Future orientation: a construct with implications for adolescent health and wellbeing

Community Asset Density and Past-Year Mental Health Symptoms Among Youths

Importance

Many youths experience mental health challenges. Identifying which neighborhood and community factors may influence mental health may guide health policy and practice.

Objective

To explore associations between community assets (eg, schools, parks, libraries, and barbershops) and past-year mental health symptoms among youths.

Design, Setting, and Participants

This cross-sectional study leveraged 3 datasets, which were linked by 26 zip codes: the Western Pennsylvania Regional Data Center, the Child Opportunity Index 2.0 database, and the Allegheny County Youth Risk Behavior Survey (YRBS). The YRBS was administered during the study period in 2018 to youths across 13 high schools in Allegheny County, Pennsylvania; the study dates were from October 15 to October 19, 2018. Dates of analysis were from August 1, 2023, to July 15, 2024.

Exposures

Asset density in each zip code across 8 asset categories (transportation, education, parks and recreation, faith-based entities, health services, food resources, personal care services, and social infrastructure) was calculated.

Main Outcomes and Measures

The main outcomes were mental health measures included in the past 12 months, which comprised feelings of hopelessness (feeing so sad or hopeless that you stopped doing activities), nonsuicidal self-injury (hurt yourself on purpose without wanting to die), and suicidal ideation (seriously considered attempting suicide). All were operationalized to any or none. Data were analyzed using multivariable generalized linear mixed models and were adjusted for age, sex assigned at birth, race and ethnicity, and identification as sexually or gender diverse.

Results

Among 6306 students who were eligible for the YRBS based on their enrollment in participating high schools, 4487 students completed surveys, and 2162 were included in the analytic sample (mean [SD] age, 15.8 [1.2] years; 1245 [57.6%] were assigned female sex at birth). Over one-third of the participants (811 [37.5%]) reported past-year feelings of hopelessness; 587 (27.2%), past-year nonsuicidal self-injury; and 450 (20.8%), past-year suicidal ideation. High total asset population density (adjusted odds ratio [AOR], 0.85 [95% CI, 0.75-0.97]; P = .01), as well as population density of transportation assets (AOR, 0.77 [95% CI, 0.66-0.90]; P < .001), educational resources (AOR, 0.78 [95% CI, 0.67-0.92]; P = .002), and health services (AOR, 0.74 [95% CI, 0.60-0.91]; P = .006), were associated with lower odds of past-year hopelessness after adjusting for covariates. There were no correlations between asset density, Child Opportunity Index, and other mental health measures.

Conclusions and Relevance

The findings of this cross-sectional study suggest that access to certain community assets was associated with lower odds of feelings of hopelessness among youths. Ongoing work is needed to characterize other forms of social and cultural capital, which may mitigate negative mental health outcomes among adolescent youths.

Asthma and Adolescence: Unique Opportunities for Fostering Asthma Self-Management and Asthma Control

Asthma is a significant worldwide concern among adolescents. Adolescents experience key cognitive and psychosocial developmental changes that they must negotiate as they transition from children to adults. Several of these changes have implications for their ability to effectively manage their asthma. When health care professionals (HCPs) understand these pivotal changes and their role in asthma management, they are better able to work with adolescents and help them become effective asthma self-managers. Therefore, this article reviews the cognitive changes that render adolescents ready to care for their asthma, as well as the following psychosocial changes that may hinder or facilitate self-management: independence from caregivers, reliance on peers, identity development, the role of social media in adolescents' lives, and risk-taking behaviors. Each developmental task is discussed in terms of asthma self-management and offers suggestions for HCPs that may help them work more effectively with adolescents with asthma.

Specificity of Episodic Future Thinking in Adolescents: Comparing Childhood Maltreatment, Autism Spectrum, and Typical Development

Maltreatment and autism can be associated with overlapping difficulties across functional domains (e.g., social, emotional, and sensory) and high rates of mental health problems. A cognitive approach focussing on affect-laden cognition, here on episodic future thinking (FT), could help inform cognitive assessments and adapt psychological interventions. Three groups of adolescents (N = 85), (i) maltreatment (n = 28), (ii) autism (n = 29), and (iii) typical development without maltreatment/autism (TD; n = 28), matched in age (10-16 years old), sex (assigned at birth), and socioeconomic status, completed a newly adapted online Autobiographical Future Thinking Test. As predicted, the maltreatment group generated significantly fewer specific future events relative to the TD group, however, the number of specific future events did not significantly differ between the autism and the other groups. Exploratory analyses showed that lower FT specificity was significantly associated with more depressive (but not anxiety) symptoms across the three groups. These findings shed light on the cognitive profiles of both maltreatment and autism during adolescence and signal FT as a potential therapeutic target for adolescents with these developmental differences. Our study lays the foundation for additional comparisons of maltreatment-related presentations versus autism with improved designs and a broader set of cognitive and clinical domains.

Perceptions of the Future and Health Behavior in Adulthood

Engagement in healthier lifestyle behaviors often is motivated by a focus on the future. However, there is limited research on the associations between health behavior and future time perspective, defined as people's tendency to perceive their future as expansive or as limited. Data came from a survey of U.S. adults (N = 805, 49.3% female; M = 50 years, range: 19 to 85 years). Participants completed measures of perceptions of future opportunities and time and health behavior. Opportunities and time factors were uniquely associated with health behavior. While the perceived opportunities factor was strongly associated with better health behavior, the time factor was associated with poorer health behavior. However, this latter association was dependent on individual demographic and health status differences. These findings suggest that perceptions of future opportunities can play an important role in health behavior engagement and thus represent an important target for health promotion.

Linking undergraduates' future orientation and their employability confidence: The role of vocational identity clarity and internship effectiveness

Given the growing research interest in students' school-to-work transition, we examine the positive effects of undergraduates' future orientation on their employability confidence. Specifically, building on social cognitive career theory which suggests that career choices are influenced by a person's experiences, beliefs, interests, and values, we explore the mediator of vocational identity clarity and the positive moderator of internship effectiveness in this association above. Two studies were conducted to test our model. Study 1 included a laboratory experiment (N = 136) and tested the positive association between undergraduates' future orientation and their employability confidence through vocational identity clarity. Study 2 used a time-lagged research design from undergraduates (N = 315) to replicate the results and to additionally test a mediating role of internship effectiveness. We find that undergraduates' future orientation has a strong positive relationship with employability confidence, and this relation is mediated by vocational identity clarity. Additionally, the results show a positive moderation effect, that is, when undergraduates' internship effectiveness is high, the above indirect relation becomes stronger. The current research enriches the existing understanding of how and when the students' future orientation can contribute to employability confidence theoretically and empirically. Meanwhile, these findings indicated valuable practical applications by encouraging universities to promote undergraduates' future orientation and provide effective internships for them towards enhancing their vocational identity clarity and ultimately boosting their employability confidence.

Developmental Trajectories of Mental Health in Chinese Early Adolescents: School Climate and Future Orientation as Predictors

There is growing support for the dual-continua model of mental health, which emphasizes psychopathology and well-being as related but distinct dimensions. Yet, little is known about how these dimensions co-develop from childhood to early adolescence and what factors predict their different trajectories. The current study aimed to identify distinct patterns of mental health in Chinese early adolescents, focusing on both psychopathological symptoms (i.e., depressive symptoms and self-harm behaviors) and subjective well-being (i.e., life satisfaction and affect balance). This study also examined the contributions of school climate and future orientation to these trajectories. A total of 1,057 students (Mage = 11.88, SDage = 1.67; 62.1% boys) completed four assessments over two years, with six-month intervals. Using parallel-process latent class growth modeling, we identified four groups: Flourishing (32.5%), Languishing (43.8%), Troubled with Stable Depressive Symptoms (16.1%), and Troubled with Increasing Self-Harm Risk (7.6%). Furthermore, school climate and future orientation contributed to adolescents' membership in these trajectories, either independently or jointly. Specifically, higher levels of future orientation combined with higher school climate were associated with a lower likelihood of belonging to the Troubled with Increasing Self-Harm Risk trajectory, compared to the Flourishing group. Our findings identified four distinct mental health trajectories consistent with the dual-continua model, and demonstrated that the development of psychopathology and well-being were not always inversely related (e.g., the Languishing group). Adolescents with unique developmental profiles may benefit from tailored intervention strategies that build on the personal and environmental assets of the adolescent.

Cash Transfers and After-School Programs: A Randomized Controlled Trial for Young Men at Risk of Violence Exposure in Wilmington, Delaware

We conducted a randomized controlled trial to determine whether an after-school program paired with a cash transfer (a conditional cash transfer) or a cash transfer alone (an unconditional cash transfer) can help improve health and economic outcomes for young men between the ages of 14 and 17 whose parents have low incomes and who live in neighborhoods with high crime rates. We find that receiving the cash transfer alone was associated with an increase in healthy behaviors (one of our primary outcome composite measures) and that the cash transfer paired with after-school programming was associated with an improvement in the financial health of participants (one of our secondary outcome composite measures). We find no differences in spending on alcohol, marijuana, cigarettes, or other drugs between either the treatment group and the control group. Neither the cash transfer alone nor the programming plus cash transfer had statistically significant effects on our other primary composite measures (physical and mental health or school attendance and disciplinary actions), or our other secondary composite measures (criminal justice engagement or social supports) but in most cases, confidence intervals were too large to rule out meaningful effects. Results suggest that cash transfers hold promise to improve the health of youth without any indication of any adverse effects.

Protective Factors in the Context of Childhood Bereavement: Youth Gratitude, Future Orientation, and Purpose in Life

The objective of the study was to examine potential associations between positive youth development constructs (gratitude, future orientation, purpose in life) and psychological functioning (posttraumatic stress symptoms, depressive symptoms, maladaptive grief reactions) among bereaved youth and test whether these associations vary by age. A diverse sample of 197 clinic-referred bereaved youth (56.2% female; M = 12.36, SD = 3.18; 36.1% Hispanic, 23.7% White, 20.1% Black, 11.9% Multiracial, and 8.2% another race/ethnicity) completed self-report measures of psychological functioning and positive youth development constructs. Linear regression models indicated that gratitude and purpose were associated with lower posttraumatic stress and depressive symptoms among bereaved youth. Future orientation was associated with higher posttraumatic stress symptoms. Results were consistent across age. If replicated longitudinally, gratitude and purpose may be important protective factors against negative mental health outcomes in the aftermath of losing a loved one.

Childhood Violence, High School Academic Environment, and Adult Alcohol Use Among Latinas and Black Women: A Structural Equation Modeling Study

OBJECTIVE

Young Latinas and Black women drink less than women of other racial/ethnic groups but experience more alcohol-related problems in midlife. This study aims to identify modifiable factors to prevent adult onset of alcohol use disorder (AUD) in this population.

METHODS

Data were collected at six time points as part of the Harlem Longitudinal Development Study from 365 Latinas (47%) and Black (53%) women (mean age at time 1 = 14, standard deviation 1.3). Structural equation modeling was used to test hypothesized pathways from childhood physical and sexual abuse to AUD via depressive mood, anxiety disorders, and somatic complaints in the 20s. We also tested the moderation effect of the high school academic environment by including in the structural equation model two latent variable interaction terms between the school environment and each of the abuse variables.

RESULTS

Childhood physical and sexual abuse was positively associated with depressive mood, anxiety disorders, and somatic complaints when participants were in the 20s. Depressive mood mediated childhood abuse and AUD when women were in the 30s. The high school academic environment attenuated the effect of physical, but not sexual abuse, on depressive mood (β = -0.59, B = -9.38, 95% CI [-14.00, -4.76]), anxiety symptoms (β = -0.61, B = -14.19, 95% CI [-21.76, -6.61]), appetite loss (β = -0.41, B = -10.52, 95% CI [-15.61, -5.42]), and sleeplessness (β = -0.50, B = -9.56, 95% CI [-13.95, -5.17]) in the early 20s.

CONCLUSIONS

Our findings underscore the need to invest in early violence prevention interventions and in education to ensure equitable access to quality, academically oriented, and safe schools.

Caregiver behaviors associated with positive youth development among bereaved children

Grounded in Multidimensional Grief Theory, this study examined the cross-sectional associations between child-reported caregiver grief facilitation behaviors (ongoing connection, grief expression, existential continuity and support, grief inhibition/avoidance) and positive youth development outcomes (future orientation, gratitude, social responsibility) in treatment-seeking bereaved children ages 7 to 18 (N = 170; 54.1% girls; 35.9% Hispanic/Latinx, 24.9% White, 17.8% Black) from the United States. Results indicate that higher levels of perceived caregiver existential continuity and support (behaviors theorized to promote the continuity of child routines and reassurance of a positive future after experiencing a death) were associated with greater future orientation and social responsibility values among participants. Findings suggest that in the wake of a death, structured and supportive caregiver responses may be related to children's positive outlook on their future and commitment to others.

Proposing and testing the pathways from bullying victimization to bringing a weapon to school

OBJECTIVE

The current study examined whether bullying victimization was associated with bringing a weapon to school, fully or partly mediated by feeling unsafe in school, negative future education orientation, and skipping school.

METHOD

Data from 6199 students (12-18 years old), who had filled out the 2017 School Crime Supplement to the National Crime Victimization Survey, were analyzed.

RESULTS

The results showed a positive association between bullying victimization and bringing a weapon to school. The link was both direct and indirect through the mediating roles of feeling unsafe in school, having a negative future education orientation, and skipping school.

CONCLUSION

Thus, victims of bullying tended to feel unsafe in school, have a negative future education orientation, and skip school-all of which were positively associated with bringing a weapon to school.

Adolescent Contact, Lasting Impact? Lessons Learned From Two Longitudinal Studies Spanning 20 Years of Developmental Science Research With Justice-System-Involved Youths

In this article, we summarize key findings from 20 years of research conducted at the intersection of developmental psychology and juvenile justice in the United States. We predominantly examine data from two large-scale, multisite longitudinal studies involving justice-system-involved adolescents-the Pathways to Desistance study and the Crossroads study. Topics of discussion include predictors of offending and desistance from crime; youth outcomes and psychosocial needs; and emerging research, programs, and policy initiatives. First, individual-level (e.g., age, psychosocial maturity) and contextual-level (e.g., antisocial peers, exposure to violence) risk factors associated with offending are explored. Second, we discuss short-term and long-term outcomes of justice-system contact for youths engaging in moderate offenses. We highlight main findings from the Crossroads study indicating that youths who are sanctioned by the justice system at their first arrest have worse outcomes than youths who are diverted from formal processing. Additionally, we discuss the high prevalence of youths' exposure to violence and mental health disorders as well as the differential treatment of youths of color in the justice system. Third, we extend the conversation to justice-system-involved young adults and discuss emerging, innovative legal solutions, including young adult courts. Last, we discuss real-world implications of these findings.

How the COVID-19 pandemic shaped adolescents' future orientations: Insights from a global scoping review

Throughout adolescence, youth imagine what the future holds and determine plans to achieve their educational, professional, and personal goals. In this article, we review research that explores how adolescents' future orientations were shaped by the societal unpredictability, physical and mental health risks, and educational disruptions brought on by the COVID-19 pandemic. Findings show that the pandemic, which exacerbated existing societal inequities, also heightened adolescents' social awareness, provoked feelings of uncertainty, and altered adolescents' short- and long-term plans for educational and career prospects. Throughout school building closures and program cancellations, families played a greater role in fostering adolescents' plans. With prospects for more societal uncertainty on the horizon, future directions point toward supporting adolescents in developing adaptable and flexible future orientations.

Decline in positive future orientations among adolescents during covid-19: The role of socioeconomic status, parental support, and sense of control

INTRODUCTION

Before coronavirus disease (covid-19), adolescents from a lower socioeconomic status (SES) background tend to have less positive future orientations, receive less parental support, and have a weaker sense of control than adolescents from a higher SES background. The covid-19 pandemic has potentially increased the socioeconomic gaps in positive future orientations, parental support, and sense of control among adolescents who are currently in vocational education. As societies are aiming to return back to precovid norms, certain groups of adolescents might require more attention for ensuring a stable future than others.

METHODS

Two-wave questionnaire data of 689 Dutch adolescents (Mage  = 17.8; 56% female) from the Youth Got Talent project was analyzed. Latent Change Score models are a relatively novel approach that allows two-wave data to estimate associations between precovid predictor variables and changes in outcome variables from before to during covid-19 (e.g., SES, positive future orientations, parental support, and sense of control). Analyses were preregistered.

RESULTS

The precovid socioeconomic differences in adolescent's positive future orientations and sense of control remained stable during covid-19, whereas the socioeconomic difference in parental support decreased during covid-19. A decline in parental support, an increase in sense of control, and more covid-19 hardships were associated with an increase in future orientations.

CONCLUSION

The covid-19 situation has not substantially increased socioeconomic differences in positive future orientations and sense of control, but did decrease socioeconomic differences in parental support among adolescents. Short-term policies should aim to facilitate parental support and positive future orientations to all adolescents who experienced a decline, while also long-term focusing on the more consistent socioeconomic difference in sense of control among adolescents.

Climate anxiety, coping strategies and planning for the future in environmental degree students in the UK

Introduction

There is increasing recognition of the mental health burden of climate change and the effects on general well-being, even in those who have not (yet) experienced direct impacts. Climate anxiety, which is prominent among young people in particular, describes a state of heightened distress about the (future) effects of climate change. Despite evidence of a link between engagement in climate change issues and heightened climate anxiety, there is a dearth of knowledge on how this affects emerging professionals preparing for careers in the environmental sector. Furthermore, there is a paucity of literature regarding the extent to which young adults are coping with their thoughts and feelings about climate change, and the extent to which they consider climate change in making future plans.

Methods

The aim of this study was to understand the occurrence and personal management of climate anxiety in UK university students through an online questionnaire. This study was the first to investigate the association between climate anxiety, coping strategies and future planning in university students.

Results and discussion

Environmental degree students (n = 249) reported greater levels of climate anxiety, more frequent employment of all three examined coping strategies and in particular considered climate change as a factor in their career plans, as compared to their non-environmental degree counterparts (n = 224). Problem-focused coping was the most commonly endorsed strategy, although the prior literature on coping suggests that this may not be sustainable for individually intractable problems. Highly climate-anxious students were more likely to consider climate change in all five decision-making domains, including family planning, long-term habitation, career, financial and travel decisions. This study has identified a need to communicate effective climate anxiety coping strategies to environmental practitioners, university students and educators. Additional research is required to validate the study findings and investigate what motivates students to incorporate climate change into future plans.

Examining Longitudinal Associations Between Future Orientation and Multiple Forms of Youth Violence Perpetration

PURPOSE

Future orientation, defined as hopes and aspirations for the future, is gaining promise as a cross-cutting protective factor against youth violence. This study assessed how future orientation longitudinally predicted multiple forms of violence perpetration among minoritized male youth in neighborhoods made vulnerable by concentrated disadvantage.

METHODS

Data were drawn from a sexual violence (SV) prevention trial among 817 predominately African American male youth, ages 13 to 19, residing in neighborhoods disproportionately impacted by community violence. We used latent class analysis to create baseline future orientation profiles of participants. Mixed effects models examined how future orientation classes predicted multiple forms of violence perpetration (i.e., weapon violence, bullying, sexual harassment, non-partner SV, and intimate partner SV) at 9-month follow-up.

RESULTS

Latent class analysis yielded four classes, with nearly 80% of youth belonging to moderately high and high future orientation classes. We found significant overall associations between latent class and weapon violence, bullying, sexual harassment, non-partner SV, and SV (all p < .01). While patterns of association differed across each type of violence, violence perpetration was consistently highest among youth in the low-moderate future orientation class. Compared to youth in the low future orientation class, youth in the low-moderate class had higher odds of bullying (odds ratio 3.51, 95% confidence interval: 1.56-7.91) and sexual harassment perpetration (odds ratio 3.44, 95% confidence interval: 1.49-7.94).

DISCUSSION

The longitudinal relationship between future orientation and youth violence may not be linear. Greater attention to nuanced patterns of future orientation may better inform interventions seeking to harness this protective factor to reduce youth violence.

How to approach and take care of minor adolescents whose situations raise ethical dilemmas? a position paper of the European academy of pediatrics

In the care of adolescents, health care providers often face situations raising ethical concerns or dilemmas, such as refusal of a treatment or hospitalization, or request of confidentiality while engaging in risky behaviors or facing unplanned pregnancy. This position paper provides concrete avenues as how to assess the adolescent's capacity for autonomous decision making, e.g. the patient's competence in a specific situation, and how to elicit informed choice or consent. To do so, professionals need to be sensitized and trained as how to assess the cognitive and socio-psychological development of the young patient. Another challenge for the health professionals is to balance the needs to support patient's autonomy while offering secure guidance and protection if needed. To optimize such a process, they establish a climate of trust and empathy that will allow the patient to participate freely in the decision. In addition, especially when the decisions have potentially important consequences on the health and life, the professionals include, with the adolescent's permission, parents, caregivers or other significant adults, as well as they may request the opinion of other members of the health care team or expert colleagues such as ethicists.

Future orientation and moral judgment in chinese youths: the mediating role of moral disengagement and the moderating role of self-control

Based on the self-regulation theory, this study aims to examine the relationship between youths' future orientation and judgment of their own immoral behaviors. A moderated mediation model was constructed to investigate the mediating role of moral disengagement and moderating role of self-control. Six hundred and twenty-eight Chinese youths, with an age range from 16 to 34 years (M = 23.08, SD = 2.65), were recruited to take part in an anonymous survey about future orientation, moral disengagement, self-control, and moral judgment. Results revealed that youths with high future orientation judged their own moral transgressions more harshly and that moral disengagement partially mediated the relationship between the two. Moderated mediation analysis further demonstrated that self-control moderated the relationship between future orientation and moral disengagement and the indirect effect between future orientation and youths' judgment of their own immoral behaviors. To be specific, the indirect effect was much stronger for youths with high levels of self-control. These findings not only enrich the research about how future orientation affects youths' judgment of their own immoral behaviors, but also reveal the underlying mechanisms between future orientation and moral judgment, which can provide practical guidance for implementing measures that effectively enhance youths' moral character and cultivate their ability to think positively about the future.

Future orientation in justice-involved youth: The effects of adverse and positive childhood experiences, and being dual-status

BACKGROUND

Justice-involved youth face diverse challenges and are likely to experience more adverse childhood experiences (ACEs) and fewer positive childhood experiences (PCEs), which can have implications for their orientation toward their future. Future orientation is thought to influence behavior, but little is known about how it is shaped. While future orientation and its correlates likely matter for all justice-involved youth, the recently recognized subcategory of Dual Status Youths (DSYs) might be especially sensitive to influences on future orientation.

OBJECTIVE

This study explores the effects of cumulative adverse childhood experiences (ACEs), cumulative positive childhood experiences (PCEs), and DSY classification on the likelihood of having a positive orientation toward the future.

PARTICIPANTS AND SETTING

The researchers analyze a sample of 3604 justice-involved youth on probation in a large metropolitan area in Texas.

METHOD

The sample includes juveniles who received the full Positive Achievement Change Tool (PACT) risk/needs assessment. The analytical plan included t-tests and two logistic regression analyses.

RESULTS

Findings were that DSY are exposed to more ACEs and fewer PCEs than non-dual status justice-involved youth. Results indicated that a greater number of PCEs is associated with future orientation, but DSY status and ACEs are not.

CONCLUSIONS

Juvenile justice programming must strive to cultivate PCEs in justice-involved youth prior to the completion of their probation supervision.

The association between callous-unemotional traits and suicide ideation among youth: A conditional process analysis

BACKGROUND

The relationship between callous-unemotional (CU) traits (the affective facet of psychopathy and the psychopathy that occurs during childhood and adolescence) and suicide ideation (SI) remains unclear. The mechanisms underlying this association still have a gap in the literature. The aims of this study were to determine whether and how callous-unemotional traits were associated with suicide ideation, and to evaluate the mediating effect of negative affect (includes irritability, depression, and anxiety) and the moderating effect of future orientation on the association.

METHODS

Data were extracted from a longitudinal study involving middle and high school students, with 1,913 students (55.3% girls) aged 11 to 19 years (14.9 ± 1.6 years) completing a self-reported online survey. The conditional process analysis was examined using Mplus 8.3.

RESULTS

We found that callous-unemotional traits positively predicted youths' current suicide ideation, with the observed positive relationship partly mediated by negative affect. However, callous-unemotional traits did not predict the worst-point suicide ideation, which indicated the connection fully mediated by negative affect. Furthermore, future orientation moderated these indirect effects.

LIMITATIONS

Use of self-report measures and cross-sectional design.

CONCLUSIONS

These findings provided evidence for current debates and conflicting conclusions, and set the foundation for future research, as well as implied the important intervention goals for reducing suicide ideation in youth.

Peers' parental education and cardiovascular disease risk in adulthood: The mediating role of health-related behaviors

RATIONALE

Although there is a growing body of empirical evidence on the relationship between peers' parental education and adolescents' educational outcomes, little is known about whether exposure to highly educated peers' parents is associated with improved physical health in adulthood.

OBJECTIVE

This study investigated the relationship between the education level of peers' parents (Wave I) and the risk of developing cardiovascular disease (CVD) in adulthood (Wave IV). Moreover, we considered a set of health-related behaviors (Wave II) as the underlying mechanisms linking peers' parental education to later-life physical health such as substance use (smoking, binge drinking, and marijuana use) and other lifestyle behaviors (physical activity, sedentary behavior, and unhealthy dietary habits).

METHODS

Data from the National Longitudinal Study of Adolescent to Adult Health (Add Health), spanning respondents' adolescence to adulthood, were used. To address the endogenous school selection problem and account for the unobserved school-level confounders, this study exploited quasi-experimental within-school/across-cohort variation in peer composition. To formally test for mediation, Sobel tests were conducted.

RESULTS

The results of this study revealed that independent of own parents' education levels, exposure to higher levels of peers' parental education is associated with a lower CVD risk score in adulthood. For a one-standard-deviation increase in peers' parental education-that is, about a 0.98-year increase in grademates' parental educational attainment, a CVD risk in adulthood increased by about 6.2%. Our mediation analyses showed that part of this association is explained by a decrease in substance use (27% for smoking, 10% for binge drinking, and 11% for marijuana use). In contrast, none of the other lifestyle behaviors evaluated significantly mediated the association.

CONCLUSION

The study's findings suggest that the role of peers' parents should not be overlooked when developing health-promoting interventions for adolescents. Policymakers and practitioners may wish to increase opportunities for students to benefit from health-related social learning from their peers' highly educated parents.

Fit for purpose: Conception and psychometric evaluation of developmentally appropriate measures to assess functional recovery in first-episode psychosis across geo-cultural contexts

OBJECTIVE

Given the paucity of functional recovery measures for young people with psychosis, we developed and conducted psychometric testing of the Functional Outcomes Interview (FOI) and the Roles and Aspirations Among Youth scale (RAY; a much-needed patient-reported outcome measure).

METHOD

Both measures were developed in English, Tamil, and French through discussions with professionals, participants, and families at early psychosis programs in Canada and India. The FOI assesses the number and tenure of functional roles and allows the nuanced assessment of each role in terms of performance, need for support, and quality of social contacts. The roles include work, school, household responsibilities, parenting/caregiving, and efforts to return to work/school. The RAY is a self-report of current roles and future aspirations. Test-retest reliability, internal consistency, factorial validity, and concurrent validity for the RAY; and inter-rater reliability (IRR), internal consistency, and concurrent validity for the FOI were assessed.

RESULTS

The RAY had adequate internal consistency and temporal stability and was unidimensional in factor analysis. The FOI had acceptable IRR and internal consistency, as evinced by comparable performance ratings across functional roles. Significant associations between our novel measures and well-established measures of functioning and negative symptoms indicate concurrent validity.

CONCLUSIONS AND IMPLICATIONS FOR PRACTICE

The FOI and RAY were designed to be youth friendly, assess aspirations, and acknowledge individuals as desiring and holding multiple roles. They thus represent a significant advancement in assessing functional recovery in first-episode psychosis. Having been tested in two distinct settings, these measures show promise for wider deployment across geo-cultural contexts. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Maternal depression and adolescent optimism

The life course perspective posits that parents' and children's lives are linked through shared experiences and interdependent contexts such as the household. In this paper, we draw on the life course perspective to examine the relationship between maternal depression and adolescent optimism, an important trait that reflects adolescents' positive expectations for the future, and how features of the family context explain this association. We use data from the Fragile Families and Child Wellbeing Study (N = 3013), taking advantage of the study's longitudinal measures of maternal depression that span a 15-year period. First, we find that current maternal depression is negatively associated with optimism among adolescents. Second, we find that the family environment and parent-child relationships, but not economic wellbeing, explain the association between maternal depression and adolescent optimism. These findings inform our understanding of how parent and adolescent wellbeing are linked and, importantly, how the family environment conditions how adolescents envision their futures.

Longitudinal association between parental involvement and internet gaming disorder among Chinese adolescents: Consideration of future consequences as a mediator and peer victimization as a moderator

BACKGROUND AND AIMS

Internet gaming disorder (IGD) in adolescents is a concerning issue. Positive parenting has been found to protect against adolescent IGD, but the underlying mechanisms await further investigation. As such, this study examined the longitudinal association between parental involvement (PI) - a specific type of positive parenting understudied in the literature of adolescent gaming disorder - and IGD. Moreover, this study also tested consideration of future consequences (CFC) as a mediator and peer victimization (PV) as a moderator.

METHODS

A two-wave longitudinal research spanning 6 months apart was conducted. Participants were Chinese adolescents (final N = 434; 222 females; Mage = 14.44 years, SD = 1.56). They provided ratings on PI, PV, and IGD at Wave 1, and CFC-immediate, CFC-future, and IGD at Wave 2.

RESULTS

Descriptive statistics showed that the prevalence rate of IGD was 10.81% and 9.45% at Waves 1 and 2, respectively. Moreover, results of moderated mediation model found that after controlling for Wave 1 IGD and covariates, Wave 1 PI was associated with Wave 2 IGD via preventing adolescents who had higher levels of PV from developing a tendence of CFC-immediate and via promoting adolescents who had lower levels of PV to develop a tendence of CFC-future.

DISCUSSION AND CONCLUSIONS

Altogether, these results suggest that facilitative ecological systems (e.g., positive parenting and good relationships with peers) and personal strengths (e.g., positive future orientation) jointly contribute to the mitigation of adolescent IGD.

Police Stops and the Erosion of Positive Future Orientation Among Urban Adolescents

PURPOSE

The objective is to examine the ramifications of adolescent personal and vicarious police stops for positive future orientation, among all adolescents and by race/ethnicity and sex subgroups, and to assess how features of police stops-including frequency, intrusiveness, resultant stigma, and resultant traumatic stress response-are associated with positive future orientation.

METHODS

We used data from the Fragile Families and Child Wellbeing Study (N = 3,437), a national sample of at-risk urban-born youth, and a series of ordinary least squares regression models that account for observed nonrandom selection into police stops to examine the relationship between adolescent police stops and positive future orientation.

RESULTS

Three key findings emerged. First, personal and vicarious police stops, compared to no police stops, are negatively associated with positive future orientation among adolescents. Second, associations are largest among Black and Hispanic girls. Third, any exposure to police stops, regardless of features of the stops (including frequency, intrusiveness, resultant stigma, and resultant traumatic stress response), is negatively associated with positive future orientation.

DISCUSSION

Given that positive future orientation is linked to mental and physical health throughout the life course, the findings suggest both personal and vicarious police stops among adolescents may increase health inequality in the United States.

Goal language is associated with attrition and weight loss on a digital program: Observational study

Behavioral weight loss reduces risk of weight-related health complications. Outcomes of behavioral weight loss programs include attrition and weight loss. There is reason to believe that individuals' written language on a weight management program may be associated with outcomes. Exploring associations between written language and these outcomes could potentially inform future efforts towards real-time automated identification of moments or individuals at high risk of suboptimal outcomes. Thus, in the first study of its kind, we explored whether individuals' written language in actual use of a program (i.e., outside of a controlled trial) is associated with attrition and weight loss. We examined two types of language: goal setting (i.e., language used in setting a goal at the start of the program) and goal striving (i.e., language used in conversations with a coach about the process of striving for goals) and whether they are associated with attrition and weight loss on a mobile weight management program. We used the most established automated text analysis program, Linguistic Inquiry Word Count (LIWC), to retrospectively analyze transcripts extracted from the program database. The strongest effects emerged for goal striving language. In striving for goals, psychologically distanced language was associated with more weight loss and less attrition, while psychologically immediate language was associated with less weight loss and higher attrition. Our results highlight the potential importance of distanced and immediate language in understanding outcomes like attrition and weight loss. These results, generated from real-world language, attrition, and weight loss (i.e., from individuals' natural usage of the program), have important implications for how future work can better understand outcomes, especially in real-world settings.

Future Orientation and Symptoms of Anxiety and Depression in Italian University Students during the COVID-19 Pandemic: The Role of Resilience and the Perceived Threat of COVID-19

Several studies have already examined the psychological impact of COVID-19 on psychological well-being in samples of the general population. However, given the importance of future orientation for university students' mental well-being, it is important to explore whether and how COVID-19 affected this vulnerable population. Therefore, the current study aims to investigate the protective role of future orientation and the mediating effect of resilience on negative emotional symptoms (anxiety and depression). An online questionnaire was administered to a sample of 244 non-infected Italian university students. The mediation analysis results indicated that resilience fully mediated the relationship between anxiety and depression. Finally, the perceived threat of death from COVID-19 moderated the association between resilience and anxiety. This study shows that university students with higher levels of future orientation exhibit higher resilience levels and, consequently, fewer symptoms of negative emotions.

The Pittsburgh Study: Learning with Communities About Child Health and Thriving

The COVID-19 pandemic has highlighted structural inequities that are barriers to thriving for children in neighborhoods with concentrated disadvantage. Health systems are increasingly addressing health-related social needs. The “Pittsburgh Study” is a longitudinal, community-partnered study focused on child and adolescent thriving and racial equity. This initiative will elucidate critical influences on childhood health and thriving, evaluate developmentally appropriate interventions to improve outcomes from birth to high school, and establish a child health data hub. Integration of community members into scientific inquiry, rapid data-to-action cycles, and workforce development are strategies health systems may consider to enhance child health equity.

The Lasting Influence of a Peer-led Adolescent Relationship Abuse Prevention Program on Former Peer Leaders' Relationships, Identities, and Trajectories in Emerging Adulthood

Adolescent relationship abuse (ARA) has well-documented detrimental health effects. Adolescence is a window of opportunity to promote development of healthy relationship behaviors. Although peer-led interventions have a history of use in the health education field, there are few rigorously evaluated peer-led interventions targeting ARA. Start Strong leverages peer support by training adolescents to deliver ARA prevention curriculum to younger peers. Although the program has shown positive results in recipients, little is known about the impact on the peer leaders themselves. This qualitative study describes the impact of being an ARA prevention peer leader on former peer leaders' relationships and trajectories in emerging adulthood. Specific objectives include: (a) how being a peer leader shaped participants' norms around romantic relationships and ARA, and (b) the impact of participating in a peer leadership program on their emerging adult lives. Researchers conducted semi-structured interviews with former peer leaders and coded transcripts using thematic analysis. Fourteen former peer leaders aged 18-26 participated. Most participants (99%) identified as Black or Afro-Latinx. Participants described a lasting impact on their relationships, identity formation, future orientation, and professional lives. Participants highlighted the skills they use to avoid unhealthy relationships and help friends and family navigate their relationships. They identified unexpected challenges, including a sense of isolation around how their relationship expectations differ from same-aged peers, and trepidation about dating partners without advanced healthy relationship knowledge. Participants highlighted positive impacts beyond those pertaining to relationships, including their identity development and expanded sense of opportunity. Finally, they identified tangible skills gained from program participation and relevance to their professional paths. This study suggests that peer-led ARA prevention programs have a far-reaching impact on participants' lives that lasts into adulthood. Future studies may examine how professional development within peer-led interventions can influence future orientation and thus bolster protective factors against ARA.

Adolescent Positivity and Future Orientation, Parental Psychological Control, and Young Adult Internalising Behaviours during COVID-19 in Nine Countries

The COVID-19 pandemic disrupted many young adults’ lives educationally, economically, and personally. This study investigated associations between COVID-19-related disruption and perception of increases in internalising symptoms among young adults and whether these associations were moderated by earlier measures of adolescent positivity and future orientation and parental psychological control. Participants included 1329 adolescents at Time 1, and 810 of those participants as young adults (M age = 20, 50.4% female) at Time 2 from 9 countries (China, Colombia, Italy, Jordan, Kenya, the Philippines, Sweden, Thailand, and the United States). Drawing from a larger longitudinal study of adolescent risk taking and young adult competence, this study controlled for earlier levels of internalising symptoms during adolescence in examining these associations. Higher levels of adolescent positivity and future orientation as well as parent psychological control during late adolescence helped protect young adults from sharper perceived increases in anxiety and depression during the first nine months of widespread pandemic lockdowns in all nine countries. Findings are discussed in terms of how families in the 21st century can foster greater resilience during and after adolescence when faced with community-wide stressors, and the results provide new information about how psychological control may play a protective role during times of significant community-wide threats to personal health and welfare.

Promoting healthy trajectories for urban middle school youth through county-funded, parks-based after-school programming

Ongoing pressure for public schools to prioritize academics has increased attention on after-school settings as a critical space for social-emotional learning (SEL). After-school programs are uniquely positioned to build protective and promotive factors that contribute to positive future orientation, especially within communities where systemic inequities create barriers to high school graduation, higher education, employment, and earnings. This study examines Fit2Lead Youth Enrichment and Sports (YES), a county-funded, parks-based after-school collaboration for middle schoolers that merges mental health and recreation to promote healthy trajectories. Eight Miami neighborhood parks were selected based on county data indicating high rates of violence. An open trial design (N = 9 parks, 198 youth; ages 9-15; 40.5% female; 66.5% Black/African American, 24.9% Hispanic/Latinx, and 76.3% low-income) tested hypotheses that participation for adolescents exposed to community violence would disrupt a commonly reported decline in self-regulation and self-efficacy, and mitigate risk for anxiety and depression. Youth completed questionnaires at the beginning and end of one school year. Paired t-tests revealed no changes from pre to post, and no differences by baseline levels of youth and parent mental health. Findings highlight the promise of prevention programs to disrupt downward trajectories for youth during the risky time of early adolescence.

Death and taxes: Examining the racial inequality in premature death across neighborhoods

Legacies of residential segregation have led to deep inequities felt in communities of color across the nation and have been established as a fundamental cause of health disparities. Historical practices such as the redlining of majority Black neighborhoods in cities have led to long term consequences on these communities, including concentrated poverty and disadvantage. Research shows a strong connection between living in a poor neighborhood and poorer health outcomes, including early death, but questions remain about what characteristics of poor neighborhoods drive these disparities. We combined data from the American Community Survey with administrative data from Pittsburgh, Pennsylvania to examine the difference in premature death in Black and white neighborhoods (N = 87) using measures of socioeconomic disadvantage and less commonly studied neighborhood features including vacancy, tax delinquency, and property sales and conditions. Results suggest that features of abandonment, particularly the percent of tax delinquent properties in a neighborhood, may capture an important structural difference between majority Black and majority white neighborhoods with impacts beyond socioeconomic disadvantage on community health. We discuss implications of these findings for research and practice.

Structural relationships among adolescents' peer attachment, career-related self-efficacy, parents' attitudes and health risk behaviours

Aim

This study aimed to determine whether the peer attachment of adolescents, mediated by career‐related self‐efficacy and having parents with positive attitudes, influences health risk behaviours.

Design

A cross‐sectional questionnaire survey.

Methods

This study adopted the secondary data analysis method, using the 2010 Korean Children and Youth Panel Survey (KCYPS). The 7th‐wave panel data of 1,932 first graders in high schools were analysed using structural equation modelling.

Results

The final model provided a good fit for the data. Having a close relationship with peers had a direct effect on adolescents’ health risk behaviours. High peer attachment also had an indirect effect on health risk behaviours, mediated by career‐related self‐efficacy and having parents with positive attitudes. Though adolescents with broad and intimate peer relationships may be exposed to more temptations towards health risk behaviours and tend to make riskier decisions, these influences are reduced by being exposed to positive parenting attitudes and having clear, conscious career goals.

The Role of Future Orientation and Self-determination on American Indian Adolescents' Intentions to Use Alcohol and Marijuana

Substance use (SU) rates among American Indian (AI) adolescents have been greater than national rates for decades, with little progress made on reducing them. Reasons for this may include lack of evidence on which to base effective interventions, the uniqueness of this population, and the overall lack of attention that this population has received in reducing socioeconomic and health disparities. Moreover, there has been limited focus on understanding how positive individual characteristics may serve as protective factors for AI adolescents. Using data from 379 AI youth living on or near four northern plains reservations, the current study examines the relationship between future orientation (FO) and self-determination (SD) and intentions to use alcohol and marijuana, with negative consequences of SU for future goals and autonomy evaluated as potential mediators. SEM models were estimated for alcohol use and marijuana use intentions, with two separate models for each dependent variable-one assessing the direct and indirect effects of FO via perceived consequences for future goals and the other assessing the effects of SD via perceived consequences for autonomy. All models displayed good fit, but the pattern of significant effects varied by substance, by construct (FO vs. SD), and by gender. Findings suggested that SD, and more proximally, perceived consequences of use for autonomy, may be particularly useful promotive factors to target SU prevention in AI adolescents. Culturally congruent interventions designed to promote SD and autonomous motivations to abstain may be particularly impactful within a young AI adolescent population, as early adolescence represents a critical period of development for personal autonomy and identity.

Posttraumatic Stress, Academic Performance, and Future Orientation as Pathways to Community Violence Exposure and Sexual Risk among African American Youth in Chicago's Southside

Posttraumatic stress, low academic performance, and future orientation as pathways from community violence exposure to sexual risk-taking behavior were examined among 753 African American youth in a large urban school district, ranging from ages of 13 to 24 years. Youth completed a self-report instrument. Youth completed a self-report instrument of Exposure to Violence Probe, University of California at Los Angeles' PTSD Reaction Index Adolescent Version, and Coopersmith's Self-Esteem Scale. Structural equation modeling was performed to examine relationships among the major study variables. Results indicated that community violence exposure was not directly associated with sexual risk behavior. However, community violence exposure had a significantly positive impact on posttraumatic stress, which was associated with low future orientation and sexual risk behavior. Findings suggest that targeted interventions need to consider variables that mediate the association between violence exposure and sexual risk behavior, which can reduce poor sexual health outcomes among urban youth who are exposed to violence in their community.

The Association between Perceived Social Hardship and Future Orientation among Hong Kong Young People: The Mediation Role of Belief in a Just World

A positive future orientation (FO) is associated with a range of positive outcomes. It is a crucial resilience factor that assists individuals to navigate developmental difficulties during the transition to young adulthood and during periods of social adversity. Exposure to negative social context threatens young people’s FO. The social demonstrations and the outbreak of coronavirus disease in Hong Kong over the past year have caused considerable hardship to the local society. Under such circumstance, young people in Hong Kong may develop a negative FO. Scant research has directly examined the relationship between perceived social hardship and FO as well as the underlying mechanism among Hong Kong young people. In this study, we tested the idea that young people’s perceived social hardship would be negatively related to FO via belief in a just world, a well-known foundation for individuals to think, feel, and plan their future. Participants were 554 students recruited from eight universities in Hong Kong. They filled in self-report questionnaires online. Results of structural equation modeling supported our hypothesis. These findings shed light on how to nurture Hong Kong young people to develop a positive mindset during periods of social hardship.

"We Are Powerful People": Health-Promoting Strengths of LGBTQ Communities of Color

Lesbian, gay, bisexual, transgender, and queer (LGBTQ) communities of color experience intersecting systems of oppression that limit access to health care, safety, and other basic resources. Important research has documented these disparities, their antecedents, and consequences. However, little research has examined the strengths of multiply marginalized LGBTQ communities. Drawing from a health equity framework, this study is based on interviews with 38 LGBTQ-identified people of color in New York City. We used framework analysis to examine participants' perspectives on the role of community in enhancing health and well-being. Community strengths identified by participants included (a) safety, acceptance, and support; (b) interconnectedness and resource sharing; and (c) advocacy, collective action, and community potential. Recommendations for policy, practice, and future research are suggested, including efforts toward community power building.

Psychosocial correlates of safe sex self-efficacy among in-school adolescent girls in Lagos, Nigeria

BACKGROUND

Adolescent girls in Nigeria are at heightened risk for HIV and other sexually transmitted infections. However, there are limited studies on psychosocial factors that are associated with safe sex intentions among this population. Self-efficacy has been established as an important correlate of behavioral intentions and the actual behavior. The objective of this research was to examine how key psychosocial factors such as social support, parental monitoring, and future orientation influence perceived safe sex self-efficacy among in-school adolescent girls in Nigeria. Furthermore, we assessed the associations between these psychosocial factors and HIV-related knowledge and safe sex self-efficacy.

METHODS

A self-administered questionnaire was distributed to 426 adolescent girls attending public and private school systems in Lagos, Nigeria. Multiple linear regression was used to evaluate the influence of psychosocial and demographic factors on safe sex self-efficacy. Further, stratified analysis was conducted to compare the estimates between participants attending public schools (n = 272) and those attending private schools (n = 154).

FINDINGS

Results from the study show that future orientation (β = 0.17; p < 0.05), participants age (β = 0.14; p < 0.05), and HIV knowledge accuracy (β = 0.17; p < 0.05) were associated with safe sex self-efficacy. Future orientation remained statistically significant in the sub-group analysis among participants attending public (β = 0.13; p < 0.05) and private schools (β = 0.24; p < 0.05). Among participants attending public schools, HIV accuracy (β = 0.2; p < 0.05) remained a significant correlate of safe sex self-efficacy while this association dissipated among private school attendees.

CONCLUSIONS

These findings point to the importance of including future orientation strategies in interventions developed for in-school adolescent girls in Nigeria. School-based interventions that increase positive future orientation outcomes may be beneficial to improve safe sex intentions among adolescent girls in Nigeria.

Different Shades of Beauty: Adolescents' Perspectives on Drawing From Observation

Background

Drawing from observation (DFO) is an art therapy method that entails drawing an object, along with guided reflections on process and outcome. In this qualitative study, we explored adolescents’ perspectives on their DFO experience, and how they perceive it as having influenced their emotional well-being.

Methods

We interviewed 10 adolescents who participated in a DFO group, regarding their perspectives on DFO. Participants were asked to refer to their experience, as well as to provide examples of their drawings. Through a thematic analysis we integrated data from interviews and drawings.

Results

Adolescents experienced three lines of tension in DFO: Between self-acceptance and self-judgment, between merging and separation, and between similarities and differences. Processing these tensions has the potential to increase their emotional well-being.

Conclusion

DFO could make a meaningful contribution to adolescents’ emotional well-being. The unique intersection between object, observation, and drawing in art-therapy addresses adolescents’ emotional-developmental challenges.

Resilience in adolescence: Prospective Self moderates the association of early life adversity with externalizing problems

INTRODUCTION

Early life adversity (ELA) can result in negative behavioral outcomes, including internalizing and externalizing problems. Evidence suggests that adolescence is a critical developmental period for processing ELA. Identity formation, which is crucial to this developmental period, may moderate the effect between ELA and these problems. One potential moderating variable associated with identity formation is the latent construct Prospective Self, comprised of future-oriented attitudes and behaviors.

METHODS

Participants are from the first wave of an ongoing longitudinal study designed to characterize behavioral and cognitive correlates of risk behavior trajectories. A community sample of 10th and 12th grade adolescents (N = 2017, 55% female) were recruited from nine public school districts across eight Southeastern Michigan counties in the United States. Data were collected in schools during school hours or after school via self-report, computer-administered surveys. Structural equation modeling was utilized to assess Prospective Self as a latent construct and to evaluate the relationship between ELA, internalizing and externalizing problems, and Prospective Self.

RESULTS

Preliminary findings indicated a satisfactory fit for the construct Prospective Self. The predicted negative associations between Prospective Self and internalizing and externalizing problems were found and evidence of moderation was observed for externalizing problems, such that the effects of ELA (i.e., childhood maltreatment) on externalizing problems were lower for individuals with higher levels of Prospective Self.

CONCLUSIONS

These results indicate that Prospective Self may play a role in supporting resilience against externalizing problems associated with ELA among adolescents.

Early information needs of adolescents and young adults about late effects of cancer treatment

BACKGROUND

Adolescent and young adult (AYA) cancer survivors have high risks of late effects. Little is known about the late-effect information needs of AYAs early in treatment or their role in treatment decision making. This study evaluated the importance, quality, and implications of information about late effects in AYAs recently diagnosed with cancer.

METHODS

This study surveyed 201 AYAs with cancer who were 15 to 29 years old and were treated at the Dana-Farber Cancer Institute (Boston, Massachusetts). Patients were approached within 6 weeks of their diagnosis and were asked about their late-effect and infertility information needs, treatment decision making, and communication outcomes.

RESULTS

Forty-five percent of the participants were female; 88% were white. Most AYAs (87% [173 of 200]) considered information about the risks of late effects to be extremely or very important; 80% (159 of 200) valued information about infertility. Many were distressed by information about late effects (53% [105 of 200]) and infertility (45% [89 of 200]); those who considered late-effect information distressing were more likely to value this information (P < .0001). Consideration of late effects (41% [82 of 201]) and infertility (36% [72 of 201]) greatly influenced many patients' treatment decision making. Although 92% of the patients (184 of 199) reported receiving high-quality information about the diagnosis, 57% (113 of 199; P < .0001) and 65% (130 of 199; P < .0001) felt that they had received high-quality information about late effects and infertility, respectively.

CONCLUSIONS

Most AYAs with cancer value early information about the risks of late effects and infertility, yet many patients felt that they had not received high-quality information about these topics. The development of age-appropriate late-effect communication strategies that recognize high AYA distress may help to address the gap between desired information and perceived information quality.

Adolescent Interventions to Manage Self-Regulation in Type 1 Diabetes (AIMS-T1D): randomized control trial study protocol

BACKGROUND

Self-regulation (SR), or the capacity to control one's thoughts, emotions, and behaviors in order to achieve a desired goal, shapes health outcomes through many pathways, including supporting adherence to medical treatment regimens. Type 1 Diabetes (T1D) is one specific condition that requires SR to ensure adherence to daily treatment regimens that can be arduous and effortful (e.g., monitoring blood glucose). Adolescents, in particular, have poor adherence to T1D treatment regimens, yet it is essential that they assume increased responsibility for managing their T1D as they approach young adulthood. Adolescence is also a time of rapid changes in SR capacity and thus a compelling period for intervention. Promoting SR among adolescents with T1D may thus be a novel method to improve treatment regimen adherence. The current study tests a behavioral intervention to enhance SR among adolescents with T1D. SR and T1D medical regimen adherence will be examined as primary and secondary outcomes, respectively.

METHODS

We will use a randomized control trial design to test the impact of a behavioral intervention on three SR targets: Executive Functioning (EF), Emotion Regulation (ER), and Future Orientation (FO); and T1D medical regimen adherence. Adolescents with T1D (n = 94) will be recruited from pediatric endocrinology clinics and randomly assigned to treatment or control group. The behavioral intervention consists of working memory training (to enhance EF), biofeedback and relaxation training (to enhance ER), and episodic future thinking training (to enhance FO) across an 8-week period. SR and treatment regimen adherence will be assessed at pre- and post-test using multiple methods (behavioral tasks, diabetes device downloads, self- and parent-report). We will use an intent-to-treat framework using generalized linear mixed models to test our hypotheses that: 1) the treatment group will demonstrate greater improvements in SR than the control group, and 2) the treatment group will demonstrate better treatment regimen adherence outcomes than the control group.

DISCUSSION

If successful, SR-focused behavioral interventions could improve health outcomes among adolescents with T1D and have transdiagnostic implications across multiple chronic conditions requiring treatment regimen adherence.

TRIAL REGISTRATION

ClinicalTrials.gov: NCT03688919; registered September 28, 2018.