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PubMedDate not supplied

Adolescent chemical dependency treatment in an HMO.

HMOs are under increasing pressure to expand benefits and services for treatment of adolescents who abuse alcohol and drugs. Little information exists, however, on these programs. This article describes a comprehensive adolescent chemical dependency treatment program within an HMO and presents data on use, costs, and results. Characteristics of clients were similar to adolescents seen in community treatment programs. Less than 1% of the HMO adolescent population sought treatment, and the mean number of outpatient treatment visits was 9.7. The median was between two and three visits, and the mode was one visit. Thirty-four percent of the adolescents required residential treatment, and 65% of the adolescents completed the recommended 28-day stay. The additional premium cost per member per month for adolescent chemical dependency treatment was approximately $0.28. A telephone follow-up survey of a random sample of treated adolescents found that most adolescents had reduced their use of alcohol and drugs and had made improvements in other areas of their lives. Few adolescents, however, met the program's goal of total abstinence.

Adolescent↗
PubMed2000

Prevalence of abnormal serum aminotransferase values in overweight and obese adolescents.

OBJECTIVES: (1) To determine the prevalence of abnormal liver enzymes in overweight and obese adolescents and (2) to determine the relationship of alcohol ingestion and serum antioxidants to the presence of abnormal liver enzymes in overweight and obese adolescents. METHODS: Serum alanine aminotransferase (ALT) and gamma-glutamyl transpeptidase levels were measured in 2450 children between the ages of 12 and 18 years, enrolled in the National Health and Examination Survey, cycle III (NHANES III). Obesity was defined as a body mass index >95th percentile for age and sex. Overweight was defined as a body mass index >85th percentile for age and sex. Nutritional intake was assessed by 24-hour dietary recall and food frequency questionnaires. Serum antioxidants were measured by high-pressure liquid chromatography. RESULTS: Sixty percent of adolescents with elevated ALT levels were either overweight or obese. Overall, 6% of overweight adolescents had elevated ALT levels (odds ratio: 3.4 [95% CI: 3.5-12.8]). Ten percent of obese adolescents had elevated ALT levels (odds ratio: 6.7 [95% CI: 3.5-12.8]). In addition, approximately 1% of obese adolescents demonstrated ALT levels over twice normal. Approximately 50% of of obsese adolescents who reported modest alcohol ingestion (4 times per month or more) had elevated ALT levels (odds ratio: 10.8, 95% CI: 1.5-77). Other factors associated with elevated ALT levels in overweight and obese adolescents include increased age, elevated glycolated hemoglobin, elevated triglycerides, and decreased levels of serum antioxidants-vitamin E, beta-carotene, and vitamin C. CONCLUSION: Overweight and obesity are the most common findings in adolescents with elevated ALT levels. Even modest alcohol consumption may significantly increase the likelihood of obese adolescents developing obesity-related liver disease.

Adolescent↗
PubMedDate not supplied

[Personality disorders in a nonclinical sample of adolescents].

OBJECTIVE: To examine the comorbidity of borderline personality disorder and other personality disorders in a nonclinical sample of high-school students. METHOD: 311 high-school students who completed the French version of the CES-D (Center for Epidemiological Studies-Depression Scale), were asked to participate to interviews evaluating personality functioning: 60 subjects (19%) accepted to participate in the study. The mean CES-D score of these 60 subjects (16 boys, 44 girls, mean age=17.7 1.7) was significantly higher than the mean score of the whole sample (23.9 10.4 versus 16.7 9.8). Thus the interviewed sample was not representative of the population of high-school students. Subjects were assessed using the major depressive episode module of the MINI (Mini International Neuropsychiatric Interview) and the SIDP IV (Structured Interview for DSM IV Personality). Inter-rater reliability was determined by comparing the independent ratings of interviewers and an experienced clinician on a random sample of 20 interviews. For DSM IV borderline personality disorder diagnosis, the Cohen's kappa coefficient was 0.85. For personality disorder criteria, kappa ranged from 0.6 to 1.0 (average kappa=0.79). RESULTS: Sixteen of these subjects (26,7%, 4 males, 12 females) received a diagnosis of borderline personality disorder according to DSM IV criteria. The mean CES-D score of borderline subjects (30.6 10.2) was significantly higher than the mean score of nonborderline subjects (21.6 10.5). Of the 16 borderline subjects, 11 (75%) received a diagnosis of major depressive disorder versus 14 (31%) of the non borderline subjects. None of the other personality disorders approached the frequency of borderline personality disorder. The next most frequent diagnoses were depressive and dependent personality disorders which occurred in respectively in 16.6% and 10% of the 60 subjects. All the personality-disorders occurred at higher rates in the group with borderline personality disorder with the exception of obsessive-compulsive personality disorder which was diagnosed only in nonborderline subjects. Of the 16 borderline subjects, 11 (68.7%) met the criteria for another personality disorder which were depressive personality disorder (N=5), paranoid personality disorder (N=4), dependent personality disorder (N=3), antisocial personality disorder (N=2), histrionic personality disorder (N=2), avoidant personality disorder (N=2), negativistic personality disorder (N=2), schizotypal personality disorder (N=1), narcissistic personality disorder (N=1), self-defeating personality disorder (N=1). The optional diagnoses (self-defeating, depressive and negati-vistic personality disorders) accounted for 8 of 23 (34.7%) cases of personality disorders diagnosed among borderline subjects. Among these 11 adolescents, 5 received 2 diagnoses of personality disorders (borderline and paranoid personality disorders, N=1; borderline and dependent personality disorders, N=1; borderline and depressive personality disorders, N=3), 3 received 3 diagnoses (borderline, antisocial and histrionic personality disorders, N=1; borderline, avoidant and negativistic personality disorders, N=1; borderline, depressive and negativistic personality disorders, N=1), 3 received 5 diagnoses (borderline, paranoid, histrionic, narcissistic and dependent personality disorders, N=1; borderline, paranoid, dependent, avoidant and depressive personality disorders, N=1; borderline, paranoid, schizotypal, antisocial and self-defeating personality disorders, N=1). Among the 44 adolescents (12 boys, 32 girls) without borderline personality disorder, 10 (22.7%) (3 boys, 7 girls) met the criteria for another personality disorder which were depressive personality disorder (N=5) or cluster C disorders -obsessive-compulsive personality disorder (N=4), dependent personality disorder (N=2), avoidant personality disorder (N=1) - with the exception of one diagnosis of histrionic personality disorder. Two subjects received 2 diagnoses (obsessive-compulsive and depressive personality disorder). The internal consistency of personality disorders criteria was assessed with Cronbach's alpha coefficient. Borderline personality disorder criteria had high internal consistency (0.82). The factor structure of borderline personality disorder criteria was studied with an exploratory factorial analysis which extracted three factors. The eigenvalues were 3.70, 1.06, and 1.01. Confirmatory factorial analyses were conducted. The correlated two-factor model and the three-factor model fit the data well but the correlation between factors was, however, judged too high, ranging from 0.70 to 0.78. The one-factor model proved to have a good fit (Goodness of Fit Index=0.89, Comparative Fit Index=0.90, Root Mean Square Residual=0.07). As a previous study showed the frequency of two schizotypal personality disorder criteria (odd beliefs/magical thinking experiences and unusual perceptual experiences), an exploratory factorial analysis was performed on the combined set of criteria of borderline and schizotypal personality disorders. It yielded 2 factors: the first factor consisted of all the borderline personality disorder criteria, odd beliefs/magical thinking, and unusual perceptual experiences and could be called the borderline factor; the second factor consisted of the paranoid and the social avoidance criteria and could be called the interpersonal hypersensitivity factor. A confirmatory factor analysis showed that this two-factor model provided a good fit to the data (GFI=0.82, CFI=0,91, RMSR=0.10). The correlation between factors was weak (0.25). These results suggest that odd beliefs/magical thinking and unusual perceptual experiences are a component of borderline symptomatology in adolescents. DISCUSSION: The high frequency of major depressive disorder and personality disorders in the interviewed sample may be due to the possibility that adolescents with psychological problems have used the interview as a way to obtain attention and support from a psychologist. The interviewed sample, which was characterized by a high intensity of depressive symptomatology and by a high frequency of borderline personality disorder, could thus be seen as intermediate between a clinical and a community sample. Our results may be more generalizable to an outpatients population of adolescents. This study found conflicting results about the construct validity of borderline personality disorder in adolescent. The high internal consistency and the one-factor structure of the borderline personality disorder criteria argue for their validity in adolescents. However, the high rates of comorbidity of borderline personality disorder with depression and other personality disorders, extended to clusters A, B and C and to optional diagnoses, suggest the lack of construct validity of either borderline personality or cluster B disorders in adolescents. CONCLUSION: Borderline symptomatology in adolescents appears more in adequacy with a dimensional model than with a typological classification. More studies are needed to assess and improve the construct validity of borderline personality disorder in adolescents.

Adolescent↗
PubMed2003

[Helicobacter pylori infection in a group of symptomatic and asymptomatic children and adolescents in the Czech Republic].

BACKGROUND: There exist only inconsistent results of studies on the relationship between Helicobacter pylori (H. pylori) infection and functional dyspepsia and/or recurrent abdominal pain in children and adolescents. The answer could bring a comparison of the epidemiological features of H. pylori infection between children and adolescents with dyspepsia and/or recurrent abdominal pain (symptomatic) and without these symptoms (asymptomatic), living in the Czech republic. METHODS AND RESULTS: Study includes children and adolescents (2-18 years) with upper gastrointestinal symptoms visiting paediatric gastroenterology department between 1994 and 1999. Age, sex, socioeconomic level matched control (asymptomatic) group consisted of children and adolescents visiting the general paediatric service with symptoms not related to the upper gastrointestinal tract. Demographic and socioeconomic factors, including parent(s) educational level, place of residence, living conditions, type of drinking water and pets in their household were evaluated. Serum of the children and adolescents was tested for H. pylori IgG by enzyme linked immunosorbent assay. In addition, the symptomatic children and adolescents underwent endoscopic examination and biopsies from gastric antrum and corpus were taken for the quick urease test, histology/histoscopy, and H. pylori cultivation. H. pylori infection in this group was stated when at least two tests were positive. Altogether 829 children and adolescents were examined, 624 cases were symptomatic and 205 represented controls (asymptomatic). The prevalence of infection was 33% among symptomatic children vs. 7.5% among controls (OR = 6.2, p.001) and was similar among boys and girls (32% vs. 34.5%, respectively). H. pylori prevalence increased with age among symptomatic children (10% for children below 6 years and 37% between 11 to 16 years) (p.001). In contrary, prevalence tended to fall with age among asymptomatic children (11% in children below 6 years vs. 6% in children over 10 years (OR = 2.0, 95% CI = 0.7-6.2). In both groups, an inverse correlation between H. pylori occurrence and mother's educational level was observed. The H. pylori incidence was 10% among asymptomatic children who drank water from municipal water supply or from a well vs. 3% among those who drank bottled water (OR = 4, 95% CI = 1.1 to 18, p.05). CONCLUSIONS: H. pylori infection was more prevalent among symptomatic children and adolescents vs. asymptomatic children and adolescents within the same population. H. pylori incidence increased with age among symptomatic children and adolescents and tended to fall among controls, showing deep differences between the two groups. With exception of the bottled water drinking, presence of any other factor studied represented significant risk for acquiring the H. pylori infection.

Adolescent↗
PubMed2006

Preventing tetanus, diphtheria, and pertussis among adolescents: use of tetanus toxoid, reduced diphtheria toxoid and acellular pertussis vaccines recommendations of the Advisory Committee on Immunization Practices (ACIP).

During spring 2005, two tetanus toxoid, reduced diphtheria toxoid and acellular pertussis vaccine (Tdap) products formulated for use in adolescents (and, for one product, use in adults) were licensed in the United States (BOOSTRIX, GlaxoSmithKline Biologicals, Rixensart, Belgium [licensed May 3, 2005, for use in persons aged 10-18 years], and ADACEL, sanofi pasteur, Toronto, Ontario, Canada [licensed June 10, 2005, for use in persons aged 11-64 years]). Prelicensure studies demonstrated safety and efficacy against tetanus, diphtheria, and pertussis when Tdap was administered as a single booster dose to adolescents. To reduce pertussis morbidity in adolescents and maintain the standard of care for tetanus and diphtheria protection, the Advisory Committee on Immunization Practices (ACIP) recommends that: 1) adolescents aged 11-18 years should receive a single dose of Tdap instead of tetanus and diphtheria toxoids vaccine (Td) for booster immunization against tetanus, diphtheria, and pertussis if they have completed the recommended childhood diphtheria and tetanus toxoids and whole cell pertussis vaccine (DTP)/ diphtheria and tetanus toxoids and acellular pertussis vaccine (DTaP) vaccination series (five doses of pediatric DTP/DTaP before the seventh birthday; if the fourth dose was administered on or after the fourth birthday, the fifth dose is not needed) and have not received Td or Tdap. The preferred age for Tdap vaccination is 11-12 years; 2) adolescents aged 11-18 years who received Td, but not Tdap, are encouraged to receive a single dose of Tdap to provide protection against pertussis if they have completed the recommended childhood DTP/DTaP vaccination series. An interval of at least 5 years between Td and Tdap is encouraged to reduce the risk for local and systemic reactions after Tdap vaccination. However, an interval less than 5 years between Td and Tdap can be used; and 3) vaccine providers should administer Tdap and tetravalent meningococcal conjugate vaccine (Menactra, sanofi pasteur, Swiftwater, Pennsylvania) to adolescents aged 11-18 years during the same visit if both vaccines are indicated and available. This statement 1) reviews tetanus, diphtheria and pertussis vaccination policy in the United States, with emphasis on adolescents; 2) describes the clinical features and epidemiology of pertussis among adolescents; 3) summarizes the immunogenicity, efficacy, and safety data of the two Tdap vaccines licensed for use among adolescents; and 4) presents recommendations for tetanus, diphtheria, and pertussis vaccination among adolescents aged 11-18 years.

Adolescent↗
PubMedDate not supplied

[Correlation between certain factors in maturation and primary dysmenorrhea in adolescence].

A total of 1,068 randomly chosen adolescent females, aged 10 to 19 years, were questioned about their (painful or painless) menstruation. The obtained rate of the prevalence of dysmenorrhea in the examined adolescent population was 52.9%. The statistical significant difference between the examined adolescent girls with and without dysmenorrhea related to the chronological age (chi 2 = 19.112; p less than 0.05). The rate of frequency of painful menstruation increases with the increasing of the chronological age of the examined adolescent females. It is the highest at the age of 16 to 19 (56.5% in 16 and 61.2% in 19 year-olds). Over the age of fifteen years dysmenorrhea is present in every other examined adolescent girl. The number of examined adolescent females with dysmenorrhea is statistically significant by greater (chi 2 = 44.448; p less than 0.001) in those who had got menarche early (11 and 12 years old). The greatest frequency of dysmenorrhea is estimated in those having got the first menstruation aged 11 (79.2%) and 12 (55.5%) years. The average age of the appearance of menarche in all the examined female population is 12.8 +/- 1.3 years. The average age of the occurrence of the first menstruation in dysmenorrhoic girls is 12.6 +/- 1.1 years and statistically significantly differs from the average age of menarche in the control group of nondysmenorrhoic adolescent females (13.1 +/- 1.2 years of life). In the first gynecological year only one third (29.6%) of the examined adolescent girls had painful menstruation. Up to the fourth gynecological year, 62.4% of the examined adolescent females experienced dysmenorrhea. Three quarters (75.3%) of them had painful menstruation in the sixth gynecological year. There is a statistically significant difference between adolescent girls with and without dysmenorrhea in relation to the gynecological year (chi 2 = 63.604; p less than 0.001).

Adolescent↗
PubMed1987

Adolescence: a growth period conductive to alienation.

This paper clarifies the relationship of alienation to the period of adolescence by developing a portrait of the alienated and the at-risk adolescent. Current research on adolescent alienation follows two converging themes, the socio-psychological, where deviant behavior is viewed as evidence of adolescent estrangement from self and society, and the sociological, where alienation is divided into a series of dimensions for empirical assessment. These two perspectives converge to describe the alienated adolescent. The alienated adolescent is disruptive, rebukes authority, drops out of school or becomes a passive participant, is prone to suicide, abuses drugs and alcohol, and rejects the norms established by family, school, and society in general. Adolescence is a high-risk period wherein the adolescent experiences multiple environments which exacerbates higher levels of alienation. These environments include disorganized or disruptive families, schools that encourage students to become passive participants in the learning process, and a high-pressured pace of life. To lessen the at-risk nature of adolescents toward alienation, society can take steps to humanize their environment. These steps include the intergenerational integration of adolescents, their assimilation into responsible societal activities, providing them with a sense of meaning, and enfranchisement into the decision-making process.

Adolescent↗
PubMed1995

Family therapy and some personality disorders in adolescence.

To prevent an endless debate between those supporting an intrinsic deficit versus an environmental deficit, the adolescent's problem has been seen here as both an individual problem and the metaphorical expression of a family problem. The intricacy of this two-faceted problem appears vividly with borderline and immature adolescents. Both the adolescent and family have, among other problems, difficulty separating. The approach described here focuses on that particular aspect; each therapeutic step is geared toward the adolescent's separation-individuation. Concerning the course of therapy, restructuring is perceived as the first therapeutic step and a prerequisite to work on such issues as delineating personal and family problems and improving communications. The approach is not, though, a panacea for the treatment of all personality disorders in adolescence and should not preempt the use of other approaches. As reported by Esman (1989) in regard to borderline adolescents, there is enough variation in the syndrome to allow the use of a variety of treatment approaches. Involving the family may not be feasible, and the adolescent sometimes must be removed from a detrimental family situation. The family of the immature or borderline adolescent is often seen as untreatable but what the therapist wants to accomplish and is ready to share often paves the way to effective intervention (Offer and Vanderstoep, 1974). The therapist must be ready to struggle with the family and with himself. The therapist has to be courageous, patient, and optimistic. The intervention is usually done on a middle-term basis with encouragement to the family to consult again if needed. The approach may thus appear obsolete at a time of a "quick-fix" culture. Family therapy can be a powerful tool with very disturbed, personality-disordered adolescents. The family approach must be flexible and based on a psychodynamic understanding of the problems. As so many of these cases fail to respond to the usual treatment and make therapists and institutions feel powerless, looking at the intervention from another angle can be refreshing. The experience can be rewarding for the adolescent, as she is becoming emancipated from the family, and for the parents, who facilitate the process. Working with these families is difficult but can also be rewarding for the clinician. Hours spent with them gives access to the subjective experiential reality that makes the substance of behavior and may allow the exploration of shadowy areas of the human condition. Family therapy becomes, then, a journey full of pain, uncertainties, and wonder for both the family and the clinician.

Acting Out↗
PubMedDate not supplied

[Communication behavior between parents and their adolescent children and correlation with indicators of self concept].

Formats of communication within families are believed to be relevant contexts for children's development. Cultural values, norms, and interpretation patterns are transferred from parents to children within the family's specific communication framework. By the same token, skills to maintain the balance of living together or to realize one's own wishes are acquired within the scope of extant formats of exchange among family members. Puberty is a period, where a child strives for more autonomy and tends to dispute present parent-child relationships. The focus of the study is on links between formats of communication within the family and adolescents' estimations of the relationships with their parents and also adolescents' judgments about their self-esteem. 67 families with an adolescent child (between 11 and 12 years old at the beginning of data collection) participated in a longitudinal study, in which adolescents judged the quality of their relationship with parents as well as their self-esteem every six months over a period of three and a half years (8 waves). In addition, concrete communication behavior between parents and adolescents was observed and recorded during the first, fourth, sixth, and eight wave of data collection. Results point to considerable differences among adolescents' judgments concerning their quality of relationship with the parents and their self-esteem. Groups could be formed according to these differences. Data also show that adolescents show a high degree of constancy in their estimations over time. However, communication behaviors in parent-adolescent dyads showed divergent patterns of communication across the different groups on the one hand, and different degrees of variation of communication formats within groups over time on the other, dependent on whether adolescents belonged to the group of high quality relationship and self-esteem (considerable variation over time) or to the group of low quality relationship and self-esteem (less variation over time). Results are discussed under the perspective of adolescents' different experiences in family communication, and implications of possible links between development of self-esteem and adaptive or nonadaptive variations in family communication are considered.

Adolescent↗
PubMed1997

Adolescent risk factors and the prediction of persistent alcohol and drug use into adulthood.

Adolescence is a time of heightened risk for relatively intensive alcohol and other drug use behaviors. However, heavy use is often "adolescence-limited," giving way to moderation or cessation in adulthood. We examined individual differences in risk factors at age 18 that were predictive of alternative alcohol and drug use trajectories from adolescence to adulthood. Data were collected prospectively on four occasions from participants in the Rutgers Health and Human Development Project. Subsets of individuals representing three prototypical trajectories of (1) consistently low alcohol and drug use during adolescence and early adulthood; (2) heavier alcohol or drug use during adolescence, but not during adulthood; and (3) persistent heavier alcohol or drug use from adolescence into adulthood were found to differ significantly on a number of intrapersonal, behavioral, and environmental risk factors, with the adolescence-limited group consistently scoring between the other two groups. Based on these results, a composite risk index was constructed. In the total sample, however, when the effect of alcohol and drug use behaviors at age 18 was controlled, the composite risk index was unrelated to adult (age 28 to 31) levels of alcohol and drug use and consequences. Thus, in this community sample, well-documented risk factors assessed in adolescence did not exhibit any direct, longterm effects on use intensity and problems in adulthood. It is concluded that the assessed risk factors (disinhibition, cognitive structure, play, deviant coping, friends' deviance, and stressful life events) are not immutable, but subject to individual and normative changes during the transition from adolescence to adulthood. More research is needed to determine the long-term stability of risk factors, and how changes in risk factors over time, discontinuities in what constitutes risk in adolescence versus adulthood, and proximal adult protective factors that compensate for early risk contribute to developmental patterns of use.

Adolescent↗
PubMed1981

An analysis of adolescent health care and the role of the obstetrician-gynecologist.

There has been documented an increase in sexual activity in adolescents in the United States and a resultant increase in related health care for pregnancy, abortion, contraception, and sexually transmitted disease. This study characterizes some elements of these services and the attitudes of physicians in regard to adolescent sexuality. The Female Datafile from the University of Southern California--Mendenhall Manpower Study and the survey of the American College of Obstetricians and Gynecologists on adolescent pregnancy suggest that obstetrician-gynecologists provide a large portion of health care to both adult (14.6%) and adolescent women (7.7%); that reproductive health care is primarily provided by obstetrician-gynecologists to female adolescents (76%); that adolescent care is generally less comprehensive in private practice than is recommended; that obstetrician-gynecologists could be the primary care physicians for both adult and adolescent women, since they are increasingly the medical contact point, especially after age 14; and, in view of the negative attitudes of physicians to adolescent sexual practices, that some training or reorientation will probably be necessary to prevent judgmental approaches from interfering with the physician-adolescent patient relationship.

Adolescent↗
PubMed2004

Provider self-efficacy and the screening of adolescents for risky health behaviors.

PURPOSE: To examine the extent to which providers' perceived self-efficacy to deliver adolescent preventive services relates to their screening practices. METHODS: Screening rates were determined by both provider self-reported screening practices and the independent report of the adolescent patient. First, 66 pediatric providers (pediatricians and nurse-practitioners), working in three pediatric clinics within a managed care organization, completed surveys assessing: (a) self-efficacy for screening adolescent patients in the areas of tobacco use, alcohol use, sexual behavior, seat belt use, and helmet use; and (b) self-reported screening of adolescents during well-visits over the past month. Second, a sample of patients, aged 14 years to 16 years, reported on whether their clinicians screened them for these behaviors during a well-visit. Adolescents completed reports (N = 323) immediately following the well visit. Data were analyzed using Pearson product-moment correlation coefficients. RESULTS: Provider self-efficacy to deliver preventive services was correlated with self-reported screening in each of the five content areas, ranging from r = .24 (p < .05) for seat belt use to r = .51 (p < .001) for helmet use. Provider self-efficacy was significantly related to adolescent reports of screening in three of the five content areas; r = .25 (p < .05) for sexual behavior and tobacco use; and r = .23 (p = .06) for alcohol use. CONCLUSIONS: Providers' self-efficacy to screen adolescents for risky behaviors was significantly related to both clinician self-report and independent adolescent reports of screening during well-visits. These findings point to the importance of enhancing clinicians' sense of competence to deliver adolescent preventive services.

Adolescent↗
PubMed2004

A predictive model of hopefulness for adolescents.

PURPOSE: To develop a predictive model of hopefulness using the variables of age, gender, and self-esteem among a sample of adolescents with cancer and a sample of healthy adolescents. METHODS: Forty-five healthy adolescents were individually matched with 45 adolescents with cancer on the basis of gender and age. Of the 90 subjects included in this study, 48 were male and 42 were female; half of the males (n = 24) and half of the females (n = 21) had cancer. Perceived level of self-esteem was measured using the Coppersmith Self-Esteem Inventory (SEI), and their degree of hopefulness was measured with the Hopefulness Scale for Adolescents (HSA). Data were analyzed using the Statistical Analysis System (SAS) Version 8. RESULTS: Adolescents' perceived level of self-esteem and hopefulness did not differ by gender or disease status. Patients with cancer had a significantly higher mean hopefulness score than healthy subjects (p = .031), and those adolescents with cancer did not have a lower perceived sense of self-esteem than healthy adolescents. The correlation coefficients between SEI and HSA were statistically significant for females with cancer, r = 0.723 (p < .001) and for healthy females, r = 0.676 (p < .001). In contrast, the correlations between SEI and HSA for males were not statistically significant. A model was constructed to predict a subject's hopefulness score that included the variables of self-esteem (p < .001), gender (p = .001), disease status (p = .005), and the interaction between self-esteem and gender (p = .002). CONCLUSIONS: The findings of this study demonstrate that hopefulness is a coping strategy used by female adolescents, both healthy and ill, that is closely related to their perceived sense of self-esteem.

Adaptation, Psychological↗
PubMed2004

Adolescents' health beliefs are critical in their intentions to seek physician care.

BACKGROUND: The examination of predictors of adolescents' intentions to use health care for different types of health issues has received little attention. This study examined adolescents' health beliefs and how they relate to intentions to seek physician care across different types of health problems. METHODS: Two hundred ten high school students (54% females; 76.6% participation rate) completed a self-administered survey of four separate age- and gender-specific health case scenarios: an adolescent who has symptoms of pneumonia; smokes five cigarettes daily; plans to initiate sex; and has symptoms of depression. For each health scenario, participants rated the seriousness of the health problem, physician effectiveness, and intentions to seek physician care. RESULTS: Most adolescents believed all health problems were serious except for planning to initiate sex (P < 0.001). Adolescents believed that physicians were most effective in diagnosis and treatment for pneumonia, followed by cigarette use, depression, and sex, respectively (P's < 0.001). Adolescents' intentions to seek physician care were greatest for physical as compared to risk behavior or mental health problems (P < 0.001). Multiple regression analyses revealed that adolescents had greater intentions to seek physician care for cigarette, sex, and depression when they believed physicians were effective and they perceived these as health problems after controlling for age and gender (all P's < 0.001). Health beliefs explained 12% to 49% of the variance in intentions to seek care (all P's < 0.001). CONCLUSIONS: Adolescents' health beliefs are important when understanding intentions to seek physician care. Health care use may be improved by increasing adolescents' beliefs that physicians are effective in areas other than physical health, including risk behaviors and mental health.

Adolescent↗
PubMed2002

America's adolescents: where have we been, where are we going?

PURPOSE: To determine historical trends and current status of the health of America's youth. METHODS: A thorough literature review was conducted to establish the best sources for adolescent data across a wide range of health-related issues using major national data sources. Data were collected and synthesized to create a comprehensive overview of adolescent health and demographic trends. RESULTS AND CONCLUSIONS: Adolescence is a distinct developmental stage posing unique challenges. Although generally considered a time of health and well-being, traditional health indicators often overlook areas specific to adolescence. Despite encouraging improvements in recent years, this population continues to have high rates of morbidity and mortality owing to violence, injury, and mental health disorders. Also, potentially health-damaging behaviors, such as premature and unprotected sexual behavior and substance use, pose significant threats. Fortunately, adolescence is a time of great behavioral plasticity. Because the vast majority of adolescent health risks are the result of behavioral causes, much of this morbidity and mortality is preventable. The adolescent population is projected to greatly increase over the next 2 decades. However, older age groups are increasing more rapidly, reducing the proportion of adolescents in the overall population. The aging population will likely demand increased access to scarce resources. The public needs to be educated about the need to support programs for youth. If resources are properly allocated, and health professionals trained to deal with adolescents' unique needs, America's youth have the potential to benefit greatly from successful implementation of new knowledge, developing healthy, positive, life-long behaviors.

Adolescent↗
PubMed2004

Primary care providers' willingness to see unaccompanied adolescents.

PURPOSE: To describe primary care practitioners' office policies and willingness to provide medical care for unaccompanied adolescents aged 11-17 years. METHODS: A unique 32-item survey was mailed in June and July, 2001 to 1979 office-based pediatricians and family practitioners randomly selected from the American Medical Association's physician database. The survey included questions regarding demographic information, number of adolescents seen in the practice, office policies regarding adolescents alone in the clinic, and 5-point Likert scales regarding their willingness to see patients in various situations, as well as to see patients in 12 brief clinical scenarios. Predictors of the willingness to see adolescents alone were identified and entered into binomial logistic regression models. Specific policies included on the surveys were coded into groups. RESULTS: Survey responses (n = 710) represented a 36% response rate. This sample included 288 family practitioners and 368 pediatricians; 43.3% of physicians reported having a specific policy regarding seeing adolescents without their parents present. Family practitioners were more likely than pediatricians to report having such a policy (51.3% vs. 38.2%, p =.001,), yet pediatricians reported a higher percentage of adolescents in their practices than family practitioners (22.6% vs. 12.4%, p <.0005). Not having a policy was an independent predictor of "often" or "always" seeing an adolescent alone for routine health maintenance (OR = 2.84, 95% CI 1.91-4.24) and urgent care visits (OR = 3.01, 95% CI 1.90-4.77). Specific policies varied, and many physicians assessed each case on an individual basis. CONCLUSIONS: Specific policies are associated with a decreased willingness of physicians to see adolescents who are unaccompanied by a parent. Carefully developed clinic policies that are consistent with legal guidelines should be implemented in order to maximize adolescents' abilities to access care.

Adolescent↗
PubMed1995

Adolescent girls' attitudes toward contraceptive subdermal implants.

Norplant, which has been shown to be a highly effective and acceptable contraceptive for adult women, may also be a very useful contraceptive for adolescents. This study is designed to determine the level of interest in Norplant for adolescent girls with and without children, their attitudes toward various features of Norplant, and the demographic and psychosocial factors predictive of their interest. A self-administered questionnaire was given to 112 adolescents attending our pediatric or adolescent clinic. Data from 28 adolescent mothers and 79 nulliparous adolescents were analyzed. Fifty-six percent of the subjects had heard of Norplant prior to the survey. The overall level of interest in Norplant was high; 70% of the adolescents without children, and 79% of the adolescent mothers were interested. In comparison to oral contraceptives, 73% of those without children and 89% of those with children thought Norplant would be a better contraceptive. The specific features of Norplant liked by 87% and 81% of the subjects, respectively, were not needing to take pills every day and its effectiveness in preventing pregnancy. The characteristics seen as most undesirable related to potential side effects with acne being mentioned by 87% of the subjects. Recursive partitioning analysis demonstrates that more than one prior pregnancy was the main characteristic predictive of very high levels of interest. In summary, this study demonstrates high levels of interest in Norplant by adolescents and suggests that it should be offered as a contraceptive option, especially to those girls who have previously been pregnant.

Adolescent↗
PubMed1998

Adolescent perceptions as mediators of parenting: genetic and environmental contributions.

Explaining how genetic factors contribute to associations between parenting and adolescent adjustment is an important next step in developmental research. This study examined the mediating effect of adolescent perceptions on these associations and the genetic and environmental influences underpinning the mediated relationship. Parent, adolescent, and observer ratings of parenting and adolescent adjustment were used in a genetically informative sample of 720 same-sex sibling pairs from 10 to 18 years old. Adolescent perceptions of parenting did significantly mediate a composite measure of parental conflict-negativity and adolescent antisocial behavior and depressive symptoms. The most substantial genetic contributions to the association between parenting and adolescent maladjustment were those mediated by adolescent perceptions. Once genetic and environmental contributions to adolescent perceptions of parenting were removed, shared environmental factors became more important for the remaining direct association.

Adolescent↗