Effectiveness and Cost of Bidirectional Text Messaging for Adolescent Vaccines and Well Care

OBJECTIVE

To evaluate the effectiveness and cost of bidirectional short messaging service in increasing rates of vaccination and well child care (WCC) among adolescents.

METHODS

We included all adolescents needing a recommended adolescent vaccine (n = 4587) whose parents had a cell-phone number in 5 private and 2 safety-net pediatric practices. Adolescents were randomized to intervention (n = 2228) or control (n = 2359). Parents in the intervention group received up to 3 personalized short messaging services with response options 1 (clinic will call to schedule), 2 (parent will call clinic), or STOP (no further short messaging service). Primary outcomes included completion of all needed services, WCC only, all needed vaccinations, any vaccination, and missed opportunity for vaccination.

RESULTS

Intervention patients were more likely to complete all needed services (risk ratio [RR] 1.31, 95% confidence interval [CI] 1.12-1.53), all needed vaccinations (RR 1.29, 95% CI 1.12-1.50), and any vaccination (RR 1.36, 95% CI 1.20-1.54). Seventy-five percent of control patients had a missed opportunity versus 69% of intervention (P = .002). There was not a significant difference for WCC visits. Responding that the clinic should call to schedule ("1") was associated with the highest effect size for completion of all needed services (RR 1.89, 95% CI 1.41-2.54). Net cost ranged from $855 to $3394 per practice.

CONCLUSIONS

Bidirectional short messaging service to parents was effective at improving rates for all adolescent vaccinations and for all needed services, especially among parents who responded they desired a call from the practice.

Socioeconomic inequalities in adolescent health 2002-2010: a time-series analysis of 34 countries participating in the Health Behaviour in School-aged Children study

BACKGROUND

Information about trends in adolescent health inequalities is scarce, especially at an international level. We examined secular trends in socioeconomic inequality in five domains of adolescent health and the association of socioeconomic inequality with national wealth and income inequality.

METHODS

We undertook a time-series analysis of data from the Health Behaviour in School-aged Children study, in which cross-sectional surveys were done in 34 North American and European countries in 2002, 2006, and 2010 (pooled n 492,788). We used individual data for socioeconomic status (Health Behaviour in School-aged Children Family Affluence Scale) and health (days of physical activity per week, body-mass index Z score [zBMI], frequency of psychological and physical symptoms on 0-5 scale, and life satisfaction scored 0-10 on the Cantril ladder) to examine trends in health and socioeconomic inequalities in health. We also investigated whether international differences in health and health inequalities were associated with per person income and income inequality.

FINDINGS

From 2002 to 2010, average levels of physical activity (3·90 to 4·08 days per week; p<0·0001), body mass (zBMI -0·08 to 0·03; p<0·0001), and physical symptoms (3·06 to 3·20, p<0·0001), and life satisfaction (7·58 to 7·61; p=0·0034) slightly increased. Inequalities between socioeconomic groups increased in physical activity (-0·79 to -0·83 days per week difference between most and least affluent groups; p=0·0008), zBMI (0·15 to 0·18; p<0·0001), and psychological (0·58 to 0·67; p=0·0360) and physical (0·21 to 0·26; p=0·0018) symptoms. Only in life satisfaction did health inequality fall during this period (-0·98 to -0·95; p=0·0198). Internationally, the higher the per person income, the better and more equal health was in terms of physical activity (0·06 days per SD increase in income; p<0·0001), psychological symptoms (-0·09; p<0·0001), and life satisfaction (0·08; p<0·0001). However, higher income inequality uniquely related to fewer days of physical activity (-0·05 days; p=0·0295), higher zBMI (0·06; p<0·0001), more psychological (0·18; p<0·0001) and physical (0·16; p<0·0001) symptoms, and larger health inequalities between socioeconomic groups in psychological (0·13; p=0·0080) and physical (0·07; p=0·0022) symptoms, and life satisfaction (-0·10; p=0·0092).

INTERPRETATION

Socioeconomic inequality has increased in many domains of adolescent health. These trends coincide with unequal distribution of income between rich and poor people. Widening gaps in adolescent health could predict future inequalities in adult health and need urgent policy action.

FUNDING

Canadian Institutes of Health Research.

Treatment outcome for adolescents abusing alcohol and cannabis: how many 'reliably improve'?

Alcohol and cannabis are the primary substances contributing to referrals of adolescents to substance abuse treatment services. Their outcome has not been examined in Ireland. A three month follow-up was conducted in an outpatient adolescent treatment program. We followed up 35 high risk users of alcohol and 55 high risk users of cannabis. Although the high risk drinkers achieved a significant reduction in median number of days drinking (p = 0.004), only four (11 %) were abstinent at follow up. A further five (14%) achieved a reliable reduction in days of drinking. The high risk cannabis users demonstrated a significant drop in median days of use (p < 0.001), although only six (11%) were abstinent at follow up. A further 20 (36%) achieved a reliable reduction in days of use. Calculation of reliable change allows examination of outcomes which fall short of the elusive goal of abstinence.

Understanding sexual and reproductive health needs of adolescents: evidence from a formative evaluation in Wakiso district, Uganda

INTRODUCTION

Adolescents are frequently reluctant to seek sexual and reproductive health services (SRH). In Uganda, adolescent health and development is constrained by translation of the relevant policies to practice. Recent studies done in central Uganda have shown that there is need for a critical assessment of adolescent friendly services (AFS) to gain insights on current practice and inform future interventions. This study aimed to assess the sexual reproductive health needs of the adolescents and explored their attitudes towards current services available.

METHODS

A qualitative study was conducted in Wakiso district, central Uganda in September 2013.Twenty focus group discussions (FGDs) stratified by gender (10 out-of-school, and 10 in-school), were purposefully sampled. We used trained research assistants (moderator and note taker) who used a pretested FGD guide translated into the local language to collect data. All discussions were audio taped, and were transcribed verbatim before analysis. Thematic areas on; adolescent health problems, adolescent SRH needs, health seeking behaviour and attitudes towards services, and preferred services were explored. Data was analysed using atlas ti version 7 software.

RESULTS

Our results clearly show that adolescents have real SRH issues that need to be addressed. In and out-of-school adolescents had sexuality problems such as unwanted pregnancies, sexually transmitted infections (STIs), defilement, rape, substance abuse. Unique to the females was the issue of sexual advances by older men and adolescents. We further highlight RH needs which would be solved by establishing adolescent friendly clinics with standard recommended characteristics (sexuality information, friendly health providers, a range of good clinical services such as post abortion care etc.). With regard to health seeking behaviour, most adolescents do not take any action at first until disease severity increase.

CONCLUSIONS

Adolescents in Uganda have multiple sexual and reproductive health needs that require special focus through adolescent friendly services. This calls for resource support in terms of health provider training, information education and communication materials as well as involvement of key stakeholders that include parents, teachers and legislators.

Predictors of Intention to Use HIV Testing Service Among Sexually Experienced Youth in Thailand

This study examined the predictors of intention to use HIV counseling and testing (HCT) services among those who had never used HCT services in a sample of 2,536 Thai youth in Bangkok (ages 15-24). Web-based questionnaires included assessments of HIV knowledge, HIV testing attitude, AIDS stigma, and youth-friendly HCT (YFHCT) service expectation. More than 80% of the sexually experienced youth had never used HCT services but among this group 74.06% reported having intentions to do so. The significant predictors consisted of favorable expectations of YFHCT services (p < .001), positive attitude toward HIV testing (p < .005), perceived high risk for HIV infection (p < .01), having multiple sex partners while also using condoms consistently (p < .01), willingness to pay (p < .001), and being informed about HCT and knowing service locations (p < .001). Policy makers, as well as health promotion program developers and researchers can use these findings to increase intention and use of HCT services among at-risk youth.

The role of positive youth development practices in building resilience and enhancing wellbeing for at-risk youth

Services that utilise positive youth development practices (PYD) are thought to improve the quality of the service experience leading to better outcomes for at-risk youth. This article reports on a study of 605 adolescents (aged 12-17 years) who were concurrent clients of two or more service systems (child welfare, juvenile justice, additional education, mental health). It was hypothesised that services adopting PYD approaches would be related to increases in youth resilience and better wellbeing outcomes. It was also hypothesised that risks, resilience, service experiences and wellbeing outcomes would differ by age, gender and ethnicity. Youth completed a self-report questionnaire administered individually. Path analysis was used to determine the relationship between risk, service use, resilience and a wellbeing outcome measure. MANOVA was then used to determine patterns of risk, service use, resilience and wellbeing among participants based on their demographic characteristics. Services using PYD approaches were significantly related to higher levels of youth resilience. Similarly, increased resilience was related to increased indicators of wellbeing, suggesting the mediating role of resilience between risk factors and wellbeing outcomes. When professionals adopt PYD practices and work with the positive resources around youth (their own resilience processes) interventions can make a significant contribution to wellbeing outcomes for at-risk youth.

Service and treatment use among children diagnosed with autism spectrum disorders

OBJECTIVE

Children diagnosed with autism spectrum disorder (ASD) require substantial support to address not only core ASD symptoms but also a range of co-occurring conditions. This study explores treatment and service use among children with ASD with and without intellectual disability (ID) and parents' perception of unmet needs from these treatments.

METHODS

Data were retrieved from a probability-based national sample of 2077 children diagnosed with ASD, ID, or both (ASD and ID). Weighted multivariate logistic regressions examined differences between diagnostic groups for current medication and service utilization with a subanalysis exploring differences among those with co-occurring psychiatric conditions. Additional modeling examined parents' perception of unmet needs.

RESULTS

Children diagnosed with ASD and ID were significantly more likely to be receiving current medication and services when compared with children with ID only or ASD only. Children with a co-occurring psychiatric diagnosis, from all 3 diagnostic groups, were more likely to be receiving a current medication, but not more likely to be receiving a current service when compared with children without a co-occurring psychiatric diagnosis. Children with ASD and a co-occurring psychiatric diagnosis were significantly more likely to have parents who reported unmet needs when compared with parents of children with ASD without a co-occurring psychiatric diagnosis.

CONCLUSIONS

Children diagnosed with ASD and ID, especially those with a comorbid psychiatric condition, represent a vulnerable population with substantial rates of current service (98%) and medication (67%) usage, but despite these high rates, approximately 30% of parents report that their child's developmental needs are still not being met by their current treatment and services.

Differences in caregiver-reported health problems and health care use in maltreated adolescents and a comparison group from the same urban environment

Maltreated youth have a high prevalence of acute and chronic mental and physical health problems, but it is not clear whether these problems are related to maltreatment or to a disadvantaged environment. To compare health status and health care use of maltreated youth who had an open case with child protective services to comparison youth living in the same community, we conducted a secondary analysis of caregiver reports for 207 maltreated adolescents (mean age 11.9 years) and 142 comparison adolescents (mean age 12.3 years) living in urban Los Angeles, using questionnaire data from a larger longitudinal study framed in a socio-ecological model. Caregivers included biological parents, relatives, and unrelated caregivers. Analyses included t-test, MANOVA, chi-square, and multivariable logistic regression. Caregivers reported similar rates of physical health problems but more mental health problems and psychotropic medicine use in maltreated youth than in the comparison youth, suggesting that maltreated youths' higher rates of mental health problems could not be attributed to the disadvantaged environment. Although there were no differences in health insurance coverage, maltreated youth received preventive medical care more often than comparison youth. For all youth, having Medicaid improved their odds of receiving preventive health and dental care. Attention to mental health issues in maltreated adolescents remains important. Acceptance of Medicaid by neighborhood-based and/or school-based services in low-income communities may reduce barriers to preventive care.

[Gap between the use of and need for youth care: research in Rotterdam neighbourhoods]

OBJECTIVE

To determine the relationship between the need for care and the use of care in the youth care system at neighbourhood level and the relationship with population characteristics, with consideration of the decentralisation of youth care.

DESIGN

Descriptive, retrospective study.

METHOD

Data on youth care use, indicators of need for care and population characteristics were gathered from monitors and the records of the municipality, institutions and health insurance companies. Data were grouped on a neighbourhood level (n = 49). For the analyses we used univariate and multivariate regression. We used these to distinguish between neighbourhoods with large and small gaps between youth care use and need for youth care. Differences between these neighbourhoods were analysed with t-tests.

RESULTS

A multivariate model showed that the percentage of youths with emotional problems and behavioural problems and the percentage of parents with self-reported need for care were not predictors of youth care use at a neighbourhood level. About two thirds of the variance in youth care use between neighbourhoods could be explained by the population characteristics of a neighbourhood, particularly the percentage of youths originally from non-western countries, the percentage of youths with a low level of education or special training and the percentage of people who received income support. The number of 12-18-year-olds in a neighbourhood was a predictor of youth mental health care, and the percentage of youths in a single-parent family was a predictor of out-patient youth and parenting support. Neighbourhoods with a large gap between the need for and use of youth care were socially more disadvantaged than neighbourhoods with a smaller gap.

CONCLUSION

Population characteristics explain the rate of use of youth care better than the need for youth care in a neighbourhood as measured by municipal monitors. The possible gap between the use of and need for youth care on an individual level in neighbourhoods with many characteristics of disadvantage is an important focus point for future neighbourhood teams.

The association between social support and mental health among vulnerable adolescents in five cities: findings from the study of the well-being of adolescents in vulnerable environments

PURPOSE

Globally, adolescents are at risk of depression, traumatic stress, and suicide, especially those living in vulnerable environments. This article examines the mental health of 15- to 19-year-old youth in five cities and identifies the social support correlates of mental health.

METHODS

A total of 2,393 adolescents aged 15-19 years in economically distressed neighborhoods in Baltimore, MD; New Delhi, India; Ibadan, Nigeria; Johannesburg, South Africa; and Shanghai, China were recruited in 2013 via respondent-driven sampling to participate in a survey using an audio computer-assisted self-interview. Weighted logistic regression and general linear models were used to explore the associations between mental health and social supports.

RESULTS

The highest levels of depression and posttraumatic stress symptoms were displayed in Johannesburg among females (44.6% and 67.0%, respectively), whereas the lowest were among New Delhi females and males (13.0% and 16.3%, respectively). The prevalence of suicidal ideation ranged from 7.9% (New Delhi female adolescents) to 39.6% (Johannesburg female adolescents); the 12-month prevalence of suicide attempts ranged from 1.8% (New Delhi females) to 18.3% (Ibadan males). Elevated perceptions of having a caring female adult in the home and feeling connected to their neighborhoods were positively associated with adolescents' levels of hope across the sites while negatively associated with depression and posttraumatic stress symptoms with some variation across sites and gender.

CONCLUSIONS

Adolescents living in the very economically distressed areas studied register high levels of depression and posttraumatic stress. Improving social supports in families and neighborhoods may alleviate distress and foster hope. In particular, strengthening supports from female caretakers to their adolescents at home may improve the outlooks of their daughters.

A global study on the influence of neighborhood contextual factors on adolescent health

PURPOSE

This study uses data collected as part of the Well-Being of Adolescents in Vulnerable Environments study to (1) compare the perceptions of neighborhood-level factors among adolescents across five different urban sites; (2) examine the associations between factors within the physical and social environments; and (3) examine the influence of neighborhood-level factors on two different health outcomes-violence victimization in the past 12 months and ever smoked.

METHODS

Across five urban sites (Baltimore, New Delhi, Johannesburg, Ibadan, and Shanghai), 2,320 adolescents aged 15-19 years completed a survey using audio computer-assisted self-interview technology. To recruit adolescents, each site used a respondent-driven sampling method, which consisted of selecting adolescents as "seeds" to serve as the initial contacts for recruiting the entire adolescent sample. All analyses were conducted with Stata 13.1 statistical software, using complex survey design procedures. To examine associations between neighborhood-level factors and among our two outcomes, violence victimization and ever smoked, bivariate and multivariate analyses were conducted.

RESULTS

Across sites, there was great variability in how adolescents perceived their neighborhoods. Overall, adolescents from Ibadan and Shanghai held the most positive perceptions about their neighborhoods, whereas adolescents from Baltimore and Johannesburg held the poorest. In New Delhi, despite females having positive perceptions about their safety and sense of social cohesion, they had the highest sense of fear and the poorest perceptions about their physical environment. The study also found that one of the most consistent neighborhood-level factors across sites and outcomes was witnessing community violence, which was significantly associated with smoking among adolescents in New Delhi and Johannesburg and with violence victimization across nearly every site except Baltimore. No other neighborhood-level factor exerted greater influence.

CONCLUSIONS

This study confirms the important associations between perceptions of a neighborhood and adolescent health. At the same time, it demonstrates that not all neighborhood-level factors are associated with adolescent health outcomes in the same way across different urban contexts. Further longitudinal research is needed to examine the direction of causation between adolescent health neighborhood contexts and health outcomes and the reasons for why different urban contexts may exert varying levels of influence on the health of adolescents.

[The condition and problems of adolescents' health in Russia]

The article presents data concerning health condition of adolescents aged 15-19 years in the Russian Federation during 2002-2012. The official statistical data concerning morbidity, disability and mortality of adolescents were analyzed. In children of this age group increasing of morbidity, disability and decreasing of mortality are established. The special studies demonstrated that true indicators of morbidity of adolescents exceed official indicators up to 1.5-2 times. The morbidity of adolescents is characterized by increasing of socially significant pathology and diseases related to behavioral risk factors. In adolescent age, the unfavorable tendencies in psychic and reproductive health are observed. In the structure of disability mental disorders and behavior disorders, diseases of nervous system and inherited malformations are in the lead. The principal limitation of vital activity is "capacity to learning". It is demonstrated that in the Russian Federation there is underestimation of cases of disability among children and adolescents.

Organizational Predictors and Use of Evidence-Based Practices in Adolescent Substance Abuse Treatment

BACKGROUND

Adolescent substance abuse remains a significant problem in the United States, yet treatment centers do not always admit adolescent clients. In this paper, we first determine the extent to which treatment is available for adolescents in general and whether or not adolescent-specific (segregated) tracks are offered. Second, we examine the organizational characteristics associated with adolescent treatment. Third, we illuminate how the adolescent caseload in a treatment center is related to offering evidence-based practices (EBPs).

METHODS

Drawing upon a nationally representative sample of US treatment programs, we use logistic regression to assess how organizational characteristics are associated with the provision of adolescent treatment. Using ordinal logistic regression, we analyze how the treatment center's adolescent caseload and organizational characteristics affect the extent to which a treatment center offers medication-assisted treatment (MAT) and psychosocial treatment.

RESULTS

Half (49.5%) of treatment programs admitted adolescents, and 41.8% offered an adolescent-specific track. Findings from the logistic regression suggested several organizational characteristics that were significantly associated with treating adolescents and/or having an adolescent-only track. Our findings from the ordinal models indicated a negative relationship between the percent of adolescents in a treatment center and the extent of MAT, and a positive relationship between the percent of adolescent clients and the extent of psychosocial treatment offered.

CONCLUSIONS

This paper highlights organizational barriers to treatment entry for adolescents, who remain a small proportion of clients in treatment centers. When treatment centers serve adolescents, however, those adolescents are likely to receive care in adolescent-only tracks and/or services and in programs that offer several psychosocial EBPs. Finally, adolescents are less likely to receive treatment in centers that offer a variety of MAT.

Rationale for periodic reporting on the use of selected clinical preventive services to improve the health of infants, children, and adolescents--United States

This supplement is the second of a series of periodic reports from a CDC initiative to monitor and report on the use of a set of selected clinical preventive services in the U.S. population in the context of recent national initiatives to improve access to and use of such services. Increasing the use of these services can result in substantial reductions in the burden of illness, death, and disability and lower treatment costs. This supplement focuses on services to improve the health of U.S. infants, children, and adolescents. The majority of clinical preventive services for infants, children, and adolescents are provided by the health-care sector. Public health agencies play important roles in increasing the use of these services by identifying and implementing policies that are effective in increasing use of the services and by collaborating with stakeholders to conduct programs to improve use. Recent health-reform initiatives, including efforts to increase the accessibility and affordability of preventive services, fund community prevention programs, and improve the use of health information technologies, offer opportunities to improve use of preventive services. This supplement, which follows a previous report on adult services, provides baseline information on the use of a set of selected clinical preventive services to improve the health of infants, children, and adolescents before implementation of these recent initiatives and discusses opportunities to increase the use of such services. This information can help public health practitioners, in collaboration with other stakeholders that have key roles in improving infant, child, and adolescent health (e.g., parents or guardians and their employers, health plans, health professionals, schools, child care facilities, community groups, and voluntary associations), understand the potential benefits of the recommended services, address the problem of underuse, and identify opportunities to apply effective strategies to improve use and foster accountability among stakeholders.

Services for adolescents with psychiatric disorders: 12-month data from the National Comorbidity Survey-Adolescent

OBJECTIVE

This study examined 12-month rates of service use for mental, emotional, and behavioral disorders among adolescents.

METHODS

Data were from the National Comorbidity Survey Adolescent Supplement (NCS-A), a survey of DSM-IV mental, emotional, and behavioral disorders and service use.

RESULTS

In the past 12 months, 45.0% of adolescents with psychiatric disorders received some form of service. The most likely were those with ADHD (73.8%), conduct disorder (73.4%), or oppositional defiant disorder (71.0%). Least likely were those with specific phobias (40.7%) and any anxiety disorder (41.4%). Among those with any disorder, services were more likely to be received in a school setting (23.6%) or in a specialty mental health setting (22.8%) than in a general medical setting (10.1%). Youths with any disorder also received services in juvenile justice settings (4.5%), complementary and alternative medicine (5.3%), and human services settings (7.9%). Although general medical providers treated a larger proportion of youths with mood disorders than with behavior disorders, they were more likely to treat youths with behavior disorders because of the larger number of the latter (11.5% of 1,465 versus 13.9% of 820). Black youths were significantly less likely than white youths to receive specialty mental health or general medical services for mental disorders.

CONCLUSIONS

Findings from this analysis of NCS-A data confirm those of earlier, smaller studies, that only a minority of youths with psychiatric disorders receive treatment of any sort. Much of this treatment was provided in service settings in which few providers were likely to have specialist mental health training.

Parental report of receipt of adolescent preventive health counseling services from pediatric providers

OBJECTIVE

Little is known about prevention-focused counseling health providers deliver to parents of adolescents. This study compared parental report of discussions with their adolescents' providers about a range of adolescent prevention topics.

METHODS

Between June and November 2009, a questionnaire was provided to parents accompanying adolescents aged 11-18 on outpatient clinic visits. Parents indicated, anonymously, which of 22 prevention topics they remembered discussing with their adolescent's provider. Hierarchical logistic regression models were used to identify correlates of parental recall.

RESULTS

Among the 358 participants, 83% reported discussing at least one prevention topic. More parents reported discussing general prevention topics than mental health or high-risk topics (e.g. sex). Adolescent gender, visit type, having a usual source of care, and parental beliefs about their adolescents' risk behaviors correlated with parental report of discussions about high-risk and mental health topics.

CONCLUSION

Most parents recalled discussing one or more topics with their adolescent's health provider. However, parental report of discussions about topics linked to significant adolescent morbidity was low.

PRACTICE IMPLICATIONS

Strategies to improve the frequency, timeliness and appropriateness of counseling services delivered to parents about adolescent preventive health are needed. Strategies that utilize decision support tools or patient education tools may be warranted.

Adolescent bariatric surgery program characteristics: the Teen Longitudinal Assessment of Bariatric Surgery (Teen-LABS) study experience

The number of adolescents undergoing weight loss surgery (WLS) has increased in response to the increasing prevalence of severe childhood obesity. Adolescents undergoing WLS require unique support, which may differ from adult programs. The aim of this study was to describe institutional and programmatic characteristics of centers participating in Teen Longitudinal Assessment of Bariatric Surgery (Teen-LABS), a prospective study investigating safety and efficacy of adolescent WLS. Data were obtained from the Teen-LABS database, and site survey completed by Teen-LABS investigators. The survey queried (1) institutional characteristics, (2) multidisciplinary team composition, (3) clinical program characteristics, and (4) clinical research infrastructure. All centers had extensive multidisciplinary involvement in the assessment, pre-operative education, and post-operative management of adolescents undergoing WLS. Eligibility criteria and pre-operative clinical and diagnostic evaluations were similar between programs. All programs have well-developed clinical research infrastructure, use adolescent-specific educational resources, and maintain specialty equipment, including high weight capacity diagnostic imaging equipment. The composition of clinical team and institutional resources is consistent with current clinical practice guidelines. These characteristics, coupled with dedicated research staff, have facilitated enrollment of 242 participants into Teen-LABS.

Psychotropic medication use among adolescents: United States, 2005-2010

Approximately 6.0% of U.S. adolescents aged 12-19 reported psychotropic drug use in the past month. The use of antidepressants (3.2%) and attention deficit hyperactive disorder (ADHD) drugs (3.2%) was highest, followed by antipsychotics (1.0%); anxiolytics, sedatives, and hypnotics (0.5%); and antimanics (0.2%). Males (4.2%) were more likely than females (2.2%) to use ADHD drugs. Females (4.5%) were more likely than males (2.0%) to use antidepressants. Psychotropic drug use was higher among non-Hispanic white (8.2%) adolescents than non-Hispanic black (3.1%) and Mexican-American (2.9%) adolescents. About one-half of U.S. adolescents using psychotropic drugs in the past month had seen a mental health professional in the past year (53.3%). Prior studies have shown an increase in psychotropic medication use among adolescents. However, most studies were based on clinical samples or high-risk populations. This report provides the estimate of any psychotropic medication use in the past month among U.S. noninstitutionalized adolescents aged 12-19 during 2005-2010, using National Health and Nutrition Examination Survey (NHANES) data. Psychotropic medication is a type of drug used to treat clinical psychiatric symptoms or mental disorders. Specific psychotropic drug types addressed are antidepressants; medications for attention deficit hyperactive disorder (ADHD); anxiolytics, sedatives, and hypnotics (ASH); antimanics; and antipsychotics. Adolescents using psychotropic drugs are further examined by sex, race and Hispanic origin, and mental health professional consultation.

[Adolescents in the walk-in clinic]

Jugendliche sind eine medizinisch unterversorgte Altersgruppe. Sind befinden sich in der Transition vom Kinderarzt weg zum Hausarzt. Sie sind häufig vom Ersten nicht ganz gelöst, geschweige bei Letzterem angekommen. In diesem Artikel wird eine sehr kurze Zusammenfassung alterstypischer Probleme und Fragestellungen mit den praktischen Erfahrungen, speziell der den Jugendlichen entgegenkommenden «Walk-in Praxis» ergänzt.

Family physician preferences and knowledge gaps regarding the care of adolescent and young adult survivors of childhood cancer

PURPOSE

Childhood cancer survivors are at risk for long-term morbidity and early mortality. Since most adult and some adolescent survivors of childhood cancer will receive their long-term care from a primary care physician, we sought to determine family physicians' comfort with caring for this population.

METHODS

A survey was mailed to 2,520 United States (US) and Canadian family physicians to assess their attitudes and knowledge regarding the care of adolescent and young adult survivors of childhood cancer.

RESULTS

One thousand one hundred twenty-four family physicians responded (704 US, 420 Canadian). Median age was 53 years; 63 % were men; 81 % had cared for ≤2 childhood cancer survivors in the past 5 years. Of those who had cared for a survivor, 48 % had never or almost never received a treatment summary from the referring cancer center; 85 % preferred to care for survivors in consultation with a cancer center-based physician or long-term follow-up program. Only 33, 27, and 23 % of respondents were very comfortable caring for survivors of childhood Hodgkin lymphoma, acute lymphoblastic leukemia or osteosarcoma, respectively. Only 16, 10, and 74 % of respondents correctly identified the guideline recommended surveillance for secondary breast cancer, cardiac dysfunction and hypothyroidism in response to a vignette describing a Hodgkin lymphoma survivor. Respondents rated access to clinical care guidelines and receipt of a patient-specific letter from specialists with surveillance recommendations as the modalities most likely to assist them in caring for survivors.

CONCLUSIONS

Most family physicians are willing to care for childhood cancer survivors in consultation with a cancer center, and with specific tools to facilitate this care.

IMPLICATIONS FOR CANCER SURVIVORS

Adult and adolescent survivors of childhood cancer who receive their follow-up care from a family physician must be empowered to choose a physician who is comfortable with caring for survivors. Further, the survivor must ensure that their physician has access to a treatment summary as well as to patient-specific recommendations for surveillance for late effects of cancer therapy.

Impact of social network characteristics on shelter use among street youth in San Francisco

PURPOSE

We examined the cross-sectional and longitudinal association between social network characteristics and street youths' shelter use, a determinant of health outcomes for homeless youth.

METHODS

We analyzed interview data from 138 street youth recruited through venue-based sampling in San Francisco, to assess the cross-sectional relationship between shelter use in youths' social networks and youths' reported shelter use. We also assessed the relationship between baseline network shelter use and shelter use at 6-month follow-up.

RESULTS

Low proportions of street youth reported shelter use at baseline (38%) and follow-up (29.6%). Twenty-nine (26.9%) youth were in networks with shelter users at baseline, compared with 17 youth (15.7%) at follow-up. In cross-sectional analysis, youth in networks with shelter users had 5-fold increased odds of reporting shelter use (OR: 5.86, p = .006). A 1-person increase in the number of network shelter users was associated with 2-fold increased odds of youths' shelter use (OR: 2.16, p = .02). In longitudinal analysis, youth in networks with shelter users at baseline had nearly 5-fold increased odds of shelter use at follow-up (OR: 4.95, p = .01). A 1-person increase in the number of network shelter users at baseline was associated with 3-fold increased odds of shelter use at follow-up (OR: 3.15, p = .004).

CONCLUSION

Shelter users seem to cluster together. Shelter use by extended network members was associated with increased odds of youths' own shelter use. Understanding how network behaviors influence street youths' health-related behaviors, such as shelter use, could inform network-based interventions encouraging service uptake among marginalized and hard-to-reach street youth populations.