Correlates of emotional distress in out-of-home youth.

PROBLEM: Adolescents in out-of-home placement have a high prevalence of mental health distress, and their vulnerability to poor mental health outcomes continues during placement. Risk and protective factors may influence mental health outcomes; however, little is known about their relationship to mental health distress in this population. METHODS: Using data from a population-based survey conducted in schools, mental health distress, along with other risk and protective factors, was evaluated in young people who reported living in out-of-home placements (n = 5,516) and a comparison group (n = 5,500). Multivariate analysis was used to determine the strength of association between risk and protective factors and mental health distress in the youth reporting out-of-home placement. FINDINGS: Comparisons of risk and protective factors indicated that out-of-home youth had greater risks (suicidal risk, mental health distress) and fewer protective factors (feeling parents care about them, other adults care, and school connectedness) than those in the comparison group. Multivariate analyses showed significant associations (38% explained variance) between mental health distress and the risk and protective factors, with the exception of other adult connectedness. CONCLUSIONS: Findings from this population-based school survey of young people reiterate that youth in out-of-home placements have higher levels of mental health distress and lower levels of protective factors compared to other youth. These results offer insights for those working with out-of-home or precariously housed young people.

Can a community-based intervention improve the home food environment? parental perspectives of the influence of the delicious and nutritious garden.

OBJECTIVE: To examine changes in parental report of the home food environment during the course of a garden-based fruit and vegetable (FV) intervention for grade school children. METHODS: Self-administered pre-post surveys were completed by parents/caregivers (n = 83). Main outcome measures included: child asking behavior, FV availability/accessibility, parental encouragement, and value of FV consumption. RESULTS: Process evaluation results indicate children shared their garden experiences at home, and as a result, the children's home food environment became increasingly supportive of FV consumption. Parents reported an increase (P < .01) in the frequency that their child asked for FVs. Parental value for FV consumption also improved (P < .01), as did home availability of fruit (P < .05), vegetables (P < .001), and parental encouragement of FVs (P = .06). CONCLUSIONS AND IMPLICATIONS: Community-based interventions that provide activities to engage parents may provide added benefit by improving the home food environment.

Characteristics of gastroesophageal reflux in adults with cystic fibrosis.

BACKGROUND: Gastroesophageal reflux (GER) in adults with cystic fibrosis (CF) is poorly characterized. This study examines the frequency and predictors of GER symptoms and their relationship to lung function in adults with CF. METHODS: Cross-sectional study of adults at the University of Minnesota CF Clinic using two validated self report surveys: The Mayo GER questionnaire and the GERD Symptom Assessment Scale (GSAS). RESULTS: Of 274 invited patients, 201 (73%) completed the surveys and 173 performed spirometry at the same visit. Frequent symptoms (at least weekly) were reported by 24% of the patients and an additional 39% experienced occasional symptoms. Heartburn, acid regurgitation and dysphagia were the most common symptoms and 18% reported that GER symptoms worsened their respiratory condition. Females and patients reporting weight loss had more symptoms (mean GSAS symptom score 4.9 vs. 4.0, p=0.025 and 5.3 vs. 4.2, p=0.04) and more severe symptoms (mean GSAS distress score 5.6 vs. 3.8, p=0.005 and 6.8 vs. 4.0, p=0.01) compared to males and those who did not report weight loss. Patients on acid suppression (n=122, 61%) continued to report heartburn (n=80, 66%) and acid regurgitation (n=47, 23%). GER symptoms and severity of symptoms were not predictive of FEV(1) or FVC. CONCLUSIONS: GER symptoms were present in a majority of patients. Females and patients with weight loss require special attention to their GER symptoms. Many patients on acid suppression continued to be report symptoms.

Health status and behavioral outcomes for youth who anticipate a high likelihood of early death.

OBJECTIVE: The relationship between adolescents' perceived risk for dying and their involvement in risk behaviors is unknown. We sought to determine the proportion of US youth who anticipate a high likelihood of early mortality and relationships with health status and risk behaviors over time. METHODS: We analyzed data from times 1 (1995), 2 (1996), and 3 (2001-2002) of the National Longitudinal Study of Adolescent Health, a nationally representative sample of youth in grades 7 through 12. The relationship between perceived risk for premature mortality and health behaviors/outcomes was assessed by using bivariate and multivariate analyses. RESULTS: At time 1, 14.7% of the 20594 respondents reported at least a 50/50 chance that they would not live to age 35. In adjusted models, illicit drug use, suicide attempt, fight-related injury, police arrest, unsafe sexual activity, and a diagnosis of HIV/AIDS predicted early death perception at time 2, time 3, or both (adjusted odds ratios: 1.26-5.12). Conversely, perceived early mortality at time 1 predicted each of these behaviors and outcomes, except illicit drug use, at time 2 or time 3, most strongly a diagnosis of HIV/AIDS (adjusted odds ratios: 7.13 [95% confidence interval: 2.50-20.36]). CONCLUSIONS: Adolescent involvement in risk behaviors predicted a belief in premature mortality 1 and 7 years later. Reciprocally, adolescents' perceived risk for early death predicted serious health outcomes, notably a diagnosis of HIV/AIDS in young adulthood. Given its frequency and influence on behavior and health, adolescents' perceived risk for early death should be incorporated into psychosocial assessments and interviews.

A garden pilot project enhances fruit and vegetable consumption among children.

Fruit and vegetable intake among children is inadequate. Garden-based nutrition education programs may offer a strategy for increasing fruit and vegetable intake in children. A 12-week pilot intervention was designed to promote fruit and vegetable intake among 4th to 6th grade children (n=93) attending a YMCA summer camp. Children participated in garden-based activities twice per week. Weekly educational activities included fruit and vegetable taste tests, preparation of fruit and vegetable snacks, and family newsletters sent home to parents. The pilot intervention was evaluated using a pre and post survey to determine participant satisfaction and the short-term impacts of the program. The process evaluation focused on program satisfaction, whereas the short-term impact evaluation assessed fruit and vegetable exposure, preference, self-efficacy, asking behavior, and availability of fruits and vegetables in the home. Data from the impact evaluation were compared from baseline to follow-up using McNemar's test (dichotomous variables) and Wilcoxon signed rank test (scales/continuous variables). Children reported high levels of enjoyment in the intervention activities. Most children (97.8%) enjoyed taste-testing fruits and vegetables. Children also liked preparing fruit and vegetable snacks (93.4%), working in their garden (95.6%), and learning about fruits and vegetables (91.3%). Impact data suggest that the intervention led to an increase in the number of fruits and vegetables ever eaten (P<0.001), vegetable preferences (P<0.001), and fruit and vegetable asking behavior at home (P<0.002). Garden-based nutrition education programs can increase fruit and vegetable exposure and improve predictors of fruit and vegetable intake through experiential learning activities. Participation in the "seed to table" experience of eating may help promote healthful eating behaviors among youth. Food and nutrition professionals should consider garden-based nutrition education programs that connect children with healthful foods through fun, hands-on activities.

Medical homes for children with autism: a physician survey.

BACKGROUND: Primary care physicians can enhance the health and quality of life of children with autism by providing high-quality and comprehensive primary care. OBJECTIVE: To explore physicians' perspectives on primary care for children with autism. METHODS: National mail and e-mail surveys were sent to a random sample of 2325 general pediatricians and 775 family physicians from April 2007 to October 2007. RESULTS: The response rate was 19%. Physicians reported significantly lower overall self-perceived competency, a greater need for primary care improvement, and a greater desire for education for children with autism compared with both children with other neurodevelopmental conditions and those with chronic/complex medical conditions. The following barriers to providing primary care were endorsed as greater for children with autism: lack of care coordination, reimbursement and physician education, family skeptical of traditional medicine and vaccines, and patients using complementary alternative medicine. Adjusting for key demographic variables, predictors of both higher perceived autism competency and encouraging an empirically supported therapy, applied behavior analysis, included having a greater number of autism patient visits, having a friend or relative with autism, and previous training about autism. CONCLUSIONS: Primary care physicians report a lack of self-perceived competency, a desire for education, and a need for improvement in primary care for children with autism. Physician education is needed to improve primary care for children with autism. Practice parameters and models of care should address physician-reported barriers to care.

Complementary alternative medicine for children with autism: a physician survey.

Previous studies suggest over half of children with autism are using complementary alternative medicine (CAM). In this study, physicians responded (n = 539, 19% response rate) to a survey regarding CAM use in children with autism. Physicians encouraged multi-vitamins (49%), essential fatty acids (25%), melatonin (25%) and probiotics (19%) and discouraged withholding immunizations (76%), chelation (61%), anti-infectives (57%), delaying immunizations (55%) and secretin (43%). Physicians encouraging CAM were more likely to desire CAM training, inquire about CAM use, be female, be younger, and report greater autism visits, autism education and CAM knowledge. Physicians were more likely to desire CAM training, inquire about CAM and view CAM as a challenge for children with autism compared to children with other neurodevelopmental and chronic/complex conditions.

Factors associated with overweight among urban American Indian adolescents: findings from Project EAT.

OBJECTIVES: To determine the prevalence of overweight in a sample of urban American Indian adolescents and identify associated behavioral, personal, and socioenvironmental factors. DESIGN AND PARTICIPANTS: Participants were 246 American Indian boys and girls from the Saint Paul-Minneapolis metropolitan area of Minnesota who completed classroom surveys and anthropometric measurements as part of Project EAT (Eating Among Teens), a population-based study of adolescent nutrition and weight. MEASURES: Survey items assessed behavioral factors (physical activity, television/video viewing, snacking and meal patterns, weight control behaviors), personal factors (body satisfaction, nutrition knowledge, nutrition/fitness attitudes, self-efficacy to make healthy food choices, perceived benefits/barriers to healthy eating), and socioenvironmental factors (family meal routines, family connectedness, parental attitudes regarding nutrition/fitness, availability of household foods, peer attitudes about weight and fitness). RESULTS: Overweight prevalence (body mass index > or =85th percentile) was 43% and 39% for American Indian boys and girls. Compared to nonoverweight American Indian youth, overweight American Indian youth reported watching more hours of television/videos, greater use of weight control behaviors, less frequent snacking, caring less about fitness, lower body satisfaction, and greater parental concern about weight. CONCLUSION: Obesity prevention programs targeting American Indian adolescents should focus on reducing time spent watching television/videos, screening for unhealthy weight-control behaviors, improving body satisfaction, and providing support for families to integrate healthy eating into their busy lifestyles.

Transition to adulthood: delays and unmet needs among adolescents and young adults with asthma.

OBJECTIVE: To examine the effect of the transition to adulthood on financial and non-financial barriers to care in youth with asthma. STUDY DESIGN: With National Health Interview Survey data from 2000 to 2005, we examined delays and unmet needs because of financial and non-financial barriers, evaluating the effect of adolescent (age, 12-17 years; n = 1539) versus young adult age (age, 18-24 years; N = 833), controlling for insurance, usual source of care, and sociodemographic characteristics. We also simulated the effects of providing public insurance to uninsured patients and a usual source of care to patients without one. RESULTS: More young adults than adolescents encountered financial barriers resulting in delays (18.6% versus 8%, P < .05) and unmet needs (26.6% versus 11.4%, P < .05), although delays caused by non-financial barriers were similar (17.3% versus 14.9%, P = not significant). In logistic models young adults were more likely than adolescents to report delays (odds ratio [OR], 1.45; 95% CI, 1.02-2.08) and unmet needs (OR, 1.8; 95% CI, 1.29-2.52) caused by financial barriers. CONCLUSIONS: Delays and unmet needs for care caused by financial reasons are significantly higher for young adults than they are for adolescents with asthma.

BMI percentiles and body image discrepancy in black and white adolescents.

The purpose of this study was to investigate the relationship between body image discrepancy (BID) and weight status as measured by BMI percentiles (BMI%) among adolescents. A cross-sectional survey was conducted among 265 adolescents at an urban clinic (females: 116 blacks and 63 whites; males: 62 blacks and 24 whites). BID was the difference between ideal and current body images selected from a 13-figure rating scale, and BMI% were calculated from measured weight and height. Regression analyses were conducted separately for girls and boys. Over half of the female and one-third of male adolescents wanted a thinner body. BID was positively related to BMI% with a one-unit increase in BID associated with a 4.84-unit increase in BMI% among females and a 3.88-unit increase in BMI% in males. Both female and male adolescents reported BID beginning at a BMI% corresponding to a normal weight. At zero BID, white females had a BMI% of 62.6, statistically different from black females (BMI% 69.7). At zero BID, white males had a mean BMI% of 69 and black males at a BMI% of 75.8, not statistically different. While black and white differences exist in BID, black female adolescents like their white counterparts are reporting BID at a weight range that is within the "normal". Our study portends the increase in BID with the increasing prevalence of obesity and highlights the need for interventions to help adolescents develop a healthy and realistic body image and healthy ways to manage their weight.

Communication with our teens: associations between confidential service and parent-teen communication.

PURPOSE: Many recent attempts have been made to eliminate health services minors can receive without parental consent or notification. One argument is that these "confidential" services undermine the parent-teen relationship. The objective of this study was to evaluate whether confidential services impact adolescent's communication with parents about their health. METHODS: This cross-sectional study included 59 adolescents (ages 12-21) seeking health services at an urban teen clinic in Minneapolis, MN. Participants were divided based on reasons for presenting at the clinic; confidential or non-confidential services. The main outcome variables were the following: discussion of clinic visit with parent, discussion of reason for clinic visit with parent, and communication with parent if diagnosed with a potentially serious health condition. RESULTS: The two groups were equally divided; 42.4% came for non-confidential services and 57.6% came for confidential services. Of the 59 participants, 69.5% told their parents they were coming to clinic. However, only 43.1% reported they would not tell their parent if they had a serious health problem; there was an equal split between the confidential services and non-confidential services groups. A statistical difference was not found between the confidential services and non-confidential services groups for any of the outcome variables. CONCLUSIONS: Obtaining confidential services was not a barrier to discussion with parents about clinic visit, reasons for coming to clinic, or telling their parent if they had a serious health care problem. Clinicians should continue to advocate for confidential services while encouraging open communication between adolescents and their parents.

Individual and environmental impacts on sexual health of Caribbean youth.

Individual health risk behaviors among Caribbean youth account for the majority of adolescent morbidity and mortality in that area. This study explores the associations between individual factors, socioenvironmental factors, and sexual health-related behaviors in Caribbean youth. Data from the 1995 Caribbean Youth Health Survey, a nine-country, cross-sectional study completed by 15,695 in-school youth 10-18 years of age were analyzed. One-third of the sample (n = 5,060) reporting sexual activity was analyzed. This study examined age at first sexual intercourse, number of sexual partners, history of pregnancy, and condom use. The predictor variables were rage, depressed mood, expectation of early death, self-reported school performance, parental mental health or substance abuse problems, and family connectedness. Bi- and multivariate analyses were done separately for males and females, controlling for age, to examine associations between individual and socioenvironmental factors and sexual health behaviors. In the multivariate model, there were associations between rage, abuse, family mental health and substance use, anticipation of early death, and many of the outcome variables in males and females. Family connectedness and positive self-reported school status were correlated with greater condom use at last intercourse in males. Family connectedness was correlated with older age at first sexual intercourse. Depressed mood was not correlated with any of the outcome variables. The findings of the study demonstrate an association between individual and socioenvironmental factors and sexual health behaviors in the lives of Caribbean youth. Strong associations between rage and physical/sexual abuse and risky sexual behaviors are of notable concern.

Parental expectations, physical punishment, and violence among adolescents who score positive on a psychosocial screening test in primary care.

OBJECTIVE: We sought to examine the relationship between perceived and stated parental expectations regarding adolescents' use of violence, parental use of physical punishment as discipline, and young adolescents' violence-related attitudes and involvement. METHODS: Surveys were completed by 134 youth and their parents attending 8 pediatric practices. All youth were 10 to 15 years of age and had scored positive on a psychosocial screening test. RESULTS: Multivariate analyses revealed that perceived parental disapproval of the use of violence was associated with a more prosocial attitude toward interpersonal peer violence and a decreased likelihood of physical fighting by the youth. Parental report of whether they would advise their child to use violence in a conflict situation (stated parental expectations) was not associated with the adolescents' attitudes toward interpersonal peer violence, intentions to fight, physical fighting, bullying, or violence victimization. Parental use of corporal punishment as a disciplining method was inversely associated with a prosocial attitude toward interpersonal peer violence among the youth and positively correlated with youths' intentions to fight and fighting, bullying, and violence victimization. CONCLUSIONS: Perceived parental disapproval of the use of violence may be an important protective factor against youth involvement in violence, and parental use of physical punishment is associated with both violence perpetration and victimization among youth. Parents should be encouraged to clearly communicate to their children how to resolve conflicts without resorting to violence and to model these skills themselves by avoiding the use of physical punishment.

Addressing transition to adult health care for adolescents with special health care needs.

OBJECTIVE: To determine the factors associated with addressing the transition from pediatric to adult-oriented health care among US adolescents with special health care needs. METHODS: Data for 4332 adolescents, 14 to 17 years of age, from the 2000-2001 National Survey of Children With Special Health Care Needs were used. The adequacy of transition services was determined by parent self-report. Explanatory variables, including parental education, family poverty status, race/ethnicity, measures of the severity and complexity of conditions, health insurance status, having a personal doctor, and the quality of the parent's relationship with the adolescent's doctor, were entered into a regression model. RESULTS: Overall, 50.2% of parents reported that they had discussed transition issues with their adolescent's doctor and 16.4% had discussed and developed a plan for addressing those needs. In a multivariate regression analysis, correlates of the adequacy of transition services included older age, female gender, complexity of health care needs, and higher quality of the parent-doctor relationship. CONCLUSIONS: Among adolescents with special health care needs, those who were older and those with more complicated needs were more likely to have addressed the transition from a pediatric to adult-oriented system of care. Furthermore, this analysis demonstrated a strong association between a high-quality parent-provider relationship and the extent to which transition issues were addressed. The importance of transition services for adolescents with less complex needs and the overall impact of health care transition services were not assessed in this study and remain important questions for future investigations.

The clustering of risk behaviors among Caribbean youth.

OBJECTIVE: To examine the relationships among risk behaviors for Caribbean youth; and to determine the correlations between initiation of sexual activity and other risk behaviors. METHODS: The associations between cigarette smoking, alcohol and marijuana use, early initiation of sexual intercourse, involvement in violence and delinquency were examined using odds ratios on data from the Caribbean Youth Health Survey (n = 15, 695). Survival analysis was then used to determine the association between initiation of sexual activity and the risk behaviors. FINDINGS: There were statistically significant relationships between all pairs of risk behaviors for both male and female adolescents. Even though more males than females had engaged in each of the behaviors, the strengths of association were higher for females. From survival analysis, initiation of sexual activity was associated with gang involvement and weapon carrying among young adolescents and even more risk behaviors among the older adolescents. CONCLUSION: Health compromising behaviors cluster among Caribbean youth with associations being stronger for females. Initiating sexual activity was a predictor of other risk behaviors with the likelihood increasing among older adolescents and females.

Sexual abuse history, risk behavior, and sexually transmitted diseases: the impact of age at abuse.

OBJECTIVE: The objective of this study was to examine the relationship between age at onset of sexual abuse, risk behaviors, and a diagnosis of sexually transmitted disease (STD) in a clinic-attending adolescent population. METHODS: Bivariate analyses were used to test association among age at onset of sexual abuse, risk behaviors, and STD diagnosis (n = 2175). Relationship between sexual abuse and STD acquisition was assessed by regression analysis. RESULTS: More females than males reported sexual abuse, 26.75% and 5.4%, respectively. Abuse at or before 10 years of age was associated with more lifetime and recent partners. History of abuse was associated with higher rates of STD tests. In regression analysis, for males and females, the odds of having an STD were 2.5 times greater if abuse occurred at 10 years or younger. CONCLUSION: Sexual abuse at a younger age is associated with more sexual risk behaviors and is a risk factor for STDs.

A rose by any other name? Objective knowledge, perceived knowledge, and adolescent male condom use.

OBJECTIVE: To investigate the role of objective and perceived knowledge about condoms in adolescent males' condom use at first intercourse. METHODS: A longitudinal analysis was conducted of data from a nationally representative sample of 404 virgin male adolescents who were aged 15 to 17 years at wave 1 and reported becoming sexually experienced at the second wave of data collection. Objective knowledge was measured as a 5-item knowledge test about condoms. Perceived knowledge was measured as a 5-item scale regarding participants' confidence about their answers on the objective knowledge test. Condom use was assessed by self-report. RESULTS: Objective and perceived knowledge were moderately correlated with each other. Male adolescents with low objective but high perceived knowledge were identified as being at particular risk for not using a condom in that they were nearly 3 times less likely to report using a condom at first intercourse (odds ratio: 0.35) than those with other levels of objective and perceived knowledge. CONCLUSIONS: Previous evidence suggests that knowledge about sex does not accurately predict sexual behavior. This lack of predictive accuracy may be because studies have focused only on objective knowledge. Our results suggest that both objective and perceived knowledge serve as antecedents to male condom use at first intercourse. However, those with higher perceived knowledge, particularly in the context of low objective knowledge, may be at greater risk for not using condoms. Addressing not only objective but also perceived knowledge may increase the effectiveness of interventions that are designed to increase rates of condom use among male adolescents.

Reducing risk, increasing protective factors: findings from the Caribbean Youth Health Survey.

PURPOSE: To identify the prevalence of health-compromising behaviors, and the risk and protective factors associated with them among youth in the Caribbean, and to predict the likelihood of these outcomes given the presence or absence of the risk and protective factors. METHODS: Analyses were done on the results of a 1997-98 survey of over 15,500 young people in nine countries of the Caribbean Community. The four health-compromising behaviors studied included violence involvement, sexual intercourse, tobacco use, and alcohol use. Logistic regression was used to identify the strongest risk and protective factors, and also to create models for predicting the outcomes given combinations of the risk and protective factors. RESULTS: Rage was the strongest risk factor for every health-compromising behavior for both genders, and across all age groups, and school connectedness was the strongest protective factor. For many of the outcomes studied, increased protective factors were associated with as much or more reduction of involvement in health-compromising behaviors than a decrease in risk factors. CONCLUSION: This research suggests the importance of strengthening the protective factors in the lives of vulnerable youth not just reducing risk.

Pelvic inflammatory disease in adolescents: high incidence and recurrence rates in an urban teen clinic.

STUDY OBJECTIVE: To determine pelvic inflammatory disease (PID) incidence and recurrence rates in an urban teen clinic. DESIGN/SETTING: A retrospective chart review of female patients seen as outpatients over an 18-month period at an urban teen clinic. 192 patients were diagnosed with PID, and the charts of these patients were reviewed in depth. MAIN OUTCOME MEASURES: PID incidence and recurrence rates. RESULTS: A PID incidence of 9.7% was identified. Of the adolescent females diagnosed with PID, 47% had recurrent PID. Of the females with recurrent PID, 27% had three or more episodes. Only 36% of adolescent females diagnosed with PID ever reported that their partners had been treated. CONCLUSIONS: This study suggests a higher incidence of PID as well as PID recurrence in the present clinic-based adolescent population than previously reported. More accurate monitoring of incidence and recurrence rates in well-defined populations of adolescents should be conducted with the hope of identifying effective avenues of intervention.

Youth violence perpetration: what protects? What predicts? Findings from the National Longitudinal Study of Adolescent Health.

PURPOSE: To identify individual, family and community-level risk and protective factors for violence perpetration in a national sample of adolescents. METHODS: Analysis of two waves of data from the National Longitudinal Study of Adolescent Health. The key outcome variable was Time 2 violence involvement, approximately 1 year after initial data collection, measured by a validated scale of violence perpetration RESULTS: Controlling for demographic covariates in multivariate regression models, key Time 1 protective factors against Time 2 violence perpetration included measures related to parental expectations, connectedness with parents and other adults, and school, higher grade point average and religiosity. Significant predictive risk factors included a history of violence involvement and violence victimization, weapon carrying, school problems, substance use, health problems, and friend suicide. Probability profiles then assessed the ability of protective factors to offset known risk factors for violence. For both girls and boys there were substantial reductions in the percentage of youth involved in violence in the presence of protective factors, even with significant risk factors present. CONCLUSIONS: Findings support the utility of a dual strategy of reducing risk factors while enhancing protective factors in the lives of adolescents.