Parentification, Stress, and Problem Behavior of Adolescents who have a Parent with Mental Health Problems.

When adolescents live with a parent with mental illness, they often partly take over the parental role. Little is known about the consequences of this so-called parentification on the adolescents' internalizing and externalizing problems. This survey study examined this effect cross-sectionally and longitudinally in a sample of 118 adolescents living with a parent suffering from mental health problems. In addition, the study examined a possible indirect effect via perceived stress. Path analyses were used to examine the direct associations between parentification and problem behavior as well as the indirect relations via perceived stress. The results showed that parentification was associated with both internalizing and externalizing problems cross-sectionally, but it predicted only internalizing problems 1 year later. An indirect effect of parentification on adolescent internalizing and externalizing problems via perceived stress was found, albeit only cross-sectionally. These findings imply that parentification can be stressful for adolescents who live with a parent with mental health problems, and that a greater awareness of parentification is needed to prevent adolescents from developing internalizing problems.

Longitudinal associations between asthma control, medication adherence, and quality of life among adolescents: results from a cross-lagged analysis.

PURPOSE: It is not completely clear whether and how medication adherence, asthma control, and quality of life (QOL) predict each other over time. Therefore, the aim of the present study was to examine the longitudinal associations between asthma control, medication adherence, and quality of life among adolescents. METHODS: In this 3-wave longitudinal study, adolescents (N = 139, Mean age = 11.8) completed questionnaires about their medication adherence (Medication Adherence Report Scale for Asthma), asthma control (Asthma Control Questionnaire), and QOL (Adolescent Asthma Quality of Life Questionnaire) during home visits in the spring/summer of 2011, 2012, and 2013. Cross-lagged analyses examined temporal interrelations between the three variables over the course of 3 years. RESULTS: Higher QOL at baseline predicted increased medication adherence at follow-up (T2), but did not predict changes in asthma control over time. Medication adherence and asthma control did not predict changes in QOL over time. There were no associations between asthma control and medication adherence over time. CONCLUSIONS: Interventions could focus on increasing QOL to increase medication adherence in adolescents with asthma.

Maternal and paternal beliefs, support and parenting as determinants of sport participation of adolescents with asthma.

RATIONALE: Few studies have examined determinants of physical activity in patients with chronic illnesses, like asthma. The aim of this study was to examine whether baseline maternal and paternal beliefs, support and parenting were associated with changes in sport participation of adolescents with asthma, and investigate the moderating effect of sex. METHODS: In a population-based cohort study, during home visits in 2012 and 2013, 253 adolescents completed a questionnaire assessing their sport participation. Both parents reported their sport-specific parenting (support, general and asthma-specific beliefs, self-efficacy to encourage sport participation). The collected data was described using descriptive statistics. Path and multi-group analyses were used to examine whether baseline parental factors predicted change in adolescent sport participation, multi-group analyses examined the moderating effect of sex. For all analyses probability p value less than the accepted level of significance α = 0.05 (p < 0.05) were taken as significant effects. RESULTS: Few parental factors associated with changes in sport participation of the adolescents, sex did not moderate the associations. In the fully adjusted models, only maternal asthma-specific beliefs about sport participation were significantly positively associated with change in adolescent sport participation. CONCLUSION: Sport-specific parenting does not appear to be a determinant of sport participation in adolescents with asthma. Future research should consider other individual, social and environmental determinants to inform intervention development.

The Common Sense Model in early adolescents with asthma: longitudinal relations between illness perceptions, asthma control and emotional problems mediated by coping.

OBJECTIVE: The present study examined the longitudinal relations between illness perceptions and asthma control and emotional problems (i.e., anxiety, depression, stress), respectively, in adolescents with asthma. Furthermore, the mediating effects of asthma-specific coping strategies on these relations were examined, as specified in the Common Sense Model (CSM). METHODS: In 2011, 2012, and 2013, adolescents (aged 10-15) with asthma were visited at home (N=253) and completed questionnaires about their illness perceptions, asthma-specific coping strategies, asthma control, symptoms of anxiety and depression, and perceived stress. Path analyses were used to examine the direct relations of illness perceptions with asthma control and emotional problems and the mediating effects of coping strategies cross-sectionally and longitudinally. RESULTS: Perceptions of less perceived control and attributing more complaints to asthma were associated with better asthma control. Perceptions of more concern, less coherence, and increased influence of asthma on emotional well-being were associated with more emotional problems. Longitudinally, perceptions of more treatment control and fewer concerns predicted less emotional problems over time. More worrying mediated the cross-sectional relation between perceiving more concern about asthma and less asthma control and the longitudinal relation between perceiving more concern about asthma and more emotional problems. CONCLUSION: Illness perceptions were associated with asthma control and emotional problems; however, over time, illness perceptions only predicted changes in emotional problems. Most coping strategies did not mediate the relation between illness perceptions and outcomes. Interventions aimed to change illness perceptions in adolescents with asthma could decrease emotional problems.

Moderating effect of gender on the prospective relation of physical activity with psychosocial outcomes and asthma control in adolescents: a longitudinal study.

OBJECTIVE: Adolescents with asthma experience more psychosocial and physiological problems compared to their healthy peers. Physical activity (PA) might decrease these problems. This study was the first observational longitudinal study to examine whether habitual PA could predict changes in psychosocial outcomes (i.e., symptoms of anxiety and depression, quality of life [QOL] and stress) and asthma control over time in adolescents with asthma and whether gender moderated these relationships. METHODS: Adolescents with asthma (N = 253; aged 10-14 years at baseline) were visited at home in the spring/summer of 2012 and 2013. They completed questionnaires assessing their habitual PA, symptoms of anxiety and depression, QOL, perceived stress and asthma control. Path analyses using Mplus were conducted to examine longitudinal relationships among habitual PA, psychosocial outcomes and asthma control (controlled for body mass index, age and gender). Using multi-group analyses, we examined whether gender moderated these relationships. RESULTS: Path analyses in the total group showed that habitual PA did not predict changes in psychosocial outcomes or asthma control over time. Multi-group analyses showed that gender moderated the relation of habitual PA with anxiety and depression. Habitual PA only significantly predicted a decrease in anxiety and depression over time for girls but not for boys. CONCLUSIONS: Increasing habitual PA in girls with asthma might decrease their symptoms of anxiety and depression.

Sport club participation of adolescents with asthma: maternal factors and adolescent cognitions.

RATIONALE: Sport participation is especially important for patients with asthma in that it decreases psychosocial and physiological problems associated with inactivity. However, adolescents with asthma seem to participate less in sports compared to their non-asthmatic peers. The current study tested the direct associations between maternal sport-specific factors and sport club participation of early adolescents with asthma and the indirect effect through adolescent's sport-specific cognitions. METHODS: During home visits, 261 adolescents (aged 10-15) completed questionnaires about self-efficacy, beliefs regarding sport participation, and their actual sport club participation. Their mothers reported their sport-specific support, beliefs about offspring's and own sport participation, their own levels of physical activity, and their self-efficacy to stimulate offspring to participate in sports. Path analyses were used to examine the direct and indirect associations of maternal sport-specific factors with adolescents sport club participation via adolescent sport-specific cognitions. RESULTS: Analyses showed that maternal sport-specific support (ß = 0.20, P = 0.007) and self-efficacy to stimulate offspring to participate in sports (ß = 0.20, P = 0.027) related positively to adolescents' sport club participation. Adolescents' self-efficacy (indirect effect = 0.09, SE = 3.01, P < 0.001) mediated the positive relation between maternal self-efficacy to stimulate offspring to participate in sport and adolescents' participation in sport clubs. CONCLUSION: Maternal sport-specific factors related to adolescents' sport club participation directly and indirectly through adolescents' sport-specific cognitions. Intervention programs should focus on maternal sport-specific support and self-efficacy and adolescents' self-efficacy to increase sport participation of adolescents with asthma.

Effect of Type D personality on medication adherence in early adolescents with asthma.

OBJECTIVE: Medication adherence for daily preventive asthma medication is especially low during adolescence. In the present study, we aimed to test whether Type D personality (both as a category and with its constituent components (negative affectivity: NA and social inhibition: SI) separately and in interaction) predicts medication adherence of early adolescents with asthma. METHODS: In a prospective study, 188 early adolescents with asthma who were prescribed daily preventive asthma medication completed questionnaires on Type D personality, medication adherence, socio-demographic and clinical information, and depressive symptoms in the Spring/Summer of 2011 (T1) and again 12months later (T2). Multiple regression analyses, controlling for demographic and clinical information and for depressive symptoms, were conducted to test whether Type D personality (either as a categorical or dimensional construct) predicted changes in medication adherence over time. RESULTS: Adherence was significantly lower at T2 than at T1 and this decrease was predicted by the categorical construct of Type D personality. Analyses of the two separate dimensions NA and SI and their interaction showed that higher scores on NA at T1 predicted more decrease in adherence over time. Neither SI nor the interaction between NA and SI predicted changes in adherence. CONCLUSION: This is the first study to test the relationship between Type D personality and medication adherence in adolescents. Although categorical Type D personality predicts mediation adherence of adolescent with asthma over time, dimensional analyses suggest that this is due to negative affectivity only, and not to the combination of negative affectivity and social inhibition.

Effects of asthma on nicotine dependence development and smoking cessation attempts in adolescence.

OBJECTIVE: The aim of this study was to investigate whether asthma predicts the development of nicotine dependence and unsuccessful smoking cessation attempts in adolescent smokers. In addition, whether nicotine dependence could explain the relation between asthma and unsuccessful cessation attempts was also investigated. METHODS: A longitudinal survey study was conducted among 286 adolescents (aged 12-15 at T1) who had never used tobacco at baseline and were current smokers at follow-up 22 months later. Regression analyses were applied to test the effects of four asthma indicators (current wheeze, indication of asthma, symptom severity, and current diagnosed asthma) on nicotine dependence and smoking cessation attempts. RESULTS: Both adolescents who had an indication of asthma as well as adolescents with higher symptom severity developed higher levels of nicotine dependence over time and made a greater number of unsuccessful smoking cessation attempts in the past 12 months compared to those without asthma or less severe symptoms. Nicotine dependence partly mediated the effects of asthma symptoms on unsuccessful cessation attempts. Current wheezing and current diagnosed asthma did not predict nicotine dependence or unsuccessful quit attempts. CONCLUSIONS: Nicotine dependence develops more quickly in youth with symptoms of asthma, and this partly explains the increased number of unsuccessful cessation attempts of adolescents with asthma. Smoking prevention and smoking cessation programs are encouraged to provide additional support for youth with asthma, focusing on both the physiological and psychological aspects of dependence.

Quality of life of adolescents with asthma: the role of personality, coping strategies, and symptom reporting.

OBJECTIVE: The aim of this study was to test which personality traits were related to quality of life (QOL) of adolescents with asthma, and whether relations between personality and QOL were mediated by coping strategies and symptom reporting. METHODS: A sample of 405 12 to 16-year-olds with asthma completed questionnaires on personality, coping, symptom reporting, and QOL (overall QOL and positive effects QOL). The direct relations between personality traits and QOL, as well as mediation pathways were tested with structural equation modeling. RESULTS: Adolescents high on extraversion and low on neuroticism had better overall QOL, while adolescents high on agreeableness had better positive-effects QOL. The coping strategy restricted lifestyle fully mediated the relation between extraversion and overall QOL, the relation between neuroticism and overall QOL was fully mediated by symptom reporting and the coping strategy worrying about asthma. The coping strategies positive reappraisal and hiding asthma fully mediated the relation between agreeableness and positive-effects QOL. CONCLUSION: The results show that personality is related to QOL in adolescents with asthma. These relations were fully mediated by coping and symptom reporting. This study sheds light on the underlying mechanism why personality is associated with QOL. The results of this study will help to understand what determines QOL in patients with chronic illness in general and adolescents with asthma specifically. Furthermore, the results will help to design interventions that could facilitate minimizing the negative effects of having asthma on the QOL of these adolescents.

Eating styles and energy intake in young women.

The aim of the present study was to examine the relations between restrained, emotional, and external eating and total energy intake, and total fat and carbohydrate intake controlling for body mass index and physical activity. The sample consisted of 475 female students. Energy intake was measured over a 1-month period using the self-report Food Frequency Questionnaire and eating styles were assessed with the Dutch Eating Behaviour Questionnaire. Structural equation modelling was used to analyze the data. The results showed that restrained eating was consistently negatively related to energy intake and fat and carbohydrate intake, whereas external eating was positively related to all dependent variables. Emotional eating was not related to energy intake or fat and carbohydrate intake. Thus, restrained eaters seem to restrict their energy intake, while external eating was found to be associated with higher levels of energy intake, especially of fat intake.

Asthma-specific predictors of smoking onset in adolescents with asthma: a longitudinal study.

OBJECTIVE: Despite even occasional smoking being more risky for adolescents with asthma, the smoking rate in this vulnerable population remains high. This is the first longitudinal study investigating asthma-specific predictors of smoking initiation. METHODS: A three-wave longitudinal survey study (22 months) among 257 adolescents with asthma was conducted. The effects of asthma-specific factors [symptom severity, medication adherence, coping, attitude towards asthma, and quality of life (QOL)] on smoking onset were tested with logistic regression models. RESULTS: Poorer self-reported adherence and the maladaptive coping strategy of hiding asthma predicted smoking onset. Poorer QOL predicted smoking in boys only. CONCLUSIONS: Our findings underscore the importance of recognizing and addressing adherence problems during adolescence as low adherence is a risk factor for smoking initiation. Moreover, psychosocial factors, such as coping and QOL for boys, were associated with smoking initiation. This highlights the importance of attending to the psychosocial needs of youth with asthma.

Adolescents' movement towards cessation of smoking: role and relative value of the processes of change and nicotine dependence.

The present study addresses the applicability of the Transtheoretical Model's processes of change in explaining adolescents' readiness to quit smoking. Furthermore, the association between nicotine dependence and readiness to quit was assessed both directly, as well as indirectly through the processes of change. A cross-sectional survey was conducted, identifying 1547 weekly smokers aged 14-18 years. Structural equation modelling showed that the processes of change were only marginally associated with readiness to quit. Adding nicotine dependence to the model showed a direct association between nicotine dependence and readiness to quit. Only one process of change, self-liberation (i.e. choice/commitment to change and belief in the ability to change), was found to mediate this association. Nicotine dependence appeared to be highly important in adolescents' readiness to quit.

Bidirectionality in the relationship between asthma and smoking in adolescents: a population-based cohort study.

PURPOSE: Several cross-sectional studies have showed higher smoking rates among adolescents with asthma, but hardly any study has investigated this relation longitudinally. This study examines whether these cross-sectional results are caused by higher smoking onset among adolescents with asthma, or by the development of asthma after smoking onset. METHODS: This was a longitudinal study (22 months) among 7,426 Dutch adolescents (mean age at baseline = 12.9 years). Asthma was assessed with self-report questionnaires of the International Study of Asthma and Allergies in Childhood (ISAAC) and the student questionnaire of the American College of Allergy, Asthma and Immunology. Adolescents' smoking and parental smoking were also assessed by adolescent-report. All analyses were controlled for age, gender, education, ethnicity, and parental smoking. RESULTS: In baseline non-smokers, adolescents with current diagnosed asthma and with more severe asthma had an increased risk to become regular smokers. Among girls and adolescents with a smoking mother, having asthma symptoms was a risk factor for starting experimental smoking. In contrast, among boys and adolescents with a non-smoking mother, having asthma symptoms was protective for experimental smoking. With regard to the effect of smoking on asthma, adolescent smoking predicted a higher incidence of asthma symptoms. In addition, smoking predicted increased symptom severity scores, and this effect was stronger in girls. Adolescent smoking was a stronger predictor for the development of asthma symptoms when the mother smoked. CONCLUSIONS: The relationship between asthma and smoking in adolescence seems to be bidirectional, with relations in both directions being stronger in females and when the mother smokes.

A longitudinal test of the theory of planned behavior predicting smoking onset among asthmatic and non-asthmatic adolescents.

Despite the particularly detrimental health risks of smoking for adolescent with asthma, several studies demonstrated higher smoking rates among asthmatic adolescents than among healthy adolescents. To gain insight into underlying mechanisms, longitudinal studies on differences in smoking predictors between asthmatic and non-asthmatic adolescents are essential. This longitudinal study with two waves with an 18 months interval tests the Theory of Planned Behavior (TPB) among 346 asthmatic adolescents and 3,733 non-asthmatic adolescents aged 12-16 years. Structural equation models were used to test the predictive value of the TPB in these two groups. The results show, consistent with the TPB, that smoking-related cognitions (attitude, perceived behavioral control, and subjective norm) predict smoking onset via intention among both asthmatic and non-asthmatic adolescents. The TPB predicted smoking onset even stronger among adolescents with asthma. These findings may contribute to the development of tailored interventions for the prevention of smoking among asthmatic adolescents.

The role of smoking-cessation-specific parenting in adolescent smoking-specific cognitions and readiness to quit.

BACKGROUND: An instrument assessing smoking-cessation-specific parenting was developed and tested in relation to a) the pros of smoking and quitting and self-efficacy to resist smoking, and b) adolescent readiness to quit. METHODS: Cross-sectional survey data from 998 Dutch adolescents who smoked regularly were used to perform structural equation analyses. RESULTS: Adolescents who perceived relatively few advantages of smoking and many benefits of quitting reported a high readiness to quit. Self-efficacy was not related to readiness to quit. Smoking-cessation-specific parenting was both directly related to a high readiness to quit, and indirectly through the perceived pros of quitting. Also, if one or both parents were smokers, adolescents reported experiencing less smoking-cessation-specific parenting and a lower readiness to quit. However, in general, differences in paths were not found between adolescents with two parents who did not smoke and adolescents with one or two parents who smoked. CONCLUSIONS: Given that anti-smoking socialisation has not yet been operationalised in terms of smoking-cessation-specific parenting, the present results will warrant further research into smoking-cessation-specific parenting in relation to adolescent smoking cessation. Further, parental smoking should not discourage parents from engaging in smoking-cessation-specific parenting as its relations with smoking cognitions and readiness to quit were highly similar in both the group with two parents who did not smoke and the group with one or two parents who smoked.

The role of coping strategies in quality of life of adolescents with asthma.

This study aimed to determine which coping strategies are associated with better quality of life (QOL) in adolescents with asthma. Furthermore, because coping can mediate the effects of health stressors on QOL, this study also examined the indirect effect of asthma severity on QOL via coping. Between January and May 2003, 553 Dutch adolescents with asthma (aged 12-16 years) completed questionnaires assessing coping strategies, symptom severity, overall QOL and positive QOL domain (positive effects of asthma domain). The relations between symptom severity, coping strategies and QOL were tested with structural equation modelling (SEM). Symptom severity affected overall and positive QOL, both directly and indirectly via coping. The coping strategies restricted lifestyle and worrying about asthma were associated with poorer overall QOL. The use of the coping strategies restricted lifestyle, positive reappraisal, and information seeking was related to increased scores on the positive QOL domain, whereas hiding asthma was related to lower scores on the positive QOL domain. The findings of this study suggest that coping mediates the effect of symptoms of asthma on QOL among adolescents with asthma. Several suggestions for interventions to improve asthma-specific QOL are discussed.

Parental smoking and adolescent smoking stages: the role of parents' current and former smoking, and family structure.

This study examined the role of parents' current and former smoking in predicting adolescent smoking acquisition stages. Participants were 7,426 students from 33 schools in the Netherlands. Participants' survey data were gathered at baseline and at two-year follow-up. Logistic regression models showed that parental smoking status was not only predictive of transitions from never smoking to trying smoking, monthly smoking, or daily smoking, but also of the progression from trying smoking to daily smoking. Further, although parental former smoking was weaker associated with progressive adolescent smoking transitions than current parental smoking, however absence of parental smoking history was most preventive. Compared to the situation in which both parents had never smoked, cessation of parental smoking after the child was born was associated with an increased risk for children to smoke. Adolescents living in a single-parent family were at greater risk of smoking than adolescents living in an intact family with both mother and father. In sum, the role of parental smoking is not restricted to smoking onset and is present throughout different phases of the acquisition process. Results support the delayed modeling hypothesis that parental smoking affects the likelihood for children to smoke even when parents quit many years before. Children living in single-parent families are only exposed to the behaviour of one parent; in two-parent families the behaviour from one parent may magnify or buffer the behaviour of the other parent.

Atopic diseases and related risk factors among Dutch adolescents.

BACKGROUND: The aim of the present study was to gain insight into the prevalence of asthma, allergic rhinitis, and eczema among Dutch early adolescents, and to study the impact of several social demographic and individual risk factors. METHODS: Cross-sectional survey study using the self-report questionnaires of the International Study of Asthma and Allergies in Childhood (ISAAC). In January 2003, 10 087 12- to 14-year-old students from 33 secondary schools in four regions of the Netherlands participated in this study. RESULTS: Of all participants, 52.6% reported that they had an allergic disease at least once in their lifetime. The 12 months prevalence of wheezing, rhinitis, and itchy rash was 12.3%, 28.3%, and 13.5%, respectively. Several social demographic and individual factors (gender, age, education levels, ethnicity, body mass index, and residential area) were significantly associated with the atopic symptoms and diseases. CONCLUSION: This study showed that allergic conditions are common in the Netherlands. Several social demographic and individual risk factors were related to the atopic diseases and symptoms.