty acids, and about 26.7% reported a cholesterol intake higher than 100 mg/1000 kcal. CONCLUSION: It can be said that fiber, total fat, saturated fatty acid, cholesterol and sodium intake of Turkish adolescents are found to be high; however, their vitamin E, vitamin B6 and folate intake are found to be low compared to AHA recommendations. Turkish adolescents' fruit and vegetable intake are also found to be low.

Adolescent↗
PubMed1985

Pulse rate, blood pressure and body composition in black adolescents: the Philadelphia Blood Pressure Project.

Patterns of pulse rate, blood pressure (BP), and body size and composition are investigated in a black urban sample of over 600 adolescents (aged 12-17) in Philadelphia as part of the Philadelphia Blood Pressure Project. Supine and seated pulse rates decline after the age of 13 in both males and females, and females have significantly higher pulse rates than males, ranging from 1.6 to 4.7 beats/30 sec higher depending upon chronological age and position. Seated pulse rates are consistently higher than supine in both sexes ranging from 1.3 to 2.9 beats/30 sec depending upon chronological age. Pulse rate and both systolic blood pressure (SBP) and diastolic phase IV blood pressure (DBP) show a positive association throughout adolescence for females (r = 0.16 SBP, r = 0.24 DBP) but not for males (r = -0.06 SBP, r = 0.06 DBP). Females in the highest diastolic IV blood pressure stratum (greater than 85%) maintain higher pulse rates throughout adolescence, while males with the highest DBP have higher pulse rates in early adolescence (ages 12-14) but lower pulse rates in later adolescence (ages 16 and 17). Females with the highest DBP also show consistently higher measures of relative fatness (triceps skinfolds) throughout adolescence. Males with the highest DBP have greater triceps skinfolds in early adolescence and lower triceps in later adolescence, a pattern similar to that shown for pulse rate. For DBP, triceps is significantly and positively associated with pulse rate in the upper DBP percentile group (p less than 0.05). Thus, females with the highest blood pressure during adolescence are characterized by higher pulse rate and greater fatness. Males show this same pattern in early adolescence; whereas, in contrast, the older adolescent males in our sample with the highest DBP are characterized by lower pulse rates, relatively decreased fatness, and increased muscularity. Our findings suggest that, at least in some older black male adolescents, a higher DBP may reflect a decrease in cardiac output as indicated by a lower pulse rate, or an increase in peripheral vascular resistance, possibly associated with relatively decreased fatness and increased muscle mass for size.

Adolescent↗
PubMed1995

Adolescent victims of sexual assault.

PURPOSE: The purpose of this study was to evaluate a group of female adolescent victims (n = 176) of sexual assault and assess the similarities and differences between them and older female victims. METHODS: All the adolescents in this study were physically mature. The demographic data and the findings of the medical evaluation are compared with those of women, 25-44 years of age, who were assaulted during the same time period (n = 197). RESULTS: The mean age of the adolescent patients was 15.2 (+/- 1.6), while the control group had a mean age of 31.9 (+/- 5.1). Racial distribution was similar in both groups. One hundred thirty-nine (79%) adolescents reported prior consensual sexual activity and 32 (18%) had been pregnant at least once. Thirty-one adolescents (19%) reported a previous sexual assault. Many adolescent victims (64%) knew their assailant. Weapons or physical force was used less frequently to subdue an adolescent victim, and firearms were used very infrequently in adolescent assault. Use of alcohol or drugs just prior to the assault was prevalent among adolescent victims (47%). Finally, adolescent victims were less likely to sustain physical injuries during the assault. CONCLUSION: The preexisting relationship between the victim and the assailant may explain other elements that distinguish an adolescent rape victim from her adult counterpart. Compared to adolescent victims, the assault on adult women is more often perpetrated by a stranger, the victim is more likely to be abducted, and weapons, especially firearms, are more likely to be used to carry out the victim's capture.

Adolescent↗
PubMed2005

[Longitudinal changes in body composition and basal metabolic rate in institutionalized or domiciled obese adolescents].

UNLABELLED: The prevalence of obesity in children has increased dramatically during the past decades, and requires efficient care. OBJECTIVES: To determine changes in anthropometric parameters and basal metabolic rate (BMR) in obese adolescents during and after 2 types of weight-reduction programs. SUBJECTS AND METHODS: Twenty-six adolescents (group I, Z-score of BMI = 4.72) followed a 9-month-weight reduction program including a moderate energy restriction and regular physical activities in a specialized institution. In addition, 39 adolescents (group E, Z-score of BMI = 2.83) followed at home a 9-month-weight reduction program including medical and dietetic advices. Body composition (by impedancemetry) and BMR (by indirect calorimetry) were assessed before the beginning (M0), 4 months after (M4) and at the end (M9) of the programs, then 4 months (M13) and 16 month (M25) after the end of the weight-reduction programs. RESULTS: Twenty-two adolescents in group I and 20 adolescents in group E completed the study. At M0, age, body weight (BW), fat-free mass (FFM) and BMR of subjects of group I were higher (1.0 year, 36 %, 30 % and 23 %, respectively, P < 0.001), than those of group E. Pubertal stage and percentage of fat mass (FM) were not significantly different between the 2 groups. At M9, adolescents of group I showed significant reductions in BW and FM (-19 and -37 %, respectively, P < 0.001), but not significant differences in FFM. In addition, BMR decreased significantly between M0 and M4, both in absolute value (-6.7%, P < 0.001) and after adjustment for FFM (-5.8%, P < 0.001), and the difference was maintained until M9. Between M9 and M13, BW and Z-score of BMI were maintained in 12 adolescents, but increased (+9.7% and 14.8%, respectively, P < 0.001) in 10 adolescents. However, BMR did not change significantly in all adolescents. Between M13 and M25, BW, FM, FFM and BMR increased significantly (+13%, +34%, +6% et +5%, respectively, P < 0.001). During the 25 month period, adolescents of group E showed significant increases in BW, FFM and BMR (+8%, +14% and +10%, respectively, P < 0.001), and maintained their Z-score and FM. CONCLUSION: The reduction in BMR during the weight-reduction program at the institution could contribute to body weight regain in the post-obese adolescents if they do not maintain the lifestyle habits taught during the weight-reduction period. In other respects, Z-score was stabilized in 51% of domiciled obese adolescents.

Adipose Tissue↗
PubMed2006

Predictors of future depression in early and late adolescence.

BACKGROUND: This study examined whether the possibility to predict future DSM-IV depressive disorder can be increased with recurrent screening for depression in community adolescents, compared to single screening in early or in late adolescence. In addition, it examined which depressive symptoms in early and late adolescence predicted future depressive disorder most accurately. METHODS: Participants from an ongoing longitudinal cohort study were assessed when they were aged between 10 and 15 (early adolescence), and between 14 and 19 (late adolescence), and were followed until they were 20-25 (young adulthood). The Child Behavior Checklist (CBCL) and Youth Self-Report (YSR) were used to screen for depression in early and late adolescence, and CIDI/DSM-IV diagnoses of depressive disorder were used as the outcome measure during follow-up. RESULTS: Recurrent screening only slightly improved the prediction of future depression, and cognitive and physical symptoms in late adolescence predicted future depression accurately in boys. Sleeping problems in early adolescence predicted future depression in girls. LIMITATIONS: The main limitation was the retrospective recall of the age of onset of a depressive disorder. CONCLUSIONS: Recurrent screening for depression did not predict future depressive disorder better than single screening in late adolescence. However, depressive symptoms like sleeping problems predicted future depression quite accurately in adolescent boys and girls. This indicates that it may be useful to screen adolescents for the presence of such symptoms, for instance in school settings, to predict which adolescents are at risk to develop DSM-IV depressive disorder in early adulthood.

Adolescent↗
PubMed2005

Comparisons of adolescent and parent willingness to participate in minimal and above-minimal risk pediatric asthma research protocols.

PURPOSE: Through the processes of permission and assent, parents and adolescents have a shared involvement in decision-making about adolescent research participation. Yet little empirical data exists examining the prevalence and contexts in which adolescents and parents disagree on research participation decisions. The purpose of this study was to compare parent and adolescent willingness to participate in minimal and above-minimal risk pediatric asthma research protocols. METHOD: Thirty-six adolescents diagnosed with asthma and a parent of each, independently rated their willingness to participate in nine pediatric asthma research protocol vignettes. The selected protocols were chosen by an expert panel as representative of typical minimal and above-minimal risk pediatric asthma studies. RESULTS: Parents and adolescents were significantly less likely to enroll in above-minimal risk studies. However, this was qualified by a finding that adolescents were significantly more willing than parents to enroll in above-minimal risk research. Across all nine studies, parents and adolescents held concordant views on participation decisions 60% of the time, on average. Perception of potential study benefit was the most frequent reason provided for participation decisions by both parents and adolescents. CONCLUSION: Parents and their adolescents report substantial discordance in their views about participating in asthma research across a variety of protocols. These differences of opinion highlight the need to carefully consider the process by which families are offered the option of adolescent research participation. Investigators may want to adopt recruitment procedures that involve adolescents in initial discussions, especially for above-minimal risk studies.

Adolescent↗
PubMed2006

Understanding confidentiality: perspectives of African American adolescents and their parents.

PURPOSE: To identify adolescents' and parents' understanding of confidentiality in the patient/doctor relationship. METHODS: In the teen clinic of an academic hospital, questionnaires were administered separately to 50 accompanying parents and 50 adolescents aged 13 to 17 years. The true/false questions were designed to identify both adolescents' and parents' perceptions of the general breadth and limitations of confidentiality and specifically related to selected high-risk behaviors. RESULTS: Most adolescents and parents understood confidentiality to mean that conversations, testing and treatments about certain aspects of health care could be kept private between a doctor and patient. However, most parents felt that confidentiality guidelines did not apply to patients under 18 years. In contrast to 36% of adolescents, 96% of parents believe that the doctor would discuss any conversation the doctor had with the patient that might be important to the parent in spite of adolescents' wish for them not to be told. Parent/adolescent dyads agreed regarding the general value of a confidential adolescent/doctor relationship and the application of confidentiality to certain topics but disagreed with respect to others. CONCLUSIONS: The adolescents and parents in this study have a good understanding of the meaning of confidentiality but are less clear on its application to the adolescent patient/doctor relationship. Nearly all adolescents and their parents appreciate the circumstances under which confidentiality will be breached. The protections confidentiality offers adolescents are understood less well by both parties, but parents seem to have a greater degree of misunderstanding. Parents believe that the doctor will inform them about many of their adolescents' high-risk behaviors. These false impressions may lead to assumptions, miscommunication, and conflict in the adolescent patient/doctor/parent triad.

Adolescent↗
PubMed2006

Anxiety levels in adolescents who stutter.

UNLABELLED: High levels of anxiety can negatively affect the lives of children and adolescents. Thirty-six adolescents who stutter and 36 adolescents who do not stutter were administered standardized scales for anxiety and self-esteem. Significant differences were found for the total T-scores for Revised Children's Manifest Anxiety Scale for the two groups, although both groups mean T-scores were within normal range. Eighty-three percent of adolescents who stutter and 95% of adolescents who do not stutter earned scores in the normal range. No significant differences were found on the self-esteem scale, with 86% of adolescents who stutter and 97% of adolescents who do not stutter earning scores in the normal/positive range. Adolescents who stutter with co-occurring disorders displayed significantly higher levels of anxiety than adolescents who stutter with no co-occurring disorders. No significant differences were found between groups on ethnicity, socioeconomic class, gender and anxiety levels. A positive, significant correlation between anxiety scores and self-esteem scores was found for both groups. LEARNING OUTCOMES: Readers will learn about and understand (a) the role of anxiety and self-esteem in stuttering; (b) the methods used to evaluate anxiety and self-esteem in adolescents; and (c) the similarities between adolescents who stutter and adolescents who do not stutter on anxiety and self-esteem scales.

Adolescent↗
PubMed1990

Adolescent wellness. Facilitating compliance in social morbidities.

The establishment of a well adolescent schedule needs to be developed similar to the scheduled clinical visits in pediatric care. However, providing adolescent wellness visits without appropriate financial reimbursement for time expended and without increased provider training may make "well" adolescent visits an unrealistic expectation. However, two major trends will significantly impact on the future of adolescent health care. These include a sharp increase in numbers of adolescents beginning in 1990 and the poverty within the adolescent population. These data suggest that obstacles, whether personal, financial, or educational, need to be addressed quickly in order to resolve these problems because of increasing numbers of adolescents and related morbidities through the year 2000. The increasing trend of juvenile poverty in this population has been significantly associated with a number of the new morbidities such as substance abuse, STD, pregnancy, and the latest morbidity, AIDS. Without a wellness schedule, it is likely that adolescents will continue to represent an underserved population; as a consequence, mortalities and morbidities will increase through the year 2000. The issue of adherence to prescribed medical regimens in the adolescent population is an interesting, complex, and especially challenging one when faced with the social morbidities. Although preliminary work in this area has progressed in the last 15 years, greater attention must be paid to the needs of adolescents in order to determine effective strategies that can minimize the effects of the current morbidities. It is important for the primary care physician not to become overwhelmed with the scope of problems that adolescents have or become discouraged because anticipatory guidance seems ineffective. Repeated dosages of anticipatory guidance should not be viewed as limitations or failures but rather as necessary and standard care. One should consider such interventions as similar to immunizations, in which certain vaccines result in life-long immunity. One would not eliminate the tetanus vaccine because the patient must receive periodic boosters. Similarly, as health care professionals, we should not consider interventions designed to preclude behavior or mental health problems as failures if periodic and developmentally appropriate relevant "boosters" are necessary. Anticipatory guidance is an extremely effective tool that every primary care physician has at his or her disposal to assist in the diagnosis of problematic behavior in adolescents and to preclude problems. Future research needs to focus on documenting strategies that can be utilized by physicians on a daily basis without excessive time or financial constraints.(ABSTRACT TRUNCATED AT 400 WORDS)

Adolescent↗
PubMed2003

Adolescent endometriosis: diagnosis and treatment approaches.

OBJECTIVES: To review the etiologies, diagnosis, and treatment options of adolescent endometriosis. METHODS: Review of publications relating to adolescent endometriosis. RESULTS: Endometriosis occurs in adolescents as young as 8 years of age; furthermore, there have been documented cases of endometriosis occurring prior to menarche. Adolescents presenting with pelvic pain are treated with cyclic combination oral contraceptive pills and nonsteroidal anti-inflammatory agents. If the pain does not respond to these therapies, then in adolescents as in adults, an operative laparoscopy is recommended for the diagnosis and surgical management of endometriosis. The operating gynecologist should be familiar with the appearance of the complete spectrum of various morphologies of endometriosis, as adolescents tend to have clear, red, white, and/or yellow-brown lesions more frequently than black or blue lesions. Subtle clear lesions of endometriosis may be better visualized by filling the pelvis with irrigation fluid so that the clear lesions can be appreciated in a three-dimensional appearance. Young women who are found to have endometriosis by laparoscopy may present with acyclic, cyclic, and constant pelvic pain. Adolescents with pelvic pain not responding to conventional medical therapy have approximately a 70% prevalence of endometriosis. It is known that endometriosis is a progressive disease and since there is no cure, adolescents with endometriosis require long-term medical management until the time in their lives when they have completed childbearing. Psychosocial support is extremely important for this population of young women with endometriosis. CONCLUSIONS: Endometriosis occurs in adolescents, and presenting symptoms may vary from those seen in adult women with the disease. All health care providers must be aware of the existence of adolescent endometriosis. They should also be aware of the presenting symptoms so that the adolescent can be appropriately referred to a gynecologist comfortable with medical and surgical treatment options in this patient population. If laparoscopy is to be undertaken, the gynecologist must be prepared not only to diagnose but to surgically manage endometriosis. In addition, the subtle laparoscopic findings of endometriosis in adolescents must be recognized for an appropriate diagnosis. Long-term medical therapy will hopefully decrease pain and the progression of the disease, thus decreasing the risk of advanced-stage disease and infertility.

Adolescent↗