[Validation of a scale for adolescents (EBHAD): a pilot study in Puerto Rico]

This investigation presents the development and validation process of a scale whose principal purpose is to identify those areas in which one is required to achieve improved functioning and adequate emotional health resulting in improved sports performance with adolescent athletes. The "Hechavarria Wellness Scale for Adolescent Athletes" (HWSAA) was developed. The concept of wellness was measured utilizing the following 4 sub-scales measuring; depressive symptomatology, trait anxiety, self-esteem and social relations. A pilot study was undertaken with a universe of 149 adolescent athletes from both sexes with an average of 15.6 years old and residing within the different municipalities of Puerto Rico. The alpha coefficient reliability of the HWSAA and its' subscales fluctuated between 0.71 and 0.82. The results suggest that the HWSAA and its' subscales possess a psychometrically adequate internal consistency. This means that the instrument is valid and reliable for the sample utilized. We suggest further research with the HWSAA.

CHIP: new opportunities in adolescent health care delivery

Children's Health Insurance Programs (CHIP), usually targeted to infants, toddlers, and school-aged children, have been expanded to include adolescents. Adolescents need some form of health insurance in order to access needed care. Moreover, programs and services that provide them with health care must be adolescent-friendly, adolescent-focused and adolescent-sensitive, and include specialized training for primary care providers. Translating this philosophy into a successful health care delivery program involves addressing the psychological, institutional and financial barriers that make it difficult for adolescents to access health care. Overcoming these barriers, especially the financial ones, requires that primary care providers advocate for teenagers and take advantage of resources made available for them. CHIP provides a critical opportunity for policy-makers and health care providers to further improve adolescent health care and to more fully integrate adolescents into the health care system.

Adolescent school-based health care: a description of two sites in their 20th year of service

PURPOSE

While there are currently nearly 1,400 school-based health centers (SBHC) nationwide, only 20% have been in operation for more than 10 years. The Mount Sinai Adolescent SBHC Program is now in its 20th year of service. The purpose of this study is to: (a) present the demographic data for 2003 high school SBHC medical visits, including age, sex and insurance status; (b) describe the current prevalence of medical and psychosocial risk factors of the students seen for examination; and (c) present general distributions for psychosocial risk factors found in 1988 archival information and note differences from current risk factors.

METHODS

A retrospective chart review was conducted in high school A, whose SBHC serves students mainly interested in going to college, and in high school B, whose SBHC has a heterogeneous population with a large proportion of recent immigrants. Data collected included demographic variables as well as reports of risk factors such as: considering oneself to be overweight, history of sexual activity, history of sexually transmitted diseases, same-sex attraction, use of alcohol, cigarette smoking, use of marijuana, suicidal ideation and exposure to violence.

RESULTS

For those participating from high school A (n=231): 78% female, mean age 15.75; asthma (17%); think oneself overweight (30%); family member with HIV (11%); sexually active (35%); same-sex attraction (3%); cigarette use (14%); marijuana use (13%); alcohol use (38%); suicide ideation (14%); witnessed violence (37%); and overweight and obese (33%). For those participating from high school B (n=241): 64% female; mean age 16; asthma (16%); think oneself overweight (32%); family member with HIV (9%); sexually active (43%); same-sex attraction (7%); cigarette use (38%); marijuana use (24%); alcohol use (53%); suicide ideation (23%); witnessed violence (33%); and overweight and obese (31%). In 1988, students at these schools reported: sexually active status (41%); marijuana use (13%); cocaine use (12%); alcohol use (20%); and sadness/depression (43%).

CONCLUSIONS

While a snapshot of the risk factors in 2003 might indicate that sexual activity has decreased somewhat, substance use, as well as eating-related and AIDS-related issues have come to the forefront. SBHCs continue to serve students with intense medical and psychological needs. It remains crucial that SBHCs provide comprehensive medical and mental health services.

Hysterectomies amongst teenagers in Calabar, Nigeria

A 10-year retrospective study of hysterectomies performed on teenagers in Calabar was carried out.

Community sex education among adolescents in rural Uganda: utilizing indigenous institutions

Although adolescent girls in Uganda are particularly vulnerable to HIV infection, providing relevant sexual health education to them is problematic. The senga (father's sister), is the traditional channel for socializing adolescent girls into sex and marriage among many ethnic groups in Uganda. This paper discusses the implementation and community acceptability of 'modern' sengas who were trained to provide HIV-related counselling to adolescent girls. Fourteen sengas were trained in two villages and, in the course of the 1-year study, 247 individuals made a total of 403 visits to them. By including both traditional services (such as advice on and assistance with labial elongation) and modern health and sex education, the sengas provided a 'middle road' between tradition and modernity. As a result, despite initial suspicion by the community, their activities were supported by the community generally and effective as intervention.

Development of Child and Adolescent Psychiatric Nursing Practice in Korea, 1980-2000

PROBLEM

Although the need for mental health services for children and youth is on the rise in Korea, there are no data available regarding the current status of psychiatric nurses working with children and adolescents.

METHODS

Descriptive statistics were used to analyze questionnaires from 324 respondents.

FINDINGS

Only 5% of psychiatric nurses in Korea are working at child and adolescent-specific programs. The level of nurses' roles and functions vary from simple to specialized.

CONCLUSIONS

More effort should be put into networking among nurses to exchange updated information and to share nursing strategies and strengthen college education for further specialization and expansion of nursing roles in the various settings.

Clinicians' views on reproductive needs and services for teens with negative pregnancy tests

ISSUES AND PURPOSE

To explore services available to adolescent girls at the time of the negative pregnancy test (NPT) in an urban community.

DESIGN AND METHODS

Clinician focus groups were conducted to identify the needs of adolescents at the time of a NPT result.

RESULTS

Teens access care in a variety of ways, services provided at the time of a NPT were agency and clinician dependent, and strategies for follow-up care often were unstructured. Few services were available for parents or partners. Barriers included difficulty communicating with agencies, lack of staff trained to work with adolescents, and time/financial constraints.

CONCLUSION

Adolescents need comprehensive, teen-friendly reproductive care at the time of a NPT result.

Use of Medical Services by Methylphenidate-Treated Children in the General Population

OBJECTIVES

To examine selected medical services for children treated for attention-deficit/hyperactivity disorder (ADHD) in a general population setting with universal health insurance.

DESIGN

Retrospective analysis of administrative prescription and health services databases spanning from 1990 to 1996.

SETTING

British Columbia, Canada.

PATIENTS

Children (<19 years of age) who had received the psychostimulant methylphenidate (MPH; Ritalin) on a chronic basis (chronic-MPH group), who had received MPH on any other basis (nonchronic-MPH group), and who were in a no-MPH comparison group.

MAIN OUTCOME MEASURES

The number of individuals who received any of the following services based on claims submitted by qualified practitioners: 1) emergency care, 2) critical care, 3) injury-related diagnostic and treatment services, 4) complementary and alternative medical (CAM) care, and 5) other diagnostic and treatment services (audiometry and allergy testing).

RESULTS

Prevalence of services users was higher among MPH-treated than nontreated children for all types of services (except critical care services in the chronic-MPH group) after adjusting for effects of age, sex, socioeconomic status, and geographic setting, with odds ratios ranging from 1.49 to 3.17. There were no differences between the 2 MPH-treated groups.

CONCLUSIONS

Children treated with MPH for ADHD or presumed ADHD are more frequent users of a wide range of medical services than are other children. Findings support and extend existing evidence of increased use of medical services by this population of children. Findings have implications for service planning, including injury prevention, with these children. High utilization of audiometric, allergy, and CAM services warrants further scrutiny.

Who should be treating adolescents and young adults with acute lymphoblastic leukaemia?

Although several cancers have a peak incidence during adolescence and young adulthood, the patients in this age group are arbitrarily referred to either paediatric or adult oncologists and, consequently, treated on different protocols. Recent reports show that paediatric oncologists are more likely to enroll patients in clinical trials, and that adolescents who are treated on paediatric protocols have a better outcome than their counterparts who are managed by adult oncologists. These observations were also noted in adolescents with acute lymphoblastic leukaemia (ALL), a disease with a bimodal peak incidence in early childhood and late adulthood. Recently, investigators have become aware that patients in the adolescent and young adult age group might be falling through the cracks because of the rigid organisation of the medical care system. In this article, I present some of the current challenges in the treatment of ALL in adolescents and young adults and propose strategies to improve outcome in these patients.

Access by the unaccompanied under-16-year-old adolescent to general practice without parental consent

BACKGROUND

The views of primary health care providers concerning their willingness to consult with under-16-year-old adolescent patients without the presence of a parent or guardian are not well documented. Many young people believe they have to be aged over 16 years to see their general practitioner (GP) alone. Confidentiality is a major concern for young people. It is important that more is known about the willingness of GPs and practice nurses (PNs) to offer unaccompanied consultations without known parental consent.

AIM

To provide information on the willingness of GPs and PNs to consult with under-16-year-olds and whether policies exist in general practices to facilitate access by unaccompanied under-16-year-olds.

STUDY DESIGN

Cross-sectional study using a postal questionnaire.

SETTING

Seventeen general practices in the West of Cornwall.

METHOD

All GPs, PNs and receptionists were sent questionnaires.

RESULTS

The overall response rate was 79% (166/209 questionnaires). The majority of GPs and PNs (91%) were willing to consult with unaccompanied under-16-year-olds. A substantial number of primary health care team members are not aware of the existence of any practice policy on access. Only 41% of receptionists, 46% of PNs and 38% of GPs were aware of a definite practice policy.

CONCLUSIONS

GPs and PNs are willing to consult with under-16-year-olds without a parent or guardian being present. Many practices in this region do not appear to have policies in place to guide health professionals on under-16 access issues.

Primary care providers' willingness to see unaccompanied adolescents

PURPOSE

To describe primary care practitioners' office policies and willingness to provide medical care for unaccompanied adolescents aged 11-17 years.

METHODS

A unique 32-item survey was mailed in June and July, 2001 to 1979 office-based pediatricians and family practitioners randomly selected from the American Medical Association's physician database. The survey included questions regarding demographic information, number of adolescents seen in the practice, office policies regarding adolescents alone in the clinic, and 5-point Likert scales regarding their willingness to see patients in various situations, as well as to see patients in 12 brief clinical scenarios. Predictors of the willingness to see adolescents alone were identified and entered into binomial logistic regression models. Specific policies included on the surveys were coded into groups.

RESULTS

Survey responses (n = 710) represented a 36% response rate. This sample included 288 family practitioners and 368 pediatricians; 43.3% of physicians reported having a specific policy regarding seeing adolescents without their parents present. Family practitioners were more likely than pediatricians to report having such a policy (51.3% vs. 38.2%, p =.001,), yet pediatricians reported a higher percentage of adolescents in their practices than family practitioners (22.6% vs. 12.4%, p <.0005). Not having a policy was an independent predictor of "often" or "always" seeing an adolescent alone for routine health maintenance (OR = 2.84, 95% CI 1.91-4.24) and urgent care visits (OR = 3.01, 95% CI 1.90-4.77). Specific policies varied, and many physicians assessed each case on an individual basis.

CONCLUSIONS

Specific policies are associated with a decreased willingness of physicians to see adolescents who are unaccompanied by a parent. Carefully developed clinic policies that are consistent with legal guidelines should be implemented in order to maximize adolescents' abilities to access care.

Effects of managed care on southern youths' behavioral services use

Children and adolescents' access to Medicaid-financed behavioral health services was examined over 8 years in Tennessee (managed care) and Mississippi (fee-for-service [FFS]) using logistic regression. Managed care reduced access to behavioral care overall, overnight services (e.g., inpatient), and specialty outpatient services. Managed care also restricted the relative use of overnight and specialty outpatient for children and adolescents. However, managed care had pronounced effects on use of case management services. We also document differences in access and mix of behavioral services used over time by race, sex, age, and Medicaid enrollment category.

The tip of the iceberg: opportunistic screening for Chlamydia trachomatis in asymptomatic patients attending a young people's health clinic reveals a high prevalence — a pilot study

Objectives: We implemented an opportunistic screening programme for Chlamydia trachomatis amongst patients presenting to a young peoples’ health service in the city of Geelong, Australia, to define the prevalence of infection and to identify specific risk factors. Methods: Over a 7-month period sexually active patients attending the young peoples’ clinic were offered C. trachomatis screening by nucleic acid amplification test. There was 100% acceptance rate among those offered the test. Patient demographics, reason for presentation at the clinic and reported symptoms were documented by the clinicians and correlated with laboratory findings. Results: 163 patients between the ages of 12–25 were tested, nine males and 154 females. The prevalence of chlamydia infection was 5.8% and was highest (16.0%) among patients presenting for the morning after pill. Inhibition of the nucleic acid amplification test occurred in 11.0% of urine samples. All patients with inhibited tests were asked to provide a repeat sample for retesting, but only 50% complied with this request. The majority of repeat samples (88.9%) had no inhibitors present and yielded a negative result. There was no correlation between symptoms and a positive chlamydia result. Conclusions: Chlamydia infection is common in young people engaging in unsafe sexual practice and cannot be predicted by the presence of symptoms. The high prevalence of infection in Geelong would make screening cost effective in this age group. Ongoing population screening of sexually active young people should be encouraged in community health centres. Inhibition of the nucleic acid amplification test was common but repeat testing of urine a few days later usually gave satisfactory results.

Who's calling the shots? Decision-makers and the adoption of effective school-based substance use prevention curricula

This study investigates the relative roles of school district and school-level decision-makers in the implementation of effective substance use prevention curricula. Drawing on a "Site-Based Management" approach to effective decision-making, we hypothesized that schools whose personnel played active decision-making roles would be more likely to implement effective curricula than those in which decision-making was the prerogative of school district personnel. Study data comprised 1369 questionnaires completed by a representative national sample of both district-level prevention coordinators and middle school-based lead prevention teachers. From the perspective of the lead prevention teachers, the school district-level prevention coordinator was more influential than school staff in selecting effective prevention curricula. However, we did find some support for our hypothesis from our district-level informants, who indicated that community groups and advisory committees also play a modest role in the selection of such curricula.

Comparing Telephone and Written Surveys to Assess Local Adolescent Immunization Coverage Rates

To identify adolescent hepatitis B coverage levels, a survey was conducted of seventh grade parents in San Diego County, California, using a random digit-dial telephone survey. A written survey was fielded also that was distributed at selected schools. Results were validated using data from a mandated report from all schools. Both survey methods overestimated the proportion completing the hepatitis B series by about 10%. Parents accurately reported immunization shot dates from the child's parent-held immunization shot record on the telephone and written surveys. The written survey, in addition to having a somewhat lower cost, may be useful when focusing on a localized area, whereas the telephone survey permits a more representative sample of a larger county-wide population.

Access to health care among Australian adolescents young people's perspectives and their sociodemographic distribution

PURPOSE

To identify the health concerns for which adolescent residents in New South Wales, Australia, do not receive health care, and the associated factors, including their sociodemographic distribution.

METHODS

Purposive sampling was used to recruit school students who were stratified by gender and age (12-14, 14-16 and 16-17 years), from schools stratified by socioeconomic status and urban/rural location. Out-of-school young people were recruited through youth health services. Qualitative methods were used to collect and analyze data.

RESULTS

Eighty-one focus groups were conducted. Most young people defined health solely in terms of their physical well-being, but still identified a broad range of situations, conditions, or behaviors which they believed might affect their health. One-third of females and two-thirds of males said they would not seek help for their health concerns, and when they did, were most likely to seek help from family, friends, or others they trusted. When professional help was sought, young people again preferred someone they knew and trusted. The three groups of barriers to accessing health care were: concerns about confidentiality, knowledge of services and discomfort in disclosing health concerns, and accessibility and characteristics of services. Factors related to use of health care services were associated with age, gender, and location, but rarely with socioeconomic status.

CONCLUSIONS

The majority of these young people in New South Wales (particularly males) do not seek health care despite identifying a broad range of issues that affect their health.

Child functioning in rural and nonrural areas: how does it compare when using the service program site as the level of analysis?

The current study uses data from the national evaluation of the Comprehensive Community Mental Health Services for Children and Their Families Program to examine child functioning in rural (n = 8) as compared to nonrural (n = 18) system-of-care communities across the United States. In this study, the topic of rural versus nonrural differences is approached from a community-level perspective with aggregated functional impairment scores as the dependent variable of interest in weighted least squares regression. The demographic characteristics of children, particularly age, were more important predictors of functional impairment than geographic locale (i.e., rural vs nonrural). Specifically, while children served in nonrural communities were older than those served in rural communities, after controlling for this difference functional impairment levels were similar. It appears from these analyses that youth served in rural and nonrural communities with systems of care were more similar than they were different with regard to their level of functional impairment. This lack of aggregate functional difference between the rural and nonrural sites reminds policymakers and funding agents that youth in rural areas need equity in both access and resource for mental health services. As indicated by the findings in the current investigation youth in rural areas are not immune to the types of mental health challenges often publicized by researchers examining youth in nonrural areas.

The relationship between school characteristics and the availability of mental health and related health services in middle and high schools in the United States

Problems related to mental illness are increasingly becoming the focal point of public concern over the safety and performance of schools, yet little is known about the availability and quality of school-based mental health services in the United States. In this article it is estimated that approximately 50% of US middle and high schools have any mental health counseling services available onsite and approximately 11% have mental health counseling, physical examinations, and substance abuse counseling available on-site. There are substantial differences in mental health counseling availability by region, urbanicity, and school size, with rural schools, schools in the Midwest and South regions, and small schools being least likely to offer mental health counseling. Multivariate estimates suggest that disparities between schools in the availability of mental health counseling and related health services may be partly explained by differences in access to Medicaid for financing of health services provided at school.

Disparities in adolescent health and health care: does socioeconomic status matter?

DATA COLLECTION/EXTRACTION METHODS

National household survey.

DATA SOURCES/STUDY SETTING

We analyzed data on 12,434 adolescents (10 through 18 years old) included in the 1999 and 2000 editions of the National Health Interview Survey.

STUDY DESIGN

We assessed the presence of income gradients using four income groups. Outcome variables included health status, health insurance coverage, access to and satisfaction with care, utilization, and unmet health needs.

PRINCIPAL FINDINGS

After adjustment for confounding variables using multivariate analysis, statistically significant disparities were found between poor adolescents and their counterparts in middle- and higher-income families for three of four health status measures, six of eight measures of access to and satisfaction with care, and for six of nine indicators of access to and use of medical care, dental care, and mental health care.

CONCLUSION

Our analyses indicate adolescents in low-income families remain at a disadvantage despite expansions of the Medicaid program and the comparatively new State Children's Health Insurance Program (SCHIP). Additional efforts are needed to ensure eligible adolescents are enrolled in these programs. Nonfinancial barriers to care must also be addressed to reduce inequities.

Adolescents' preventive care experiences before entry into the State Children's Health Insurance Program (SCHIP)

BACKGROUND

Adolescence has traditionally been thought of as a time of good health. However, adolescents comprise an important group with unique needs among State Children's Health Insurance Program (SCHIP) enrollees. Throughout the 1990s, there was increasing evidence of unacceptably high morbidity and mortality among adolescents from injuries, suicide, sexually transmitted diseases, substance abuse, and other conditions associated with risk behaviors. The establishment of relationships with the health care system can ensure prompt treatment and help promote healthy behaviors, assuming that the adolescent feels comfortable seeking help for his or her health-related concerns. However, health care systems typically are not designed to ensure that adolescents receive the primary and preventive care that might ameliorate the negative consequences of health-damaging behaviors.

OBJECTIVES

The purpose of this study was to examine the following hypotheses. 1) Adolescents with special health care needs, those engaging in risk behaviors, and those who were insured before program enrollment would be more likely than those who were healthy and those not engaging in risk behaviors to have a preventive care visit in the year preceding the interview. No differences would be observed in the odds of preventive care visits based on age, race/ethnicity, and gender. 2) No differences would be observed in the receipt of risk-behavior counseling for those with a preventive care visit based on the adolescents' sociodemographic and health characteristics. 3) Adolescents who were older would be more likely to engage in risk behaviors than younger adolescents. There would be no differences in reports of risk behaviors based on gender, race/ethnicity, and children with special health care needs status.

METHODS

Adolescents 12 to 19 years old and newly enrolled in SCHIP were eligible for the study. Telephone interviews were conducted within 3 months after enrollment with parents of adolescents to obtain sociodemographic information and information about the adolescents' health by using the Children with Special Health Care Needs screener. Interviews also were conducted with the adolescents themselves to obtain information about the adolescents' risk behaviors and experiences with preventive care before SCHIP enrollment.

RESULTS

Interviews were completed with 1872 parents. In addition, a total of 918 interviews were completed with adolescents. Approximately 73% of adolescents reported engaging in at least one risk behavior. Approximately 69% reported having a primary care visit during the last year with 46% of those reporting that the visit was private. Of those reporting a primary care visit, between 41% and 53% reported receiving counseling along 1 of the 5 content dimensions of anticipatory guidance. Older adolescents were more likely to engage in risk behaviors than younger adolescents. Hispanic adolescents were approximately 30% less likely than white non-Hispanic adolescents to report engaging in risk behaviors. In terms of having a preventive care visit, adolescents with a special need were twice as likely to have a visit when compared with their healthy counterparts. Hispanics and black non-Hispanics were half as likely to have a preventive care visit (odds ratios of 0.59 and 0.54, respectively) than white non-Hispanics. Those engaging in risk behaviors were almost 50% less likely to report private preventive care visits than those reporting no risk behaviors. Privacy during the preventive care visit was associated with a greater odds of receiving counseling for risk behaviors in general, sexual activity, and emotional health and relationships. Depending on the type of counseling, those with private preventive care visits were 2 to 3 times more likely to receive the counseling than those whose visits were not private. In addition, those engaging in risk behaviors were 1.45 to almost 2 times more likely to receive counseling than those not engaging in any risk behaviors.

CONCLUSIONS AND IMPLICATIONS

Based on our findings, health plans health plans and providers involved in SCHIP are likely to serve adolescents who have had limited opportunities for private preventive care visits and counseling during such visits. The most underserved are likely to be black and Hispanic adolescents who may have had no preventive care at all compared with their white non-Hispanic counterparts. State agencies, health plans, and providers need to follow established guidelines for adolescent health care that emphasize the provision of counseling for risk behaviors for all adolescents, not just those engaging in risk behaviors or those with special health care needs. Moreover, providers need to seek opportunities to ensure privacy for the adolescents during their preventive care visits so that much-needed counseling can be provided. Particular attention needs to be given to adolescents from minority groups to encourage them to seek preventive care.

[Efficiency of ambulatory services for female adolescent]

OBJECTIVE

To evaluate effectiveness conditions of ambulatory services for female adolescent within Instituto Mexicano del Seguro Social, (Mexican Institute of Social Security) in Colima State, Mexico.

METHODOLOGY

A cross-sectional study was conducted in 10 medical units of Instituto Mexicano del Seguro Social, Colima District, from June 2001 to June 2002. Data were collected using applied questionnaire Evaluation of ambulatory services for adolescents: effectiveness conditions of the Pan American Health Organization, the information collected included eight divisions with the mayor importance areas for the function services. We estimated frequencies and percentages.

RESULTS

By 14 possible activities, 1 of the 10 units does not achieve anything, 3 achieved one to tree, and 6 achieved four to nine activities. CONCLUSIONS. The conditions of effectiveness of ambulatory services for female adolescent were under of the minor limit in seven of the eight evaluated areas.