Adolescents and smoking: the first puff may be the worst.
Explore the source record for details and available documents.
Adolescent↗
Biomedical subjects
Jonathan D Klein
Publications and source records attributed to Jonathan D Klein.
Herbal products and their association with substance use in adolescents.
PURPOSE: To describe the prevalence of herbal product use in adolescents and the association between herbal product use and tobacco, alcohol, and other drug use. METHODS: The 1999 Monroe County, New York Youth Risk Behavior Survey provided data on a random sample of 2,006 high school students. Herbal product use was defined by lifetime use of "herbal or other natural products--to feel better, or perform better in sports or school." Bivariate analyses using chi2 tests and logistic regressions were used to describe the independent associations between herbal product use and substance use. RESULTS: Overall, 28.6% reported using herbal products. Herbal product use increased with age (24.5% of 9th graders to 29.9% of 12th graders; p < .04) and varied by ethnicity (33% of Hispanics, 30.9% of Caucasians, 28.8% of Asians, Native Americans, or Pacific Islanders, and 12.1% of African Americans; p < .001), but not by gender. After controlling for gender, grade, and ethnicity, logistic regression models showed herbal product use to be associated with lifetime use of: cigarettes (OR = 2.2; 95% CI = 1.8-2.8), alcohol (OR = 3.5; 2.5-4.9), marijuana (OR = 2.2; 1.8-2.7), and other drugs (odds ratios from 4.4 to 14.5). All p values were < .001. CONCLUSIONS: Over one-quarter of high school students report herbal product use, and this use is associated with drug use. Health care providers should inquire about adolescents' herbal product use, and disclosure should prompt an in-depth substance use history.
Adolescent↗
Patient safety problems in adolescent medical care.
PURPOSE: This study estimates the annual incidence and describes the nature, types, and contributing factors involved in patient safety problems in adolescent medical care. METHODS: This study uses data from the population-based Colorado and Utah Medical Practice Study to describe the incidence of hospital-based adverse events and preventable adverse events in adolescents and "critical incidence analysis" data reported by pediatric clinicians to elucidate the nature, types, and contributing factors in adolescent patient safety problems. RESULTS: The incidence of adverse events in adolescents in the Colorado and Utah Medical Practice Study was 2.74 (CI 95% = 2.62-2.86), significantly higher than all other age groups of children. The incidence of preventable adverse events in adolescents was 0.95 (CI 95% = 0.65-1.25), significantly higher than that of children 1-12 years old, but not significantly different than infants. Diagnostic events were most common, followed by medication events. Services associated with the highest frequency of events were pharmacy and Family Practice. In the critical incident analysis, adolescent-specific factors contributed to 54.8% of the described patient safety problems. Discomfort with adolescents, a factor not described for other age groups of children, contributed to 17% of the adolescent patient safety problems. CONCLUSIONS: Adolescents experience relatively high rates of patient safety problems compared with other age groups of children. Adolescents represent a defined population with a patient safety risk profile that differs from adults and younger children. The substantial contribution of adolescent-specific factors suggests that patient safety improvements, to be effective, should address adolescent-specific risks.
Adolescent↗
Use of complementary medicine and dietary supplements among U.S. adolescents.
PURPOSE: Use of complementary and alternative medicine (CAM) is increasing, but some dietary supplements have potentially negative side effects. This study examines CAM and dietary supplement use among a national sample of adolescents. METHODS: A total of 1280 adolescents 14-19 years old completed an online survey in 2002 about lifetime and past-30-day use of all CAM modalities, and specifically about use of herbal medicines and dietary supplements. We e-mailed invitations to 12,353 members of Harris Interactive's national Youth Query panel, and filled age/gender quotas sample targets. Data were then weighted to reflect the U.S. adolescent population by gender, race/ethnicity, urbanicity, region, parents' education, propensity to be online, and likelihood of nonresponse. Chi-square and logistic regression analyses were done using SPSS. RESULTS: Seventy-nine percent of adolescents had used CAM in their lifetime, 48.5% in the previous month; 46.2% had used dietary supplements in their lifetime, 29.1% in the previous month; 9.3% reported concurrent use of supplements and prescription medication in the previous month. Factors associated with CAM and supplement use included being female, positive attitudes towards CAM, and being age 16-17 years (rather than in younger or older age groups). Commonly used supplements included ginseng, zinc, echinacea, ginkgo, weight loss supplements, and creatine. CONCLUSIONS: Many adolescents use CAM and dietary supplements, including a significant number concurrent with prescription medications. Commonly used supplements (weight loss supplements and creatine) are closely linked to attempts to change body shape. Health care providers should be aware of CAM and supplement use by adolescents.
Adolescent↗
Do physicians discuss needed diet and nutrition health topics with adolescents?
PURPOSE: Preventive services guidelines recommend screening all adolescents for diet habits, physical activity and growth, counseling underweight teens about body image and dieting patterns, and counseling overweight or obese teens about dietary habits and exercise. In this study, we assess whether adolescents at risk for overweight or for eating disorders have discussed recommended diet and nutrition topics with their physicians. METHODS: We surveyed 14-18-year-old adolescents who had been seen for well care in primary care pediatric and family medicine practices. Adolescents self-reported their weight, height, body image, dieting habits, and issues they had discussed with their clinicians. Body mass index (BMI) was used to define those "at risk for an eating disorder" (< 5% BMI), "at risk of becoming overweight" (85%-95% BMI), and "overweight" (> 95% BMI). RESULTS: A total of 8384 adolescents completed surveys (72% completion rate). Nearly one-third of adolescents were "at risk" or overweight. Females were less likely to be overweight than males (9.4% vs. 15.7%; p < .001). Although 26.4% were attempting to lose weight, only 12.2% of all teens were actually overweight. Exercise and restricting intake were the preferred methods of weight loss. Physicians routinely discussed adolescents' weight during visits, and were more likely to discuss it with those "at risk" (p < .001). Body image was more often discussed with girls than with boys (52% vs. 44.6%, p < .001) and with those at risk (51.6% vs. 45.5%; p < .001). Discussion of healthy eating and weight loss occurred more often with adolescents "at risk" for becoming overweight (p < .001). CONCLUSIONS: Many adolescents are at risk for being overweight or are currently overweight, confirming the importance of clinicians discussing diet and nutrition health topics with all teens. Many adolescents also misclassify their body image, and hence perceive their body image to be different from their actual BMI; clinicians should discuss body image with all adolescents, not just those at risk for eating disorders. Better interventions are needed to promote healthy nutrition and physical activity to all adolescents.
Adolescent↗
Development of a new Adolescent Patient-Provider Interaction Scale (APPIS) for youth at risk for STDs/HIV.
PURPOSE: Although an adult model of patient-provider mutual exchange of information has been proposed, there is no guiding model for adolescents or measurement methodology. Our purpose was to develop a new scale of patient-provider interaction for adolescents accessing reproductive health care and at risk for sexually transmitted diseases (STDs) and human immunodeficiency virus (HIV), and assess the reliability and validity of the scale. METHODS: The Adolescent Patient-Provider Interaction Scale (APPIS) was developed from the Roter and Hall theory of doctor-patient relationships, previously validated adolescent satisfaction and communication scales, and focus group and individual elicitation interviews. To assess construct validity, the new nine-item APPIS was compared with the satisfaction scale used by the Young Adult Health Care Survey (YAHCS), and Kahn's Provider Communication Scale. Pearson correlation coefficients were used to examine convergence across scales, and factor analysis of the APPIS was performed. RESULTS: The study recruited 192 African American girls aged 17.9 +/- 1.7 years (range 15-21 years) from three sites: a county STD clinic (n = 51), urban adolescent clinic (n = 99), and a family planning clinic (n = 42). Most participants (85%) rated their overall health care highly (> or = 7 on a 10-point scale); 49% felt that both the provider and patient were "in charge" of the visit, and 88% "strongly agreed" or "agreed" that there was an equal "exchange of information" during the visit. The APPIS showed good internal consistency (Cronbach alpha = .75), and moderate convergence with the six-item YAHCS scale (r = .57, p < .001) and seven-item Kahn scale (r = .48, p < .001). Three factors emerged from exploratory factor analyses, supporting our conceptualization of patient-provider interaction as being multi-dimensional. CONCLUSIONS: A new theory-based scale of adolescent patient-provider interaction compares favorably with previous scales of health care satisfaction and communication. The new APPIS may be useful for evaluating approaches to improve health care outcomes for adolescents at-risk for STDs and HIV.
Adolescent↗
The changing risk profile of the American adolescent smoker: implications for prevention programs and tobacco interventions.
PURPOSE: To determine how the association between cigarette smoking and other risky behaviors, such as substance use, violence, and risky sexual practices, has changed between 1991 and 2003. METHODS: Youth Risk Behavior Surveys (YRBS) from 1991 to 2003 were analyzed. For each cohort, logistic regression models controlling for gender, race/ethnicity, and school grade were used to describe the associations between smoking and other risky behaviors. Changes in the odds ratios over time were confirmed with a trend analysis. RESULTS: The strength of the relationship between smoking and other risky behaviors increased for lifetime number of sexual partners (1991 odds ratio [OR] 1.49; 2003 OR 1.61 (p < .001)), sexual partners in the past 3 months (1991 OR 1.77; 2001 OR 2.05 (p < .001)), and never wearing a bicycle helmet 1991 OR 1.40; 1997 OR 5.94 (p < .001). Increases were also seen for binge drinking, and physical fighting. The association between cigarette smoking and marijuana use decreased slightly. CONCLUSIONS: Future prevention efforts and tobacco intervention programs should recognize that current adolescent smokers are even more likely to engage in risky sexual behavior, risky alcohol-related behaviors, and to not use a seatbelt or bicycle helmet than were adolescents in the early nineties.
Adolescent↗
Development and factor structure of a brief instrument to assess the impact of community programs on positive youth development: The Rochester Evaluation of Asset Development for Youth (READY) tool.
PURPOSE: Positive youth development is increasingly recognized as important to the health and well-being of adolescents. We describe the development of a brief, standardized instrument for measuring outcomes and indicators important for youth development evaluation. Additionally, we describe the psychometric properties of these constructs. METHODS: A coalition of representatives from 12 community organizations, funders, and researchers identified four core outcomes associated with positive youth development likely able to be affected by community-based youth-serving agencies. Items were piloted and field tested to test feasibility and establish face validity with experts and with adolescents. Furthermore, we tested construct reliability using factor analysis to determine how well the items reflected underlying constructs. RESULTS: Items representing four empirical constructs were used to survey 389 adolescents. Those who participated in the pilot took an average of 11 minutes to complete the survey. Overall, 24 items loaded on to six discrete factors representing the outcomes of basic social skills, caring adult relationships, and decision-making. When participants under age 13 years were eliminated from the analysis, items were more cohesive, resulting in a five-factor solution with all items loading at .40 or higher. CONCLUSIONS: The four youth development outcomes identified by community-based youth-serving organizations factor into reliable constructs with acceptable alpha coefficients for adolescents over age 13. A major strength of this youth development outcome measurement is that it has an easy-to-administer format, which allows community-based programs to receive feedback for program improvement, and to track the effectiveness of their programs for funders.
Adolescent↗
Measuring youth development outcomes for community program evaluation and quality improvement: findings from Dissemination of the Rochester Evaluation of Asset Development for Youth (READY) tool.
PURPOSE: The Rochester Evaluation of Asset Development for Youth (READY) is a brief program-controlled evaluation and quality improvement tool used for assessment of four developmental assets for youth: caring adult relationships, basic social skills, decision making, and constructive use of leisure time. This article reports on the early implementation and combined benchmark data generated from the use of the READY tool by community-based youth-serving agencies in Rochester, New York. METHODS: Nine youth-serving agencies used the 40-item READY tool in 2002-2003. In addition to individual program evaluation and quality improvement, a combined dataset was developed and analyzed to establish community benchmarks. Program leaders' qualitative feedback on their experience with the READY tool is also reviewed. RESULTS: 1,070 youth participated. Those youth who reported feeling more connected to the programs in which they participated and having more active and frequent participation had consistently higher scores on measured outcomes. Overall, most agencies required some technical assistance to first field READY. Most agencies successfully used their own data to address program quality improvement, and reported being happy with their ability to do so. DISCUSSION: READY is a promising tool for measuring community-based program-attributable positive developmental outcomes for youth.
Adolescent↗
Adolescents and the internet: health and sexuality information.
PURPOSE OF REVIEW: Adolescents are known to be frequent users of the Internet, but less is known about the frequency and nature of their searches for information about health and sexuality. In theory, the Internet offers adolescents unprecedented access to such information in a convenient and confidential way. In turn, this information may help them to seek medical care or advice. This article reviews new research relating to adolescents' uses of the Internet for health and sexuality information, including contextual adult population studies. RECENT FINDINGS: Adolescents are using the Internet in order to find health information on a range of subjects. Search engines are the primary strategy for such searches. The quality of the online experience is often limited by health/online literacy skills. The only reference to adolescents' quests for online information about sexuality was that they frequently sought this information from a Web site created primarily to provide information about sexually transmitted diseases. SUMMARY: Empirical research with adolescents on this subject is scarce. More research is needed regarding issues such as the impact of software filters on ability to access health information and the medium's potential to help and harm adolescents.
Adolescent↗
Improved asthma care after enrollment in the State Children's Health Insurance Program in New York.
BACKGROUND: Uninsured children with asthma are known to face barriers to asthma care, but little is known about the impact of health insurance on asthma care. OBJECTIVES: We sought to assess the impact of New York's State Children's Health Insurance Program (SCHIP) on health care for children with asthma. DESIGN: Parents of a stratified random sample of new enrollees in New York's SCHIP were interviewed by telephone shortly after enrollment (baseline, n = 2644 [74% of eligible children]) and 1 year later (follow-up, n = 2310 [87%]). Asthma was defined by parent report using questions based on National Heart, Lung, and Blood Institute criteria. A comparison group (n = 401) who enrolled in SCHIP 1 year later was interviewed as a test for secular trends. MAIN OUTCOME MEASURES: Access (having a usual source of care [USC], unmet health needs, problems receiving acute asthma care), asthma-related medical visits, quality (continuity of care at the USC, problems receiving chronic asthma care, use of antiinflammatory medications), and asthma outcomes (change in asthma care or severity) were the main outcome measures used. Bivariate and multivariate analyses compared measures at baseline (year before SCHIP) versus follow-up (year during SCHIP). RESULTS: Three-hundred eighty-three children (14%) had asthma at baseline, and 364 had asthma at follow-up (16%). No secular trends were detected between the baseline study group and the comparison group. After enrollment in SCHIP, improvements were noted in access: lacking a USC (decrease from 5% to 1%), unmet health needs (48% to 21%), and problems getting to the USC for asthma (13 to 4%). Children had fewer asthma-related attacks and medical visits after SCHIP (mean number of attacks: 9.5 to 3.8: mean number of asthma visits: 3.0 to 1.5; hospitalizations: 11% to 3%). Quality of asthma care improved for general measures (most/all visits to USC: 53% to 94%; mean rating of provider: 7.9 to 8.8 of 10) and asthma-specific measures (problems getting to the USC for asthma care when child was well: 13% to 1%). More than two thirds of the parents at follow-up reported that both quality of asthma care and asthma severity were "better or much better" than at baseline, generally because of insurance coverage or lower costs of medications and medical care. CONCLUSIONS: Enrollment in New York's SCHIP was associated with improvements in access to asthma care, quality of asthma care, and asthma-specific outcomes. These findings suggest that health insurance improves the health of children with asthma.
Adolescent↗
Youth tobacco use: a global perspective for child health care clinicians.
Tobacco dependence, responsible for approximately 4 million annual deaths worldwide, is considered to be a "pediatric disease." The smoking epidemic is spreading rapidly in developing countries. Factors contributing to youth smoking in developing countries include cultural traditions, tobacco's easy accessibility and moderate pricing, peer and family influences, and tobacco companies' advertisements and promotional activities. Secondhand tobacco smoke exposure is a substantial problem that causes increased rates of pneumonia, otitis media, asthma, and other short- and long-term pediatric conditions. Parental tobacco use results in children's deprivation of essential needs such as nutrition and education. In this article we review contemporary evidence with respect to the etiology of nicotine dependence among youth, the forms of youth tobacco products worldwide, global youth tobacco-control efforts to date, medical education efforts, and child health care clinicians' special role in youth tobacco-control strategies. In addition, we provide a review of currently available funding opportunities for development and implementation of youth tobacco-control programs.
Adolescent↗
The effects of marriage, civil union, and domestic partnership laws on the health and well-being of children.
Explore the source record for details and available documents.
Adult↗
Predictors of partner abuse in a nationally representative sample of adolescents involved in heterosexual dating relationships.
This article's goals are to identify the characteristics of abusive heterosexual dating relationships among adolescents. Using the National Longitudinal Study of Adolescent Health dataset, an analysis of 4,441 heterosexual relationships was completed using logistic regression models (SAS PROC GENMOD). The associations between being verbally and physically abused were examined with respect to the following relationship characteristics: involvement in sexual intercourse or pregnancy with the relationship partner, description of the relationship as a "special romantic relationship," duration of the relationship, age at relationship initiation, and age difference between partners. The findings indicate that involvement in a sexual or "special romantic" relationship was associated with greater likelihood of being abused in both genders. Increased length of time in the relationship was associated with verbal abuse in both genders. Involvement in a pregnancy was associated with being verbally and physically abused among males. It is thus concluded that relationship characteristics play an important role in the development of abusive relationships among adolescents.
Adolescent↗
Intimate partner abuse and the reproductive health of sexually active female adolescents.
PURPOSE: The purpose of this study was to determine the associations between verbal and minor physical abuse by an intimate partner and reproductive health behavior. METHODS: Logistic regression analyses of 1996 cross-sectional data from 973 sexually active, dating female adolescents surveyed for wave II of the National Longitudinal Study of Adolescent Health Public Use Dataset examining the relationship between abuse by an intimate partner and reproductive health. We measured verbal (insulted in public, sworn at, or threatened with violence) and minor physical (threw something at them, pushed them, or shoved them) abuse by any intimate partner during the past 18 months and by any current intimate partner. Reproductive health variables included condom use with most recent intercourse, contraception use with most recent intercourse, history of sexually transmitted infection, and history of pregnancy. RESULTS: After adjusting for sociodemographic factors, number of intimate partners, and history of forced sexual intercourse, the current involvement in a verbally abusive relationship was associated with not using a condom during the most recent intercourse (odds ratio, 1.56; 95% confidence interval, 1.02-2.40), and both a history of involvement and current involvement in a physically abusive relationship were associated with a history of pregnancy (odds ratio, 2.50; 95% confidence interval, 1.47-4.17; and odds ratio, 3.57; 95% confidence interval, 1.85-6.67, respectively). Neither verbal nor physical abuse were associated with the other reproductive health outcomes. CONCLUSIONS: Physical abuse by an intimate partner is associated with pregnancy and current involvement in a verbally abusive relationship is associated with decreased condom use among sexually experienced female adolescents. Health care providers should be attentive to the association between abuse and pregnancy among adolescents.
Adolescent↗
The Internet: a window on adolescent health literacy.
PURPOSE: Adolescents are well served by the Internet through school access, but they will only derive maximum benefit from this information resource if they are able to search for, evaluate, and use its online information effectively. Internet use, however, requires significant literacy skills, and little is known about the health literacy of adolescents. The aim of this paper is to describe functional, critical, and interactive health literacy challenges experienced by adolescent students when using the Internet for online health information. METHODS: Twenty-six focus groups with 157 adolescent students, aged 11-19, conducted within a convenience sample of middle and high schools in diverse geographical and socioeconomic settings in the United Kingdom (UK) and United States of America (US) between May 2001 and May 2002. RESULTS: Many students cited difficulties in accessing health information online. Functional health literacy challenges included, for example, spelling medical terms correctly and being able to construct questions describing symptoms accurately. Critical challenges included discerning relevance of information retrieved by search engines and knowing which sites to trust. Interactive challenges included the appropriate application of health information to address personal health concerns within their local neighborhood. CONCLUSIONS: Exploring the challenges faced when adolescents search for online health information indicates deficiencies regarding health literacy skills. Difficulties regarding functional, critical, and interactive skills were all present. The Internet may offer opportunities for identifying such deficiencies and building better health literacy skills among adolescents, as part of health curriculum interventions to improve the population's future health.
Adolescent↗
Factors that influence adolescent reports of counseling by physicians on risky behavior.
PURPOSE: To determine factors that affect whether low-income adolescents report that their doctor talked with them about risky behavior. METHODS: Random digit-dial survey of low-income adolescents in New York City asking about depression, smoking, alcohol use, and sexual activity and the screening and counseling they received on these risk factors and risks during health visits. RESULTS: Prevalence of counseling by physicians was low, according to adolescent reports, ranging from 17% of adolescents counseled about depression to 52% about sexually transmitted diseases. Older adolescents were more likely than younger to receive counseling about all topics. In bivariate and multivariate models, having the risk factor was strongly associated with physicians counseling for depression (adjusted [adj.] OR = 4.42; p < 0.001); for sexual activity and counseling about condom use (adj. OR = 4.06; p < 0.01), and birth control (adj. OR = 2.76; p < 0.03). Still, many adolescents at risk had not received counseling. Many adolescents have not had a private and confidential visit with their provider. Having a private and confidential visit was also associated with receipt of counseling. CONCLUSIONS: Adolescents are not receiving sufficient counseling about risks and risky behavior, according to their own reports. There is need to improve delivery of counseling and ensure that private and confidential visits are provided to youth.
Adolescent↗
Adolescents' knowledge of and beliefs about herbs and dietary supplements: a qualitative study.
OBJECTIVE: To explore adolescents' knowledge of and beliefs about dietary supplements, including herbs, and over-the-counter (OTC) medications. METHODS: Eighteen focus groups with 81 adolescents in Monroe County, New York, explored teens' familiarity with and beliefs about CAM, specifically dietary supplements. We asked about general health beliefs and opinions of OTC medications to provide a framework for understanding how dietary supplements are conceptualized. Groups were conducted with suburban adolescents, urban minority adolescents, adolescents with chronic illness, (asthma, eating disorders, and diabetes), and patients of complementary/alternative practitioners ("CAM practitioners"). Transcripts were analyzed for themes relating to prevention ("staying healthy") and treatment of illness ("getting better"); direct quotations are used to illustrate adolescents' views. RESULTS: Most adolescents are familiar with "herbal medicine," "herbal remedies," or "nutritional supplements," and are able to name specific products or complementary/alternative medicine (CAM) therapies; however, many are unfamiliar with the term "alternative medicine." Adolescents are more familiar with remedies or CAM therapies commonly used by people from their own cultural or ethnic background. Older suburban females and those with chronic illnesses are more familiar with herbs and supplements than other adolescents. Most supplement use is conceptually linked with treating illness rather than with preventive care. CONCLUSIONS: Most adolescents are familiar with culturally based herbal products and nutritional supplements, used for treatment of illnesses, and not for preventive care. Providers and researchers should consider chronic illness status and culture/family tradition, and clarify terms, when asking adolescents about self-care, OTCs, or CAM.
Adolescent↗