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1.
FP Essent ; 507: 11-18, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34410092

RESUMO

Communication is an essential component in providing health care for adolescent patients. A critical part of adolescence is identity development. Affirmation of identity and emphasis on individual strengths are important for this age group. The concept of resilience is at the center of adolescent care and shapes how care is defined and delivered. A primary goal is to protect patients from harm through a combination of promotion of protective factors, including resilience, and risk factor reduction. In adolescents, use of motivational interviewing has been shown to decrease risky sexual behaviors, help prevent unplanned pregnancy, increase physical activity levels, and decrease substance use. Confidentiality is another essential component of care. The American Academy of Pediatrics (AAP) recommends use of the Strengths, School, Home, Activities, Drugs/substance use, Emotions/eating/depression, Sexuality, Safety (SSHADESS) screen for psychosocial assessment. Several other standardized, validated screening tools also may be valuable in guiding discussions and identifying risky behaviors. Sexual orientation, gender identity, religious, racial, and ethnic components of identity development should be addressed. The empowerment of adolescent patients to achieve personal independence in the health care setting is part of the transition from an adolescent approach to health care to an adult approach.


Assuntos
Saúde do Adolescente , Identidade de Gênero , Adolescente , Adulto , Criança , Comunicação , Feminino , Humanos , Masculino , Gravidez , Assunção de Riscos , Comportamento Sexual , Estados Unidos
2.
FP Essent ; 507: 19-25, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34410093

RESUMO

Unintentional injuries, suicide, and homicide were the leading causes of deaths among US individuals ages 10 to 24 years in 2017. Motor vehicle crashes are the leading cause of death by unintentional injury among US adolescents. Family physicians can encourage adolescent patients who drive to use safe driving practices (eg, seat belt use, cell phone-free driving, sober driving). Poisoning and drowning are the second and third most common causes of death by unintentional injury among adolescents, respectively. Suicide is the second overall leading cause of death among adolescents and is a growing problem. Depression is a risk factor. The Ask Suicide-Screening Questions (ASQ) suicide risk screening tool has been validated for use in patients ages 10 to 21 years in all medical settings. Screening, diagnosis, treatment, and follow-up of adolescent patients for depression and development of safety plans are key to suicide prevention. Homicides are the third leading cause of death among adolescents, and firearms are a clear contributor. Family physicians should assess adolescent patients for risk factors for violence, provide trauma-informed care, promote resilience and strong relationships with adults, and empower adolescents to use their strengths and skills to reduce their risk of involvement in violence.


Assuntos
Saúde do Adolescente , Suicídio , Adolescente , Adulto , Causas de Morte , Criança , Homicídio , Humanos , Suicídio/prevenção & controle , Violência , Adulto Jovem
3.
FP Essent ; 507: 26-32, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34410094

RESUMO

Substance use in adolescents affects brain development and can influence health in adulthood. The substances most commonly used by adolescents are alcohol, cannabis, and tobacco. Adolescent alcohol use has been shown to inhibit and alter normal brain development, and has been associated with alcohol use disorder and other mental disorders in adulthood. Cannabis use during adolescence has been associated with adverse mental health outcomes. Adolescents may incorrectly assume that the negative health effects of smoking will not affect them. Electronic nicotine delivery systems, such as e-cigarettes, for vaping may be used to inhale nicotine, cannabis, or both. Strong family relationships and parental monitoring are protective factors against substance use. Screening at every preventive services visit is an essential element of adolescent care. The evidence-based Screening, Brief Intervention, and Referral to Treatment (SBIRT) strategy has been shown to decrease substance use and its adverse effects in adolescents. On societal and community levels, family physicians have numerous opportunities to advocate for adolescent well-being and prevention of substance use. The American Academy of Family Physicians (AAFP) recommends that family physicians advocate for legislation and governmental policies that facilitate the prevention, diagnosis, and treatment of substance use.


Assuntos
Sistemas Eletrônicos de Liberação de Nicotina , Transtornos Relacionados ao Uso de Substâncias , Vaping , Adolescente , Saúde do Adolescente , Adulto , Humanos , Fumar , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Transtornos Relacionados ao Uso de Substâncias/prevenção & controle
4.
FP Essent ; 507: 33-38, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34410095

RESUMO

Digital media use has increased rapidly during the past two decades, and media use is now a major issue in adolescent development. Online connections and communities can help foster healthy identity development and provide needed peer support, particularly for adolescents from historically marginalized communities. Online harassment, or cyberbullying, is a common phenomenon. Media use can interfere with sleep hygiene and quality, and screen-based sedentary behaviors have been associated with decreased physical activity, decreased aerobic fitness, and increased adiposity among adolescents. The literature on media use and adolescent mental health still is evolving. Some research suggests a U-shaped association between these two factors, with high and low levels of internet use associated with depression. Social media use may amplify peer pressure to engage in sexual behavior, provide exposure to a greater network of individuals with sexual experience, and increase the risk of sexual behaviors. Counseling adolescent patients about safe and healthy media use is essential. Conversations with patients and their families about media use should begin before adolescence and continue through adolescence in the context of routine preventive care. The American Academy of Pediatrics (AAP) recommends creation and implementation of a Family Media Use Plan.


Assuntos
Saúde do Adolescente , Mídias Sociais , Adolescente , Criança , Comunicação , Humanos , Internet
10.
JMIR Form Res ; 4(1): e12618, 2020 Jan 24.
Artigo em Inglês | MEDLINE | ID: mdl-32012034

RESUMO

BACKGROUND: Latinx families are among the highest users of smartphones, yet few health-focused Web programs have been developed for this audience. Parent-based smartphone apps designed for Latinx families may help increase access to evidence-informed parenting programming and ultimately reduce health disparities among children and adolescents. To maximize uptake of such apps, the Center for eHealth Research and Disease Management (CeHRes) Roadmap for electronic health (eHealth) development recommends 5 phases of development: (1) contextual inquiry, (2) value specification, (3) design, (4) operationalization, and (5) evaluation. OBJECTIVE: Guided by the CeHRes Roadmap, our objective was to apply a community-based participatory research (CBPR) approach to mobile app development. We present a formative evaluation to inform the design of an eHealth mobile app for Latinx parents of adolescents based on a face-to-face parenting program, Padres Informados/Jovenes Preparados (PIJP). METHODS: Community participants in the process included Latinx parents and stakeholders. We conducted a parent survey (N=115) and interviews (N=20) to understand the context and obtain feedback on a mockup and prototype of the app, facilitator workshops to streamline content, and stakeholder interviews (N=4) to discuss values and app requirements. RESULTS: We report results from the first 3 phases of the CeHRes Roadmap. In the survey, 96.5% (111/115) of parents reported they had access to a cell phone, 85.6% (89/104) reported they would use a parenting app in the next month if they had access, and 80.2% (89/111) reported intentions to use a stress reduction app. Parents reported that setting goals about parenting and tracking those goals were important potential features of an app. In logistic regression analyses, technology attitudes and barriers were not related to parent's intentions to use a parenting mobile app (95% CI 0.51-1.17 and 95% CI 0.28-2.12, respectively). Qualitative interviews confirmed Latinx parents' technology engagement and desire for education and child development information online. Stakeholder interviews identified 3 community values: familism, the promotion of adolescent health, and delivery of economic value. Community stakeholders participated in defining the mobile app requirements. On the basis of community and parent input, the mobile app prototype was designed with 3 sections: (1) 8 modules of video-based parenting skills instruction with content from the face-to-face PIJP program, (2) breath rate information from a wearable device to support awareness of stress levels that could affect parenting, and (3) goal setting and tracking capacities. CONCLUSIONS: The findings of this study highlight the utility of an iterative, participatory design process. The CBPR approach and community collaboration enhanced the CeHRes Roadmap by promoting power sharing, facilitating recruitment, and building trust among community members. Experiences applying community research to the initial 3 phases of the CeHRes Roadmap in a Latinx community are discussed, along with plans for the 2 final phases.

11.
J Adolesc Health ; 66(3): 296-300, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-31831320

RESUMO

PURPOSE: Electronic health records (EHRs) have led to more transparency and improvements in patient safety, yet electronic access to personal health information can pose significant threats to maintaining confidentiality for adolescents. To date, no studies have explored clinicians' perspectives on EHR functionality and institutional policies related to confidentiality and health information sharing for adolescents aged <18 years. METHODS: A Web-based survey was sent out via the national listserv of the Society for Adolescent Health and Medicine. All English-speaking members practicing in the U.S. were eligible to participate. The survey included questions about demographics, EHR functionality, information sharing, and attitudes about confidentiality within the EHR. RESULTS: Participants included 212 clinicians who consented to the survey and used an EHR to document clinical visits with minors. Most participants were physicians and nurse practitioners (96.5%), and 60.0% had been on their institution's EHR for >5 years. Positive findings included high levels of experience and comfort using the EHR and awareness of confidential features within their EHR. However, providers reported lack of training related to confidentiality within the EHR, low confidence in their EHR's ability to maintain confidentiality, and variation in approaches to portal access for adolescents and their adult proxies. CONCLUSIONS: Despite high comfort levels and robust EHR functionality at many institutions, significant concerns about adolescent confidentiality remain. Varying institutional approaches to protecting confidentiality underscores the need for a standardized and comprehensive framework to enable providers and institutions to take better care of adolescents in the age of EHRs.


Assuntos
Serviços de Saúde do Adolescente , Confidencialidade , Registros Eletrônicos de Saúde , Médicos/psicologia , Adolescente , Saúde do Adolescente , Adulto , Idoso , Humanos , Disseminação de Informação , Inquéritos e Questionários
12.
Children (Basel) ; 6(8)2019 Aug 20.
Artigo em Inglês | MEDLINE | ID: mdl-31434278

RESUMO

Immigrant and refugee youth have higher rates of trauma than youth who are not transnational. While youth are incredibly resilient, trauma and toxic stress can result in poor health outcomes that persist throughout life. However, clinical interventions can promote resilience and decrease the negative impact of trauma. This article will review the principles of trauma-informed care and its application for the care of immigrant and refugee youth and their families by sharing concrete and feasible strategies for primary care providers and systems.

13.
Fam Pract ; 34(3): 347-352, 2017 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-28158524

RESUMO

Background: Participatory research (PR) trials aim to achieve the dual, and at times competing, demands of producing an intervention and research process that address community perspectives and priorities, while establishing intervention effectiveness. Objective: To identify research and community priorities that must be reconciled in the areas of collaborative processes, study design and aim and study implementation quality in order to successfully conduct a participatory trial. We describe how this reconciliation was approached in the smoking prevention participatory trial Padres Informados/Jovenes Preparados (Informed Parents/Prepared Youth) and evaluate the success of our reconciled priorities. Methods: Data sources to evaluate success of the reconciliations included a survey of all partners regarding collaborative group processes, intervention participant recruitment and attendance and surveys of enrolled study participants assessing intervention outcomes. Results: While we successfully achieved our reconciled collaborative processes and implementation quality goals, we did not achieve our reconciled goals in study aim and design. Due in part to the randomized wait-list control group design chosen in the reconciliation process, we were not able to demonstrate overall efficacy of the intervention or offer timely services to families in need of support. Conclusion: Achieving the goals of participatory trials is challenging but may yield community and research benefits. Innovative research designs are needed to better support the complex goals of participatory trials.


Assuntos
Pesquisa Participativa Baseada na Comunidade , Comportamento Cooperativo , Pesquisa , Adolescente , Criança , Hispano-Americanos , Humanos , Minnesota , Pais/educação , Projetos de Pesquisa , Prevenção do Hábito de Fumar/métodos
14.
Health Promot Pract ; 18(5): 751-762, 2017 09.
Artigo em Inglês | MEDLINE | ID: mdl-27288691

RESUMO

The growth of the Latino youth population, combined with the reality that many Latino adolescents live in environments characterized by social disparities, reveals a compelling need to address health inequalities affecting Latinos through effective health promotion programs designed by and for this population. This article presents findings from a pilot study of Encuentro, a health promotion program for young Latino teens and their parents. Developed by a community-university partnership, Encuentro aims to bolster internal assets, familial and cultural supports for young teens' positive development, and healthy sexual decision making and behaviors. Encuentro was pilot tested with 49 Latino families at 3 community sites in Minneapolis/St. Paul. Families were assigned to a program group or a control group. Pilot study findings confirm program feasibility and acceptability. Compared to the control group, program group youth reported substantially more involvement in activities celebrating Latino culture, and greater communication with their parents about sexual health topics. Parents in the program group reported greater ethnic pride, engaging in more activities to share Latino values and traditions with their teens, greater communication with their teens about sexual health topics, and increased parental monitoring than did parents in the control group. Findings demonstrate the potential of the Encuentro program.


Assuntos
Comunicação , Promoção da Saúde/organização & administração , Hispano-Americanos , Pais/educação , Adolescente , Criança , Tomada de Decisões , Feminino , Humanos , Masculino , Projetos Piloto , Comportamento Sexual/etnologia , Saúde Sexual/etnologia
15.
Pediatrics ; 137(6)2016 06.
Artigo em Inglês | MEDLINE | ID: mdl-27244851

RESUMO

OBJECTIVE: To determine the association between enrollment in patient-centered medical homes (PCMHs) and the receipt of preventive services among adolescents and young adults. METHODS: Retrospective cohort study including patients of Hennepin County aged 10 to 24 who had face-to-face or telephone encounters with health care providers between 2010 and 2014 at clinics with PCMHs at the Hennepin County Medical Center, Minnesota. Exposure was enrollment in PCMHs. Outcomes were receipt of (1) preventive visits; (2) prescriptions for influenza, meningococcal, and human papillomavirus vaccinations; (3) screening for sexually transmitted infections; (4) prescription of any contraceptive and long-acting reversible contraceptives; and (5) cervical cancer screening. Generalized mixed effect models in a propensity-score-matched sample were used for data analysis. RESULTS: Overall, 21 704 patients were included. Most patients were female, US-born, Hispanic/Latino, with an average age of 20.8 years. Patients enrolled in PCMH (n = 729) were more likely to be Latino, students, and have health insurance (P < .001). Adjusted odds ratios (99% confidence intervals) comparing the receipt of preventive services of patients enrolled in PCMHs to youth who did not receive these services were as follows: (1) preventive visits 1.10 (0.93-1.29); (2) influenza 0.89 (0.74-1.07), meningococcal 1.53 (1.30-1.80), and human papillomavirus vaccinations 1.53 (1.28-1.84); (3) screening for sexually transmitted infections 1.69 (1.28-2.24); (4) prescription of any type of contraception 2.18 (1.56-3.03) and long-acting reversible contraceptives 2.66 (1.89-3.74); and (5) cervical cancer screening 1.14 (0.87-1.48). CONCLUSIONS: Overall, patients enrolled in PCMHs had higher odds of receiving multiple preventive services.


Assuntos
Assistência Centrada no Paciente , Serviços Preventivos de Saúde/estatística & dados numéricos , Adolescente , Instituições de Assistência Ambulatorial , Criança , Grupos Étnicos , Feminino , Humanos , Masculino , Minnesota , Pontuação de Propensão , Estudos Retrospectivos , Provedores de Redes de Segurança , Adulto Jovem
16.
Int J Adolesc Med Health ; 28(1): 61-8, 2016 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-25807580

RESUMO

BACKGROUND: Parenting adolescents poses challenges that are exacerbated by immigration. Aqui Para Ti [Here for You] (APT) is a clinic-based, healthy youth development program that provides family-centered care for Latino youth and their families who are mostly immigrants from Mexico and Latin America. OBJECTIVES: To present the APT model of care and report the experiences of youth and their parents. SUBJECTS: APT patients between 11 and 24 years (n=30) and parents (n=15). Most youth patients were female, between 11 and 17 years, and from Mexico. Most parents were female, 40 years or younger, and from Mexico. METHODS: Youth participants completed a survey and participated in an individual semi-structured interview, and parent participants attended focus groups. Descriptive statistics summarized survey data. Interviews and focus groups were transcribed and analyzed in Spanish using content analysis by two independent coders. Quantitative and qualitative findings were integrated using side-by-side comparisons. Researchers not involved in the coding process contributed with the interpretation of the findings. RESULTS: Youth and parents were satisfied with the services received at APT. Youth felt listened to by their providers (100%), felt they could trust them (100%) and valued comprehensive care. Eighty-seven percent reported that their experiences at APT were better than at other clinics. Parents valued the family parallel care, confidentiality, family-centeredness, and the cultural inclusivity of the APT services. CONCLUSION: Patients and parents were satisfied with the services offered at APT. Family parallel care could be a positive alternative to deliver confidential and family-centered services to immigrant families.


Assuntos
Desenvolvimento do Adolescente , Confidencialidade/normas , Assistência à Saúde Culturalmente Competente/organização & administração , Emigrantes e Imigrantes/psicologia , Pais/educação , Satisfação do Paciente , Assistência Centrada no Paciente/organização & administração , Adolescente , Adulto , Criança , Confidencialidade/psicologia , Assistência à Saúde Culturalmente Competente/normas , Estudos de Avaliação como Assunto , Feminino , Grupos Focais , Hispano-Americanos/psicologia , Humanos , Entrevistas como Assunto , Masculino , Modelos Organizacionais , Pais/psicologia , Assistência Centrada no Paciente/normas , Pesquisa Qualitativa , Inquéritos e Questionários , Adulto Jovem
17.
Health Promot Pract ; 17(1): 57-69, 2016 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-25869496

RESUMO

Community-based participatory research (CBPR) can help increase the attendance in community programs. Padres Informados, Jovenes Preparados (PIJP) is a program that aims to prevent tobacco and other substance use among Latino youth by promoting positive parenting. Although the trial used CBPR approaches, attendance was inconsistent. In the present study, factors associated with attendance and nonattendance and recommendations to maximize participation were explored in 12 brief feedback discussions (BFDs) with participants and in 10 in-depth interviews (IDIs) with facilitators who delivered PIJP. Content analysis guided two pairs of researchers, who independently coded emerging themes and categories (κ = .86 for BFDs and .73 for IDIs). Data from BFDs and IDIs were merged and interpreted together. We grouped factors that positively affected participation into three categories: individual and family (e.g., motivation), program (e.g., offering food and childcare and having facilitators who are trusted), and research (e.g., having incentives). Barriers to participation were grouped into four categories: individual and family (e.g., family conflicts), sociocultural (e.g., community and cultural beliefs), program (e.g., fixed schedules), and research (e.g., recruitment procedures). Participants provided recommendations to address all types of barriers. Although PIJP used CBPR, complete satisfaction of community needs is difficult. Effective community programs must address participants' needs and preferences.


Assuntos
Atitude Frente a Saúde , Hispano-Americanos/psicologia , Motivação , Pais/psicologia , Adolescente , Adulto , Atitude Frente a Saúde/etnologia , Criança , Pesquisa Participativa Baseada na Comunidade , Emigração e Imigração , Feminino , Promoção da Saúde/métodos , Humanos , Entrevistas como Assunto , Masculino , Pessoa de Meia-Idade , Poder Familiar , Fatores Socioeconômicos , Transtornos Relacionados ao Uso de Substâncias/prevenção & controle , Uso de Tabaco/prevenção & controle
18.
Health Promot Pract ; 17(2): 186-98, 2016 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-26429993

RESUMO

PURPOSE: To obtain contextualized insights from professionals regarding factors that contribute to or inhibit the healthy development of Latino youth. METHOD: A community-engaged study in which semistructured in-depth interviews were conducted with 30 professionals who work extensively with Latino youth in urban clinics, schools, and other community-based settings. RESULTS: Every key informant expressed opinions regarding factors that contribute to healthy development of Latino youth, ranging from cultural identity and a sense of belonging to family connectedness and adult role models. Contributing and inhibiting factors were characterized by being either intrinsic to the individual (e.g., sense of belonging, hope) or extrinsic (e.g., family support and love, community support). CONCLUSION: Recognition of and appreciation for the importance of cultural influences in the lives of Latino youth is a critical starting point on which professionals must build to respectfully and successfully encourage healthy youth development. Factors that contribute to the healthy development of Latino youth range from cultural identity and cultural pride to family connectedness, adult role models, and a sense of belonging. In working with Latino young people, professionals must recognize and appreciate cultural influences as foundational to this population's health and well-being.


Assuntos
Desenvolvimento do Adolescente , Hispano-Americanos , Adolescente , Serviços de Saúde do Adolescente , Cultura , Feminino , Hispano-Americanos/psicologia , Humanos , Entrevistas como Assunto , Masculino , Minnesota , Autoimagem , Identificação Social , Apoio Social
19.
Prog Community Health Partnersh ; 9 Suppl: 61-9, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-26213405

RESUMO

BACKGROUND: Community Networks Program (CNP) centers are required to use a community-based participatory research (CBPR) approach within their specific priority communities. Not all communities are the same and unique contextual factors and collaborators' priorities shape each CBPR partnership. There are also established CBPR and community engagement (CE) principles shown to lead to quality CBPR in any community. However, operationalizing and assessing CBPR principles and partnership outcomes to understand the conditions and processes in CBPR that lead to achieving program and project level goals is relatively new in the science of CBPR. OBJECTIVES: We sought to describe the development of surveys on adherence to and implementation of CBPR/CE principles at two CNP centers and examine commonalities and differences in program-versus project-level CBPR evaluation. METHODS: A case study about the development and application of CBPR/CE principles for the Missouri CNP, Program for the Elimination of Cancer Disparities, and Minnesota CNP, Padres Informados/Jovenes Preparados, surveys was conducted to compare project versus program operationalization of principles. Survey participant demographics were provided by CNP. Specific domains found in CBPR/CE principles were identified and organized under an existing framework to establish a common ground. Operational definitions and the number of survey items were provided for each domain by CNP. CONCLUSION: There are distinct differences in operational definitions of CBPR/CE principles at the program and project levels of evaluation. However, commonalities support further research to develop standards for CBPR evaluation across partnerships and at the program and project levels.


Assuntos
Redes Comunitárias/organização & administração , Pesquisa Participativa Baseada na Comunidade/organização & administração , Disparidades nos Níveis de Saúde , National Cancer Institute (U.S.)/organização & administração , Neoplasias/etnologia , Grupos de Populações Continentais , Comportamento Cooperativo , Humanos , Liderança , Grupos Minoritários , Desenvolvimento de Programas , Estados Unidos
20.
Prim Care ; 41(3): 489-506, 2014 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-25124202

RESUMO

Healthy adolescent development and successful transition to adulthood begins in the family. Supporting families in their communities and cultures ultimately makes this support system stronger. Parenting adolescents is described as the most challenging life stage for parents. Primary care providers are in an ideal position to support families with teens. This article reviews stressors, recommends strength-based strategies, describes how health care delivery systems can be organized to address the needs of adolescents and their families, shares a case study of a family-oriented, youth-friendly primary care clinic, and provides practical strategies for developing family-centered adolescent care within primary care practices.


Assuntos
Medicina do Adolescente , Medicina de Família e Comunidade , Atenção Primária à Saúde , Adolescente , Família , Humanos , Relações Pais-Filho , Poder Familiar , Pais
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