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Adolescents' perceptions of risk for HIV infection: implications for future research.

Few studies have investigated adolescents' perceptions of their risk for HIV infection. Findings from two studies of adolescents in Massachusetts indicate that there are differences in the knowledge, beliefs, behaviors, and perceptions of risk among adolescents and suggest the need for understanding the differences among adolescents from different racial or ethnic backgrounds. In both studies, white students were the most knowledgeable about casual, sexual, and drug use transmission of HIV followed by black, Hispanic, and Asian students. In both studies more black adolescents than other racial or ethnic groups were sexually active, and black and Hispanic adolescents began having sexual intercourse at an earlier age than white or Asian adolescents. Asian and Hispanic adolescents were most worried about getting AIDS. Although more Hispanics than other groups reported changing their behavior because of AIDS, fewer of them who had changed their sexual or contraceptive behavior were using effective methods. Despite clear differences in the perceived risk of getting AIDS among these adolescents, the underlying reasons remain to be explicated, using, among other data collection methods, ethnographic techniques to probe adolescents' risk perceptions, their understandings of sickness, and their explanatory models of AIDS. Life events affect risk taking behaviors and also shape perceptions of risk. To understand what it is that adolescents consider 'risky' requires seeing their life options as they do in the larger context of their aspirations and worries about how 'to fit in'.

Acquired Immunodeficiency Syndrome↗

Adolescents' perception of body weight and parents' weight for height status.

PURPOSE: To obtain data on the relationships between weight for height status, in adolescents and their parents, and adolescents' perceptions of body image and weight-loss behavior. METHODS: Weight and height were measured in both parents and adolescents from 213 families with an adolescent child aged 14-15 years who were participating in a community-based study of risk factors for coronary heart disease in Geelong, Australia. Information on adolescents' perceptions of body image, desired weight, and weight loss behaviors was obtained by questionnaire. RESULTS: Forty-one percent of the girls and 14% of the boys considered themselves overweight while 18% of both boys and girls were in this category on the basis of their body mass index (BMI). Most boys tended to see themselves as of normal weight while only girls below the 10th centile for BMI consistently rated themselves as normal. Adolescents who rated themselves as slim had parents whose BMI was significantly lower than that of the parents of adolescents who rated themselves as overweight. A significant proportion of adolescent girls (69%) and boys (27%) had at some time tried to lose weight. Female, but not male, adolescents of normal BMI who had tried to lose weight were themselves heavier and had significantly heavier mothers, but not fathers, than those in the normal range for BMI who had not attempted to do so. Adolescents who perceived an advantage in gaining weight had significantly shorter and lighter, but not leaner, fathers than those who perceived an advantage in losing weight. Only individuals below the 10th centile for BMI appeared to be content with their weight. On average the weight desired by girls and boys in the normal range for BMI was 6.6 and 2.0 kg less than their actual weight, while their desired height was 8.0 and 12.8 cm more than their actual height. CONCLUSIONS: The findings confirm gender differences in perceptions of and attitudes to body weight and body build. They also provide evidence for an association between adolescents perceptions of body weight and parents' weight for height status and suggest that the size of the "gap" between desired and actual weight is associated with the prevalence of weight-loss behavior.

Adolescent↗

Supervisory neglect and adolescent alcohol use disorders: effects on AUD onset and treatment outcome.

BACKGROUND: While parental supervision has been demonstrated to influence adolescent alcohol involvement, lack of a threshold defining inadequate supervision and little study of DSM defined alcohol use disorders (AUDs) have limited clinical applications. Utilizing a four-item supervision scale, this study identified adolescents with inadequate supervision, and examined effects on AUD development and treatment outcome. METHODS: Two groups of adolescent subjects (ages 14-17) were recruited: (1) a representative community sample of adolescents (n = 170) and (2) adolescents with AUDs from drug and alcohol or psychiatric treatment programs (n = 194). Supervision was determined by the adolescent's responses to items inquiring whether parents typically had knowledge of the adolescent's activities away from home, including with whom, where, when, and communication items. Adolescents with unusually low parental supervision (i.e., Supervisory Neglect) were identified by scale distributions. Follow-up assessments were conducted 1, 3, and 5 years after the initial assessment. RESULTS: Among community subjects, adolescents with inadequate supervision were significantly more likely to drink alcohol in a variety of situations, were more likely to have AUDs at the initial assessment and, among those without AUDs, were more likely to develop AUDs in the follow-up period. Among adolescents receiving treatment for AUDs, those with inadequate supervision were less likely to be free of AUD symptoms over a 1-year follow-up period. CONCLUSIONS: These results indicate that the described method was a straightforward and potentially clinically applicable approach to identifying adolescents with inadequate parental supervision.

Adolescent↗

African-American and Hispanic adolescents' intentions to delay first intercourse: parental communication as a buffer for sexually active peers.

PURPOSE: Parents and peers often create conflicting influences on adolescent sexual delay. This study examines the moderating effects of mothers' responsiveness during sex discussions on the negative relationship between sexually active peers and sexual delay among African-American and Hispanic adolescents. METHODS: Interview data from 530 African-American and Hispanic non-sexually active high school students were used to examine the effects of mother-adolescent sex discussions and peer norms on intentions to delay or initiate intercourse within the next year. Logistic regression was performed to test the moderating effects of adolescents' reports of mothers' responsiveness (openness, comfort, and understanding during sex discussions) on the relationship between perceived peer sexual activity and adolescent sexual delay. RESULTS: The relationship between mothers' responsiveness during sex discussions, peer sexual activity, and their effects on adolescent sexual delay is complex. Mother's responsiveness had a buffering effect on the negative effects of sexually active peers. Among adolescents who perceived a high percentage of their peers to be sexually active, those who reported that their mothers had above-average responsiveness were 1.6 times more likely to plan to delay intercourse than were adolescents who reported that their mothers had average responsiveness. CONCLUSIONS: Parents and peers are mutually contingent influences in the dynamic social context of adolescents' lives. Although sexually active peers have a negative effect on adolescent sexual delay, responsive parent-adolescent sex discussions can buffer these effects. Intervention efforts can help parents develop the knowledge and communication skills they need to discuss sexual topics with their children effectively.

Adolescent↗

Adolescents' knowledge of and beliefs about herbs and dietary supplements: a qualitative study.

OBJECTIVE: To explore adolescents' knowledge of and beliefs about dietary supplements, including herbs, and over-the-counter (OTC) medications. METHODS: Eighteen focus groups with 81 adolescents in Monroe County, New York, explored teens' familiarity with and beliefs about CAM, specifically dietary supplements. We asked about general health beliefs and opinions of OTC medications to provide a framework for understanding how dietary supplements are conceptualized. Groups were conducted with suburban adolescents, urban minority adolescents, adolescents with chronic illness, (asthma, eating disorders, and diabetes), and patients of complementary/alternative practitioners ("CAM practitioners"). Transcripts were analyzed for themes relating to prevention ("staying healthy") and treatment of illness ("getting better"); direct quotations are used to illustrate adolescents' views. RESULTS: Most adolescents are familiar with "herbal medicine," "herbal remedies," or "nutritional supplements," and are able to name specific products or complementary/alternative medicine (CAM) therapies; however, many are unfamiliar with the term "alternative medicine." Adolescents are more familiar with remedies or CAM therapies commonly used by people from their own cultural or ethnic background. Older suburban females and those with chronic illnesses are more familiar with herbs and supplements than other adolescents. Most supplement use is conceptually linked with treating illness rather than with preventive care. CONCLUSIONS: Most adolescents are familiar with culturally based herbal products and nutritional supplements, used for treatment of illnesses, and not for preventive care. Providers and researchers should consider chronic illness status and culture/family tradition, and clarify terms, when asking adolescents about self-care, OTCs, or CAM.

Adolescent↗

Tobacco use among immigrant and nonimmigrant adolescents: individual and family level influences.

PURPOSE: To identify individual and family level characteristics that might explain differences in rates of tobacco use among immigrant and nonimmigrant adolescents. METHODS: Data for analysis come from a probability sample of 5401 adolescents aged 12-18 years participating in the Ontario Health Survey (OHS). Three groups were compared: (a) adolescents born in Canada to Canadian-born parents (n = 3886), (b) adolescents born in Canada to immigrant parents (n = 1233), and (c) adolescents born outside of Canada (n = 282). Discrete, multilevel logistic regression was used in the analysis. RESULTS: Adolescents born outside of Canada report the lowest rates of tobacco use, despite greater economic hardship. A negative association emerges between family socioeconomic status and tobacco use among adolescents born in Canada but not among adolescents born outside of Canada. Immigrant youth are less likely to affiliate with peers who smoke and are more likely to come from families where parents do not smoke: these differences partially explain the decreased rates of tobacco use among immigrant adolescents. CONCLUSIONS: Although subject to greater economic hardship, immigrant youth are less likely to engage in tobacco use. Protective factors associated with immigrant family life, such as lower rates of parental tobacco use and less exposure among immigrant adolescents to peers who smoke, may counteract some of the negative effects of poverty and social hardship. Future research should begin to address the processes that lead to adaptive outcomes among adolescents from immigrant families, despite greater exposure to social disadvantage.

Adolescent↗

Improving the health and well-being of adolescent boys.

Adolescent men are at risk of having significant unmet health care needs. Like adolescent girls, they have complex health care needs and are more likely than younger children to be to be uninsured. They are less likely than women and other age groups to seek medical attention from traditional sources of care. Because of inadequate youth-oriented services, as well as teens' developmental stage, they have a tendency to receive care that is brief and problem oriented [20]. Such care is not likely to address complex problems that may be related to risk behaviors. Adolescent boys are also more concerned with the skills of the provider offering services than with the system in which the provider functions. Opportunities for outreach to adolescent men exist within many institutions. Nurses as advocates, educators, counselors, and providers of preventive health care have a creative opportunity for enhancing services to the teenage boy. The school is a natural place to begin as adolescents spend a significant part of each day there. Family planning and STI clinics are a source of care that are not well used by adolescent males, but when they do attend it is an opportunity to identify problems, provide counseling and referrals, and offer continuity. These health care institutions are not often welcoming or comfortable for the male youth. Use of these clinics will be enhanced by providers demonstrating increased acceptance of the adolescent when he attends as well as actively requesting that he attend with his partner. The most unusual but sorely needed outreach must be made to incarcerated and delinquent adolescent male. Residential facilities for delinquent youth need to be encouraged to provide a multidisciplinary comprehensive medical, mental health, and social services model. This approach will not only benefit the adolescent but the youth's community as well. Emergency rooms represent another crucial, missed opportunity to connect with young men. With some forethought and follow-up, emergency departments must become connected to appropriate and accessible adolescent primary care resources in the community. Finally, adolescent men are an underinsured population. Nurses can be important advocates of available state insurance funds, sliding scale or free services to youth, and must be a voice in youth policy-making.

Adolescent↗

Selective screening for gestational diabetes mellitus in adolescent pregnancies.

OBJECTIVE: It is unclear whether it is cost-effective to universally screen adolescent gravidas for gestational diabetes mellitus (GDM). Our objective was to identify the prevalence of gestational diabetes in our adolescent population and to review risk factors that would most easily identify a subset of adolescent patients at greatest risk for the development of gestational diabetes. METHODS: Six hundred thirty-two adolescents were identified from 11,486 deliveries in our institution through International Classification of Diseases (9th edition) codes. Eleven of those adolescents had GDM. Their charts and those of a representative group of nondiabetic adolescent gravidas were analyzed for GDM risk factors, including race/ethnicity, body mass index (BMI), family history of diabetes, other medical disorders, and previous history of GDM, macrosomia, stillbirths, or anomalous fetus. Statistical analyses used chi2 and Student t tests as appropriate. RESULTS: The prevalence of GDM among adolescent gravidas was 1.7%. No difference was identified between the adolescent pregnancies with GDM and the comparison group for race/ethnicity, family history, or presence of medical disorders. Risk factors requiring a previous obstetric history could not be evaluated adequately because of the high prevalence of nulliparas. There was a higher prevalence of BMI over 27 in adolescents with GDM (P < .001). CONCLUSION: Body mass index is an important risk factor for the development of gestational diabetes in adolescent gravidas. We recommend that selective screening for GDM of adolescent gravidas be performed on the basis of BMI.

Adolescent↗

Adolescent health care in a pediatric emergency department.

STUDY OBJECTIVE: We examined the use of the pediatric emergency department of an urban children's hospital by adolescents. This study included visits by all adolescents aged 13 to 18 years in a 1-week period from each season during 1992. RESULTS: The ED saw 426 adolescents, representing approximately 15% of the total ED visits. Fifty percent of these patients were male. More than half of the patients were black; a few were members of other minority groups. Eighteen percent had emergency, 60% urgent, and 21% nonurgent conditions. Forty-three percent of the patients came to the ED between 3 PM and 11 PM. Injuries accounted for 47% of male visits and 42% of female visits. Approximately half of the injuries resulted from violent events. Twenty-seven percent of the visits were for exacerbation of a chronic illness such as asthma or diabetes. The most common reason for adolescent female visits was gynecologic problems. Injury was the most common reason for adolescent male visits. Only 27% of the adolescents lived in a two-parent home. In 16% of the cases, the adolescents were treated without consent. Nineteen percent of the adolescents were uninsured, and nearly 50% were publicly insured. CONCLUSION: Issues of violence, consent, and insurance present problems for many adolescents in the pediatric ED. Injuries, particularly those related to violent events, are cause for many adolescent visits. ED staff members should develop plans to care for the complex psychosocial and medical problems of adolescents.

Adolescent↗

Eligibility and enrollment of adolescents in Medicaid and SCHIP: recent progress, current challenges.

PURPOSE: To examine the effect of recent federal and state policy changes on adolescents' eligibility and enrollment in Medicaid and the State Children's Health Insurance Program (SCHIP). METHODS: By analyzing relevant provisions in federal and state laws, approved state plans and amendments, annual reports and evaluations, and enrollment data provided by states, this article explores the extent to which states have taken full advantage of opportunities to expand Medicaid and SCHIP eligibility for adolescents. RESULTS: Between March 1997 and September 2001, states made significant progress toward expanding Medicaid and SCHIP coverage for adolescents. During that time, the number of states that provided Medicaid coverage to all poor adolescents aged younger than 19 years doubled, most states eliminated the disparities that previously existed in Medicaid eligibility levels for younger children and adolescents, and virtually every state raised the income level at which adolescents are eligible for public coverage in either Medicaid or SCHIP. These changes resulted in an increase in the number of adolescents who are enrolled in Medicaid and SCHIP. Nevertheless, many states implemented other policies that create barriers to adolescents' eligibility and enrollment. CONCLUSIONS: Despite recent expansions of public insurance eligibility, millions of adolescents remain uninsured. Much work remains to address eligibility gaps and to ensure that eligible adolescents are actually enrolled and use services. The current political and economic environment threatens to undermine the ability of adolescents to access services through these important programs.

Adolescent↗

Pregnant adolescents: experiences and behaviors associated with physical assault by an intimate partner.

OBJECTIVE: To better understand the experiences and behaviors of battered pregnant adolescents and the characteristics of their intimate partners. METHODS: As part of a longitudinal multiracial/ethnic study of drug use among pregnant and parenting adolescents, 724 adolescents < or = 18 years of age completed face-to-face interviews on the postpartum unit between April 1994 and February 1996. Adolescent mothers reported on demographic characteristics, social support and peer contact, level of substance use before and during pregnancy, nonconforming behaviors, and both lifetime and concurrent exposure to violence. Information about the father of her baby included his level of substance use, gang and police involvement, and intimate partner violence. Chi-square and Student's t tests were used to identify victim, partner, and relationship characteristics associated with being assaulted by the father of her baby during the preceding year. RESULTS: Eighty-six (11.9%) adolescents reported being physically assaulted by the fathers of their babies. Assaulted adolescents were significantly more likely than nonassaulted adolescents to have been exposed to other forms of violence over the same 12-month period, including verbal abuse, assault by family members, being in a fight where someone was badly hurt, reporting fear of being hurt by other teens, witnessing violence perpetrated on others, and carrying a weapon for protection. A history of nonconforming behavior and frequent or recent substance use was more common among both battered adolescents and their perpetrator partners. The age and race/ethnicity of the pregnant adolescent and the length of her relationship with the father of her baby were not associated with assault status. CONCLUSIONS: Pregnant adolescents who are assaulted by intimate partners appear to live in violence-prone environments and to have partners who engage in substance use and other nonconforming behaviors. Comprehensive assessments are critical for all adolescent females at risk of assault, and direct questions about specific behaviors or situations must be used.

Adolescent↗

Bipolar disorders during adolescence.

OBJECTIVE: To examine the incidence, correlates, course and family history of bipolar disorder (BD) and subthreshold BD in adolescents. METHOD: Structured diagnostic interviews were conducted with a large community sample of adolescents and their first-degree relatives, and the adolescents were re-evaluated as young adults. RESULTS: The first lifetime onset of BD and subthreshold BD almost always occurred in adolescence. Adolescent BD and subthreshold BD were associated with elevated impairment, comorbidity, and suicide attempts. Adolescents with BD were at increased risk for BD, and adolescents with subthreshold BD were at increased risk for major depressive disorder (MDD) in young adulthood. Relatives of BD adolescents had elevated rates of subthreshold BD and MDD, and relatives of subthreshold BD adolescents had elevated rates of BD and MDD. CONCLUSION: 'Classical' BD clearly exists in adolescence, but there is also a spectrum of milder bipolar conditions. Remediating and preventing BD in adolescents should be a high public health priority.

Adolescent↗

Association of parental characteristics with adverse outcomes of adolescent pregnancy.

BACKGROUND: It is well-known that pregnancy in adolescence has an increased risk of adverse reproductive outcomes. It remains unclear whether this association is due mainly to the unfavourable sociodemographic status or due solely to biological immaturity of pregnant adolescents. OBJECTIVE: The purpose of this study was to determine the association of parental sociodemographic characteristics with the adverse outcomes of adolescent pregnancy. METHOD: Data from certificates of live births in Taichung County, Taiwan in 1994 of 7994 singleton, first-born babies whose mothers were 15-34 years of age were analysed. The relative risk of having adverse pregnancy outcomes for adolescent subgroups was obtained as compared with that among mothers 20-34 years of age with the same characteristics. The adjusted relative risk of having adverse pregnancy outcomes for each covariate was calculated by a multiple logistic regression analysis. RESULTS: Of 7994 babies born to mothers of 15-34 years of age, 8.3% were born to adolescent mothers. In all age groups, the younger adolescent mothers (15-17 years of age) had the highest percentage of both infants with low birth weight (10.6%) and preterm births (7.1 %). Younger adolescent mothers in almost all sociodemographic categories had higher risks of having both low-birth-weight and preterm births than those of older adolescent mothers. Multiple logistic regression analysis showed that a younger maternal age is the only significant risk factor for having infants with low birth weight (adjusted RR = 2.5, 95% Cl 1.8-4.5 and adjusted RR = 1.7, 95% Cl 1.2-2.6 for younger and older adolescent mothers, respectively) or preterm birth (adjusted RR = 1.9, 95% Cl 1.1-3.4 and adjusted RR = 1.5, 95% Cl 1.0-2.3 for younger and older adolescent mothers, respectively). CONCLUSIONS: Adolescent pregnancy carries an increased risk of having low-birth-weight and preterm births, and a younger maternal age is causally implicated.

Adolescent↗

A comparison of tobacco-related risk factors between adolescents with and without cancer.

OBJECTIVE: To compare adolescents with and without cancer on current smoking status, intentions to smoke, and tobacco-related risk factors. METHODS: Ninety adolescents undergoing treatment for cancer (median time since diagnosis was 2.4 months) and a comparison sample of 279 adolescents without cancer, ages 12 to 18 years, completed questionnaires that asked about their smoking habits, intentions to smoke, and tobacco-related psychosocial risk factors. RESULTS: Approximately 2% of adolescents with cancer and 22% of adolescents without cancer reported current smoking. Compared to nonsmoking adolescents without cancer, nonsmoking adolescents with cancer were one third less likely to report intentions to smoke. No significant interactions were detected between group (having cancer or not) and each of the tobacco-specific and psychosocial variables tested in two separate multivariable models. Intentions to smoke were best predicted by variables most proximal to smoking. Adolescents who smoked in the past and who had lower tobacco knowledge and greater perceived instrumental value were more likely to report intentions to smoke. Adolescents who were less optimistic were also more likely to intend to smoke. CONCLUSIONS: Tobacco-related risk factors for intentions to smoke appeared to be similar among adolescents with and without cancer. Implications of these findings for tobacco control among adolescents with cancer are discussed.

Adolescent↗

Multimethod assessment of suicidality in adolescent psychiatric inpatients: preliminary results.

OBJECTIVE: To examine agreement among multiple assessments of adolescent suicidal ideation and suicidal behavior for adolescent psychiatric inpatients, including pencil/paper checklists; structured and unstructured interviews; and adolescent, clinician, and parent reports, and to provide suggestions for the accurate and reliable assessment of suicidality in adolescence. METHOD: Participants included 153 adolescent psychiatric inpatients (54 boys, 99 girls) between the ages of 12 and 17 years. Measurement of suicidal ideation and behavior included common assessment instruments and standard clinical practices, including the Suicidal Ideation Questionnaire, NIMH Diagnostic Interview Schedule for Children, clinician interview, and parent report (Behavior Assessment Scale for Children). RESULTS: Results revealed significantly different rates of suicidality across each instrument and poor to moderate agreement between similar measures of adolescent suicidal ideation and suicidal behavior. Agreement between measures was generally best for boys, for older adolescents, and for assessments relying on a single informant. Reporters were most likely to agree on the presence of suicidality for more severely suicidal adolescents; this finding suggests that agreement in itself may be a useful marker for adolescent suicide. CONCLUSIONS: Results of this preliminary study supported the use of multiple measurement approaches when examining adolescent suicidality, particularly those that rely on clinician judgment and adolescents' own reports. Implications for future research and for clinical practice are also discussed.

Adolescent↗

Windows of vulnerability to psychopathology and therapeutic strategy in the adolescent rodent model.

Adolescence comes in association with puberty, when maturation and rearrangement of major neurotransmitter pathways and functions are still taking place. The neurobiological processes occurring in the brain during this developmental period have been so far poorly investigated. Yet, it is during adolescence that some major neuropsychiatric disorders may become evident, including ADHD, schizophrenia, and drug abuse. Moreover, the age-related neurobehavioural plasticity renders adolescents particularly vulnerable to the consequences of psychoactive drug exposure. In this view, there is an increased likelihood that addiction will develop when psychoactive drug use starts early during adolescence. From all these observations adolescence emerges as a critical phase in development. In the present review, we focus on recent neurobiological characterization of adolescent rats and mice. As for vulnerability to addictive behaviour, nicotine exposure during adolescence dose-dependently down-regulated levels of AMPA GluR2/3 subunits in the striatum, suggesting a reduced neurobehavioural plasticity in adult subjects. Comparable exposure during adulthood had opposite effects. It was found consistently that exposure to nicotine during adolescence, but not similar exposure in the post-adolescent period, increased the expression of specific subunits of the acetylcholine receptor in adult rats, thus enhancing the reinforcing efficacy of nicotine in a self-administration paradigm. The present data identified a specific age-window, characterized by long-term effects on behavioural and neurochemical indexes, of vulnerability. With respect to potential therapeutic approaches in ADHD, we studied the adolescent spontaneously-hypertensive-rat (SHR) in an intolerance-to-delay operant-behaviour paradigm. The model was further validated by the finding that impulsivity was reduced by chronic methylphenidate administration. Impulsive SHR animals were characterized by reduced cannabinoid CB1 receptor density in the prefrontal cortex. Interestingly, an acute cannabinoid agonist increased levels of self-control behaviour in these animals. The present data suggest that pharmacological modulation of the cannabinoid system might improve some behavioural anomalies seen in ADHD. In conclusion, modelling the adolescent phase in rats and mice appears to be useful for the investigation of determinants of vulnerability to addiction and to other early-onset neuropsychiatric disorders.

Adolescent↗

A qualitative evaluation of an adolescent cancer unit.

MULHALL A., KELLY D. & PEARCE S. (2004) European Journal of Cancer Care13, 16-22 A qualitative evaluation of an adolescent cancer unit The Expert Advisory Group on Cancer (1995) recommended that cancer centres in the UK should make provision for adolescents with cancer. However, although their number is growing, only a small number of specialist adolescent cancer units currently exist, and teenagers may often be treated in more general settings. To date, no formal evaluation of adolescent cancer units has taken place. This study adopted a qualitative approach to evaluate the first specialist adolescent oncology unit, which was established in the UK 10 years ago. The aim was to provide insight into: the culture of the unit; the experiences of patients and parents on the unit and the staff who worked there; and how the unit was valued by these groups. Semi-structured interviews were conducted with 10 teenagers with cancer, 10 parents and 14 professionals. Systematic non-participant observation of routine activities in the unit was undertaken also. Interview transcripts and observational data were analysed to identify key themes and categories. Six categories emerged from the data: (1) cancer and the cancer unit: although the word cancer had negative connotations, it provided a common supportive bond for adolescents and families on the unit; (2) what it feels like over time: key points in the adolescent cancer experience were emphasized as significant. These included diagnosis, end of treatment and recurrence of cancer; (3) physical structures and facilities: these were focused around the needs of adolescents with cancer and helped to provide a suitable environment of care; (4) the social context: approaches to care were relaxed in nature and suited the needs of adolescents and their families; (5) the family: there was an emphasis on maintaining normal routines whilst managing the impact of cancer on family relationships; and (6) specialism and expertise: the availability of an expert team of professionals with specialized insight into adolescents' needs was pivotal to creating an appropriate environment of care. In conclusion, the complex care and treatment needs of adolescents with cancer may best be met by specialist units.

Adolescent↗

Adolescents' proxy reports of parents' socioeconomic status: How valid are they?

STUDY OBJECTIVE: Children's proxy reports on indicators of their parents' socioeconomic status (SES) have either been used uncritically or dismissed as invalid. This paper examines the validity of young adolescents' reports of parental SES by comparing adolescent reports with parents' own reports of SES. DESIGN, SETTING AND PARTICIPANTS: In 1990, 924 13 year olds, along with 648 of their fathers and 735 of their mothers, participated in the baseline survey of The Norwegian Longitudinal Health Behaviour Study. Data on parental occupation were collected from both adolescents and parents at baseline, while data on parental education were collected at follow up from the adolescents at age 15 and from their parents when the adolescents were 19 years old. MAIN RESULTS: Three different ways of grouping the SES categories based on occupational data were investigated, and the strength of agreement was good for all three groups, with kappa statistics ranging from 0.65 to 0.86. There were no significant improvements of agreement when comparing adolescent data from age 15 to adolescent data from age 13. The strength of agreements between the adolescents' and parents' reports of parental education were fair; kappa statistics were 0.30 and 0.38 for fathers' and mothers' education, respectively. The proportions of unclassified answers or no responses from the adolescents were similar for questions on occupation and education, and ranged from 11% to 16%. CONCLUSIONS: The agreement between adolescents' and parents' reports of SES based on occupation was judged to be good, but adding a few specific questions may cue the adolescent to provide more detailed information, thereby reducing the numbers of unclassified answers or non-responders.

Adolescent↗