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PubMed2004

Continuity of binge and harmful drinking from late adolescence to early adulthood.

OBJECTIVE: To test the hypothesis that late adolescent drinking behavior (ages 17-20) is associated with harmful and binge drinking in early adulthood (ages 30-31). METHODS: We used the National Longitudinal Survey of Youth (NLSY), a nationally representative longitudinal data set. We used harmful and binge drinking at ages 17 to 20 to predict harmful and binge drinking at ages 30 to 31, stratifying for gender and controlling for confounders. RESULTS: Data were available on harmful drinking at both the adolescent and the early adult age period for 3790 individuals and on binge drinking for 2387 individuals. Harmful drinking during adolescence was significantly associated with harmful drinking at ages 30 to 31 for men only. Among male adolescents, 14% of harmful drinkers continued harmful drinking at ages 30 to 31, compared with 4% of nonharmful drinkers who became harmful drinkers. In Poisson regression models, binge drinking during adolescence was associated with binge drinking at ages 30 to 31 for both men and women, generating relative risks of 2.3 (95% confidence interval: 1.8-3.0) and 3.0 (95% confidence interval: 2.4-4.8), respectively. Half of binge-drinking male adolescents and one third of binge-drinking female adolescents engaged in binge drinking into early adulthood, compared with 19% for non-binge-drinking male adolescents and 8% of non-binge-drinking female adolescents. CONCLUSIONS: Problem drinking during adolescence is associated with problem drinking in early adulthood. Efforts to prevent and treat adolescent problem drinking could have an impact on the progression of alcohol-related disease.

Adolescent↗
PubMed2004

Are clinical impressions of adolescent substance use accurate?

OBJECTIVE: To compare providers' impressions of adolescents' level of substance use with diagnostic classifications from a structured diagnostic interview. METHODS: Secondary analysis of data was conducted from a validation study of the CRAFFT substance abuse screening test of 14- to 18-year-old medical clinic patients (n = 533) and their corresponding medical care providers (n = 109) at an adolescent clinic affiliated with a large tertiary care pediatric hospital. Medical care providers completed a form that recorded their clinical impressions of patients' level of alcohol and drug involvement (none, minimal, problem, abuse, dependence) and demographic characteristics. The form included brief diagnostic descriptions for each level of use. After the medical visit, patients completed the Adolescent Diagnostic Interview (ADI), a structured diagnostic interview that yields diagnoses of abuse and dependence according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV). On the basis of their past 12 months of alcohol and drug use on the ADI interview, adolescents were classified into 5 mutually exclusive diagnostic groups. "None" was defined by no reported use of alcohol or drugs during the past year. "Minimal use" was defined as use of alcohol or drugs but no report of any substance-related problems. "Problem use" was defined as reporting 1 or more substance-related problems but no diagnosis of abuse or dependence. "Abuse" was defined by meeting any 1 of 4 DSM-IV diagnostic criteria for either alcohol or drug abuse but no diagnosis of dependence. "Dependence" was defined by meeting any 3 of 7 diagnostic criteria for either alcohol or drug dependence, with or without a diagnosis of abuse. Proportions were compared using Fisher exact test. Agreement was assessed with the weighted kappa, and these analyses were stratified by substance used (ie, alcohol vs drug) and demographic characteristics. Sensitivity, specificity, and positive and negative predictive values were calculated from 2 x 2 tables. RESULTS: Compared with the criterion standard interview, providers identified significantly fewer patients with problem use and abuse and no patients with dependence. Of >100 patients whom the ADI classified with substance problem use, providers correctly identified 18. Of 50 patients who were classified with a diagnosis of alcohol or drug abuse, providers correctly identified 10. Of 36 patients who were classified with a diagnosis of alcohol or drug dependence, providers correctly identified none. For the 86 adolescents who were classified with a substance-related disorder (ie, abuse or dependence), providers' impressions were "none" (24.4%), "minimal use" (50%), "problem use" (15.1%), "abuse" (10.5%), and "dependence" (0%). There was only marginal agreement between providers' impressions and diagnoses related to alcohol use (kappa = .29), drug use (kappa = .31), and any substance use (kappa = .30). Kappa was not significantly affected by the patient's age, but it was by gender. Among boys, kappa was significantly higher for impressions of drug use versus alcohol use (kappa = .48 vs kappa = .27); and, among drug users, kappa was significantly higher among boys compared with girls (kappa = .48 vs kappa = .24). Kappa did not differ significantly across race/ethnicity subgroups, although there is a suggestive trend toward higher agreement for black non-Hispanic compared with white non-Hispanic adolescents (kappa = .35 vs kappa = .21). Kappa did not differ significantly on the basis of the visit type, but the size of this difference (kappa = .36 vs kappa = .24) suggests that the longer well-child visit yielded greater identification of substance-related pathology. Providers' impressions had a sensitivity of .63 for identifying use of alcohol or drugs. However, sensitivity was poor for identification of problem use (.14), abuse (.10), and dependence (0), whereas specificity and positive predictive values were high. Of the 86 adolescents with a diagnosis of abuse or dependence, 75.6% were correctly identified by providers as using substances; however, the level of use in 50% of these adolescents was reported by providers as minimal. CONCLUSIONS: In this study, clinical impressions of adolescents' alcohol/drug involvement underestimated substance-related pathology. When providers thought that use was present, there was a very high likelihood that a problem or disorder existed. The use of structured screening devices would likely improve identification of adolescents with substance-related pathology in primary care settings and should be considered for use with all adolescent patients, rather than only those who are perceived to be at higher risk.

Adolescent↗
PubMed2005

Pertussis in adolescents and adults: should we vaccinate?

BACKGROUND: The incidence of reported pertussis among adolescents, adults, and young infants has increased sharply over the past decade. Combined acellular pertussis vaccines for adolescents and adults are available in Canada, Australia, and Germany and may soon be considered for use in the United States. OBJECTIVE: To evaluate the potential health benefits, risks, and costs of a national pertussis vaccination program for adolescents and/or adults. DESIGN, SETTING, AND POPULATION: The projected health states and immunity levels associated with pertussis disease and vaccination were simulated with a Markov model. The following strategies were examined from the health care payer and societal perspectives: (1) no vaccination; (2) 1-time adolescent vaccination; (3) 1-time adult vaccination; (4) adult vaccination with boosters; (5) adolescent and adult vaccination with boosters; and (6) postpartum vaccination. Data on disease incidence, costs, outcomes, vaccine efficacy, and adverse events were based on published studies, recent unpublished clinical trials, and expert panel input. MAIN OUTCOME MEASURES: Cases prevented, adverse events, costs (in 2004 US dollars), cost per case prevented, and cost per quality-adjusted life-year (QALY) saved. RESULTS: One-time adolescent vaccination would prevent 30800 cases of pertussis (36% of projected cases) and would result in 91000 vaccine adverse events (67% local reactions). If pertussis vaccination cost $15 and vaccine coverage was 76%, then 1-time adolescent vaccination would cost $1100 per case prevented (or $1200 per case prevented) or $20000 per QALY (or $23000 per QALY) saved, from the societal (or health care payer) perspective. With a threshold of $50000 per QALY saved, the adolescent and adult vaccination with boosters strategy became potentially cost-effective from the societal perspective only if 2 conditions were met simultaneously, ie, (1) the disease incidence for adolescents and adults was > or =6 times higher than base-case assumptions and (2) the cost of vaccination was less than $10. Adult vaccination strategies were more costly and less effective than adolescent vaccination strategies. The results were sensitive to assumptions about disease incidence, vaccine efficacy, frequency of vaccine adverse events, and vaccine costs. CONCLUSIONS: Routine pertussis vaccination of adolescents results in net health benefits and may be relatively cost-effective.

Adolescent↗
PubMed2005

Posttraumatic stress disorder and physical comorbidity among female children and adolescents: results from service-use data.

OBJECTIVE: In adults, posttraumatic stress disorder (PTSD) is associated with adverse health outcomes and high medical utilization and cost. PTSD is twice as common in women and is associated with increased risk for a range of diseases, chronic conditions, and reproductive-health problems. Little is known about the health effects of PTSD in children. The purpose of this study was to explore patterns of physical comorbidity in female children and adolescents with PTSD by using population data. METHODS: This study was a cross-sectional, descriptive epidemiologic case-control analysis of a Midwestern state's Medicaid eligibility and paid-claims data for girls (0-8 years old) and teens (9-17 years old). Data were from 1994-1997. All those with the PTSD diagnostic code were compared with randomly selected controls in relation to 3 sets of outcomes: (1) International Classification of Diseases, Ninth Revision (ICD-9) categories of disease; (2) chronic conditions previously associated with sexual trauma and PTSD in women; and (3) reproductive-health problems. Analyses included bivariate odds ratios (OR) and logistic-regression models that control for the extent of insurance coverage and the independent associations of victimization and psychiatric comorbidity with the 3 sets of outcomes. The mental health covariate was categorical to allow consideration of a range of severity. There were 4 categories for the young girls: neither PTSD nor depression, PTSD without depression, depression without PTSD, and PTSD + depression. For the adolescent analysis, a fifth category reflecting a "complex PTSD" was added, defined as having PTSD complicated by a dissociative disorder or borderline personality disorder diagnosis. RESULTS: There were 647 girls and 1025 adolescents with the PTSD diagnosis. Overall, PTSD was associated with adverse health outcomes in both age strata. Victimization was sometimes independently associated with adverse health outcomes, but PTSD often was a mediator, especially in the adolescent age stratum. The importance of PTSD diagnosis as a predictor of the ICD-9 categories of disease or chronic conditions seemed to increase with age. In the younger age stratum, the increased bivariate ORs of significant associations with PTSD ranged from 1.4 for digestive disorders to 3.4 for circulatory disorders. Among younger girls, PTSD diagnosis was associated with significantly greater bivariate odds for 9 of the 12 ICD-9 categories of disease but not for neoplasms, blood disorders, or respiratory disorders and with threefold increased odds for chronic fatigue. They also had 1.8 times greater odds for sexually transmitted infections, some of which could be from congenital transmission in this age group, which includes infants. In the multivariate models for the young girls, the mental health variable seemed to mediate the relationship between victimization and increased odds of infectious and parasitic diseases, endocrine/metabolic/immune disorders, circulatory diseases, skin and cutaneous tissue disorders, and having any 1 of the 5 chronic conditions. The mental health categories that were significantly associated with health outcomes varied across the conditions. There were no health outcomes in which the depression-without-PTSD category was the only one significantly associated with the outcome condition. Circulatory and musculoskeletal disorders were significantly associated with all 3 of the mental health categories. Having any 1 of the 5 chronic conditions was significantly associated only with simple PTSD (PTSD without depression). Genitourinary disorders and signs/symptoms/ill-defined conditions were significantly associated with both simple and comorbid PTSD. PTSD with comorbid depression, the most severe of the mental health categories in this younger age group, was the only category associated with the endocrine/metabolic/immune disorders and skin disorders outcomes. In the adolescent age stratum, the bivariate ORs significantly associated with PTSD ranged from 2.1 for blood disorders to 5.2 for irritable bowel syndrome. Adolescents with PTSD were nearly twice as likely to have a sexually transmitted infection and 60% more likely to have cervical dysplasia. However, their rate of pregnancy was lower (23% vs 31%), a one-fourth decreased odds. In the adolescent group, only 4 outcomes (nervous system/sense organ, digestive, and genitourinary disorders and signs/symptoms/ill-defined conditions) remained statistically significantly associated with victimization after the mental health variable was added, suggesting an additive model of risk for these outcomes but a mediating role for PTSD in relation to the majority of the health outcomes. Among the adolescent girls, the range of ORs for the ICD-9 and chronic-condition diagnoses generally increased across the categories of the mental health variable in a dose-response pattern. Compared with adolescents with neither PTSD nor depression, those with PTSD without depression had statistically significant ORs from 1.5 to 3.6. Those with depression without PTSD had statistically significant ORs from 1.9 to 4.4. The significant ORs for those with PTSD comorbid with depression were from 2.3 to 6.6, and those in the complex-PTSD category had significant ORs of between 2.5 and 14.9. Only blood disorders seemed to be more strongly associated with depression alone than with the comorbid and complex forms of PTSD. The simple-PTSD category was not significantly associated with blood disorders, chronic pelvic pain, fibromyalgia, or dysmenorrhea. Depression without PTSD was not significantly associated with chronic pelvic pain or fibromyalgia. Fibromyalgia was only significantly associated with complex PTSD. CONCLUSIONS: In young girls who receive Medicaid benefits, PTSD was associated with increased odds of a range of adverse health conditions. The pattern and odds of physical comorbidity among adolescent recipients with PTSD was nearly as extensive as that seen in adult women. Overall, the pattern observed suggests that objective disease states (eg, circulatory problems, infections) may be associated with PTSD to an extent nearly as great as that of PTSD with more subjective somatic experience of loss of wellness. Using the concepts of allostatic load and allostatic support, professionals who work with children and adolescents may be able to decrease the toll that traumatic stress takes on health even if available interventions can only be thought of as supportive and fall short of completely preventing trauma exposure or completely healing posttraumatic stress. Clinical research to extend these exploratory findings is warranted.

Adolescent↗
PubMed2003

Adolescent and adult alcohol attitudes in a high alcohol consumption community.

The study examines alcohol-related attitudes among adolescents and adults in a high consumption community, exploring whether adolescents and adults hold similar or different views regarding adolescent drinking. Data were gathered from adults in a Midwestern city via random telephone survey of 487 adults (30% with children under the age of 21). Students in grades 6-12 (n = 558) also completed a youth version of the survey in classrooms. Results indicated that becoming a parent was associated with more restrictive attitudes about adolescent alcohol use, regardless of the age of their children. Adolescents aged 14 to 17 had the least restrictive attitudes. Adults aged 18 to 24 (who were not parents) reported values similar to older adolescents. Younger adolescents, while similar to older adolescents in perception of community alcohol problems, were more like parents and older adults in attitudes about adolescent drinking. Both adolescents and adults greatly overestimated actual amounts of community adolescent binge drinking.

Adolescent↗
PubMed1999

Discordance between physician and adolescent assessments of adherence to treatment: influence of HbA1c level. The PEDIAB Collaborative Group.

OBJECTIVE: To compare the subjective assessments (perceptions) of physicians and adolescent diabetic patients on the adolescents' adherence to treatment and to test the hypothesis that the HbA1c level influences physicians' perceptions. RESEARCH DESIGN AND METHODS: In a multicenter cross-sectional survey, 143 adolescents with diabetes (mean age 14.6 years) auto-assessed, while their pediatricians independently assessed, the level of adherence to treatment on a four-point scale. Scores of adherence given by a validated scale and metabolic control (HbA1c) were compared according to those assessments. RESULTS: Agreement between the adherence perceptions from adolescents and physicians was low (kappa = 0.23), and adolescents scored significantly higher (P < 0.001). Mean adherence score to diabetes treatment was significantly higher when the adolescents' perception of their self-care behaviors was good than when it was poor (P = 0.01), but did not significantly differ according to physicians' perception. Mean HbA1c level was significantly lower when the self-care behavior perception was good than when it was poor, both for the adolescents (P = 0.02) and for the physicians (P < 0.001). Multivariate analyses showed that only the adherence scale score was significantly associated with the adolescents' perception (P = 0.015), whereas only HbA1c level was significantly associated with the physicians' perception (P = 0.0008). CONCLUSIONS: By identifying the possible discrepancy between their own assessment of adherence and that of adolescents, and by avoiding the systematic attribution of poor metabolic control to poor adherence, physicians could generate a more confident and collaborative relationship with diabetic adolescents and therefore facilitate adolescents' self-management.

Adolescent↗
PubMed2004

Adolescent alcohol use and injury. A summary and critical review of the literature.

BACKGROUND: Survey research indicates that alcohol use and misuse by adolescents is prevalent worldwide and has been associated with multiple negative health, social, and economic consequences. Physical injury is one of the negative consequences of alcohol use that appears to be on the rise among adolescents. METHODS: A retrospective review was conducted of published data currently available regarding alcohol use and injury among adolescents. Studies were reviewed if 1) the sample included adolescents between the ages of 13 and 19 years, 2) the study site was a medical setting, and 3) data were collected regarding alcohol ingestion. RESULTS: Data indicate that rates of adolescent alcohol use range from 5% among general emergency department (ED) admissions to nearly 50% among trauma admissions. Alcohol-positive adolescents are more likely than alcohol-negative adolescents to be injured, have a prior history of injury, require trauma service care, and have injury complications. One-third to one-half of alcohol-positive adolescents are referred for or receive intervention related to their alcohol use. CONCLUSIONS: Alcohol use by adolescents is associated with increases in severity of injury and cost of medical treatment. Screening of adolescent trauma unit admissions for alcohol use might be justified based on the literature. Optimal methods of screening, identification, and brief intervention for alcohol abusing adolescents within the medical setting are discussed.

Adolescent↗
PubMed2005

Dietary practices of adolescents in Singapore and Malaysia.

INTRODUCTION: This study sets out to investigate any differences in dietary practices between adolescents in Singapore and Malaysia. METHODS: An adolescent dietary practices survey was conducted in Singapore and Malaysia involving 200 adolescents (100 from each country) aged 11 to 21 years in order to have a better understanding of the adolescents' dietary practices. Dietary practices were assessed by a self-administered dietary practices questionnaire (DPQ). RESULTS: The major differences identified between adolescents' dietary practices in Singapore and Malaysia are related to alcohol consumption and venue for taking of lunch. More Malaysian adolescents have their lunch prepared at home (32.9 percent), compared with 7.2 percent of Singaporean adolescents. More adolescents in Malaysia drink alcohol (49.4 percent), compared with only 21.7 percent of Singaporean adolescents. CONCLUSION: From the dietary practices survey of adolescents from Singapore and Malaysia, it may be concluded that while general dietary practices are similar, the major differences identified were significantly (p-value is less than 0.05) higher alcohol consumption by Malaysian adolescents and significantly (p-value is less than 0.05) more Malaysians took their lunch at home compared with Singaporeans. The reasons for the differences are discussed in the paper.

Adolescent↗
PubMed1989

Improving access to health services for adolescents from economically disadvantaged families.

An analysis of the health status and health care utilization patterns of poor and nonpoor adolescents was conducted using a sample of 22,792 adolescents 10 to 18 years of age from the 1983 and 1984 National Health Interview Surveys. The results indicate that adolescents from families with incomes below the poverty level were three times as likely to be reported in only fair or poor health status and were 47% more likely to suffer from disabling chronic illnesses than adolescents from families with incomes above the poverty level. Use of inpatient hospital services was similar for adolescents from poor and nonpoor families when health status was controlled. However, adolescents from poor families were 35% more likely than those from nonpoor families to have waited 2 or more years between physician contacts. In addition, poor adolescents made 13% fewer physician contacts on an annual basis when compared with nonpoor adolescents. Substantial differences in utilization rates were found when poor adolescents were disaggregated according to whether they were covered by Medicaid. Those with Medicaid coverage used physician services at rates similar to nonpoor adolescents, whereas those without Medicaid coverage lagged substantially behind. Based on the conclusion that Medicaid is effective in reducing barriers to needed services, strategies for expanding Medicaid eligibility to additional low-income adolescents are discussed.

Adolescent↗
PubMed1993

Surveillance for gonorrhea and primary and secondary syphilis among adolescents, United States--1981-1991.

PROBLEM/CONDITION: During the 1980s, an increasing proportion of adolescent women reported having had premarital sexual intercourse, thus potentially placing an increasing number of young persons at higher risk of acquiring a sexually transmitted infection. REPORTING PERIOD COVERED: To determine rates and examine trends of sexually transmitted infections among adolescents, we analyzed data for reported cases of gonorrhea and primary and secondary syphilis among 10- to 19-year-olds for 1981 through 1991. DESCRIPTION OF SYSTEM: Summary data for cases of gonorrhea and primary and secondary syphilis that were identified and reported to state health departments were sent annually to CDC. These data included total number of cases by disease (gonorrhea, primary and secondary syphilis), sex, racial/ethnic group (white, not of Hispanic origin; black, not of Hispanic origin; Hispanic; Asian/Pacific Islander; or American Indian/Alaskan Native), 5-year age group, and source of report (public, private). RESULTS: From 1981 through 1991, 24%-30% of the reported morbidity from gonorrhea and 10%-12% of the reported morbidity from primary and secondary syphilis in the United States affected the adolescent age groups. Some of the highest rates of gonorrhea during that time period were among 15- to 19-year-olds. Gonorrhea rates among adolescents increased or remained unchanged from 1981 through 1991, while the rates among older age groups decreased. Although primary and secondary syphilis rates were lower among adolescents than older age groups, adolescents contributed to the epidemic of syphilis that occurred from 1987 through 1990. Differences in reported rates of both syphilis and gonorrhea among white, black, and Hispanic adolescents increased during the latter half of the 1980s. INTERPRETATION: Reporting biases could account for some the differences among rates for white, black, and Hispanic adolescents. However, if gonorrhea has been underreported for any racial group, the high rates of gonorrhea among 15- to 19-year-olds represented an underestimate of the true infection rate. Increases in sexual activity among adolescents and a lack of clinical services in settings convenient to adolescents could have contributed to the increasing rates of gonorrhea and syphilis among these young persons during this time period. ACTIONS TAKEN: If gonorrhea and other sexually transmitted infections are cofactors for facilitating the transmission of human immunodeficiency virus (HIV), the high incidence of gonorrhea in some locales among some populations of adolescents could result in dramatic increases in HIV acquisition, a situation that demands attention from public health organizations.

Adolescent↗
PubMed2005

Longitudinal antiretroviral adherence among adolescents infected with human immunodeficiency virus.

OBJECTIVES: To longitudinally follow a cohort of adolescents with human immunodeficiency virus (HIV) and to investigate long-term antiretroviral therapy adherence and factors associated with adherence. DESIGN, SETTING, AND PATIENTS: Adolescents infected with HIV (N = 231; mean age, 18.4 years; 72.7% female; 74.9% African American) from 13 cities throughout the United States were assessed at 3-month intervals. MAIN OUTCOME MEASURES: Self-reported adherence measures were validated by comparison with HIV-1 RNA viral load, and behavioral factors that may be associated with antiretroviral therapy adherence were assessed. RESULTS: At the initial visit, approximately 69% of the adolescents reported being adherent to antiretroviral therapy. Adolescents in the later HIV disease stage were less likely to be adherent compared with those in the earlier disease stage. Less alcohol use and being in school were associated with adherence by adolescents on weekends and over the preceding month. Longitudinal adherence was investigated among 65 subjects initially adherent with available information for at least 4 consecutive visits. The median time to nonadherence was 12 months, and failure to maintain adherence was significantly associated with younger age and depression. Among adolescents who attained an undetectable viral load, only about 50% maintained an undetectable viral load for the year. CONCLUSIONS: These findings indicate an urgent need for better interventions to assist adolescents with HIV in adhering to their medication regimens. Adolescents with advanced disease are likely to need more intervention. New treatments recently found effective for adolescent depression may assist in improving adherence for a majority of adolescents with HIV.

Adolescent↗
PubMed1996

Communication between adolescents and physicians about sexual behavior and risk prevention.

OBJECTIVES: To assess the extent to which adolescents in a nonclinical community-based population have talked with a physician about sexual behavior and risk prevention and to examine whether adolescents value these discussions and trust physicians to protect their confidentiality. DESIGN: Self-administered anonymous survey. SETTING: Urban California school district. PARTICIPANTS: A total of 2026 students in 9th to 12th grade, 98% of the eligible students present on the survey day. OUTCOME MEASURES: Discussions with physicians about sexual matters, helpfulness of discussions, trust in physicians to protect confidentiality, and knowledge about confidentiality laws. RESULTS: Thirty-nine percent of adolescents reported discussions with physicians about how to avoid getting acquired immunodeficiency syndrome from sex, 37% about using condoms for vaginal intercourse, 13% about how to use condoms, 15% about the adolescent's sex life, 13% about how to say no to unwanted sex, and 8% about sexual orientation. In addition, 8% of adolescents had been given a condom by a physician. Adolescents were more likely to report most of these topics if they had ever had vaginal intercourse or if they had a regular physician. Most adolescents (80%-90%) would find it at least a little helpful to talk with a physician about various sexual matters. Most would trust a physician to keep secret that they asked questions about sex (75%), that they were having sex (65%), or that they were using contraception (68%). Fewer would trust physicians to keep secret a sexually transmitted disease (44%) or pregnancy (44%). For adolescents who knew that physicians in their state do not have to tell parents about sexually transmitted diseases or pregnancy, levels of trust rose, but only to 54%. CONCLUSIONS: Although professional medical organizations recommend that physicians discuss sexual matters and risk prevention with their adolescent patients, most adolescents report not having received these services. Physicians should be more aggressive about discussing these topics.

Adolescent↗
PubMed2005

Predictors of STI vaccine acceptability among parents and their adolescent children.

PURPOSE: To identify attitudes and behavioral factors associated with parental intent to vaccinate their adolescent children against sexually transmitted infections (STI) and adolescent intent to accept vaccination for the prevention of STI. METHODS: In this cross-sectional study, 320 parents and their adolescent children (aged 12-17 years) were recruited from urban adolescent health clinics and private practice pediatric offices to complete audio, computer-assisted self-interviews (A-CASI). Parents and their adolescents were asked about acceptability of gonorrhea, genital herpes, and human immumodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS) vaccines. These three items were summed to create an STI vaccine acceptability scale, the primary outcome variable. Potential predictors measured included health beliefs, sociodemographic factors, and health and sexual behaviors. RESULTS: A substantial majority of parents and their adolescent children rated the three STI vaccines as very acceptable. Parental health beliefs and parental history of STI diagnosis were significant independent predictors of intent to vaccinate adolescent children against STI. Parental intent to vaccinate and having a friend who had engaged in sexual intercourse were significant independent predictors of adolescents' intent to accept STI vaccination. CONCLUSIONS: The majority of these parents and their adolescent children found STI vaccination very acceptable, suggesting that there will be great interest in these vaccines once they become available. Interventions designed to address parental health beliefs may prove successful at maintaining or increasing interest in STI vaccines. Adolescents are likely to look to their parents for guidance around acceptance of these vaccines, but personal experiences also may play a role.

AIDS Vaccines↗
PubMed2002

Race, adolescent contraceptive choice, and pregnancy at presentation to a family planning clinic.

OBJECTIVE: To assess racial/ethnic differences in pregnancy and contraceptive choice among adolescent family planning patients. METHODS: The charts of 605 female adolescents presenting to a teen family planning clinic for an initial visit were retrospectively reviewed for demographic and reproductive health information, sexual risk behaviors, pregnancy, and current and dispensed contraceptive method. Logistic and multinomial logistic regression analysis were used to estimate the association of these factors with pregnancy and contraceptive choice. RESULTS: Black adolescents were three times more likely than white adolescents to be pregnant at presentation to the clinic (P =.05). Ninety-one percent of adolescents did not want to be pregnant; pregnancy desire was highly correlated with current contraceptive method. None of the adolescents who reported being unsure or wanting to be pregnant used hormonal methods. Black adolescents were more likely to rely on barrier methods than hormonal methods (P =.04); choice of barrier methods over hormonal methods was not correlated with risk for sexually transmitted diseases. There were no differences, however, in method dispensed by race. Black and white adolescents were equally likely to choose hormonal methods at the end of the visit, but adolescents who used hormonal methods at presentation-who were more likely to be white-were significantly more likely to leave the clinic with hormonal methods. CONCLUSION: Black race/ethnicity was an independent risk factor for use of less effective barrier contraceptive methods and pregnancy at presentation to the clinic. Understanding how black adolescents make contraceptive choices is essential to helping them avoid unintended pregnancies.

Adolescent↗
PubMed2003

Peer and adult relationships of adolescents with disabilities.

The purpose of this study was to enhance our knowledge of what it is like to grow up with a disability, specifically, with focus on how adolescents with restricted mobility perceive social roles and relationships to peers and adults. The group investigated consisted of 12 adolescents with restricted mobility from northern Sweden, aged from 15 to 19 years. The adolescents were individually interviewed. The analysis resulted in a core category (Who am I), which describes how the adolescents perceive themselves. The core category was related to three subcategories: Relationships to friends--describes the adolescents' experiences of peer relationships, Relationships to adults--describes adolescents' relationships to adults, Thoughts about relationships in the future--comprises wishes for future relationships. The results indicated that the 12 disabled adolescents saw themselves as regular members of the adolescent peer group but that the members of the adolescent group saw them as being different. The relationships to friends of the same age were either markedly defective or did not exist at all, while relationships to adults were often characterized as ambivalent or asymmetric, i.e. the adults were simultaneously helpful and supportive while over protective and dominant. The study revealed that despite the many hindrances, the adolescents had a comparatively positive view of their future.

Adaptation, Psychological↗
PubMed2003

Influences on adolescent eating patterns: the importance of family meals.

PURPOSE: To provide national estimates of the frequency and determinants of adolescents' consumption of fruits, vegetables, and dairy foods. METHODS: Analyses were based on 18,177 adolescents in the first interview of the National Longitudinal Study of Adolescent Health. Multivariate logistic regressions provide estimates of the unique contribution of sociodemographic characteristics, body weight perception, and parental influences on adolescent food consumption. RESULTS: Almost one in five adolescents reported skipping breakfast the previous day. A large percentage of adolescents reported eating less than the recommended amount of vegetables (71%), fruits (55%), and dairy foods (47%). Adolescents with better-educated parents had better consumption patterns than those with less-educated parents. Consumption patterns differed significantly by race. Adolescents who perceived themselves to be overweight were significantly more likely to have poor consumption patterns. Parental presence at the evening meal was associated with a lower risk of poor consumption of fruits, vegetables, and diary foods as well as the likelihood of skipping breakfast. CONCLUSION: Parental presence at the evening meal is positively associated with adolescents' higher consumption of fruits, vegetables, and dairy foods. Nutrition and health professionals should educate parents about the role of family mealtimes for healthy adolescent nutrition.

Adolescent↗
PubMed2003

Parental presence and adolescent reproductive health among the Nairobi urban poor.

PURPOSE: To investigate whether the presence of parents constitute a protective factor against adverse reproductive health outcomes for adolescents living in slums of Nairobi, Kenya. METHODS: The data come from a cross-sectional survey that canvassed a random sample of 4564 households representative of all Nairobi slums in February-June 2000. Structured questionnaires on household census, reproduction and adolescent health were verbally administered to household heads, women of reproductive ages, and adolescents, respectively. We restrict the analysis to a sub-sample of 788 never-married adolescent girls aged 12-19 years. We compare reproductive health outcomes of adolescents who live with neither parent, father only, mother only, and both parents. Data were analyzed using simple descriptive analysis and logistic regression models of three outcome variables: ever sexually active, ever experienced an unplanned pregnancy, and sexually active within the past 4 weeks. For each of the outcome variables, two models, one with and one without a proxy for adolescents' disorderly behavior are presented to establish whether parental presence affects adolescents' reproductive health. RESULTS: When the father is present in the household (i.e., father only or both parents present), adolescent girls are 42% less likely to have ever had sex (p<.05), 45% less likely to have been sexually active in the most recent 4-week period (p<0.1), and 59% less likely to have ever experienced an unwanted pregnancy (p<.05) than when neither parent, or only the mother, is present in the household. CONCLUSIONS: In the slums of Nairobi, father's presence, unlike that of the mother, is associated with stronger resilience among adolescents. When programming for adolescents in these resource-constrained settings, it is important, therefore, to involve parents.

Adolescent↗
PubMed1998

Health counseling in adolescent preventive visits: effectiveness, current practices, and quality measurement.

Most morbidity and mortality among adolescents results from their participation in health-compromising behaviors. Recent guidelines for clinical adolescent preventive services recommend that primary care clinicians routinely screen for and counsel adolescents about these behaviors, identify and address related social, psychological, and biologic factors. Office-based counseling can influence adult health behaviors, but little is known about the effectiveness of office-based counseling for adolescents. In this review we: (a) evaluate available information about the effectiveness of office-based health counseling to improve outcomes; (b) report what is known about the health counseling adolescents receive from primary care clinicians; and (c) critically review different approaches that have been, or might be, used to measure the content and quality of health counseling provided during adolescent medical visits. With the emphasis on accountability in the current health care environment, evidence supporting the effectiveness of counseling is needed to justify investment in this aspect of clinical adolescent preventive services. Challenges to studying the effectiveness of health counseling include the lack of well-defined theory-based models for adolescent office-based counseling, the complexity of measuring counseling quality, and the many factors that influence adolescent outcomes. Reliable and valid measures of counseling quality are needed both to study and to ensure the quality of counseling received by adolescents. No single measure can be expected to fully capture counseling quality, although patient self-report deserves further development.

Adolescent↗