The 1998 Herbert L. Needleman Award Lecture. Adolescent health: priorities for the next millennium

Population medicine in a curricular revision at Case Western Reserve

Inclusion of population medicine in a medical school curriculum has received growing attention. Recently, the Association of American Medical Colleges has highlighted this issue through support of the Regional Medicine and Public Health Education Centers initiative. The Case Western Reserve University School of Medicine joined this consortium while implementing a new curriculum in which population medicine would be an underlying theme woven with the classic science elements of disease. The organization for the first two years of the new curriculum, which was implemented in 2006, is a six-block structure during which the basic sciences are learned with key concepts of population medicine woven throughout. The focus for this article is Block One, in which population medicine is the major emphasis of the introduction to medicine. The first week, students learn social determinants, impact on communities, and social aspects of diabetes mellitus, even before addressing a patient's clinical presentation. Emphasis on student-centered learning is undertaken as part of the new curriculum, using a series of weekly, case-based, small-group sessions. This type of group learning is used throughout Block One as students encounter key components of population medicine. A thesis requirement was also introduced as a mechanism to emphasize research with opportunities for research in population medicine as well as other medical sciences. A variety of mechanisms are described to measure the outcomes of Block One.

The Intention of Future Mammography Screening Among Korean Women

The purpose of this study was to understand factors that influence future mammography intention and to differentiate significant factors influencing future mammography intention between those who have past mammography experience and those who do not. A cross-sectional study design was used to analyze characteristics and factors that influence the intention to have a mammogram among middle-aged Korean women. A total of 310 women, aged 30 and older, participated in the study. The study results indicated that a combination of the Health Belief Model and the Theory of Reasoned Action was effective in predicting mammography intention of Korean women. It found that knowledge, perceived benefits, self-efficacy, and the subjective norm were significant factors affecting mammography intention in women who have past mammography experience. For women who have never had a mammogram, age, knowledge, perceived benefits, and self-efficacy provided a significant contribution to predicting mammography intention. Thirty-three to 43% of the variability in mammography intention can be explained by the combined influence of these independent variables. The findings from this study can be used to guide the design and implementation of tailored health education and promotion programs for Korean women according to their mammography experience, so as to increase mammography screening.

Quality health care for adolescents with special health-care needs: issues and clinical implications

Assuring quality health care for the diverse U.S. adolescent population is a subject of growing concern among health-care providers and policy makers. Health-care services and policies must appreciate that experiences of adolescents with special health-care needs include challenges that stretch beyond those unique to their conditions to include relationships with family, friends, and professionals as well as their ability to function in school, clinics, and other settings. This review explores those issues while building upon the six core outcomes delineated in the draft 10-year action plan offered as an accompaniment to the U.S. Department of Health and Human Services' Healthy People 2010 guidelines.

Depressive symptoms and health risk among rural adolescents

OBJECTIVE

To determine the stability of depression and its relationship with health risk factors among rural adolescents.

METHODS

A clinic-based longitudinal study was conducted to test for depression and risk factors in 64 participants who attended a rural, primary care, adolescent medicine clinic. The primary measure of risk and depression was the Perkins Adolescent Risk Screen (PARS). Adolescent patients who were aged 12 to 18 years and had PARS assessments during a previous visit to the adolescent clinic were invited to complete a follow-up PARS assessment.

RESULTS

The mean age of adolescents at baseline was 12.79 years; 14.59 years at follow-up. With age and gender being controlled, adolescent depression and various adolescent risk indices were significantly related at baseline. Longitudinally, baseline depression score on PARS were related to follow-up: depression, school problems, substance abuse, tobacco use, sexual activity, and violent behavior scores and a history of physical/sexual abuse. On multivariate analysis controlling for other significantly associated variables, the relationship persisted for baseline depression and follow-up: tobacco, substance abuse, depression, and history of physical/sexual abuse.

CONCLUSION

This study confirms a strong longitudinal relationship between baseline depressive symptoms and several important risk behaviors/factors measured at follow-up in a clinic population of rural adolescents. Also, longitudinal stability of depression over time is supported.

Risk factors for substance abuse in adolescents

Much is written of adolescents taking risks, including using drugs and alcohol, without a clear understanding of factors that promote or deter such behaviors. This article attempts to clarify these factors in order to help physicians understand why adolescents behave in these ways and to help physicians develop methods to prevent these risky behaviors.