Referral to Adolescent Weight Management Interventions: Qualitative Perspectives From Providers.

OBJECTIVE: Current guidelines for treatment of obesity in adolescence include screening and referring youth with obesity to appropriate weight management (WM) care. However, prior work has not explored the referral process to adolescent WM programs, especially for youth from lower-income backgrounds, who are at increased risk of obesity and related negative health outcomes. This qualitative study sought to understand pediatricians' current practices regarding referrals to adolescent WM interventions with a focus on adolescents from lower-income backgrounds. METHODS: Individual interviews were conducted with 11 medical providers that had referred at least 5 adolescents from low-income backgrounds to WM interventions. Applied thematic analysis was used for data analysis. RESULTS: Identified themes included weight-related discussions with adolescents as potentially fraught, as providers want to address weight-related health concerns while being thoughtful about potential harm. Providers also noted varied factors affecting their decision to refer to WM programs, including health implications, perceived motivation of the patient and family, and availability of programs. Providers identified that many families experience shame or guilt around referral to WM. Few themes were identified regarding impact of income on weight-related conversations with adolescents. CONCLUSION: Findings were novel in regard to discussions of weight in adolescents with obesity leading to WM referral. Despite being a primary focus of the present study, few themes were identified regarding specific considerations for adolescents from low-income backgrounds. Future clinical research should focus on provider-focused interventions to increase sensitivity regarding weight-related discussions and attention to diversity, equity, and inclusion.

Weight Management Engagement for Teens From Low-Income Backgrounds: Qualitative Perspectives From Adolescents and Caregivers.

OBJECTIVE: Adolescents from low-income backgrounds are at increased risk for obesity and related negative health outcomes. Furthermore, these adolescents have less access to, and success in, weight management (WM) programs. This qualitative study sought to better understand engagement in a hospital-based WM program from the perspective of adolescents and caregivers at different levels of program initiation and engagement. METHODS: Qualitative interviews were conducted with 55 participants (29 adolescents and 26 caregivers). This included: (a) those that were referred to, but never initiated, WM treatment (non-initiators); (b) those that prematurely disengaged from treatment (drop-outs); and (c) those that had ongoing participation in treatment (engaged). Data were analyzed using applied thematic analysis. RESULTS: Related to program initiation, participants across all groups (including adolescents and caregivers) noted that they did not have a full understanding of the scope or goals of the WM program following initial referral. In addition, many participants identified misperceptions of the program (e.g., perceptions of a screening visit as compared to an intensive program). Both caregivers and adolescents identified caregivers as drivers of engagement, with adolescents often hesitant about participation in the program. However, engaged adolescents found the program valuable and sought ongoing participation following caregiver initiation. CONCLUSIONS: When considering initiation and engagement in WM services for adolescents at highest risk, healthcare providers should provide more detailed information concerning WM referrals. Future research is needed to improve adolescent perception of WM, especially for adolescents from low-income backgrounds, which could increase initiation and engagement for this population.

Personalized Digital Health Information to Substantiate Human-Delivered Exercise Support for Adults With Type 1 Diabetes.

OBJECTIVE: Pilot-test personalized digital health information to substantiate human-delivered exercise support for adults with type 1 diabetes (T1D). DESIGN: Single-group, 2-week baseline observation, then 10-week intervention with follow-up observation. SETTING: Community-based sample participating remotely with physician oversight. PARTICIPANTS: Volunteers aged 18 to 65 years with T1D screened for medical readiness for exercise intervention offerings. N = 20 enrolled, and N = 17 completed all outcomes with 88% to 91% biosensor adherence. INTERVENTION: Feedback on personalized data from continuous glucose monitoring (CGM), its intersection with other ecological data sets (exercise, mood, and sleep), and other informational and motivational elements (exercise videos, text-based exercise coach, and self-monitoring diary). MAIN OUTCOME MEASURES: Feasibility (use metrics and assessment completion), safety (mild and severe hypoglycemia, and diabetic ketoacidosis), acceptability (system usability scale, single items, and interview themes), and standard clinical and psychosocial assessments. RESULTS: Participants increased exercise from a median of 0 (Interquartile range, 0-21) to 64 (20-129) minutes per week ( P = 0.001, d = 0.71) with no severe hypoglycemia or ketoacidosis. Body mass index increased (29.5 ± 5.1 to 29.8 ± 5.4 kg/m 2 , P = 0.02, d = 0.57). Highest satisfaction ratings were for CGM use (89%) and data on exercise and its intersection with CGM and sleep (94%). Satisfaction was primarily because of improved exercise management behavioral skills, although derived motivation was transient. CONCLUSIONS: The intervention was feasible, safe, and acceptable. However, there is a need for more intensive, sustained support. Future interventions should perform analytics upon the digital health information and molecular biomarkers (eg, genomics) to make exercise support tools that are more personalized, automated, and intensive than our present offerings.

Adverse childhood experiences, health behaviors, and associations with obesity among youth in the United States.

Adverse Childhood Experiences (ACEs) affect almost half of youth in the U.S. and are linked to a host of deleterious medical and psychosocial outcomes. The current study examines the relationships among ACEs, childhood obesity, and modifiable lifestyle behaviors to inform clinical care, future research, and policy. Using data from the 2016-2018 National Survey of Children's Health (NSCH), associations between children's ACEs, weight status, and health behaviors that may influence the link between ACEs and obesity were examined. In the NSCH data, 25.3% of youth aged 10-17 years experienced one ACE with another 25.9% experiencing two or more ACEs. Having ACEs was related to excess screen time and inadequate sleep, and independently associated with obesity. Findings highlight the importance of providers screening and finding ways to intervene on behalf of youth with obesity. The present provides guidelines for providers on intervening with youth experiencing ACEs.

What COVID-19 Teaches Us About Implicit Bias in Pediatric Health Care.

OBJECTIVES: To highlight the role of implicit bias in contributing to existing health disparities among pediatric populations during the coronavirus disease 2019 (COVID-19) pandemic and recommend strategies to reduce its impact. METHODS: A topical review of the recent literature on implicit bias describing its potential impact in key areas of pediatric health care within the context of COVID-19 was conducted. RESULTS: Pediatric provider implicit bias has been found to be similar to the general population and can negatively influence clinical decision-making and outcomes for marginalized youth and families, particularly under stressful conditions such as the COVID-19 pandemic. Implicit bias can be mitigated through strategies proposed at the individual, institutional/organizational, educational, and scientific/research levels. CONCLUSIONS: The additional strain on provider resources, staff, and supplies created by COVID-19 may exacerbate providers' susceptibility to implicit bias and contribute to health disparities. Pediatric psychologists are encouraged to recognize implicit biases in themselves and colleagues and promote identified strategies to reduce the impact of implicit bias on perpetuating health disparities in marginalized youth and families.

Introduction to the Special Issue: Addressing Health Disparities in Pediatric Psychology.

This introduction to the special issue on Addressing Health Disparities in Pediatric Psychology provides context for why this special issue is needed, reviews key findings of the accepted articles, and discusses future directions for advancing the field. This special issue, one of three on this topic area that has been put forth in the history of this journal, comes at a critical point in our world. This is a time when the COVID-19 pandemic is systematically infecting Black, Indigenous, and People of Color and when there has been increased attention to systemic racism and intersecting violence inherent in multiple systems, including the justice, health, and educational systems. Using Kilbourne et al. (2016) framework, this special issue focuses on Phase 2 and Phase 3 research. Rather than only identifying health disparities (Phase 1), this issue focuses on understanding mechanisms and translating such understanding into interventions and policy changes. The accepted articles span a wide gamut from obesity to autism to rural populations. Furthermore, the articles provide methods for advancing the field beyond simply noting that systematic differences exist toward strategies to address these inequities. We conclude this introduction by discussing next steps for future research, with hopes that it inspires the next generation to study issues of disparities and inequity in deeper, more meaningful, and impactful ways.

Comparison of clinical, biochemical and histomorphometric analysis of bone biopsies in dialysis patients with and without fractures.

Chronic kidney disease-mineral bone disorders (CKD-MBD) are associated with increased risk of fracture. Studies report about 3% of fractures in CKD patients, and these occur earlier than in the general population, namely 16 and 13 years earlier for men and women, respectively. Better understanding of the pathophysiology of fractures would probably contribute to new therapeutic approaches. This study aimed to evaluate report of long bone fractures from a bone biopsies bank from patients on hemodialysis and compare clinical and biochemical characteristics, as well as the results of the histomorphometric analysis of trabecular and cortical bone of these patients with a control group (without fractures), paired for age, gender, and time on hemodialysis. Bone proteins (SOST, DMP1 and MEPE) were evaluated by immunohistochemistry. Seventeen patients with fracture and controls were studied. Fracture prevalence was 0.82/1000 patients/year. Serum phosphorus levels were significantly lower in the fracture group. Histomorphometric analysis revealed that all the patients had high turnover disease, and the fracture group had smaller volume and trabecular thickness, greater osteoid surface, smaller eroded surface, smaller mineralizing surface, formation rate and longer mineralization lag time when compared to controls; the DMP1 expression in the cortical bone was smaller and the SOST in the trabecular bone was higher in fractured patients. As conclusion, we found low prevalence of fractures. Both groups had high turnover disease, but the fractured ones presented more impaired bone microarchitecture, as well as lower formation and greater mineralization defect. Bone proteins expression correlated with parameters involved in bone remodeling.

Moving Beyond Statements to Protect Transgender Youth.

This Viewpoint explores the politicized nature of gender-affirming care for transgender and nonbinary youth and how children's hospitals can provide education, resources, and access to families seeking care.

The Relationship Between Experiences of Pain Among Youth With Obesity and Health-Related Quality of Life: The Role of Functional Limitation, Sleep, and Depressive Symptoms.

Background: Pediatric obesity is a growing concern in the United States and has been linked to negative psychological health outcomes such as depression, anxiety, and decreased quality of life. Obesity is a complex disease that is influenced by several environmental and social factors that are often out of an individuals' control. The etiology of pain in youth with obesity is not well understood. There are likely many factors that overlap and influence each other, including those related to functional limitation, sleep quality, and psychological health that exacerbate symptoms as a whole. Methods: This study examined the relationship between obesity level (BMI z-score) and youth self reports of: pain, functional limitation, sleep quality, depressive symptoms, and health-related quality of life (HRQoL). Ninety-eight patients completed validated surveys of pain, pain burden, functional disability, sleep, depression, and HRQoL as standard of care during their initial visit in Weight Management Program at Connecticut Children's Medical Center. Indirect effects of pain measures (pain scores and pain burden) on HRQoL through functional limitation, sleep quality, and depressive symptoms, respectively, were tested using bootstrapping according to Hayes.34 Results: Significant indirect effects and full mediation for both models were found. Conclusions: This study uniquely contributes to existing research through the discovery of the serial mediating effects of these variables in the relationship between youth pain and HRQoL. Although these variables have been studied independently as influential in this relationship in past research, this is the first study to examine how they interact through serial mediation models.

Role of the exercise professional in metabolic and bariatric surgery.

BACKGROUND: Physical activity (PA) is important for the long-term health and weight management of patients who undergo metabolic and bariatric surgery (MBS). However, the roles of exercise professionals in MBS settings have not been systematically determined. OBJECTIVES: To investigate: (1) who are the professionals implementing PA programming in MBS clinical settings; and (2) what patient-centric tasks do they perform? SETTING: Clinical and academic exercise settings worldwide. METHODS: This multimethod study included a scoping review of PA programs in MBS described in the research literature. Data about job tasks were extracted and provided to 10 experts to sort into categories. Cluster analysis was utilized to find the hierarchical structure of tasks. A Delphi process was used to agree on a final model. RESULTS: The majority of PA professionals were exercise physiologists in the USA and physiotherapists or other types of exercise professionals elsewhere. Forty-three tasks were identified, the most reported being supervision of exercise, fitness testing, and exercise prescription. Seven higher-order categories were determined: (1) Exercise-related health assessment, (2) Body composition and physical fitness assessment, (3) Lifestyle physical activity and sedentary behavior assessment, (4) Education, instruction, and prescription, (5) Exercise monitoring, (6) Behavioral counseling and psychosocial support, and (7) Dietary support. The following statements were rated an average of 9.0, classifying them as "imperative": 1) "Pre- and postoperative PA/exercise guidelines for MBS patients are needed", 2) "MBS programs need to include PA/exercise as part of multidisciplinary care". CONCLUSIONS: The expert group reached a consensus on 7 major classifications of job tasks for the exercise professional. It is important for governing medical associations across the world to formally recognize experienced exercise professionals as playing pivotal roles in continuing, multidisciplinary care for MBS patients. These findings also provide evidence-based information in the effort to solidify these positions within the greater context of healthcare.

Challenges and solutions to sustaining paediatric weight management programs in the United States.

Paediatric weight management (PWM) programs in the United States (US) face challenges in providing sustainable multidisciplinary care for patients. The aim of this study was to report PWM program approaches to sustaining program delivery. A survey of 39 PWM programs was administered to identify challenges and solutions to program sustainability. Common and useful strategies for optimizing reimbursement for services included the use of applicable reimbursable diagnostic codes and management, billing for assessments and non-medical personnel services, and the use of hospital outpatient department clinic billing. Increasing clinical breadth and capacity was achieved by offering telemedicine and other services, such as psychotherapy, pharmacotherapy, and metabolic and bariatric surgery, as well as active management of schedules. Securing institutional and extramural funding was also reported. One of the positive changes during the pandemic was the fast adoption of telemedicine services. Although delivering sustainable evidence-based multidisciplinary PWM under the current US payment models has its challenges, PWM programs implement practical operational strategies to support this work.

Role of the exercise professional in metabolic and bariatric surgery.

Background: Physical activity (PA) is important for the long-term health and weight management of patients who undergo metabolic and bariatric surgery (MBS). However, the roles of exercise professionals in MBS settings have not been systematically determined. Objectives: To investigate: (1) who are the professionals implementing PA programming in MBS clinical settings; and (2) what patient-centric tasks do they perform? Setting: Clinical and academic exercise settings worldwide. Methods: This multimethod study included a scoping review of PA programs in MBS described in the research literature. Data about job tasks were extracted and provided to 10 experts to sort into categories. Cluster analysis was utilized to find the hierarchical structure of tasks. A Delphi process was used to agree on a final model. Results: The majority of PA professionals were exercise physiologists in the USA and physiotherapists or other types of exercise professionals elsewhere. Forty-three tasks were identified, the most reported being: supervision of exercise, fitness testing, and exercise prescription. Seven higher-order categories were determined: (1) Exercise-related health assessment, (2) Body composition and physical fitness assessment, (3) Lifestyle physical activity and sedentary behavior assessment, (4) Education, instruction, and prescription, (5) Exercise monitoring, (6) Behavioral counseling and psychosocial support, and (7) Dietary support. The following statements were rated an average of 9.0, classifying them as "imperative": 1) "Pre- and post-operative PA/exercise guidelines for MBS patients are needed", 2) "MBS programs need to include PA/exercise as part of multidisciplinary care". Conclusions: The expert group reached a consensus on 7 major classifications of job tasks for the exercise professional. It is important for governing medical associations across the world to formally recognize experienced exercise professionals as playing pivotal roles in continuing, multidisciplinary care for MBS patients. These findings also provide evidence-based information in the effort to solidify these positions within the greater context of healthcare.

Harmonizing disease prevention and police practice in the implementation of HIV prevention programs: Up-stream strategies from Wilmington, Delaware.

INTRODUCTION: Improving access to sterile injection equipment is a key component in community-based infectious disease prevention. Implementation of syringe access programs has sometimes been complicated by community opposition and police interference. CASE DESCRIPTION: In 2006, the Delaware legislature authorized a pilot syringe exchange program (SEP). A program designed to prevent, monitor, and respond to possible policing and community barriers before they had a chance to effect program implementation and operation. A program designed to prevent, monitor, and respond to these barriers was planned and implemented by a multidisciplinary team of legal practitioners and public health professionals. DISCUSSION: We report on an integrated intervention to address structural barriers to syringe exchange program utilization. This intervention employs community, police and client education combined with systematic surveillance of and rapid response to police interference to preempt the kinds of structural barriers to implementation observed elsewhere. The intervention addresses community concerns and stresses the benefits of syringe exchange programs to officer occupational safety. CONCLUSIONS: A cohesive effort combining collaboration with and educational outreach to police and community members based on the needs and concerns of these groups as well as SEP clients and potential clients helped establish a supportive street environment for the SEP. Police-driven structural barriers to implementation of public health programs targeting populations engaged in drug use and other illicit behavior can be addressed by up-stream planning, prevention, monitoring and intervention strategies. More research is needed to inform the tailoring of interventions to address police-driven barriers to HIV prevention services, especially among marginalized populations.

Obesity Pillars roundtable: Metabolic and bariatric surgery in children and adolescents.

Background: Obesity is a chronic disease which frequently begins in childhood and requires a life-long multidisciplinary approach. Metabolic-bariatric surgery (MBS) is a key component of the treatment of severe obesity in children, adolescents and adults. Children and adolescents who have class II obesity and a complication of obesity or have class III obesity should be considered for MBS, regardless of age, race, sex, or gender. Children and adolescents with cognitive disabilities, a history of mental illness, a treated eating disorder, immature bone growth, or low Tanner Stage should not be denied treatment. Early intervention can reduce the risk of persistent obesity, end organ damage, and sequelae from long-standing complications of obesity. Methods: This roundtable discussion includes three pediatric obesity specialists with experience in the medical and surgical management of children and adolescents with obesity. Included are citations regarding metabolic-bariatric surgery in children and adolescents. Results: MBS in pediatric patients is increasingly recognized as an essential part of managing the disease of obesity in combination with medication, nutrition, behavioral training, and physical activity. Vertical sleeve gastrectomy or Roux-en-Y gastric bypass in patients meeting criteria for severe obesity should be considered, especially when children have complications such as poor quality of life, orthopedic disease, idiopathic intracranial hypertension, type 2 diabetes mellitus, obstructive sleep apnea, or cardiovascular risk. Children and adolescents with autism, developmental delay, or syndromic obesity should be considered for MBS on a case-by-case basis. Early intervention may result in improved long-term outcomes, and referral for MBS should not be conditional based on stage of pubertal development (Tanner Staging), bone age, or prior weight loss attempts. Conclusions: Children and adolescents who suffer from severe obesity need the entire spectrum of treatment modalities available to achieve a healthy weight and control obesity-related complications. This treatment spectrum should include MBS. These children and adolescents should be cared for by a pediatric weight management team prepared to care for them until they transition to adult care.

Obesity and Adipose Tissue Dysfunction: From Pediatrics to Adults.

Obesity is a growing health problem that affects both children and adults. The increasing prevalence of childhood obesity is associated with comorbidities such as cardiovascular disease, type 2 diabetes and metabolic syndrome due to chronic low-grade inflammation present at early stages of the disease. In pediatric patients suffering from obesity, the role of epigenetics, the gut microbiome and intrauterine environment have emerged as causative factors Interestingly, pediatric obesity is strongly associated with low birth weight. Accelerated weight gain oftentimes occurs in these individuals during the post-natal period, which can lead to increased risk of adiposity and metabolic disease. The pathophysiology of obesity is complex and involves biological and physiological factors compounded by societal factors such as family and community. On a cellular level, adipocytes contained within adipose tissue become dysregulated and further contribute to development of comorbidities similar to those present in adults with obesity. This review provides an overview of the current understanding of adipose tissue immune, inflammatory and metabolic adaptation of the adipose tissue in obesity. Early cellular changes as well as the role of immune cells and inflammation on the progression of disease in pivotal pediatric clinical trials, adult studies and mouse models are emphasized. Understanding the initial molecular and cellular changes that occur during obesity can facilitate new and improved treatments aimed at early intervention and subsequent prevention of adulthood comorbidities.

Somatosensory Profiles Differentiate Pain and Psychophysiological Symptoms Among Young Adults With Irritable Bowel Syndrome: A Cluster Analysis.

OBJECTIVE: The aim of this study was to investigate if somatosensory profiles can differentiate pain and psychophysiological symptoms among young adults with irritable bowel syndrome (IBS). METHODS: We performed a cluster analysis of data collected from a randomized clinical trial of 80 IBS patients and 21 age-matched healthy controls (HCs) to stratify pain and symptoms among young adults with IBS by their peripheral sensory profiles. Data of quantitative sensory testing and IBS-related pain and symptoms were collected at baseline and 6-week and 12-week follow-ups. RESULTS: Using the K-means method, IBS patients were classified into 2 clusters, the "IBS normal threshold" (IBS-NT) and the "IBS increased threshold" (IBS-IT). The IBS-NT cluster had a similar pain threshold as the HCs, and the IBS-IT cluster had an increased threshold of somatic pain perception (lower cold pain threshold, higher heat pain threshold, and higher pressure pain threshold, all P<0.001) than HCs. Compared with the IBS-NT cluster, the IBS-IT cluster reported higher levels of IBS-related pain intensity, anxiety, fatigue, and sleep disturbance over the 3 visits (all P<0.05). DISCUSSION: Young adults with IBS fell into 2 clusters, one with a similar sensory threshold as the HCs and another with an increased pain threshold, who reported higher pain intensity and more severe symptoms. Somatic sensory profiles should be integrated into further personalized self-management intervention among patients with IBS.

Patient Retention in Pediatric Weight Management Programs in the United States: Analyses of Data from the Pediatrics Obesity Weight Evaluation Registry.

Objective: Meeting recommended provider contact hours in multicomponent pediatric weight management (PWM) programs is difficult when patient retention is low. Our objective was to examine associations between individual patient characteristics, program characteristics, and patient retention. Methods: Using the Pediatric Obesity Weight Evaluation Registry, a prospective longitudinal study of 32 PWM programs, we included children (≤18 years; n = 6502) enrolled for a full year. We examined associations between retention (any follow-up visit) and patient and program characteristics using multivariable models with site-clustering random effects. Results: Sixty-seven percent of children had at least one follow-up visit, whereas 12% had four or more visits. Compared with non-Hispanic white children, non-Hispanic black children were less likely to have a follow-up visit [adjusted odds ratio (aOR) = 0.79], whereas Hispanic children (any race) were more likely (aOR = 1.22). Children with Medicaid had similar retention to those with private insurance. Retention did not differ by age, gender, weight status, or comorbidities, nor by program characteristics. Conclusions: Few characteristics of PWM programs are clearly associated with retention, indicating that a variety of formats can support continued treatment and likely reflect the influence of unmeasured characteristics. Clearer ways to identify and overcome barriers for individual patients will be needed to improve retention in PWM.

Addressing Structural Racism Is Critical for Ameliorating the Childhood Obesity Epidemic in Black Youth.

Racism and childhood obesity are both pervasive factors adversely affecting the health and wellbeing of children and adolescents in the United States. The association between racism and obesity has been touched upon in the literature; yet most work has focused on a few dimensions of intersectionality of these two domains at one time. The renewed focus on structural racism as the primary contributor to distress of Black individuals in the United States has highlighted the urgency of identifying the contributions of racism to the childhood obesity epidemic. The current article is not a complete review of the literature, rather, it is meant to take a broad narrative review of the myriad ways in which racism contributes to the obesity epidemic in Black youth to serve as a call to action for more research, prevention, and intervention. The current article illustrates how a number of mechanisms for the etiology and maintenance of obesity are heavily influenced by racism and how addressing racism is critical for ameliorating the childhood obesity epidemic.

Elevated blood pressure in youth in pediatric weight management programs in the Pediatric Obesity Weight Evaluation Registry (POWER).

Blood pressure (BP) assessment and management are important aspects of care for youth with obesity. This study evaluates data of youth with obesity seeking care at 35 pediatric weight management (PWM) programs enrolled in the Pediatric Obesity Weight Evaluation Registry (POWER). Data obtained at a first clinical visit for youth aged 3-17 years were evaluated to: (1) assess prevalence of BP above the normal range (high BP); and (2) identify characteristics associated with having high BP status. Weight status was evaluated using percentage of the 95th percentile for body mass index (%BMIp95); %BMIp95 was used to group youth by obesity class (class 1, 100% to < 120% %BMIp95; class 2, 120% to < 140% %BMIp95; class 3, ≥140% %BMIp95; class 2 and class 3 are considered severe obesity). Logistic regression evaluated associations with high BP. Data of 7943 patients were analyzed. Patients were: mean 11.7 (SD 3.3) years; 54% female; 19% Black non-Hispanic, 32% Hispanic, 39% White non-Hispanic; mean %BMIp95 137% (SD 25). Overall, 48.9% had high BP at the baseline visit, including 60.0% of youth with class 3 obesity, 45.9% with class 2 obesity, and 37.7% with class 1 obesity. Having high BP was positively associated with severe obesity, older age (15-17 years), and being male. Nearly half of treatment-seeking youth with obesity presented for PWM care with high BP making assessment and management of BP a key area of focus for PWM programs.

Preliminary Validation of the Pain Burden Inventory in a Pediatric Chronic Pain Population.

OBJECTIVE: To determine the preliminary reliability and validity of the Pain Burden Inventory-Youth (PBI-Y), a 7-item measure of the impact of chronic pain in adolescents with chronic pain that was, initially validated in youth with sickle cell disease. MATERIALS AND METHODS: A retrospective chart review of 130 patients presenting to an interdisciplinary pain clinic were examined with 98 (mean age=14.49; 66% female) comprising the final sample. Demographic information as well as adolescent and parent self-reported measures were examined. RESULTS: Youth reported a variety of pains including abdominal pain, headaches, back pain, and amplified musculoskeletal pain. The PBI-Y demonstrated strong internal reliability (α=0.792) and strong cross-informant concordance (r=0.822; P=0.000). Good construct validity was seen where higher scores on the PBI-Y were correlated with higher scores of (1) functional disability (r=0.689; P=0.000), (2) pain catastrophizing (r=0.494; P=0.000), (3) pain frequency days (r=0.526; P=0.000), (4) usual pain intensity (r=0.467; P=0.000), and (5) the worst pain intensity (r=0.485; P=0.000). Similar results were seen with caregiver assessments. Neither caregiver nor youth reports differed based on the sex or age of the child. DISCUSSION: The results support the psychometric properties of a brief self-report measure of pain impact in a pediatric chronic pain population. This measure may have great utility for clinicians caring for youth with chronic pain.