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Pham MD, Sawyer SM, Agius PA, Kennedy EC, Ansariadi A, Kaligis F, Wiguna T, Wulan NR, Devaera Y, Medise BE, Riyanti A, Wiweko B, Cini KI, Tran T, Fisher J, Luchters S, Azzopardi PS. Foregone health care in adolescents from school and community settings in Indonesia: a cross-sectional study. THE LANCET REGIONAL HEALTH. SOUTHEAST ASIA 2023; 13:100187. [PMID: 37383556 PMCID: PMC10305962 DOI: 10.1016/j.lansea.2023.100187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 12/21/2022] [Accepted: 03/22/2023] [Indexed: 06/30/2023]
Abstract
Background Adolescence is a development period marked by the onset of a new set of health needs. The present study sought to quantify the prevalence of foregone care (not seeking medical care when needed) and identify which adolescents are at greater risk of having unmet healthcare needs. Methods A multi-stage random sampling strategy was used to recruit school participants (grade 10-12) in two provinces in Indonesia. Respondent driven sampling was used to recruit out-of-school adolescents in the community. All participants completed a self-reported questionnaire which measured healthcare seeking behaviours, psychosocial wellbeing, use of healthcare services, and perceived barriers to accessing healthcare. Multivariable regression analysis was performed to examine factors associated with foregone care. Findings A total of 2161 adolescents participated in the present study and nearly one in four adolescents reported foregone care in the past year. Experiences of poly-victimisation and seeking care for mental health needs increased the risk of foregone care. In-school adolescents who reported psychological distress [adjusted risk ratio (aRR) = 1.88, 95%CI = 1.48-2.38] or had high body mass index (aRR = 1.25, 95%CI = 1.00-1.57) were at greater risk of foregone care. The leading reason for foregone care was lack of knowledge of available services. In-school adolescents predominantly reported non-access barriers to care (e.g., perception of the health concern or anxiety about accessing care) whereas most out-of-school adolescents reported access barriers (e.g., did not know where to get care or could not pay). Interpretation Foregone care is common among Indonesian adolescents, especially in adolescents with mental and physical health risks. Differences between in-school and out-of-school adolescents suggest that interventions to promote appropriate healthcare use will need tailoring. Further research is needed to determine causal relationships around barriers in access to healthcare. Funding Australia-Indonesia Centre.
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Affiliation(s)
- Minh D. Pham
- Burnet Institute, Melbourne, Australia
- Department of Epidemiology and Preventative Medicine, Monash University, Melbourne, Australia
| | - Susan M. Sawyer
- Murdoch Children's Research Institute, Parkville, Melbourne, Australia
- Centre for Adolescent Health, Royal Children's Hospital, Melbourne, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, Australia
| | - Paul A. Agius
- Burnet Institute, Melbourne, Australia
- Department of Epidemiology and Preventative Medicine, Monash University, Melbourne, Australia
- Faculty of Health, Deakin University, Melbourne, Australia
| | - Elissa C. Kennedy
- Burnet Institute, Melbourne, Australia
- Department of Epidemiology and Preventative Medicine, Monash University, Melbourne, Australia
- Murdoch Children's Research Institute, Parkville, Melbourne, Australia
| | - Ansariadi Ansariadi
- Centre for Epidemiology and Population Health Studies, Faculty of Public Health, Hasanuddin University, Makassar, Indonesia
| | - Fransiska Kaligis
- Department of Psychiatry, Universitas Indonesia, Jakarta, Indonesia
- Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Tjhin Wiguna
- Department of Psychiatry, Universitas Indonesia, Jakarta, Indonesia
- Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | | | - Yoga Devaera
- Department of Child Health, Universitas Indonesia, Jakarta, Indonesia
| | - Bernie E. Medise
- Cipto Mangunkusumo Hospital, Jakarta, Indonesia
- Department of Child Health, Universitas Indonesia, Jakarta, Indonesia
| | - Aida Riyanti
- Department of Obstetrics and Gynaecology, Universitas Indonesia, Jakarta, Indonesia
| | - Budi Wiweko
- Research and Social Services, Universitas Indonesia, Jakarta, Indonesia
| | - Karly I. Cini
- Burnet Institute, Melbourne, Australia
- Murdoch Children's Research Institute, Parkville, Melbourne, Australia
- Centre for Adolescent Health, Royal Children's Hospital, Melbourne, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, Australia
| | - Thach Tran
- Department of Epidemiology and Preventative Medicine, Monash University, Melbourne, Australia
| | - Jane Fisher
- Department of Epidemiology and Preventative Medicine, Monash University, Melbourne, Australia
| | - Stanley Luchters
- Liverpool School of Tropical Medicine (LSTM), Liverpool, UK
- Centre for Sexual Health and HIV & AIDS Research (CeSHHAR), Harare, Zimbabwe
- International Centre for Reproductive Health, Department of Public Health and Primary Care, Ghent University, Belgium
| | - Peter S. Azzopardi
- Burnet Institute, Melbourne, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, Australia
- South Australian Health and Medical Research Institute, Adelaide, Australia
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2
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May EM, Witherspoon DP. Reciprocal links between marijuana use and school adjustment in Black and White rural adolescents. Child Dev 2022; 93:1819-1836. [PMID: 35818849 PMCID: PMC9633353 DOI: 10.1111/cdev.13823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Although research has established that school adjustment is associated with marijuana use (MU) in adolescence, few studies have tested these associations bidirectionally. Using random intercepts cross-lagged panel modeling, this study examined reciprocal associations between MU and school adjustment across 8th to 10th grade, including the transition to high school. Participants included 5470 rural adolescents (59% White, 41% Black) aged 12-17 years in 2002-2005. School adjustment factors predicted subsequent MU (i.e., higher self-reported grades were protective for Black and White youth; valuing education was protective for Black youth; school behavior problems predicted increased MU across the transition to high school for White youth). MU had several adverse effects on school adjustment, particularly during the transition to high school.
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Affiliation(s)
- Emily M. May
- Department of Psychiatry and Human Behavior, Brown University, Providence, Rhode Island, USA
| | - Dawn P. Witherspoon
- Department of Psychology, The Pennsylvania State University, State College, Pennsylvania, USA
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3
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Goyal MK, Richardson T, Masonbrink A, Reed JL, Alpern ER, Hall M, Neuman MI. Reliance on Acute Care Settings for Health Care Utilization: A Comparison of Adolescents With Younger Children. Pediatr Emerg Care 2021; 37:e1128-e1132. [PMID: 32776762 PMCID: PMC7775320 DOI: 10.1097/pec.0000000000001924] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Because a goal of the Affordable Care Act was to increase preventive care and reduce high-cost care, the objective of this study was to evaluate current health care use and reliance on acute care settings among Medicaid-enrolled children. METHODS This was a retrospective cohort study of the 2015 Truven Marketscan Medicaid claims database among children 0 to 21 years old with at least 11 months of continuous enrollment. We calculated adjusted probabilities of health care use (any health care use and ≥1 health maintenance visit) and high acute care reliance (ratio of emergency department or urgent care visits to all health care visits >0.33) by age and compared use between adolescents and younger children using multivariable logistic regression. RESULTS Of the 5,182,540 Medicaid-enrolled children, 18.9% had no health care visits and 47.3% had 1 or more health maintenance visit in 2015. Both health care use and health maintenance visits decreased with increasing age (P < 0.001). Compared with younger children (0-10 years old), adolescents were more likely to have no interaction with the health care system [adjusted odds ratio (aOR), 2.20; 95% confidence interval (CI), 2.19-2.21] and less likely to have health maintenance visits (aOR, 0.40; 0.39-0.40). High acute care reliance was associated with increasing age, with adolescents having greater odds of high acute care reliance (aOR, 1.08; 1.08-1.09). CONCLUSIONS Medicaid-enrolled adolescents have low rates of health care use and have high reliance on acute care settings. Further investigation into adolescent-specific barriers to health maintenance care and drivers for acute care is warranted.
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Affiliation(s)
- Monika K. Goyal
- Department of Pediatrics, Children’s National Health System, The George Washington University, Washington, DC
| | | | - Abbey Masonbrink
- Department of Pediatrics, Children's Mercy Hospital, University of Missouri-Kansas City, Kansas City, Missouri
| | - Jennifer L. Reed
- Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center and Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Elizabeth R. Alpern
- Department of Pediatrics, Ann & Robert H. Lurie Children’s Hospital, Northwestern University, Chicago, IL
| | - Matt Hall
- Children’s Hospital Association, Lenexa, KS
| | - Mark I. Neuman
- Division of Pediatric Emergency Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA
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Rankine J, Yeramosu D, Matheo L, Sequeira GM, Miller E, Ray KN. Optimizing e-Consultations to Adolescent Medicine Specialists: Qualitative Synthesis of Feedback From User-Centered Design. JMIR Hum Factors 2021; 8:e25568. [PMID: 34383665 PMCID: PMC8380586 DOI: 10.2196/25568] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 01/21/2021] [Accepted: 05/24/2021] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND e-Consultations between primary care physicians and specialists are a valuable means of improving access to specialty care. Adolescents and young adults (AYAs) face unique challenges in accessing limited adolescent medicine specialty care resources, which contributes to delayed or forgone care. e-Consultations between general pediatricians and adolescent medicine specialists may alleviate these barriers to care. However, the optimal application of this model in adolescent medicine requires careful attention to the nuances of AYA care. OBJECTIVE This study aims to qualitatively analyze feedback obtained during the iterative development of an e-consultation system for communication between general pediatricians and adolescent medicine specialists tailored to the specific health care needs of AYAs. METHODS We conducted an iterative user-centered design and evaluation process in two phases. In the first phase, we created a static e-consultation prototype and storyboards and evaluated them with target users (general pediatricians and adolescent medicine specialists). In the second phase, we incorporated feedback to develop a functional prototype within the electronic health record and again evaluated this with general pediatricians and adolescent medicine specialists. In each phase, general pediatricians and adolescent medicine specialists provided think-aloud feedback during the use of the prototypes and semistructured exit interviews, which was qualitatively analyzed to identify perspectives related to the usefulness and usability of the e-consultation system. RESULTS Both general pediatricians (n=12) and adolescent medicine specialists (n=12) perceived the usefulness of e-consultations for AYA patients, with more varied perceptions of potential usefulness for generalist and adolescent medicine clinicians. General pediatricians and adolescent medicine specialists discussed ways to maximize the usability of e-consultations for AYAs, primarily by improving efficiency (eg, reducing documentation, emphasizing critical information, using autopopulated data fields, and balancing specificity and efficiency through text prompts) and reducing the potential for errors (eg, prompting a review of autopopulated data fields, requiring physician contact information, and prompting explicit discussion of patient communication and confidentiality expectations). Through iterative design, patient history documentation was streamlined, whereas documentation of communication and confidentiality expectations were enhanced. CONCLUSIONS Through an iterative user-centered design process, we identified user perspectives to guide the refinement of an e-consultation system based on general pediatrician and adolescent medicine specialist feedback on usefulness and usability related to the care of AYAs. Qualitative analysis of this feedback revealed both opportunities and risks related to confidentiality, communication, and the use of tailored documentation prompts that should be considered in the development and use of e-consultations with AYAs.
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Affiliation(s)
- Jacquelin Rankine
- Division of Adolescent and Young Adult Medicine, Department of Pediatrics, University of Pittsburgh School of Medicine, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, United States
| | - Deepika Yeramosu
- Department of Pediatrics, University of Pittsburgh School of Medicine, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, United States
| | - Loreta Matheo
- Division of Adolescent and Young Adult Medicine, Department of Pediatrics, University of Pittsburgh School of Medicine, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, United States
| | - Gina M Sequeira
- Division of Adolescent and Young Adult Medicine, Department of Pediatrics, University of Pittsburgh School of Medicine, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, United States.,Division of Adolescent Medicine, Seattle Children's Hospital, Seattle, WA, United States
| | - Elizabeth Miller
- Division of Adolescent and Young Adult Medicine, Department of Pediatrics, University of Pittsburgh School of Medicine, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, United States
| | - Kristin N Ray
- Department of Pediatrics, University of Pittsburgh School of Medicine, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, United States
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5
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Rural-urban residence and emergency contraception use, access, and counseling in the United States, 2006-2017. Contracept X 2021; 3:100061. [PMID: 33718861 PMCID: PMC7921752 DOI: 10.1016/j.conx.2021.100061] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 01/27/2021] [Accepted: 02/02/2021] [Indexed: 11/20/2022] Open
Abstract
Objective To estimate differences in emergency contraception (EC) use, access, and counseling by rural-urban residence among reproductive age women in the United States. Study design We examined respondent data (2006–2017) from the National Survey of Family Growth for women ages 15-44 (n = 28,448) to estimate EC use, access, and counseling by rural-urban county of residence. Rural-urban prevalence ratios for EC outcome measures were estimated using predicted margins from logistic regression models, which were adjusted for demographic differences and current contraceptive method use. Changes in ever-use of EC over time were estimated for rural and urban respondents, separately, using Chi-square tests and trends were estimated using inverse variance weighted linear regression models. Results During 2006 to 2017, 10% of rural and 19% of urban women who had ever had sex reported ever using EC pills. Among rural women, ever-use increased from 6% in 2006-2008 to 15% in 2015-2017 (Chi-square p < 0.01; trend p-value < 0.01); among urban women, ever-use increased from 11% to 27% (Chi-square p < 0.01; trend p-value < 0.01). Rural and urban women were similarly likely to have obtained EC without a prescription and from a drug store. Rural women were less likely to have received EC counseling than urban women; however, counseling rates were low among all women. Conclusion We observed differences in EC ever-use and receipt of EC counseling by rural-urban residence among US women ages 15 to 44, adding to the evidence that rural-urban residence is an important factor in reproductive health. More research is needed to explore factors contributing to rural-urban differences in EC use. Implications Our key finding that EC use varied by rural-urban county residence offers additional evidence that rural-urban residence should be considered in reproductive health practice and policy. We discuss areas for future research into potential barriers to EC use in rural populations.
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Hardin HK, Alchami HK, Connell A. Depressive Symptoms and Trust of Healthcare Provider in Rural Adolescents: Relationships and Predictors. Issues Ment Health Nurs 2021; 42:208-215. [PMID: 32721182 PMCID: PMC7855091 DOI: 10.1080/01612840.2020.1789783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The purpose of this study was to evaluate associations among depressive symptoms, trust of healthcare provider, and health behavior in adolescents who live in a rural area. Two hundred twenty-four adolescents aged 14-19 years old attending public high school in the Midwestern United States were surveyed. Results showed a diagnosis of depression, trust of healthcare provider, health awareness, and stress management predicted depressive symptoms in adolescents living in a rural area. Healthcare providers should take extra care to promote trust in the healthcare provider-patient relationship with adolescents and to follow guidelines for annual screening of adolescents for depressive symptoms. Nursing implications include adolescent psychoeducation to improve health awareness and stress management.
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Affiliation(s)
- Heather K Hardin
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio, USA
| | - Hana K Alchami
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio, USA
| | - Arin Connell
- Department of Psychology, Case Western Reserve University, Cleveland, Ohio, USA
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7
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Hardin HK, Alchami H, Lee D, Jones MS. Unmet health need and perceived barriers to health care among adolescents living in a rural area. CHILDRENS HEALTH CARE 2020; 50:108-123. [PMID: 33424079 PMCID: PMC7787257 DOI: 10.1080/02739615.2020.1833333] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
This study investigated the perceived health care needs, unmet health need, and barriers to health care in 224 rural-dwelling adolescents. A cross-sectional, descriptive design was used to survey adolescents attending a public high school in a low-resource, rural Indiana community. One in five adolescents reported an unmet health need. The most common barriers to health care were related to access, apathy, anxiety, and parenting issues. Implications include confidentiality protocols in family healthcare practices, school-based health centers, and intervention research targeting adolescents' communication skills and healthcare consumer skills.
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Affiliation(s)
- Heather K. Hardin
- Case Western Reserve University, Frances Payne Bolton School of Nursing
| | - Hana Alchami
- Case Western Reserve University, Frances Payne Bolton School of Nursing
| | - David Lee
- Case Western Reserve University, Frances Payne Bolton School of Nursing
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8
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Griffin M, Jaiswal J, Krytusa D, Krause KD, Kapadia F, Halkitis PN. Healthcare experiences of urban young adult lesbians. ACTA ACUST UNITED AC 2020; 16:1745506519899820. [PMID: 31950883 PMCID: PMC6970478 DOI: 10.1177/1745506519899820] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Purpose: This cross-sectional study of young adult lesbians explores their healthcare experiences including having a primary care provider, forgone care, knowledge of where to obtain Pap testing, and sexually transmitted infection testing. Methods: Quantitative surveys were conducted at lesbian, gay, bisexual, and transgender venues and events with a sample of 100 young adult lesbians in New York City between June and October 2016. Using the Andersen model of healthcare access, this study examined associations between sociodemographic characteristics and healthcare experiences using multivariable logistic regression models. Results: Having a primary care provider was associated with having health insurance (adjusted odds ratio (AOR) = 4.9, p < 0.05). Both insurance (AOR = 0.2, p < 0.05) and employment (AOR = 0.2, p < 0.05) status were protective against foregone care among young adult lesbians. Disclosure of sexual orientation to a provider improved knowledge of where to access Pap testing (AOR = 7.5, p < 0.05). Disclosure of sexual orientation to friends and family improved knowledge of where to access sexually transmitted infection testing (AOR = 3.6, p < 0.05). Conclusion: Socioeconomic factors are significantly associated with healthcare access among young adult lesbians in New York City. Maintaining non-discrimination protections for both healthcare services and insurance coverage are important for this population. In addition, financial subsidies that lower the cost of health insurance coverage may also help improve healthcare access among young adult lesbians.
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Affiliation(s)
- Marybec Griffin
- Departments of Biostatistics, and Social and Behavioral Health Sciences, Rutgers School of Public Health, Rutgers University, Piscataway, NJ, USA.,Center for Health, Identity, Behavior and Prevention Studies, Rutgers University, Newark, NJ, USA
| | - Jessica Jaiswal
- Center for Health, Identity, Behavior and Prevention Studies, Rutgers University, Newark, NJ, USA.,Department of Health Science, University of Alabama, Tuscaloosa, AL
| | - Dawn Krytusa
- Departments of Biostatistics, and Social and Behavioral Health Sciences, Rutgers School of Public Health, Rutgers University, Piscataway, NJ, USA.,New Jersey Medical School, Rutgers University, Newark, NJ, USA
| | - Kristen D Krause
- Departments of Biostatistics, and Social and Behavioral Health Sciences, Rutgers School of Public Health, Rutgers University, Piscataway, NJ, USA.,Center for Health, Identity, Behavior and Prevention Studies, Rutgers University, Newark, NJ, USA
| | - Farzana Kapadia
- Center for Health, Identity, Behavior and Prevention Studies, Rutgers University, Newark, NJ, USA.,College of Global Public Health, New York University, New York, NY, USA.,Department of Population Health, Langone Medical Center, New York University, New York, NY, USA
| | - Perry N Halkitis
- Departments of Biostatistics, and Social and Behavioral Health Sciences, Rutgers School of Public Health, Rutgers University, Piscataway, NJ, USA.,Center for Health, Identity, Behavior and Prevention Studies, Rutgers University, Newark, NJ, USA.,Department of Urban-Global Public Health, Rutgers School of Public Health, Rutgers University, Newark, NJ, USA.,Graduate School of Applied and Professional Psychology, Rutgers University, Newark, NJ, USA.,School of Public Affairs and Administration, Rutgers University, Newark, NJ, USA
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9
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Paricio D, Herrera M, Rodrigo MF, Viguer P. Association Between Group Identification at School and Positive Youth Development: Moderating Role of Rural and Urban Contexts. Front Psychol 2020; 11:1971. [PMID: 32849154 PMCID: PMC7427468 DOI: 10.3389/fpsyg.2020.01971] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 07/16/2020] [Indexed: 01/07/2023] Open
Abstract
These studies are framed within Social Identity Theory and the Positive Youth Development approach. The aim is: (1) to analyze the relationship between group identification at school and key positive development variables (such as self-esteem, self-efficacy, assertiveness, empathy, alexithymia, satisfaction with life, and academic performance); and (2) examine the moderator role of context (rural or urban areas of residence) and sex in these relationships. The samples were composed of 246 adolescents from a rural context (Study 1) and 156 students from rural and urban contexts (Study 2). As proposed in our hypotheses, the results show statistically significant relationships between group identification and all the variables considered, higher group identification with the class in the rural context, and a moderator role of the context in the relationships between group identification and satisfaction with life, assertiveness, and empathy. These results are relevant for designing and implementing psychoeducational programs to promote positive youth development in both rural and urban contexts.
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Affiliation(s)
| | - Marina Herrera
- Department of Social Psychology, University of Valencia, Valencia, Spain
| | - María F Rodrigo
- Department of Methodology for the Behavioural Sciences, University of Valencia, Valencia, Spain
| | - Paz Viguer
- Department of Developmental and Educational Psychology, University of Valencia, Valencia, Spain
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10
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Stjerneklar S, Hougaard E, McLellan LF, Thastum M. A randomized controlled trial examining the efficacy of an internet-based cognitive behavioral therapy program for adolescents with anxiety disorders. PLoS One 2019; 14:e0222485. [PMID: 31532802 PMCID: PMC6750608 DOI: 10.1371/journal.pone.0222485] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Accepted: 08/30/2019] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Anxiety disorders are highly prevalent in adolescence, but access to health care services is limited and only few receive professional help. Internet-based cognitive behavioral therapy (ICBT) has been proposed to increase accessibility and reduce costs of treatment. OBJECTIVE The study evaluated the efficacy of a Danish version of the guided ICBT program ChilledOut Online, developed at the Centre for Emotional Health, Macquarie University, Australia. METHOD At the Centre for Psychological Treatment of Children and Adolescents, Aarhus University, Denmark, a randomized controlled trial was conducted with 70 adolescents (13-17 years) with anxiety disorders according to DSM-IV. Participants were randomly assigned to a 14-weeks therapist-guided ICBT or to a waitlist condition. Outcomes were evaluated post-treatment and at 3- and 12-month follow-up. RESULTS At post-treatment, the ICBT group significantly outperformed the waitlist condition with moderate to large between-group effect sizes on diagnostic severity and anxiety symptoms rated by clinicians, and by adolescents and their parents. Forty percent of adolescents in ICBT were free of their primary diagnosis compared to 16% in the waitlist condition. Treatment gains were maintained at 3- and 12-month follow-up. CONCLUSION Results of the study provide support for the efficacy of guided ICBT for adolescents with anxiety disorders. TRIAL REGISTRATION ClinicalTrials.gov: NCT02535403.
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Affiliation(s)
- Silke Stjerneklar
- Department of Psychology and Behavioral Sciences, School of Business and Social Sciences, Aarhus University, Aarhus, Denmark
| | - Esben Hougaard
- Department of Psychology and Behavioral Sciences, School of Business and Social Sciences, Aarhus University, Aarhus, Denmark
| | - Lauren F. McLellan
- Centre for Emotional Health, Department of Psychology, Macquarie University, New South Wales, North Ryde, Australia
| | - Mikael Thastum
- Department of Psychology and Behavioral Sciences, School of Business and Social Sciences, Aarhus University, Aarhus, Denmark
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Barral RL, Cartujano B, Perales J, Ramirez M, Cowden JD, Trent ME, Ramaswamy M, Kessler SF. Knowledge, Beliefs, and Attitudes About Contraception Among Rural Latino Adolescents and Young Adults. J Rural Health 2019; 36:38-47. [PMID: 31430396 DOI: 10.1111/jrh.12390] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
PURPOSE Latino youth experience significant disparities in rates of teen pregnancy, and reproductive health needs of rural Latino youth are not well understood. The purpose of this study was to describe knowledge, beliefs, and attitudes about contraception among rural Latino adolescents and young adults (Latino youth). METHODS Eighty-four Latino youth, aged 15-24 years from rural Kansas communities participated in 15 focus groups (FG) and completed an individual survey. The survey assessed demographics and acculturation. FG participants discussed attitudes, subjective norms, and perceived sexual behaviors regarding teen sexuality, pregnancy, and contraception. RESULTS FGs revealed multiple obstacles to accessing reproductive health services: geographical/rural location, cultural barriers, religious influences, lack of sexual education, and personal attitudes toward pregnancy and contraception use. Participants described close-knit communities with limited access to confidential reproductive health care. They identified cultural and religious factors (sexual taboo, virginity, Familismo, and family dishonor) that influence family planning behaviors among Latino youth and obstruct access to sexual health and contraception knowledge and services. Ambivalence regarding pregnancy intentions was common, along with the belief that contraception equates with abortion. CONCLUSIONS Latino youth in rural communities face multiple physical and sociocultural obstacles to accessing family planning information and services. Community-based pregnancy prevention interventions must target these obstacles to optimize reproductive health outcomes for Latino youth in rural settings.
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Affiliation(s)
- Romina L Barral
- Division of Adolescent Medicine, Children's Mercy Hospital and Clinics, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri
| | - Brenda Cartujano
- Department of Psychiatry, Maimonides Medical Center, Brooklyn, New York
| | - Jaime Perales
- University of Kansas Alzheimer's Disease Center, Kansas City, Kansas
| | - Mariana Ramirez
- Department of Preventive Medicine & Public Health, University of Kansas Medical Center, Kansas City, Kansas
| | - John D Cowden
- Department of Pediatrics, Children's Mercy Hospital and Clinics, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri
| | - Maria E Trent
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Megha Ramaswamy
- University of Kansas Alzheimer's Disease Center, Kansas City, Kansas
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12
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Géczy I, Saewyc EM, Poon CS, Homma Y. Health-Risk Behaviors and Protective Factors Among Adolescents in Rural British Columbia. J Rural Health 2019; 36:65-76. [PMID: 31411774 DOI: 10.1111/jrh.12389] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
PURPOSE This study explores the relationship between rural residency, selected protective factors (family and school connectedness along with prosocial peer attitudes), and health-compromising behaviors (alcohol and tobacco use and nonuse of seatbelt) among adolescents. METHODS A subsample of adolescents residing in remote areas was extracted from a province-wide, school-based survey in British Columbia (BC), Canada (weighted N = 2,999). We employed χ2 statistic to test rural-urban differences separately by gender. Logistic regression analysis was used to examine the relationship between protective factors and behaviors compromising health. FINDINGS In boys, rural residency was associated with multiple problem behaviors (binge drinking, smokeless tobacco use, and nonuse of seatbelt), whereas for girls it was linked to riding without a seatbelt. The final logistic regression models confirmed that rural environment was a significant risk factor for not wearing a seatbelt among both boys and girls, and smokeless tobacco among boys (adjusted odds ratio between 1.44 and 3.05). Rurality, on the other hand, did not predict binge drinking. Logistic regression analyses also revealed that both school connectedness and prosocial peer attitude protected boys against binge drinking and smokeless tobacco, but the results were not as robust for girls. CONCLUSIONS These findings could provide information for location-based intervention efforts promoting adolescent health, highlighting the protective role of the school atmosphere and prosocial peer relationships, especially among boys.
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Affiliation(s)
- István Géczy
- Northern Lights College, University Arts and Sciences, Fort St. John, British Columbia, Canada
| | - Elizabeth M Saewyc
- School of Nursing, University of British Columbia, Vancouver, British Columbia, Canada.,McCreary Centre Society, Vancouver, British Columbia, Canada
| | - Colleen S Poon
- School of Nursing, University of British Columbia, Vancouver, British Columbia, Canada
| | - Yuko Homma
- School of Nursing, Mukogawa Women's University, Nishinomiya, Hyogo, Japan
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13
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Stjerneklar S, Hougaard E, Thastum M. Guided internet-based cognitive behavioral therapy for adolescent anxiety: Predictors of treatment response. Internet Interv 2019; 15:116-125. [PMID: 30792963 PMCID: PMC6371410 DOI: 10.1016/j.invent.2019.01.003] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Revised: 01/15/2019] [Accepted: 01/17/2019] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Guided internet-based cognitive behavioral therapy (ICBT) has been found efficacious in reducing symptoms of anxiety in adolescents with anxiety disorders, but not all respond equally well. OBJECTIVE In this study, we explored candidate predictors of ICBT treatment response within the frame of a randomized controlled trial. METHODS Sixty-five adolescents (13-17 years) with anxiety disorders according to DSM-IV received 14 weeks of therapist-guided ICBT. Outcome was evaluated as improvement (continuous change score) from pre-treatment to 12-month follow-up according to self-reported anxiety symptoms and clinician-rated diagnostic severity. Clinical predictors included baseline self- and parent-reported anxiety symptom levels, baseline clinician-rated severity of primary diagnosis, summed baseline clinician-rated severity of all anxiety diagnoses, baseline self-rated depressive symptoms, age of onset, and primary diagnosis of social phobia. Demographic predictors included age, gender and computer comfortability. Therapy process-related predictors included number of completed modules and therapist phone calls, summed duration of therapist phone calls, degree of parent support, and therapeutic alliance. Multi-level models were used to test the prediction effects over time. RESULTS Higher levels of self- and clinician-rated baseline anxiety and self-rated depressive symptoms, female gender, and higher levels of computer comfortability were associated with increased treatment response. None of the proposed therapy process-related predictors significantly predicted treatment response. CONCLUSION The present findings indicate that ICBT may be an acceptable choice of treatment for youths, even those with relative high levels of anxiety and depressive symptoms.
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Affiliation(s)
- Silke Stjerneklar
- Department of Psychology and Behavioral Sciences, Aarhus BSS, Aarhus University, Bartholins Allé 9, 8000 Aarhus C, Denmark
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14
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Griffin-Tomas M, Cahill S, Kapadia F, Halkitis PN. Access to Health Services Among Young Adult Gay Men in New York City. Am J Mens Health 2018; 13:1557988318818683. [PMID: 30569800 PMCID: PMC6775565 DOI: 10.1177/1557988318818683] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
This research is a cross-sectional study of young adult gay men (YAGM), ages 18 to 29, that aims to understand their health-care access including: having a primary care provider (PCP), frequency of health-care visits, and instances of foregone health care. Surveys were conducted with a modified time-space sample of 800 YAGM in New York City (NYC). Surveys were conducted between November 2015 and June 2016. This study examined associations between sociodemographic characteristics and health-care access using multivariable logistic regression models. In multivariable logistic regression models, there were higher odds of having a PCP among participants enrolled in school (Adjusted Odds Ratio [AOR] = 1.85, 95% CI [1.18, 2.91], p < .01) and covered by insurance (AOR = 21.29, 95% CI [11.77, 38.53], p < .001). Modeling indicated higher odds of more than one health visit in the past 12 months for non-White participants (AOR = 2.27, 95% CI [1.43, 3.63], p < .001), those covered by insurance (AOR = 3.10, 95% CI [1.06, 9.04], p < .05), and those who disclosed their sexual orientation to their PCP (AOR = 2.99, 95% CI [1.58, 5.69], p < .001). Participants with insurance were less likely to report instances of foregone care (AOR = 0.21, 95% CI [0.21, 0.13], p < .001). Understanding the facilitators and barriers to health-care access among YAGM populations is of critical importance, as many YAGM between the ages of 18 and 29 are establishing their access to health care without parental guidance. Health-care access, including the decision to forego care, can represent a missed opportunity for primary prevention and early diagnosis of health issues, as well as more effective, less invasive, and less costly treatments.
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Affiliation(s)
- Marybec Griffin-Tomas
- 1 New Jersey City University, Health Sciences Department, Jersey City, NJ, USA.,2 Center for Health, Identity, Behavior and Prevention Studies, Rutgers University, Newark, NJ, USA
| | - Sean Cahill
- 3 National LGBT Health Education Center, The Fenway Institute, Boston, MA, USA
| | - Farzana Kapadia
- 1 New Jersey City University, Health Sciences Department, Jersey City, NJ, USA.,2 Center for Health, Identity, Behavior and Prevention Studies, Rutgers University, Newark, NJ, USA.,4 Department of Population Health, Langone Medical Center, New York University, New York, NY, USA
| | - Perry N Halkitis
- 2 Center for Health, Identity, Behavior and Prevention Studies, Rutgers University, Newark, NJ, USA.,5 Department of Biostatistics & Epidemiology, Rutgers School of Public Health, Rutgers University, Piscataway, NJ, USA.,6 Rutgers Robert Wood Johnson Medical School, Rutgers University, Piscataway, NJ, USA.,7 Graduate School of Applied and Professional Psychology, Rutgers University, Piscataway, NJ, USA.,8 Department of Urban-Global Public Health, Rutgers School of Public Health, Rutgers University, Newark, NJ, USA
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15
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Bunting AM, Oser CB, Staton M, Eddens KS, Knudsen H. Clinician identified barriers to treatment for individuals in Appalachia with opioid use disorder following release from prison: a social ecological approach. Addict Sci Clin Pract 2018; 13:23. [PMID: 30509314 PMCID: PMC6278109 DOI: 10.1186/s13722-018-0124-2] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Accepted: 11/21/2018] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND The non-medical use of opioids has reached epidemic levels nationwide, and rural areas have been particularly affected by increasing rates of overdose mortality as well as increases in the prison population. Individuals with opioid use disorder (OUD) are at increased risk for relapse and overdose upon reentry to the community due to decreased tolerance during incarceration. It is crucial to identify barriers to substance use disorder treatment post-release from prison because treatment can be particularly difficult to access in resource-limited rural Appalachia. METHODS A social ecological framework was utilized to examine barriers to community-based substance use treatment among individuals with OUD in Appalachian Kentucky following release from prison. Semi-structured qualitative interviews with 15 social service clinicians (SSCs) employed by the Department of Corrections were conducted to identify barriers at the individual, interpersonal, organizational/institutional level, community, and systems levels. Two independent coders conducted line-by-line coding to identify key themes. RESULTS Treatment barriers were identified across the social ecological spectrum. At the individual-level, SSCs highlighted high-risk drug use and a lack of motivation. At the interpersonal level, homogenous social networks (i.e., homophilious drug-using networks) and networks with limited treatment knowledge inhibited treatment. SSC's high case load and probation/parole officer's limited understanding of treatment were organizational/institutional barriers. Easy access to opioids, few treatment resources, and a lack of community support for treatment were barriers at the community level. SSC's noted system-level barriers such as lack of transportation options, cost, and uncertainty about the implementation of the Affordable Care Act. CONCLUSIONS More rural infrastructure resources as well as additional education for family networks, corrections staff, and the community at large in Appalachia are needed to address barriers to OUD treatment. Future research should examine barriers from the perspective of other key stakeholders (e.g., clients, families of clients) and test interventions to increase access to OUD treatment.
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Affiliation(s)
| | - Carrie B. Oser
- Department of Sociology, University of Kentucky, Lexington, USA
- Center on Drug and Alcohol Research, University of Kentucky, Lexington, USA
| | - Michele Staton
- Center on Drug and Alcohol Research, University of Kentucky, Lexington, USA
- Department of Behavioral Science, University of Kentucky, Lexington, USA
| | - Katherine S. Eddens
- Indiana University Network Science Institute, Indiana University, Bloomington, USA
| | - Hannah Knudsen
- Center on Drug and Alcohol Research, University of Kentucky, Lexington, USA
- Department of Behavioral Science, University of Kentucky, Lexington, USA
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16
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Adams WB, Rovito MJ, Craycraft M. The Connection Between Testicular Cancer, Minority Males, and Planned Parenthood. Am J Mens Health 2018; 12:1774-1783. [PMID: 30008248 PMCID: PMC6142153 DOI: 10.1177/1557988318786874] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Testicular cancer (TCa) is the most prevalent neoplasm diagnosed in males aged 15-40 years. Lack of access to care is a key impediment to early-stage TCa diagnosis. Health equity concerns arise, however, as poor access largely manifests within underserved male populations, therefore, placing them at a higher risk to develop late-stage TCa. Planned Parenthood Federation of America (PPFA) offers a myriad of male reproductive/sexual health care options, including TCa screening and referral services. Therefore, expanding these amenities in traditionally underserved communities may address the concern of TCa screening opportunities. An ecological analysis was performed using data from the United States Cancer Statistics, American Community Survey, and PPFA databases to assess the impact of TCa upon minority males, identify associations between PPFA services and minority males, and provide future implications on the role PPFA may play in bridging health-care access gaps pertaining to TCa screenings. Results indicate that states with higher rates of poverty and uninsured individuals, as well as specifically Black/African American males, have lower TCa incidence and limited access to screening services. PPFA service presence and Black/African American, as well as uninsured, males had a negative association but revealed positive correlations with TCa incidence. Considering the emerging TCa outcome disparities among minority males, expanding PPFA men's health services is crucial in providing affordable options to help identify testicular abnormalities that are early stage or carcinoma in situ. Many at-risk males have limited means to obtain TCa screening services. Expanding this discussion could provide a foundation for future advocacy.
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Affiliation(s)
- Wesley B Adams
- 1 Behavioral Health Research Group, College of Health and Public Affairs, Department of Health Professions, University of Central Florida, Orlando, FL, USA
| | - Michael J Rovito
- 1 Behavioral Health Research Group, College of Health and Public Affairs, Department of Health Professions, University of Central Florida, Orlando, FL, USA
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17
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Kvasny L, Payton FC. Managing Hypervisibility in the HIV Prevention Information‐Seeking Practices of Black Female College Students. J Assoc Inf Sci Technol 2018. [DOI: 10.1002/asi.24001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Lynette Kvasny
- Pennsylvania State University, College of Information Sciences & Technology, 329C IST Building, University Park PA16802
| | - Fay Cobb Payton
- North Carolina State University, College of Management, Campus Box 7229Raleigh NC27695
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18
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Stjerneklar S, Hougaard E, Nielsen AD, Gaardsvig MM, Thastum M. Internet-based cognitive behavioral therapy for adolescents with anxiety disorders: A feasibility study. Internet Interv 2018; 11:30-40. [PMID: 30135757 PMCID: PMC6084871 DOI: 10.1016/j.invent.2018.01.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Revised: 12/21/2017] [Accepted: 01/04/2018] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Cognitive behavioral therapy (CBT) is a well-documented effective method for the treatment of anxiety disorders in children and adolescents. While internet based CBT (ICBT) programs for adults have been widely investigated, research on ICBT programs for anxiety disorders in youth is still in an early phase: To date, no such program has been developed or evaluated in Denmark. AIM As preparation for a randomized controlled efficacy trial, this study aimed at evaluating the feasibility of a translated and adapted version of the ICBT program 'Chilled Out' for adolescents with anxiety disorders, developed at Macquarie University, Australia. METHODS At the University Clinic in Aarhus, Denmark, we conducted a feasibility study with six adolescents with a primary anxiety disorder. The 12-week ICBT intervention consisted of eight online modules. Participants received weekly phone calls from a clinical psychologist. Semi-structured interviews on participant's experiences of the program were administered post-treatment and at three-month follow-up. Outcome was evaluated post-treatment and at follow-up using diagnostic interview and questionnaires. RESULTS Five of the six participants completed the program. Participants were generally satisfied with the program and the majority would recommend it to others. Preliminary clinical outcome results indicated moderate to large improvements (e.g., a standardized mean difference from pre- to post-treatment of d = 1.54 on the clinical severity rating of their primary anxiety disorder). CONCLUSION Results from this study indicate that a translated and revised version of the Chilled Out program could be a feasible psychological intervention for Danish adolescents with anxiety disorders.
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Affiliation(s)
- Silke Stjerneklar
- Department of Psychology and Behavioral Sciences, Aarhus BSS, Aarhus University, Bartholins Allé 9, 8000 Aarhus C, Denmark
| | - Esben Hougaard
- Department of Psychology and Behavioral Sciences, Aarhus BSS, Aarhus University, Bartholins Allé 9, 8000 Aarhus C, Denmark
| | | | - Majken M. Gaardsvig
- Department of Psychology and Behavioral Sciences, Aarhus BSS, Aarhus University, Bartholins Allé 9, 8000 Aarhus C, Denmark
| | - Mikael Thastum
- Department of Psychology and Behavioral Sciences, Aarhus BSS, Aarhus University, Bartholins Allé 9, 8000 Aarhus C, Denmark
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Chelvakumar G, Ford N, Kapa HM, Lange HLH, McRee AL, Bonny AE. Healthcare Barriers and Utilization Among Adolescents and Young Adults Accessing Services for Homeless and Runaway Youth. J Community Health 2018; 42:437-443. [PMID: 27817043 DOI: 10.1007/s10900-016-0274-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Homeless and runaway youth are at disproportionate risk for adverse health outcomes. Many barriers to accessing healthcare have been documented; however, the relative impact of discrete barriers on homeless youth healthcare utilization behavior is not firmly established. We administered a survey examining reported barriers and healthcare utilization among adolescents and young adults accessing services at three community centers for homeless and runaway youth. Of 180 respondents, 57 % were male, 80 % non-White, and 21 % identified as a sexual minority. Stepwise logistic regression models, controlling for age and study site, explored associations between barriers and 3 healthcare utilization outcomes (doctor visit in past 12 months; regular care provider; frequent emergency department (ED) visits). The most commonly reported barriers were "don't have a ride" (27.2 %), "no insurance" (23.3 %), and "costs too much" (22.8 %). All fear-based barriers (e.g., "I don't trust the doctors") were reported by <5 % of surveyed youth. Significant predictors of having seen a doctor in the past 12 months included sexual minority status (OR 2.8, p = 0.04) and possession of health insurance (OR 4.9, p < 0.001). Female sex (OR 5.2, p < 0.001) and reported external barriers other than health insurance (OR 0.2, p < 0.001) were associated with having a regular care provider. Fear-based concerns were associated (OR 3.8, p = 0.02) with frequent ED visits, as was being insured (OR 2.2, p = 0.03). These results underscore the need to clearly define healthcare outcomes when investigating barriers to care among homeless and runaway youth as the impact of discrete barriers varies depending on outcome of focus.
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Affiliation(s)
- Gayathri Chelvakumar
- Division of Adolescent Medicine, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH, 43205, USA.
- The Ohio State University College of Medicine, Columbus, OH, USA.
| | - Nancy Ford
- Division of Adolescent Medicine, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH, 43205, USA
| | - Hillary M Kapa
- The Research Institute at Nationwide Children's Hospital, Columbus, OH, USA
| | - Hannah L H Lange
- The Research Institute at Nationwide Children's Hospital, Columbus, OH, USA
| | - Annie-Laurie McRee
- Division of General Pediatrics & Adolescent Health, University of Minnesota, Minneapolis, MN, USA
| | - Andrea E Bonny
- Division of Adolescent Medicine, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH, 43205, USA
- The Ohio State University College of Medicine, Columbus, OH, USA
- The Research Institute at Nationwide Children's Hospital, Columbus, OH, USA
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20
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Bersamin M, Fisher DA, Marcell AV, Finan LJ. Reproductive Health Services: Barriers to Use Among College Students. J Community Health 2018; 42:155-159. [PMID: 27604424 DOI: 10.1007/s10900-016-0242-2] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
The objective of the current study was to explore demographic, financial, and psychosocial barriers associated with the use/non-use of reproductive health (RH) services. The sample included 212 college students (60 % female) aged 18-19 from a Northern California public university. In October, 2014, students took an on-line survey with questions on knowledge, access, barriers, and use of different RH services and settings. Findings indicated that college students were more likely to visit a primary care setting and/or school-based setting for their RH care. Sexual intercourse was the strongest correlate of having received RH care in the past year, followed by gender, social disapproval, and knowledge of available services. Analyses stratified by gender found a similar pattern among females. However, the only significant predictor among males was knowledge of available services. These finding highlight universities as uniquely positioned to reduce perceived barriers to accessing RH services by making use of technology, promoting health and wellness centers, and providing/adding sexual and reproductive information to general education classes.
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Affiliation(s)
- Melina Bersamin
- Prevention Research Center, 180 Grand Avenue, Suite 1200, Oakland, CA, 94612, USA
| | - Deborah A Fisher
- Pacific Institute for Research and Evaluation, 11720 Beltsville Drive, Suite 900, Calverton, MD, 20705, USA
| | - Arik V Marcell
- Department of Pediatrics, Johns Hopkins University, 200 N. Wolfe Street, Room 2062, Baltimore, MD, 21287, USA
| | - Laura J Finan
- Prevention Research Center, 180 Grand Avenue, Suite 1200, Oakland, CA, 94612, USA.
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21
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The Health Needs of Young Women: Applying a Feminist Philosophical Lens to Nursing Science and Practice. ANS Adv Nurs Sci 2016; 39:108-18. [PMID: 27149225 DOI: 10.1097/ans.0000000000000119] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Ongoing development of nursing science requires attention to the philosophical and theoretical bases upon which the science is built. A feminist theoretical perspective offers a useful lens for understanding the needs of both nurses and their clients. Adolescent and young adult women are an underserved and understudied population for whom nursing care can be especially beneficial. Considering the needs of this population from a philosophical perspective, through a feminist lens, is one effective means of developing nursing science approaches that contribute to and ultimately improve care for adolescent and young adult women.
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Obadeji A, Oluwole LO, Dada MU, Ajiboye AS. Pattern and predictors of alcohol use disorders in a family practice in Nigeria. Indian J Psychol Med 2015; 37:75-80. [PMID: 25722517 PMCID: PMC4341316 DOI: 10.4103/0253-7176.150824] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Primary care has been identified as a key setting for the reduction of alcohol-related harm, while general practitioners are expected to play a significant role. The study aimed at identifying pattern of, and factors that are associated with alcohol use disorders (AUDs) among patients attending Family Medicine unit of State University Teaching Hospital. MATERIALS AND METHODS Sample was selected through a random sampling from a population of patients, aged 18-65 years, attending the general medical out-patients unit of the hospital from January to April 2013. A pretested, semi-structured questionnaire was administered, incorporating sociodemographics and the diagnoses made by the attending Physician. The participants also completed the alcohol use disorders identification test (AUDIT) questionnaire and the patient health questionnaire-9. RESULTS The prevalence of AUDs among the population of general out-patients was 9.7%. The AUDIT scores of the participants range from 0 to 29 with a mean of 1.3 (standard deviation = 4.08). AUDs were significantly associated with gender, level of education, occupational class, and the presence of significant depressive symptoms (P < 0.05). There was no statistically significant association found for age, employment status, marital status, and religion. CONCLUSION The prevalence of AUDs among population studied was lower compared with a similar study in similar setting, but however, significant. AUDs were predicted by gender, lower education level, occupational group, and the presence of significant depressive symptoms mostly in the mild to moderate form. Identifying the group at risk in clinical setting may go a long way in reducing the adverse effect of AUDs in our society.
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Affiliation(s)
- Adetunji Obadeji
- Department of Psychiatry, Ekiti State University Teaching Hospital, Ado-Ekiti, Ekiti State, Nigeria
| | - Lateef O Oluwole
- Department of Psychiatry, Ekiti State University Teaching Hospital, Ado-Ekiti, Ekiti State, Nigeria
| | - Mobolaji U Dada
- Department of Psychiatry, Ekiti State University Teaching Hospital, Ado-Ekiti, Ekiti State, Nigeria
| | - Adedotun S Ajiboye
- Department of Psychiatry, Psychology Unit, Ekiti State University Teaching Hospital, Ado-Ekiti, Ekiti State, Nigeria
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Divin AL, Zullig KJ. The Association between Non-Medical Prescription Drug Use and Suicidal Behavior among United States Adolescents. AIMS Public Health 2014; 1:226-240. [PMID: 29546088 PMCID: PMC5690255 DOI: 10.3934/publichealth.2014.4.226] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2014] [Accepted: 10/10/2014] [Indexed: 11/27/2022] Open
Abstract
Adolescence represents a vulnerable time for the development of both drug use/abuse and mental illness. Although previous research has substantiated a relationship between drug use and suicidal behavior, little research has examined this relationship with non-medical prescription drug use. Given the growing prevalence of non-medical prescription drug use (NMPDU) among adolescents, this study explored the association between NMPDU and suicidal behavior. Nationally representative data were derived from 16, 410 adolescents who completed the 2009 National Youth Risk Behavior Survey. Approximately 19.8% of participants reported lifetime NMPDU. NMPDU was associated with significantly increased odds of suicidal behavior (P < 0.01), with seriously considering attempting suicide and making a plan about attempting suicide representing the strongest correlates for males and females. Results suggest the importance of 1) continued reinforcement of drug education programs in high school begun at earlier ages and 2) mental health care and screenings among adolescents.
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Affiliation(s)
- Amanda L. Divin
- Department of Health Sciences and Social Work, Western Illinois University, Macomb, IL 61455, USA
| | - Keith J. Zullig
- Department of Social and Behavioral Sciences, West Virginia University, Morgantown, WV 26501, USA
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Secor-Turner MA, Randall BA, Brennan AL, Anderson MK, Gross DA. Rural adolescents' access to adolescent friendly health services. J Pediatr Health Care 2014; 28:534-40. [PMID: 25017940 DOI: 10.1016/j.pedhc.2014.05.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2014] [Revised: 05/16/2014] [Accepted: 05/18/2014] [Indexed: 11/16/2022]
Abstract
INTRODUCTION The purpose of this study was to assess rural North Dakota adolescents' experiences in accessing adolescent-friendly health services and to examine the relationship between rural adolescents' communication with health care providers and risk behaviors. METHODS Data are from the Rural Adolescent Health Survey (RAHS), an anonymous survey of 14- to 19-year-olds (n = 322) attending secondary schools in four frontier counties of North Dakota. Descriptive statistics were used to assess participants' access to adolescent-friendly health services characterized as accessible, acceptable, and appropriate. Logistic regressions were used to examine whether participant-reported risk behaviors predicted communication with health care providers about individual health risk behaviors. RESULTS Rural adolescents reported high access to acceptable primary health care services but low levels of effective health care services. Participant report of engaging in high-risk behaviors was associated with having received information from health care providers about the leading causes of morbidity and mortality. DISCUSSIONS These findings reveal missed opportunities for primary care providers in rural settings to provide fundamental health promotion to adolescents.
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Haller DM, Narring F, Chondros P, Pejic D, Sredic A, Huseinagic S, Perone N, Sanci LA, Meynard A. Development of youth friendly family medicine services in Bosnia and Herzegovina: protocol for a cluster randomized controlled trial. SPRINGERPLUS 2014; 3:319. [PMID: 25077056 PMCID: PMC4112032 DOI: 10.1186/2193-1801-3-319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/12/2013] [Accepted: 06/11/2014] [Indexed: 11/30/2022]
Abstract
Background Young people face many barriers in accessing health services that are responsive to their needs. The World Health Organization has led a call to develop services that address these barriers, i.e. youth-friendly health services. Addressing the needs of young people is one of the priorities of Foundation fami, an organisation working in collaboration with the Swiss Federal Department of Development and Cooperation and Geneva University Hospitals to develop quality family medicine services in Bosnia and Herzegovina. This paper describes the design of a trial to assess the effectiveness of a multifaceted intervention involving family medicine teams (primary care doctors and nurses) to improve the youth-friendliness of family medicine services in Bosnia and Herzegovina. Methods/Design This is a stratified cluster randomised trial with a repeated cross-sectional design involving 59 health services in 10 municipalities of the canton of Zenica in Bosnia and Herzegovina. Municipalities were the unit of randomisation: five municipalities were randomised to the intervention arm and five to a wait-list control arm. Family medicine teams in the intervention arm were invited to participate in an interactive training program about youth-friendly service principles and change processes within their service. The primary outcome was the youth-friendliness of the primary care service measured using the YFHS-WHO + questionnaire, a validated tool which young people aged 15 to 24 years complete following a family medicine consultation. A total of 600 young people aged 15 to 24 years were invited to participate and complete the YFHS-WHO + questionnaire: 300 (30 per municipality) at baseline, and 300 at follow-up, three to five months after the training program. Discussion The results of this trial should provide much awaited evidence about the development of youth-friendly primary care services and inform their further development both in Bosnia and Herzegovina and worldwide. Trial registration Australian New Zealand Clinical Trials Registry_ ACTRN12610000142033
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Affiliation(s)
- Dagmar M Haller
- Primary Care Unit, Faculty of Medicine, University of Geneva, Geneva, Switzerland ; Department of community, primary care and emergency medicine, Geneva University Hospitals, 4 av Gabrielle-Perret-Gentil, 1211 Geneve 14, Switzerland ; Department of Pediatrics, Geneva University Hospitals, Geneva, Switzerland ; Department of General Practice, The University of Melbourne, Melbourne, Australia
| | - Françoise Narring
- Department of community, primary care and emergency medicine, Geneva University Hospitals, 4 av Gabrielle-Perret-Gentil, 1211 Geneve 14, Switzerland ; Department of Pediatrics, Geneva University Hospitals, Geneva, Switzerland
| | - Patty Chondros
- Department of General Practice, The University of Melbourne, Melbourne, Australia
| | | | - Ana Sredic
- Foundation fami, Doboj, Bosnia & Herzegovina
| | - Senad Huseinagic
- Public Health Institute of Zenica-Doboj canton, Zenica, Bosnia & Herzegovina
| | - Nicolas Perone
- Department of community, primary care and emergency medicine, Geneva University Hospitals, 4 av Gabrielle-Perret-Gentil, 1211 Geneve 14, Switzerland
| | - Lena A Sanci
- Department of General Practice, The University of Melbourne, Melbourne, Australia
| | - Anne Meynard
- Department of Pediatrics, Geneva University Hospitals, Geneva, Switzerland
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Adolescent views on comprehensive health risk assessment and counseling: assessing gender differences. J Adolesc Health 2014; 55:24-32. [PMID: 24613096 PMCID: PMC5645795 DOI: 10.1016/j.jadohealth.2013.12.002] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2013] [Revised: 10/14/2013] [Accepted: 12/01/2013] [Indexed: 11/21/2022]
Abstract
PURPOSE Adolescence is an important time for the detection of health risk behaviors and factors with subsequent counseling and intervention. Limited research has examined adolescent perceptions of comprehensive health risk assessments (HRAs) and counseling with an assessment of gender differences. METHODS Participants were identified using Florida's Medicaid and State Children's Health Insurance Program databases. A total of 35 low-income, racially/ethnically diverse adolescents (ages 14-18 years) participated in eight focus groups stratified by gender. Adolescents completed an internet-based, tablet-administered, comprehensive HRA and then participated in a semi-structured interview. Discussions were recorded, transcribed, and analyzed using a multi-step, team-based approach applying grounded theory to determine major themes. RESULTS Male adolescents desired less parental involvement, had less understanding of the protections of clinical confidentiality and the need for comprehensive HRA, and placed greater emphasis on the importance of professional appearance. In contrast, more females valued face-to-face interactions and stressed the importance of concern from the health risk assessor. Overall, adolescents placed importance on their relationship with the health risk assessor, and on valuing trust, confidentiality, and nonjudgmental care. Adolescents preferred to complete HRAs in clinical, private, and professional settings, and reported that tablet technology supported their confidentially in completing the HRA. Furthermore, they stressed the importance of autonomy and learning about the health risk outcomes for risk reduction. CONCLUSIONS Gender differences exist in adolescent perceptions of comprehensive HRAs. Adolescent perceptions of HRAs support their use in confidential primary care settings using modalities that emphasize nonjudgmental, private care, and the use of communication techniques that respect adolescents' autonomy to change health risks.
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Logsdon MC, Mittelberg M, Myers J. Use of social media and internet to obtain health information by rural adolescent mothers. Appl Nurs Res 2014; 28:55-6. [PMID: 25015899 DOI: 10.1016/j.apnr.2014.04.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2014] [Revised: 04/22/2014] [Accepted: 04/30/2014] [Indexed: 11/30/2022]
Abstract
BACKGROUND Adolescent mothers residing in rural areas need accurate health information to care for themselves and their babies. The purpose of this study was to determine the use of social media and Internet by adolescent mothers residing in rural areas, particularly in regard to obtaining health information. METHODS Using a cross-sectional design, a convenience sample of adolescent mothers living in a rural county in a state located in the southern U.S. (n = 15), completed the Pew Internet Survey during home visits with nurses from a community health agency. RESULTS All adolescent mothers accessed Internet using cell phones (93%) or computers (100%). Many adolescent mothers sent or received over 50 text messages per day. Thirty-three percent of adolescent mothers searched for health information on the Internet every few weeks; 27% received health information from Facebook. CONCLUSIONS Communication of health information using the Internet and social media may be effective with adolescent mothers residing in rural areas.
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Affiliation(s)
- M Cynthia Logsdon
- School of Nursing, University of Louisville, Louisville, Kentucky 40202, USA.
| | - Meghan Mittelberg
- School of Nursing, University of Louisville, Louisville, Kentucky 40202, USA.
| | - John Myers
- Department of Pediatrics, School of Medicine, University of Louisville, Louisville, Kentucky 40202, USA.
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Ervin K, Phillips J, Tomnay J. Establishing a clinic for young people in a rural setting: a community initiative to meet the needs of rural adolescents. Aust J Prim Health 2014; 20:128-33. [DOI: 10.1071/py12157] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2012] [Accepted: 07/14/2013] [Indexed: 11/23/2022]
Abstract
This paper describes the establishment and evaluation of a rural clinic for young people. A conceptual approach to community development was used to establish the clinic in a small north Victorian rural health service, with qualitative methods used to evaluate services. Study participants were members of an operational committee and advisory committee for the establishment of the rural clinic for young people. The clinic was evaluated against the World Health Organization framework for the development of youth-friendly services. With robust community support, the clinic was established and is operational. Most consultations have been for sexual and mental health. Qualitative evaluation identifies that not all the World Health Organization benchmarks have been met, but this is hampered predominantly by financial constraints. In conclusion, establishing clinic for young people in a small rural setting can be achieved with community support and the development of referral pathways.
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Mollen CJ, Miller MK, Hayes KL, Wittink MN, Barg FK. Developing emergency department-based education about emergency contraception: adolescent preferences. Acad Emerg Med 2013; 20:1164-70. [PMID: 24238320 PMCID: PMC4047822 DOI: 10.1111/acem.12243] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2013] [Revised: 06/17/2013] [Accepted: 06/26/2013] [Indexed: 11/28/2022]
Abstract
OBJECTIVES The objective was to identify adolescent preferences for emergency department (ED)-based education about emergency contraception. METHODS This was a cross-sectional computerized survey, using adaptive conjoint analysis (ACA). Patients were eligible if they were females ages 14 through 19 years old and were seeking care in one of two urban EDs. Patients were excluded if they were too ill to participate in the survey or if they were non-English speaking. Participants completed a computerized survey that used ACA, a technique that can be used to assess patients' relative preferences for services. ACA uses the individual's answers to update and refine questions through trade-off comparisons, so that each respondent answers a customized set of questions. The survey assessed preferences for the following attributes of emergency contraception education: who should deliver the education, if anyone (e.g., nurse, doctor); how the education should be delivered (e.g., by a person or via video); how often the education should be offered if patients were to frequent the ED (e.g., every time or only when asking for it); length (e.g., 5 minutes, 10 minutes); and chief complaint that would trigger the education (e.g., headache or stomach pain). RESULTS A total of 223 patients were enrolled (37.2% at Hospital 1 and 62.8% at Hospital 2). The mean (±SD) age of the participants was 16.1 (±1.3) years. Just over half (55%) reported a history of sexual activity; 8% reported a history of pregnancy. Overall, the participants preferred education that was delivered by a person, specifically a doctor or nurse. They preferred a slightly longer education session and preferred education directed at patients seeking care in the ED for complaints potentially related to sexual activity. CONCLUSIONS Adolescents have specific preferences for how education about emergency contraception would best serve their needs. This information can inform clinicians as they work to improve adolescents' knowledge about pregnancy prevention and emergency contraception in particular.
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Affiliation(s)
- Cynthia J Mollen
- Division of Emergency Medicine, The Children's Hospital of Philadelphia, Philadelphia, PA; Department of Pediatrics, The University of Pennsylvania, Philadelphia, PA
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Lo CC, Weber J, Cheng TC. Urban-rural differentials: a spatial analysis of Alabama students' recent alcohol use and marijuana use. Am J Addict 2013; 22:188-96. [PMID: 23617858 DOI: 10.1111/j.1521-0391.2012.12023.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2011] [Revised: 09/26/2011] [Accepted: 10/14/2011] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND AND OBJECTIVES This study of Alabama public school students sought urban-rural differences in social and spatial mechanisms connecting structural factors to recent use of alcohol and marijuana. METHODS Its dataset comprised a state-sponsored 2002 need-assessment survey of Alabama students; Alabama education department data; U. S. Census data; and alcohol-outlet locations listed by Alabama's Alcoholic Beverage Control Board. It measured structural-disadvantage factors (population disadvantages, community instability, alcohol-outlet density), social-organization factors (protective role of community, protective role of school), and recent-use factors. Using Geographic Information Systems (GIS), it generated maps of school catchment areas (SCAs)-the units of analysis for the study-that outline spatial patterns (across areas deemed urban or rural) of students' recent use of alcohol and marijuana. RESULTS In the final sample of 370 SCAs, significant urban-versus-rural differences were observed for certain structural factors and in how these factors were associated with substance use. These differences aside, spatial analysis weighing the SCAs' particular geographic characteristics suggested location's importance, showing that a school playing a strong protective role significantly reduced not just its own students' recent substance use, but that of students in neighboring SCAs as well. CONCLUSIONS AND SCIENTIFIC SIGNIFICANCE The findings show students' recent use of alcohol and marijuana are associated with characteristics of the environment. (Am J Addict 2013; 22:188-196).
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Affiliation(s)
- Celia C Lo
- School of Social Work, University of Alabama, Tuscaloosa, AL 35487, USA.
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Curtis AC, Waters CM, Brindis C. Rural Adolescent Health: The Importance of Prevention Services in the Rural Community. J Rural Health 2010; 27:60-71. [DOI: 10.1111/j.1748-0361.2010.00319.x] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Gordon AJ, Ettaro L, Rodriguez KL, Mocik J, Clark DB. Provider, patient, and family perspectives of adolescent alcohol use and treatment in rural settings. J Rural Health 2010; 27:81-90. [PMID: 21204975 PMCID: PMC3138630 DOI: 10.1111/j.1748-0361.2010.00321.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
PURPOSE We examined rural primary care providers' (PCPs) self-reported practices of screening, brief interventions, and referral to treatment (SBIRT) on adolescent alcohol use and examined PCPs', adolescents', and parents' attitudes regarding SBIRT on adolescent alcohol use in rural clinic settings. METHODS In 2007, we mailed surveys that inquired about alcohol-related knowledge, attitudes, and treatment practices of adolescent alcohol use to all PCPs in 8 counties in rural Pennsylvania who may have treated adolescents. We then conducted 7 focus groups of PCPs and their staffs (n = 3), adolescents (n = 2), and parents (n = 2) and analyzed the narratives using structured grounded theory, evaluating for consistent or discordant themes. RESULTS Twenty-seven PCPs from 7 counties returned the survey. While 92% of PCPs felt that routine screening for alcohol use should begin by age 14, 84% reportedly screened for alcohol use occasionally, and reportedly 32% screened all adolescent patients. The provider focus groups (n = 20 PCPs/staff) related that SBIRT for alcohol use for adolescents was not currently effective. Poor provider training, lack of alcohol screening tools, and lack of referral treatment options were identified barriers. Adolescents (n = 12) worried that physicians would not maintain confidentiality. Parents (n = 12) acknowledged a parental contribution to adolescent alcohol use. All groups indicated computer-based methods to screen for alcohol use among adolescents may facilitate PCP engagement. CONCLUSIONS Despite awareness that rural adolescent alcohol use is a significant problem, PCPs, adolescents, and parents recognize that SBIRT for adolescent alcohol use in rural PCP settings is ineffective, but it may improve with computer-based screening and intervention techniques.
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Affiliation(s)
- Adam J Gordon
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.
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Braun RA, Provost JM. Bridging the gap: using school-based health services to improve chlamydia screening among young women. Am J Public Health 2010; 100:1624-9. [PMID: 20634446 DOI: 10.2105/ajph.2009.186825] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We implemented a chlamydia screening program targeted at young women accessing reproductive health care services in a school-based setting, and we assessed racial/ethnic factors associated with infection. METHODS The California Family Health Council partnered with 9 health care agencies receiving federal Title X family planning funding and 19 educational institutions to implement the Educational Partnerships to Increase Chlamydia Screening (EPICS) program from January 2008 through December 2008. RESULTS EPICS agencies provided reproductive health services to 3396 unique sexually active females, 85% of whom self-reported no other source for reproductive health care. Chlamydia screening was provided to 3026 clients (89.1% chlamydia screening coverage). Of those screened for chlamydia, 5.6% tested positive. Clients who were African American (odds ratio [OR]=7.5; 95% confidence interval [CI]=3.9, 14.3), Pacific Islander (OR=4.1; 95% CI=1.1, 15.5), or Asian (OR=3.3; 95% CI=1.4, 8.1) were more likely to have a positive test than were White clients. CONCLUSIONS Chlamydia screening programs implemented in school-based settings have the capacity to identify and treat a significant amount of asymptomatic infection in a population that otherwise may not be reached. To facilitate screening, school-based clinics should implement outreach strategies that target their school population and clinical strategies that maximize opportunities for screening.
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Affiliation(s)
- Rebecca A Braun
- Clinical and Community Health Programs Division, California Family Health Council, 2550 9th St, Suite 110, Berkeley, CA 94710, USA.
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Akers AY, Youmans S, Lloyd SW, Smith DM, Banks B, Blumenthal C, Albritton T, Ellison A, Smith GC, Adimora AA. Views of young, rural African Americans of the role of community social institutions in HIV prevention. J Health Care Poor Underserved 2010; 21:1-12. [PMID: 20453373 DOI: 10.1353/hpu.0.0280] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND We explored rural African American youths' perceptions about the role of community social institutions in addressing HIV. METHODS We conducted four focus groups with African Americans aged 16 to 24 years in two rural counties in North Carolina. Groups were stratified by gender and risk status. We used a grounded theory approach to content analysis. RESULTS Participants identified four social institutions as primary providers of HIV-related health promotion efforts: faith organizations, schools, politicians, and health agencies. They reported perceiving a lack of involvement in HIV prevention by faith-based organizations, constraints of abstinence-based sex education policies, politicians' lack of interest in addressing broader HIV determinants, and inadequacies in health agency services, and viewed all of these as being counter-productive to HIV prevention efforts. CONCLUSIONS Youth have important insights about local social institutions that should be considered when designing HIV prevention interventions that partner with local organizations.
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Affiliation(s)
- Aletha Y Akers
- Department of Obstetrics, Gynecology and Reproductive Science at Magee-Womens Hospital in Pittsburgh, USA
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Bradley KL, McGrath PJ, Brannen CL, Bagnell AL. Adolescents' attitudes and opinions about depression treatment. Community Ment Health J 2010; 46:242-51. [PMID: 19636707 DOI: 10.1007/s10597-009-9224-5] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2008] [Accepted: 07/13/2009] [Indexed: 11/30/2022]
Abstract
The purpose of this study was to determine adolescent preferences for depression treatment. Adolescents (n = 156) completed a survey that included: their preferences for type of depression treatment and the method of delivering it; their perception of the importance of side effects of depression treatments and a rating of their willingness to seek treatment if they were depressed. A screen for depressive symptoms (CES-D10) was also completed. Adolescents showed higher preference for psychotherapy than antidepressants. Greater severity of depression symptoms, perceived social support for the particular treatment modality, and general willingness to seek treatment predicted greater preference for psychotherapy than for antidepressants. Family doctors, psychiatrists, and psychologists were the preferred treatment providers, and adolescents preferred that treatment be delivered in a private office. Weight gain was the most deterring side effect of antidepressants for girls and loss of sex drive for boys. Adolescents' preference for psychological therapy suggests that broader availability of psychotherapy may enhance help-seeking and compliance in depression treatment in this vulnerable population.
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Affiliation(s)
- Kristina L Bradley
- Department of Psychology, Dalhousie University, IWK Health Centre, Halifax, NS, Canada.
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Clark DB, Moss HB. Providing alcohol-related screening and brief interventions to adolescents through health care systems: obstacles and solutions. PLoS Med 2010; 7:e1000214. [PMID: 20231870 PMCID: PMC2834707 DOI: 10.1371/journal.pmed.1000214] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Duncan Clark and Howard Moss identify obstacles to alcohol-related screening and treatment for adolescents and propose policy solutions.
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Affiliation(s)
- Duncan B Clark
- Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States of America.
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Bottorff JL, Johnson JL, Moffat BM, Mulvogue T. Relief-oriented use of marijuana by teens. Subst Abuse Treat Prev Policy 2009; 4:7. [PMID: 19389223 PMCID: PMC2683812 DOI: 10.1186/1747-597x-4-7] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2008] [Accepted: 04/23/2009] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There are indications that marijuana is increasingly used to alleviate symptoms and for the treatment of a variety of medical conditions both physical and psychological. The purpose of this study was to describe the health concerns and problems that prompt some adolescents to use marijuana for therapeutic reasons, and their beliefs about the risks and benefits of the therapeutic use of marijuana. METHODS As part of a larger ethnographic study of 63 adolescents who were regular marijuana users, we analyzed interviews conducted with 20 youth who self-identified as using marijuana to relieve or manage health problems. RESULTS Thematic analysis revealed that these teens differentiated themselves from recreational users and positioned their use of marijuana for relief by emphasizing their inability to find other ways to deal with their health problems, the sophisticated ways in which they titrated their intake, and the benefits that they experienced. These teens used marijuana to gain relief from difficult feelings (including depression, anxiety and stress), sleep difficulties, problems with concentration and physical pain. Most were not overly concerned about the risks associated with using marijuana, maintaining that their use of marijuana was not 'in excess' and that their use fit into the realm of 'normal.' CONCLUSION Marijuana is perceived by some teens to be the only available alternative for teens experiencing difficult health problems when medical treatments have failed or when they lack access to appropriate health care.
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Affiliation(s)
- Joan L Bottorff
- Centre for Healthy Living and Chronic Disease Prevention, University of British Columbia Okanagan, 3333 University Way, Kelowna, BC V1V 1V7, Canada
- NEXUS Research Unit, University of British Columbia, 302-6190 Agronomy Road, Vancouver, BC V6T 1Z3, Canada
| | - Joy L Johnson
- NEXUS Research Unit, University of British Columbia, 302-6190 Agronomy Road, Vancouver, BC V6T 1Z3, Canada
- School of Nursing, University of British Columbia, 302-6190 Agronomy Road, Vancouver, BC V6T 1Z3, Canada
| | - Barbara M Moffat
- NEXUS Research Unit, University of British Columbia, 302-6190 Agronomy Road, Vancouver, BC V6T 1Z3, Canada
| | - Tamsin Mulvogue
- NEXUS Research Unit, University of British Columbia, 302-6190 Agronomy Road, Vancouver, BC V6T 1Z3, Canada
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Mielck A, Kiess R, Knesebeck OVD, Stirbu I, Kunst AE. Association between forgone care and household income among the elderly in five Western European countries - analyses based on survey data from the SHARE-study. BMC Health Serv Res 2009; 9:52. [PMID: 19309496 PMCID: PMC2666678 DOI: 10.1186/1472-6963-9-52] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2008] [Accepted: 03/23/2009] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Studies on the association between access to health care and household income have rarely included an assessment of 'forgone care', but this indicator could add to our understanding of the inverse care law. We hypothesize that reporting forgone care is more prevalent in low income groups. METHODS The study is based on the 'Survey of Health, Ageing and Retirement in Europe (SHARE)', focusing on the non-institutionalized population aged 50 years or older. Data are included from France, Germany, Greece, Italy and Sweden. The dependent variable is assessed by the following question: During the last twelve months, did you forgo any types of care because of the costs you would have to pay, or because this care was not available or not easily accessible? The main independent variable is household income, adjusted for household size and split into quintiles, calculating the quintile limits for each country separately. Information on age, sex, self assessed health and chronic disease is included as well. Logistic regression models were used for the multivariate analyses. RESULTS The overall level of forgone care differs considerably between the five countries (e.g. about 10 percent in Greece and 6 percent in Sweden). Low income groups report forgone care more often than high income groups. This association can also be found in analyses restricted to the subsample of persons with chronic disease. Associations between forgone care and income are particularly strong in Germany and Greece. Taking the example of Germany, forgone care in the lowest income quintile is 1.98 times (95% CI: 1.08-3.63) as high as in the highest income quintile. CONCLUSION Forgone care should be reduced even if it is not justified by an 'objective' need for health care, as it could be an independent stressor in its own right, and as patient satisfaction is a strong predictor of compliance. These efforts should focus on population groups with particularly high prevalence of forgone care, for example on patients with poor self assessed health, on women, and on low income groups. The inter-country differences point to the need to specify different policy recommendations for different countries.
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Affiliation(s)
- Andreas Mielck
- Helmholtz Zentrum Muenchen – German Research Center for Environmental Health, Institute of Health Economics and Health Care Management, P.O. Box 1129, 85758 Neuherberg, Germany
| | - Raphael Kiess
- Helmholtz Zentrum Muenchen – German Research Center for Environmental Health, Institute of Health Economics and Health Care Management, P.O. Box 1129, 85758 Neuherberg, Germany
| | - Olaf von dem Knesebeck
- University Medical Center Hamburg-Eppendorf, Department of Medical Sociology, Martinistr. 52, 20246 Hamburg, Germany
| | - Irina Stirbu
- Erasmus Medical Center, Department of Public Health, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Anton E Kunst
- Erasmus Medical Center, Department of Public Health, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
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Coker-Appiah DS, Akers AY, Banks B, Albritton T, Leniek K, Wynn M, Youmans SE, Parker D, Ellison A, Henderson S, Stith D, Council B, Oxendine-Pitt P, Corbie-Smith G. In their own voices: rural African American youth speak out about community-based HIV prevention interventions. Prog Community Health Partnersh 2009; 3:301-12. [PMID: 20097991 PMCID: PMC4167354 DOI: 10.1353/cpr.0.0093] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND The HIV epidemic is a major public health problem in the United States, particularly among rural African American adolescents and young adults. OBJECTIVES We sought to explore young, rural African American's perspectives about key programmatic components to consider when designing youth-targeted, community- based HIV prevention interventions. METHODS We report data from four focus groups with adolescents and young adults aged 16 to 24 (n = 38) conducted as part of a community-based participatory research (CBPR) project designed to develop multilevel HIV risk reduction interventions in two rural North Carolina communities with high HIV rates. Analysis was performed by academic and community partners using a modified grounded theory approach to content analysis. RESULTS Interventions should target preadolescents and early adolescents rather than older adolescents and young adults in an effort to "catch them while they're young." Intervention developers should obtain input from local young people regarding critical programmatic components, such as whom to employ as study recruiters and intervention leaders; intervention format and delivery options, acceptable recruitment and intervention locations, and incentive structures. Participants believe selecting community collaborators representing varied community sectors is critical. Important barriers to address included limited transportation, discomfort communicating about sexual issues, lack of community interest in HIV prevention, and unwillingness to acknowledge and address sexual activity among adolescents. CONCLUSION When designing HIV/AIDS prevention interventions, targeting young people, it is important to form academic-community partnerships that ensure young people's perspectives are integral to the intervention development process.
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Abstract
PURPOSE To discuss important factors that influence teens and provide guidance for nurse practitioners (NPs) to promote safe adolescent sexual decision making. DATA SOURCES A selective review of current professional literature and professional practice. CONCLUSIONS To promote safe sexual decision making in adolescents, communication with parents, other significant adults, and teens is essential. Being knowledgeable about factors that influence the choices of adolescents and willing to discuss them openly is an important component of NP practice and could make a difference in the lives of many teens. IMPLICATIONS FOR PRACTICE NPs are frontline healthcare providers who have many opportunities to promote safe adolescent sexual decision making. This article provides a guide to assist in this work.
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Affiliation(s)
- Josie A Weiss
- Christine E. Lynn College of Nursing, Florida Atlantic University, Treasure Coast Campus, Port St. Lucie, Florida, USA.
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Haller DM, Sanci LA, Patton GC, Sawyer SM. Toward youth friendly services: a survey of young people in primary care. J Gen Intern Med 2007; 22:775-81. [PMID: 17380370 PMCID: PMC2219862 DOI: 10.1007/s11606-007-0177-5] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2006] [Revised: 03/01/2007] [Accepted: 03/13/2007] [Indexed: 11/30/2022]
Abstract
BACKGROUND The World Health Organization encourages the development of youth friendly services, yet little is known on how youth currently present in general practice. OBJECTIVE To describe the perspectives, expectations, and service receipt of young people presenting to family doctors to inform the development of youth friendly services. DESIGN Cross-sectional survey. PARTICIPANTS AND MEASUREMENTS Consecutive young people attending 26 randomly selected practices were recruited in the waiting rooms. Standardized instruments were used to interview them before their consultation. RESULTS Of 501 young people who were approached, 450 participated (91% participation rate). Most had respiratory (26%) or dermatological complaints (18%). When asked to assess their health status, 59% perceived they had neither a physical nor a mental illness. However, 43% stated they had fears about their health problem and 1 in 5 feared it could be life-threatening. Although only 10% presented with psychological complaints, 24% perceived they currently had a mental illness. The most common expectations were treatment (50%) and good communication (42%). Most youth were prescribed medication (60%), but 40% of those who received a prescription had not expected to receive a treatment. A follow-up appointment was offered to 57% of participants. CONCLUSIONS This study identifies a gap between young people's perception of illness and their presentations to family doctors. It also highlights unexpected fears, and a mismatch between expectations and service receipt. These findings have implications for family medicine training and for clinical practice. They should inform the development of youth friendly services.
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Affiliation(s)
- Dagmar M Haller
- Centre for Adolescent Health, Murdoch Children's Institute at the Royal Children's Hospital, Melbourne, Australia.
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Objective and Self-Perceived Resources as Predictors of Depression Among Urban and Non-Urban Adolescent Mothers. J Youth Adolesc 2006. [DOI: 10.1007/s10964-006-9108-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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