Intervention booster: adding a decision-making module to risk reduction and other health care programs for adolescents

A substance use decision aid for medically at-risk adolescents: results of a randomized controlled trial for cancer-surviving adolescents

BACKGROUND

Adolescent survivors of childhood cancer engage in risky behaviors.

OBJECTIVE

This study tested a decision aid for cancer-surviving adolescents aimed at difficult decisions related to engaging in substance use behaviors.

METHODS

This randomized controlled trial recruited 243 teen survivors at 3 cancer centers. The cognitive-behavioral skills program focused on decision making and substance use within the context of past treatment. Effects at 6 and 12 months were examined for decision making, risk motivation, and substance use behaviors using linear regression models.

RESULTS

The majority of the teen cancer survivors (90%) rated the program as positive. There was an intermediate effect at 6 months for change in risk motivation for low riskers, but this effect was not sustained at 12 months. For quality decision making, there was no significant effect between treatment groups for either time point.

CONCLUSIONS

The overall program effects were modest. Once teen survivors are in the program and learn what quality decision making is, their written reports indicated adjustment in their perception of their decision-making ability; thus, a more diagnostic baseline decision-making measure and a more intensive intervention are needed in the last 6 months. With 2 of 3 teen participants dealing with cognitive difficulties, the data suggest that this type of intervention will continue to be challenging, especially when 90% of their household members and 56% of their close friends model substance use.

IMPLICATIONS FOR PRACTICE

This effectiveness trial using late-effects clinics provides recommendations for further program development for medically at-risk adolescents, particularly ones with cognitive difficulties.

The effect of alcohol use on human adolescent brain structures and systems

This article reviews the neurocognitive and neuroimaging literature regarding the effect of alcohol use on human adolescent brain structure and function. Adolescents who engage in heavy alcohol use, even at subdiagnostic levels, show differences in brain structure, function, and behavior when compared with non-drinking controls. Preliminary longitudinal studies have helped disentangle premorbid factors from consequences associated with drinking. Neural abnormalities and cognitive disadvantages both appear to predate drinking, particularly in youth who have a family history of alcoholism, and are directly related to the neurotoxic effect of alcohol use. Binge drinking and withdrawal and hangover symptoms have been associated with the greatest neural abnormalities during adolescence, particularly in frontal, parietal, and temporal regions.

Neurotoxic effects of alcohol in adolescence

This review examines neuroimaging and neurocognitive findings on alcohol-related toxicity in adolescents. Teens who meet criteria for alcohol use disorders, as well as those who engage in subdiagnostic binge drinking behaviors, often show poorer neurocognitive performance, alterations in gray and white matter brain structure, and discrepant functional brain activation patterns when compared to nonusing and demographically matched controls. Abnormalities are also observed in teens with a family history of alcoholism, and such differences in neuromaturation may leave youths at increased risk for the development of an alcohol use disorder or increased substance use severity. More prospective investigations are needed, and future work should focus on disentangling preexisting differences from dose-dependent effects of alcohol on neurodevelopment. Intervention strategies that utilize neuroimaging findings (e.g., identified weaknesses in particular neural substrates and behavioral correlates) may be helpful in both prevention and intervention campaigns for teens both pre- and postinitiation of alcohol use.

Neurotoxic effects of alcohol in adolescence

This review examines neuroimaging and neurocognitive findings on alcohol-related toxicity in adolescents. Teens who meet criteria for alcohol use disorders, as well as those who engage in subdiagnostic binge drinking behaviors, often show poorer neurocognitive performance, alterations in gray and white matter brain structure, and discrepant functional brain activation patterns when compared to nonusing and demographically matched controls. Abnormalities are also observed in teens with a family history of alcoholism, and such differences in neuromaturation may leave youths at increased risk for the development of an alcohol use disorder or increased substance use severity. More prospective investigations are needed, and future work should focus on disentangling preexisting differences from dose-dependent effects of alcohol on neurodevelopment. Intervention strategies that utilize neuroimaging findings (e.g., identified weaknesses in particular neural substrates and behavioral correlates) may be helpful in both prevention and intervention campaigns for teens both pre- and postinitiation of alcohol use.

The relationship between female adolescent self-esteem, decision making, and contraceptive behavior

PURPOSE

To examine the relationship between female adolescent self-esteem, decision making, and contraceptive behavior in multiethnic, 14- to 17-year-olds, residing on the Big Island of Hawaii.

DATA SOURCES

This was a descriptive cross-sectional survey design using a convenience sample of 98 female adolescents aged 14-17 who came to five different clinics on the Big Island of Hawaii for health care. Along with a brief demographic questionnaire, global self-esteem was measured by Rosenberg's Self-Esteem Scale, decision making was measured by the Flinders Adolescent Decision Making Questionnaire, and sexual activity and contraception use was measured by a nonnormed Sexual History and Contraceptive Use Questionnaire developed for this study. Descriptive statistics, logistic regression, and correlations were used to analyze associations and correlations between age, global self-esteem, decision self-esteem, decision coping (vigilant and maladaptive), and contraceptive use for sexually active female adolescents.

CONCLUSIONS

No significant associations or correlations were found between age, global self-esteem, decision self-esteem, decision coping (vigilance), and the decision to use contraception in sexually active adolescent females. There was, however, significant negative correlation (p < .05) between overall maladaptive decision making and contraceptive use in sexually active female adolescents. This suggests that sexually active adolescent females with higher maladaptive scores are less likely to use contraception. There was also significant association (p < .05) between maladaptive decision making in contraceptive use and sexually active female adolescents. For every one unit increase on the maladaptive scale, the odds of using contraception were estimated to decrease by 7%.

IMPLICATIONS FOR PRACTICE

Adolescence is a period of transition that involves biological, cognitive, psychological, and social changes. During the vulnerable transition period of adolescence, decisions relating to contraception may occur. Interventions focused on improving decision-making skills and stimulating thinking around not only sexual issues but also on relationship and communication in adolescent issues may facilitate more competent decision making. Understanding the relationship between female adolescent self-esteem, decision making, and contraceptive behavior has contributed to the knowledge base about female contraceptive behavior. Gaining further insight into these relationships will help healthcare professionals provide counseling and health care to female adolescents.

Men's experiences viewing an HIV/AIDS prevention education film by and for women

The purpose of this study is to understand (a) the experience of men viewing the film Women's Voices Women's Lives (WVWL), a prevention education film for and by heterosexual African American women living with HIV/AIDS in the United States, and (b) the perceived needs of male viewers on how to best access effective HIV/AIDS prevention messages. A postviewing structured written survey was completed addressing the experience of viewing the film and HIV prevention services in the community, respectively (N = 16). Responses include stunning realization and anger that motivated viewers to get immediately screened for HIV. In addition, the men felt they were informed about HIV risk through the courage and candidness of the women describing their experience. Participants reported that a film similar to WVWL should be made for heterosexual/bisexual men. The authors conclude film prevention messages are a powerful means to convey health education ideas.

Chronic and cancer pain management

PURPOSE OF REVIEW

Chronic pain management in children is not recognized and treated adequately. The purpose of this review is to recognize some common chronic pain problems in children and offer guidelines for their management.

RECENT FINDINGS

This points to newer research in understanding complex regional pain syndromes-type 1 in children. This review will also discuss some recent findings regarding pain management techniques in children particularly the use of intravenous regional anesthesia for sympathetic blockade for complex regional pain syndromes-type 1. Cancer pain and headache with a logical step ladder management will be discussed.

SUMMARY

Although the under-treatment of chronic pain in children is still prevalent, it is important to understand the mechanisms and management of common pain problems in children and adolescents.

Maturing responsibility in young teens participating in an asthma camp: adaptive mechanisms and outcomes

PURPOSE

The purpose of this study was to describe adolescent adaptation in the four adaptive modes of the Roy Adaptation Model in campers attending a Young Teen Asthma Camp and relate that adaptation to the acquisition of asthma responsibility.

DESIGN AND METHODS

The camp experience included asthma education and an opportunity to grow socially. A quasi-experimental design investigated ratings of self-efficacy and responsibility from before to after camp.

RESULTS

Improvements in self-efficacy supported adaptation in self-concept and role function. Adolescents demonstrated maturing responsibility in asthma management in interdependence mode.

PRACTICE IMPLICATIONS

Asthma camps are effective for delivering asthma education, enhancing maturation, and assisting with normalizing life experiences. Nurses can be instrumental in facilitating adolescents' participation.

An exploration of decision-making factors regarding advance directives in a long-term care facility

PURPOSE

To explore the experiences of residents who had signed an advance directive on admission to a long-term care facility and apply the Advance Directive Decision-Making Model to this process.

DATA SOURCES

Interactive interviews with 13 elders. Questions related to how each felt about their life and death, how each perceived the advance directive discussion, and what factors influenced their decisions were discussed.

CONCLUSIONS

The thematic analysis suggested that the decision regarding advance directives was multifaceted and complex. It required preparation, understanding, and time. Decision-making ability was sometimes compromised by the other stressors associated with the move to a long-term care facility.

IMPLICATIONS FOR PRACTICE

Nurse practitioners will have an easier time discussing medical conditions and choices regarding end-of-life care with residents and their families if advance directives are discussed thoroughly on admission to a long-term care facility and are updated routinely.

A model of teen-friendly care for young women with negative pregnancy test results

Sexually active adolescents, and especially those who receive negative pregnancy test results, are a self-identified group at particularly high risk for STIs and unintended pregnancies. Although reproductive health care alone will not totally prevent the occurrence of teen pregnancy and STIs, providing care that is accessible and designed to be teen-friendly will help diminish this area of health risk for hundreds of thousands of U.S. adolescents. Clinical interventions that are theoretically sound and based on research allow for the development of innovative, individualized, and evolving models of adolescent health care to address the needs of a challenging group of patients within a changing and competitive health care environment.

Unintentional injuries in the young adult male

PURPOSE

To review the primary causes of unintentional deaths in young adult males and suggest strategies for educating young men about reducing risks for accidental death.

DATA SOURCES

Selected scientific literature and Internet sources.

CONCLUSIONS

Unintentional deaths are the fifth leading cause of death in all age groups, after heart disease, cancer, stroke, and chronic obstructive pulmonary disease. Accidental death is the leading cause of death in males 1 to 44 years of age. Motor vehicle crashes, drowning, gunshot wounds, and occupational fatalities are among the leading injuries that contribute to the unanticipated death of the young adult male.

IMPLICATIONS FOR PRACTICE

The ability to make sound decisions is a developmental process that is not achieved until later in adolescence or early adulthood. Nurse practitioners must assess the adolescent developmentally to provide appropriate guidance and assistance with behavior change.

Children's competence to participate in healthcare decisions

Advances in chronic and genetic disease management and technology create new challenges for healthcare professionals and patients in making informed decisions. The growing interest in children's involvement in their own healthcare decisions and a rebalancing of child and adolescent rights and responsibilities compounds these challenges. This article presents an overview of research and standards of practice regarding children's participation in research and healthcare decisions. Further research on children's competence to participate in healthcare decisions is recommended. Reasons for and against children's increased involvement in healthcare decisions are included. There is a preponderance of support for involving children in the process, and a dearth of well-articulated reasons to exclude them.

A clinical profile to predict decision making, risk behaviors, clinical status, and health-related quality of life for cancer-surviving adolescents: part 2

This is the second part of a two-part article describing a multifactorial model of clinical factors predicting decision-making quality, risk behaviors, clinical status, and health-related quality of life for cancer-surviving adolescents. To support the conceptualization of the model, findings from the literature and from the research program of the current author are presented. In part 1, support for the antecedent predictors, both primary and secondary factors, was presented. In part 2, the mediator of decision making, the moderator of risk motivation, and the expected outcomes related to risk behaviors, clinical status, and health-related quality of life are addressed. Besides a description supporting the second part of the clinical profile and its empirical underpinnings in part 2, methodologic challenges in future research and implications for clinical trials and clinical use specific to cancer-surviving adolescents also are discussed.