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Youth evaluators describe their findings from an extensive evaluation of forty youth programs in San Francisco. Interviews with current youth and the former program director provide insight into the promise and challenge of youth participation.
OBJECTIVE: Our goal was to estimate the prevalence of diabetes mellitus in youth <20 years of age in 2001 in the United States, according to age, gender, race/ethnicity, and diabetes type. METHODS: The SEARCH for Diabetes in Youth Study is a 6-center observational study conducting population-based ascertainment of physician-diagnosed diabetes in youth. Census-based denominators for 4 geographically based centers and enrollment data for 2 health plan-based centers were used to calculate prevalence. Age-, gender-, and racial/ethnic group-specific prevalence rates were multiplied by US population counts to estimate the total number of US youth with diabetes. RESULTS: We identified 6379 US youth with diabetes in 2001, in a population of approximately 3.5 million. Crude prevalence was estimated as 1.82 cases per 1000 youth, being much lower for youth 0 to 9 years of age (0.79 cases per 1000 youth) than for those 10 to 19 years of age (2.80 cases per 1000 youth). Non-Hispanic white youth had the highest prevalence (1.06 cases per 1000 youth) in the younger group. Among 10- to 19-year-old youth, black youth (3.22 cases per 1000 youth) and non-Hispanic white youth (3.18 cases per 1000 youth) had the highest rates, followed by American Indian youth (2.28 cases per 1000 youth), Hispanic youth (2.18 cases per 1000 youth), and Asian/Pacific Islander youth (1.34 cases per 1000 youth). Among younger children, type 1 diabetes accounted for > or = 80% of diabetes; among older youth, the proportion of type 2 diabetes ranged from 6% (0.19 cases per 1000 youth for non-Hispanic white youth) to 76% (1.74 cases per 1000 youth for American Indian youth). We estimated that 154,369 youth had physician-diagnosed diabetes in 2001 in the United States. CONCLUSIONS: The overall prevalence estimate for diabetes in children and adolescents was approximately 0.18%. Type 2 diabetes was found in all racial/ethnic groups but generally was less common than type 1, except in American Indian youth.
BACKGROUND: The choice of informant is a critical piece in the identification of psychosocial problems in youth. While many behavioural measures have been adapted to include information from multiple sources, in the case of parents and youth, poor agreement has been found. Our study purpose was to identify youth and parent factors associated with whether the youth agrees with a positive parent-completed screen of youth psychosocial problems. METHODS: Parents of youth aged 10-15 years who were seen for a medical visit at eight clinics completed the 17-item Pediatric Symptom Checklist (PSC-17). Youth scoring positive on the screen and their parents/guardians were interviewed by telephone after the visit (n = 145). We conducted bivariate and multivariate analyses to identify parent characteristics and child factors associated with whether the youth agrees with the positive parent-completed screen. RESULTS: Fifty per cent of youth participants agreed with their parent on a positive parent-completed PSC-17 based on their completion of the Y-PSC-17 as a self-report measure. Youth who reported a positive Y-PSC-17 in agreement with their parent were twice as likely to meet diagnostic cut-offs on sub-scales of anxiety/depression and aggression on the Child Behaviour Checklist (P < 0.01 and P < 0.05 respectively), reported lower parent-child connectedness (P < 0.01) and their parents reported more anger/frustration (P < 0.05) than youth who disagreed with the positive parent-completed screen. Most of these associations remained significant when controlling for the other factors and demographic characteristics in multivariate analysis. CONCLUSIONS: Findings indicate that when the youth agrees with a positive parent-completed PSC-17, there is higher parent frustration, lower parent-child connectedness, and the youth is more likely to have a diagnosis of an emotional or behavioural disorder. Thus, when possible, the use of both parent and youth as informants provides necessary information in formulating a comprehensive treatment strategy to address the psychosocial needs of youth.
CONTEXT: Firearms are used in approximately half of all youth suicides. Many state and federal laws include age-specific restrictions on the purchase, possession, or storage of firearms; however, the association between these laws and suicides among youth has not been carefully examined. OBJECTIVE: To evaluate the association between youth-focused firearm laws and suicides among youth. DESIGN, SETTING, AND PARTICIPANTS: Quasi-experimental design with annual state-level data on suicide rates among US youth aged 14 through 20 years, for the period 1976-2001. Negative binomial regression models were used to estimate the association between state and federal youth-focused firearm laws mandating a minimum age for the purchase or possession of handguns and state child access prevention (CAP) laws requiring safe storage of firearms on suicide rates among youth. MAIN OUTCOME MEASURES: Association between youth-focused state and federal firearm laws and rates of firearm, nonfirearm, and total suicides among US youth aged 14 to 17 and 18 through 20 years. RESULTS: There were 63 954 suicides among youth aged 14 through 20 years during the 1976-2001 study period, 39 655 (62%) of which were committed with firearms. Minimum purchase-age and possession-age laws were not associated with statistically significant reductions in suicide rates among youth aged 14 through 20 years. State CAP laws were associated with an 8.3% decrease (rate ratio [RR], 0.92; 95% confidence interval [CI], 0.86-0.98) in suicide rates among 14- to 17-year-olds. The annual rate of suicide in this age group in states with CAP laws was 5.97 per 100 000 population rather than the projected 6.51. This association was also statistically significant for firearm suicides (RR, 0.89; 95% CI, 0.83-0.96) but not for nonfirearm suicides (RR, 1.00; 95% CI, 0.91-1.10). CAP laws were also associated with a significant reduction in suicides among youth aged 18 through 20 years (RR, 0.89; 95% CI, 0.85-0.93); however, the association was similar for firearm suicides (RR, 0.87; 95% CI, 0.82-0.92) and nonfirearm suicides (RR, 0.91; 95% CI, 0.85-0.98). CONCLUSIONS: There is evidence that CAP laws are associated with a modest reduction in suicide rates among youth aged 14 to 17 years. As currently implemented, minimum age restrictions for the purchase and possession of firearms do not appear to reduce overall rates of suicide among youth.
CONTEXT: State policies aimed at controlling youth access to tobacco are an important component of public health efforts to reduce smoking prevalence among youth and prevent subsequent disease. OBJECTIVES: This study sought to assess the extensiveness of state youth access tobacco control legislation in the United States, describe how state policies changed over a 4-year period, explore how various political and economic characteristics are related to state policies, and determine the relationship of youth smoking behavior to state youth tobacco control policies. DESIGN: This descriptive and correlational study utilized data from multiple national surveillance, economic, and sociodemographic data sets. PARTICIPANTS: All 50 states and the District of Columbia provided economic and political data. A standard tobacco-control policy score was developed by an expert panel for each state. Aggregated state-level measures of youth smoking behavior were provided by 79,491 youth in 33 states and the District of Columbia. MAIN OUTCOME MEASURES: Included were extent of state tobacco control policies and changes over time, relationship between state political and economic characteristics and tobacco control policies, and relationship between state policies and youth smoking behavior. RESULTS: State policy scores increased in variability and in mean value over the 4-year period, from a mean score of 7.2 in 1993 to 9.0 in 1996. State policy scores were significantly correlated with several state political and economic variables. States with more extensive tobacco control policies had significantly lower youth smoking rates. There was some evidence that a strong state tobacco economy may limit the effectiveness of tobacco control policies on youth smoking rates. CONCLUSIONS: It is possible to reliably measure the extent to which states are achieving important public health goals in limiting youth access to tobacco products. Comprehensive state tobacco control policies are important for increasing prevention and cessation of smoking among youth.
CONTEXT: Youth assets are associated with a reduction in sexual risk behavior; however, little is known about this association among youth at high risk of engaging in unsafe behavior, such as those in one-parent households. METHODS: In-home interviews were used to collect data from 1,253 inner-city teenagers and their parents. Multivariate logistic regressions were conducted separately for youth from one- and two-parent households to assess relationships between youth assets and four behaviors related to sexual risk: never having had sexual intercourse, not being currently sexually active, having delayed intercourse until age 17, and having used birth control at last intercourse. RESULTS: Among youth living in one-parent households, those with the aspirations for the future, good health practices (exercise/nutrition), peer role models and family communication assets had significantly elevated odds of reporting one of the behaviors examined (odds ratios, 1.8-7.3). The peer role models asset also interacted with parental education to significantly predict an absence of current sexual activity for youth in one-parent households (21.2). Among youth living in two-parent households, community involvement was linked to increased odds of never having had sex (1.9), but no other significant relationships were found. Youths' total number of assets significantly predicted three of the four behaviors among youth in one-parent households (1.2-1.8), but predicted only sexual inexperience among those in two-parent households (1.4). CONCLUSION: Future research should more fully investigate the role of family structure in relationships between youth assets and risk behaviors. Certain youth assets may be particularly effective in reducing sexual risk behavior among youth in one-parent households.
OBJECTIVE: To describe dietary intake among a large cohort of youth with type 1 or type 2 diabetes and to compare their intake with current nutrition recommendations. DESIGN: SEARCH for Diabetes in Youth is a multicenter study of diabetes in youth. Diet was assessed among youth aged 10 to 22 years who attended a SEARCH research clinic visit and completed a previous-week food frequency questionnaire that included foods to reflect the ethnic and regional diversity represented by the cohort. SUBJECTS/SETTING: Included were 1,697 youth with physician-diagnosed diabetes mellitus (89% type 1 diabetes, 11% type 2 diabetes), with diabetes mellitus duration of at least 12 months. STATISTICAL ANALYSES: Descriptive data and comparisons with nutrition recommendations were unadjusted. Analyses of covariance with adjustment for total energy, clinic site, sex, race/ethnicity, age, and parental education were used to compare intake according to diabetes type. RESULTS: Percent of energy from total fat was consistent at 37% to 38% across subgroups of age (10 to 14 years, >15 years) and diabetes type (ie, type 1 or type 2). Youth with type 2 diabetes consumed less calcium, magnesium, and vitamin E than youth with type 1 diabetes (P<0.01 for each). Intake of sweetened carbonated beverages among older (aged >15 years) youth with type 2 diabetes was twice that of older youth with type 1 diabetes (P<0.01). Only 6.5% of the cohort met American Diabetes Association recommendations of <10% of energy from saturated fat. Less than 50% met recommendations for total fat, vitamin E, fiber, fruits, vegetables, and grains, although a majority met recommendations for vitamin C, calcium, and iron. CONCLUSIONS: Overall, dietary intake in this large cohort of youth with diabetes substantially failed to meet current recommendations. There is a critical need for improvement in dietary intake in youth with diabetes.
The Boston HAPPENS Program is a collaborative network of care consisting of multiservice outreach agencies; community health centers; and hospitals for HIV-positive, homeless, and hard-to-reach youth. In four years of data collection, the program served more than 2,000 youth, including 54 HIV-positive youth. The youth were 19.9 +/- 2.9 years old; 64 percent female; 45 percent youth of color; 11 percent gay/lesbian, bisexual, or undecided; and 13 percent homeless or runaway. Homeless youth were much more likely to have been involved with a mental health system (47% vs. 12%, P < 0.001), the criminal justice system (20% vs. 2%, P < 0.001), high-risk sexual behaviors (21% vs. 3%, P < 0.001), and substance abuse (25% vs. 6%, P < 0.001) than were other youth served by the program. Comprehensive networks of care offering a continuum of services and a variety of entry routes and types of care sites are needed to connect under-served youth to health care. Outreach and human immunodeficiency virus (HIV) counseling and testing services can offer important portals of entry into health services for at-risk youth. Support services such as outreach, case management, and mental health services are needed to complement medical services by all youth at-risk for contracting HIV. Support services are necessary for the initiation and retention of youth in care so that early case identification and complex treatment regimens can be initiated and tailored to the individual.
PURPOSE: To describe and analyze the process of transitioning HIV-infected youths from the point of HIV diagnosis into HIV treatment. Rather than simply offering HIV positive youths a list of referrals, the youth-focused SPNS grantees (AWAC) found it vital that youths were immediately assisted with linkage to a medical provider. METHODS: From February 1997 to December 2000, 107 identified HIV-infected youths from the five adolescent SPNS projects were surveyed on needs and barriers. The time interval between HIV testing and youth linkage to care was also noted. RESULTS: Nine percent of youth reported perceived barriers to accessing health care. Perceived needs were identified as Mental Health (44.9%; n = 48); Alcohol and drug treatment (14%; n = 15); transportation to health care settings (40.2%; n = 43); and housing (46.7%; N = 50). At sites tracking linkage to care, the time of being transitioned into a medical setting ranged from 5 to 55 days (average 26 days). CONCLUSIONS: The period of transitioning identified HIV-infected youths into care can be reduced from 1-5 years to as short as 5-55 days. Success with linking these youth to care involves establishing a series of contacts at outreach sites wherein program staff seeks to build trusting relationships with youths, is able to track these youths and identify and address perceived needs.
PURPOSE: To examine the relationship between parent-youth concordance with regard to youth exposures to violence and youth psychosocial functioning, including perpetration of violence, distress symptomatology, and social skillfulness. METHODS: A battery of self-report questionnaires were completed by 333 parent-youth dyads residing in urban public housing developments. Concordance status (<50%, 50-80%, and >80%) was based on dyad agreement regarding youth's violence exposures. The relationship between concordance and psychosocial factors was assessed by a series of analyses of covariance tests. RESULTS: Parents underestimated the extent to which their children were victims of or witnesses to violence and suffered from distress symptoms. Low concordance status was associated with youth perpetration of violence and distress symptomatology, as well as lower self-esteem and problem-solving skillfulness. Youth in the low concordance group characterized their families as exhibiting less involvement, open communication, and parental monitoring. CONCLUSIONS: Concordance between parents and youth is associated with youth psychosocial competence and strong family functioning. Findings underscore the need to incorporate a parent component in primary and secondary violence-prevention programs. Further examination of the processes which contribute to concordance may enhance our ability to prevent youth engagement in violence and its untoward psychosocial sequelae.
OBJECTIVE: This report describes the development of the Massachusetts Youth Screening Instrument-Second Version (MAYSI-2), a brief screening measure to identify youths with potential mental, emotional, or behavioral problems at entry points in the juvenile justice system. METHOD: This 52-item self-report measure, with content relevant to common mental health problems in delinquent populations, was administered to 1,279 male and female youths, aged 12 to 17, in Massachusetts juvenile justice facilities. A subsample of youths also received the Millon Adolescent Clinical Inventory (MACI) and the Youth Self-Report (YSR). The instrument was subsequently administered to 3,804 male and female youths in California Youth Authority custody. RESULTS: Factor analyses of the 52 items identified seven scales that were conceptually associated with various mental, emotional, and behavioral problems of youths, which were generally confirmed by separate factor analyses with the California sample. The scales manifested adequate internal consistency and test-retest reliability. Most scales were substantially correlated with conceptually similar scales in the MACI and YSR, and they identified most youths who scored at clinically significant levels on those instruments. CONCLUSIONS: The MAYSI-2 shows promise as a reliable and valid screening tool to assist juvenile justice staff in identifying youths who may need an immediate response to mental or emotional problems.
PURPOSE: This study examined the awareness and impact of antitobacco media messages among rural, suburban, and urban youth. METHOD: Self-administered questionnaires were received from 1,622, 1,059, and 1,177 middle school (sixth, seventh, and eighth grade) students in rural, suburban, and urban locations, respectively. Logistic regression compared media awareness and impact among the groups, controlling for grade, gender, race, and smoking behavior. RESULTS: Compared to rural youth, suburban youth were more likely to recall media messages about the dangerous health effects of tobacco use (odds ratio [OR] = 1.94) and have their personal choice to use tobacco affected by the messages (OR = 1.85). Suburban and urban youth more often recalled antitobacco messages (OR = 2.00 and 2.15), reported that the messages made them think about the dangers of tobacco use (OR = 2.02 and 1.47), believed that these ads prevent youth from initiating tobacco use (OR = 3.21 and 1.46) and stop youth from using tobacco (OR = 2.25 and 1.47), and recalled seeing specific campaign television ads (OR = 3.72 and 3.57). Urban youth were more likely to recall specific campaign messages on the radio (OR = 1.58). Neither suburban nor urban youth differed from the rural youth on whether the campaign-specific radio and television ads made them think about not using tobacco. CONCLUSIONS: The results support the need for targeting antitobacco media announcements to youth, based on their residence.
OBJECTIVE: To determine the effectiveness of laws restricting youth access to cigarettes on prevalence of smoking among teens. METHODS: We conducted a systematic review of studies that reported changes in smoking associated with the presence of restrictions on the ability of teens to purchase cigarettes. We calculated the correlation between merchant compliance levels with youth access laws and prevalence (30-day and regular) prevalence of youth smoking, and between changes in compliance and prevalence associated with youth access interventions. We also conducted a random effects meta-analysis to determine the change in youth prevalence associated with youth access interventions from studies that included control communities. RESULTS: Based on data from 9 studies, there was no detectable relationship between the level of merchant compliance and 30-day (r =.116; n = 38 communities) or regular (r =.017) smoking prevalence. There was no evidence of a threshold effect. There was no evidence that an increase in compliance with youth access restrictions was associated with a decrease in 30-day (r =.294; n = 18 communities) or regular (r =.274) smoking prevalence. There was no significant difference in youth smoking in communities with youth access interventions compared with control communities; the pooled estimate of the effect of intervention on 30-day prevalence was -1.5% (95% confidence interval: -6.0% to +2.9%). CONCLUSIONS: Given the limited resources available for tobacco control, as well as the expense of conducting youth access programs, tobacco control advocates should abandon this strategy and devote the limited resources that are available for tobacco control toward other interventions with proven effectiveness.
OBJECTIVES: This study assessed whether mental health services for youths differ with respect to medical assistance aid category. METHODS: Computerized claims for 15,507 youths with Medicaid insurance in a populous county of a mid-Atlantic state were used to establish population-based prevalence estimates of mental disorders and psychotherapeutic treatments during 1996. RESULTS: An analysis of service claims revealed that the prevalence of mental disorders among youths enrolled in foster care (57%) was twice that of youths receiving Supplemental Security Income (SSI; 26%) and nearly 15 times that of other youths receiving other types of aid (4%). Rates of mental health service use were pronounced among foster care youths aged 6 to 14 years. Attention deficit/hyperactivity disorder, depression, and developmental disorders were the most prevalent disorders. Stimulants, antidepressants, and anticonvulsants were the most prevalent medications. CONCLUSIONS: Youths enrolled in foster care and youths receiving SSI use far more mental health services than do youths in other aid categories. Additional research should evaluate the complexity and outcomes of mental health services for youths in foster care.
OBJECTIVES: The objectives of this study were to compile data on Asian American and Pacific Islander (AAPI) youth tobacco use in Florida and conduct comparisons with state and national data. This research will contribute to reducing the gap in information regarding current smoking prevalence among AAPI youth in Florida and provide direct comparisons with another state (Texas) and National Youth Tobacco Survey (NYTS) data on AAPI youth. METHODS: Current cigarette use data from the Florida Youth Tobacco Surveys conducted in 1998, 1999, and 2000 were examined for trends in AAPI and state prevalence rates. AAPI data from Florida's baseline 1998 youth tobacco survey were compared to Texas data after applying a common set of data preparation edits. AAPI data from the NYTS were also compared to Florida's AAPI youth population. FINDINGS: Current cigarette use for AAPI students in Florida was generally below the overall prevalence rates among Florida's public middle or high school students. In 1998, current smoking prevalence among Texas AAPI middle and high school students was 18.7% compared to 19.4% among Florida students. Among high school students, the NYTS found that 21.2% of AAPI students were current cigarette smokers nationally in comparison to 21.7% of AAPI high school youth in Florida. In middle school, the current smoking prevalence among AAPI students was 5.5% in the NYTS as compared to 9.4% in Florida. The NYTS data in particular highlight the magnitude of the increasing trend of cigarette smoking among AAPI youth as they progress through the high school grades. CONCLUSIONS: Of all the racial/ethnic groups in Florida, only AAPIs did not have a significant decline in current cigarette use. While the Florida Tobacco Pilot Program has implemented many worthwhile initiatives, the anti-tobacco interventions do not appear to have exerted a noticeable effect on AAPI youth.
BACKGROUND AND OBJECTIVES: This study explores youth and parent agreement about conversations on specific topics related to sexual risk behavior and youth-parent relationship. The study's objective was to determine if the amount of agreement was associated with youth sexual behavior. METHODS: Data were collected using a computer-assisted data entry system from one parent and one youth in 1,350 randomly selected households in inner-city areas of two Midwestern cities. RESULTS: Youth-parent positive agreement scores about these conversations were significant after controlling for youth age, race, gender, family structure, and parental income and education. Scores were associated with youth abstinence and with the use of contraception if the youth had become sexually active. CONCLUSIONS: In this study, youth-parent agreement regarding their communication was associated with positive youth behaviors, including abstinence and the use of contraception if sexually active.
BACKGROUND: There is a limited understanding of the social influences, such as the role of parents on youth sun-safe practices, that may reduce the risk of developing skin cancer later in life. METHODS: This study examined the degree of correlation in sun-safe practices between youth and their parents and assessed independent parental factors of youth sunscreen use in a 1998 cross-sectional, population-based telephone survey of U.S. youth (11- to 18-year-olds) and their parents/caregivers (N=1192 pairs of youth and parents). RESULTS: Sunscreen-use practices between youth and their parents were significantly correlated, albeit small. Youth were significantly more likely to use sunscreen frequently if their parents applied it frequently on themselves. Multivariate analysis revealed three independent parental factors associated with frequent youth sunscreen use: Their parent reported to insist frequently that the child uses sunscreen (adjusted prevalence odds ratio [aPOR]=2.4, 95% confidence interval [CI], 1.6-3.8); parent reported no difficulty with protecting their child from the sun (aPOR=1.4, 95% CI, 1.1-1.9); and parent's own frequency of sunscreen use (aPOR=1.3, 95% CI, 0.9-1.8). CONCLUSIONS: Sun-safe practices were correlated between parent-child pairs and parental factors exerted a positive role on youth sunscreen-use frequency. These data may guide further sociobehavioral and intervention research for the design of skin cancer prevention programs in schools and communities to improve levels of sun-safe practices.
OBJECTIVE: Considering the well-documented low level of agreement between youth and parent reports on the diagnosis of major depressive disorder (MDD), uncertainties remain as to the informativeness of discrepant youth and parent reports in clinical studies. To this end we evaluated whether morbidity and functional correlates on the diagnosis of MDD in youth vary by informant source. METHODS: The sample consisted of 186 pairs of independently assessed mother and youth self-reports on the diagnosis of MDD using structured diagnostic interviews ascertained in a large study of youth with and without attention deficit hyperactivity disorder of both genders. Subjects were also assessed on measures of interpersonal, school, and family functioning as well as prior treatment history. RESULTS: The diagnosis of MDD endorsed by youth self-report only when compared with that reported by the mother was characterized by significantly: shorter duration episode, later age at onset, milder depression-associated impairment, less impairment in interpersonal functioning, lower rates of comorbid disorders, and decreased likelihood to receive any course of treatment for depression. The morbidity and dysfunction associated with MDD varied significantly by informant source, and followed a dose-response association with the highest morbidity associated with the concurrent reports of the youth and the mothers, followed by mother report alone, with the least morbidity and dysfunction when endorsed by youth alone. CONCLUSIONS: These findings suggest that exclusive reliance on youth self-reports may identify a mild form of depression associated with limited morbidity and disability compared with that identified by parental reports.