Health risks for older US adolescents in foster care: the significance of important others' health behaviours on youths' health and health behaviours

Background   Little research to date has examined older foster care youths' physical health and the associated health behaviours of the youth and important people in their lives (parents, peers and important non-parental adults).
Methods   Older US foster care youth ( n = 188) completed surveys on multiple indicators of self-report physical health, including number of chronic health problems, overall health and sick symptoms, as well as their own health-compromising behaviours and the health-compromising behaviours of important others.
Results   The findings suggested that boys, particularly those placed in non-kin foster homes and group homes, appeared to have poorer health than did boys in these placement settings. Girls, however, engaged in similar levels of health-compromising behaviours as boys. Furthermore, the health-compromising behaviours of peers and important non-parental adults (VIPs), but not parents, were associated with youths' health behaviours, which, in turn, were associated with the physical health status of the foster care youth.
Conclusion   Youth report high levels of health-related problems and involvement in health-compromising behaviours. Healthcare practitioners can help to improve the health and well-being of children in foster care by becoming informed about adolescent health behaviours, as well as the health behaviours of their peers and other important non-parental adults.     

An Evaluation of a Positive Youth Development Program for Adolescents with Chronic Illness

PurposeYouth with chronic illness often struggle transitioning to adulthood and adult medical care. This article examines the outcomes of a group mentoring program called The Adolescent Leadership Council (TALC) that brings together high school participants and college mentors, all with chronic illness. TALC uses a positive youth development (PYD) approach, emphasizing strong relationships between youth and adults in an environment where youth can learn important life skills and take a leadership role.MethodsA pre-/postprogram participant survey was conducted for high school participants using a loneliness scale and a transition readiness survey. An alumni survey was conducted with all high school and college mentor graduates to assess educational-, vocational-, and health care-related outcomes.ResultsProgram records review and the alumni survey indicated that TALC was consistent with the PYD program model. Twenty high school students participated in the pre-/postprogram outcomes evaluation, which demonstrated a decrease in loneliness from 46 to 38.5 (p < .001) and an increase in health care self-advocacy from 3.8 to 4.2 (p < .001). Thirty-four alumni participated in the alumni survey. All high school and college mentor alumni had graduated from high school and college, respectively, and all were either currently in school or working. The majority of alumni were seeing adult providers for medical care.ConclusionsThe TALC program applies the principles of PYD to support positive educational, vocational, and health care outcomes for youth with chronic illness. Program development using the PYD perspective is an important new approach for supporting adult development of youth with chronic illness.     

The impact of transitional programmes on post‐transition outcomes for youth leaving out‐of‐home care: a meta‐analysis

Youth residing in out‐of‐home care settings have often been exposed to childhood trauma, and commonly report experiencing adverse outcomes after transitioning from care. This meta‐analysis appraised internationally published literature investigating the impact of transitional programme participation (among youth with a baseline age of 15–24 years) on post‐transition outcomes of housing, education, employment, mental health and substance use. A comprehensive search of sociology (e.g. ProQuest Sociology), psychology (e.g. PsycInfo) and health (e.g. ProQuest Family Health) electronic abstraction databases was conducted for the period 1990–2014. Search terms included ‘out‐of‐home care’, ‘transition’, ‘housing’, ‘education’, ‘employment’, ‘mental health’ and ‘substance use’. Nineteen studies, all from the United States, met the inclusion criteria and were included in the meta‐analysis. Living independently and homelessness were the most commonly described housing outcomes. Rates of post‐transition employment varied, while rates of post‐secondary education were low. Depression and alcohol use were commonly reported among transitioning youth. Findings of the meta‐analysis showed that attention should be given to the potential benefit of transitional programme participation on outcomes such as housing, employment and education. Moderator analyses showed that these benefits may differ based on study design, sample size and sampling unit, but not for mean age or gender. Detailed and rigorous research is needed internationally to examine the characteristics of transitional programmes resulting in more successful outcomes for youth, and whether these outcomes are sustained longitudinally.     

Child and parent perceptions of monitoring in chronic illness management: a qualitative study

Background The management of a childhood chronic illness can be challenging because it can involve frequent and complex treatment tasks that must be carried out on a daily basis. Parental monitoring of the treatment regimen and child disclosure of health‐related information may impact effective illness management but are not well understood. Methods The present study utilized qualitative methods to examine parental monitoring‐related behaviours, youth disclosure of health‐related information, and both perceptions about, and reactions to, these behaviours in a sample of youth diagnosed with a chronic illness (e.g. asthma, diabetes and cystic fibrosis) and parents of youth with one of these illnesses. Results Parents solicited information from youth verbally, observed symptoms, reminded youth about treatments and tracked indicators of treatment adherence (e.g. dose counters; glucose meters). Youth reactions varied from acceptance to irritation. Youth behaviours included withholding information and freely disclosing spontaneously and in response to requests. Conclusions Findings derived from this qualitative methodology demonstrate convergence with findings from quantitative studies on this topic, add to the literature related to parental monitoring of chronic illness management and suggest several avenues for future research.     

Challenges in comparing the methods and findings of cohort studies of oral health: the Dunedin (New Zealand) and Pelotas (Brazil) studies

Objective: to systematically compare methods and some findings from two prospective cohort studies of oral health. Methods : This paper describes and compares two such population‐based birth cohort studies of younger adults: the Dunedin Multidisciplinary Health and Development Study (conducted in New Zealand); and the 1982 Pelotas Birth Cohort Study (conducted in Brazil). Results: The two cohorts showed socio‐demographic similarities and differences, with their gender mixes being similar, but their ethnic compositions differing markedly. There were some important similarities and differences in methods. Overall dental caries experience was higher among the Dunedin cohort. Each of the studies has examined the association between childhood‐adulthood changes in socio‐economic status and oral health in the mid‐20s. Both studies observed the greatest disease experience among those who were of low SES in both childhood and adulthood, and the least among those who were of high SES in both childhood and adulthood. In each cohort, disease experience in the upwardly mobile and downwardly mobile groups lay between those two extremes. Conclusions and implications: There are important similarities and differences in both methods and findings. While the need for a degree of methodological convergence in future is noted, the two studies are able to use each other as replicate samples for research into chronic oral conditions.     

Assessing the Health Perspectives of Unique Populations of Adolescents: A Focus Group Study

Few articles report on youth's perceptions about health-related issues and needs and even fewer have given voice to youth with disabilities, chronic health conditions, or youth in therapeutic foster care. The purpose of this study was to explore perceptions of health issues from the perspectives of youth placed in therapeutic foster care, youth with chronic medical conditions, and youth with disabilities. Twelve focus groups with 67 youth aged 13–20 were conducted in rural, suburban, and urban communities in the Commonwealth of Virginia. Data analysis revealed both within unique group themes and themes that cut across unique groups. Youth in therapeutic foster care with chronic health conditions or with disabilities perceive themselves as being different from their peers. Participants in each group expressed concerns about the unique issues that they confront daily and how these challenges differentiate them from youth who do not share their life experiences. They expressed the desire for other youth to understand them better and to not treat them differently. Discussion and implications focus on the need to create programs to support the unique needs of these youth.     

Life Course Outcomes on Mental and Physical Health: The Impact of Foster Care on Adulthood

Objective. We compared the prevalence rates of mental health and physical health problems between adults with histories of childhood foster care and those without.Methods. We used 2003–2005 California Health Interview Survey data (n = 70 456) to test our hypothesis that adults with childhood histories of foster care will report higher rates of mental and physical health concerns, including those that affect the ability to work, than will those without.Results. Adults with a history of childhood foster care had more than twice the odds of receiving Social Security Disability Insurance because they were unable to work owing to mental or physical health problems for the past year, even after stratifying by age and adjusting for demographic and socioeconomic characteristics.Conclusions. Childhood foster care may be a sentinel event, signaling the increased risk of adulthood mental and physical health problems. A mental and physical health care delivery program that includes screening and treatment and ensures follow-up for children and youths who have had contact with the foster care system may decrease these individuals’ disproportionately high prevalence of poor outcomes throughout their adulthood.More than 250 000 US children enter foster care every year and almost 20% of them reside in California.1 Children living in foster care, compared with other children, disproportionately come from low-income families, are ethnic and racial minorities,2 and have higher rates of physical, psychological, and social problems.3–6 The current literature suggests that the psychosocial concerns noted for some children who enter foster care persist as they get older and are manifested as severe social problems, including high rates of teen pregnancy, substance abuse, and arrests.7,8 Disproportionately high percentages of children who have a history of foster care, compared with those who do not, exhibit mental health problems.9,10At age 18 years, when adolescents “age out” or are emancipated from the foster care system, the newly independent young adults have very little support and encounter astonishingly high rates of unemployment and homelessness.11,12 Mental health, social, and other concerns appear to continue among children who have experienced foster care throughout their youth.Although the idea that a childhood event could have adulthood risks and ramifications is not new, there is a resurgence of interest in this paradigm, as it may be possible to intervene and reduce or prevent adulthood sequellae.13 Almost a decade ago, a study using a sample drawn from a large Southern California managed care program (i.e., Kaiser Permanente’s Adverse Childhood Experiences or ACE) examined the prevalence of several adverse childhood events (e.g., psychological, physical, and sexual abuse) and household dysfunction (e.g., parental substance abuse, mental illness, incarceration, and domestic violence) and found a correlation between the number of adverse childhood events and several adulthood risk factors for death (e.g., smoking, obesity, depressed mood, alcoholism, and drug use).14The life course approach, the idea that an event or injury occurring in childhood could manifest health risks and ramifications later in adulthood, notes that the timing of an event in the life trajectory is important. There are critical periods in a lifetime when a dramatic event at a point in childhood is more likely to have a serious effect in adulthood, but the same dramatic event may have lesser effects if it occurs at another time point. For example, some investigations have found that adults’ health status and morbidity and mortality rates were linked to their father’s job and education levels when they were children.15–17Researchers studying homeless populations have found that childhood histories of foster care are correlated with the presence of adulthood mental disorders.18–20 Yet, these studies used samples consisting of only homeless adults. Are these findings generalizable to all adults with histories of childhood foster care? We compared prevalence rates of mental health and physical health problems between 2 groups of adults: those with histories of childhood foster care and those without. Accordingly, we hypothesized that adults who have had childhood histories of foster care, compared with those who have not, will report higher rates of mental and physical health concerns, including those that affect the ability to work.     

Academic and Mental Health Outcomes of Youth Placed in Out-of-Home Care: The Role of School Stability and Engagement

Background

Youth placed in out-of-home care are at significant risk of low academic achievement and poor mental health. Few studies have considered the potential effects of school-related factors, such as school placement stability and school engagement, on youth outcomes.

Objective

The current study examined the potential main effects of school placement stability and engagement on academic achievement and mental health. Furthermore, we examined whether school-related factors moderated the association between home placement stability and youth outcomes.

Methods

Participants included 420 youth (age 6–14 at baseline) placed in out-of-home care participating in a national longitudinal study of youth in contact with the child welfare system. Youth, caregivers, and caseworkers provided relevant information at baseline, 18, and 36 months. Hierarchical regression models were constructed to test potential main and moderating effects of school engagement and school placement stability on youth mental health and academic achievement prospectively, while accounting for relevant covariates.

Results

School placement stability was an independent predictor of youth internalizing and externalizing symptoms, but was not significantly associated with academic outcomes. Furthermore, there were no main effects of school engagement or home placement stability on youth outcomes and school-related factors did not moderate the relationship between home placement stability and youth outcomes.

Conclusion

For children and adolescents who do not have the benefit of a stable, safe, or caring home environment, school stability may be contribute to an environment that can foster healthy development.

     

Sociodemographic and substance use characteristics associated with typologies and composition of social support networks among youth experiencing homelessness in Los Angeles,USA

Youth experiencing homelessness are a vulnerable population with increased behavioural health risks. Social networks are a consistent correlate of youths’ substance use behaviours. However, less is known about the reciprocal relationships among these constructs. This study classified youth experiencing homelessness according to their social support network type (e.g. instrumental, emotional, service) and composition (e.g. family, peers, service staff) and linked their membership in these social network classes to sociodemographic and substance use characteristics. Four waves of cross‐sectional data were collected between October 2011 and June 2013 from youth experiencing homelessness, ages 14–29, at three drop‐in centres in Los Angeles, CA (N = 1,046). This study employed latent class analysis to identify subgroups of youth experiencing homelessness according to the type and composition of their social support networks. Multinomial logistic regression analyses were then conducted to identify the sociodemographic and substance use characteristics associated with social support network class membership. Five latent classes of youths’ social support networks were identified: (a) high staff emotional and service support; (b) high home‐based peer and family emotional, service and instrumental support; (c) moderate street‐ and home‐based peer emotional support; (d) low or no support and (e) high home‐based peer and family emotional and instrumental support. Multinomial logistic regression models indicated that race/ethnicity, gender, sexual orientation, literal homelessness, former foster care experience, depression, heroin and marijuana use were significant correlates of social support network class membership. Results indicate distinct classes of social support networks among youth experiencing homelessness, with certain sociodemographic and substance use characteristics implicated in youths’ social networks.     

The Long-Term Effects of Maternal Depression: Early Childhood Physical Health as a Pathway to Offspring Depression

PurposeCross-sectional and retrospective studies have highlighted the long-term negative effects of maternal depression on offspring physical, social, and emotional development, but longitudinal research is needed to clarify the pathways by which maternal depression during pregnancy and early childhood affects offspring outcomes. The current study tested one developmental pathway by which maternal depression during pregnancy might negatively impact offspring mental health in young adulthood, via poor physical health in early childhood.MethodsThe sample consisted of 815 Australian youth and their mothers who were followed for 20 years. Mothers reported on their own depressive symptoms during pregnancy and offspring early childhood. Youth completed interviews about health-related stress and social functioning at age 20 years, and completed a questionnaire about their own depressive symptoms 2 to 5 years later.ResultsPath analysis indicated that prenatal maternal depressive symptoms predicted worse physical health during early childhood for offspring, and this effect was partially explained by ongoing maternal depression in early childhood. Offspring poor physical health during childhood predicted increased health-related stress and poor social functioning at age 20. Finally, increased health-related stress and poor social functioning predicted increased levels of depressive symptoms later in young adulthood. Maternal depression had a significant total indirect effect on youth depression via early childhood health and its psychosocial consequences.ConclusionsPoor physical health in early childhood and its effects on young adults' social functioning and levels of health related stress is one important pathway by which maternal depression has long-term consequences for offspring mental health.     

Low‐income homebound older adults receiving home‐delivered meals: Physical and mental health conditions,incidence of falls and hospitalisations

Significant differences in health across racial/ethnic and socioeconomic groups in the US signal increasing numbers of low‐income homebound older adults in a rapidly ageing society. The purpose of this study was to examine physical and psychiatric conditions and their association with incidence of self‐reported falls and hospitalisations among largely low‐income and racial/ethnic minority adults age 50+ (N = 2,224), clients from a home‐delivered meals programme in Central Texas. Data came from comprehensive, in‐home assessments done in 2017 by these older adults’ case managers. We used bivariate analyses to compare those with and without incidence of self‐reported past‐year falls and those with and without a hospitalisation episode with respect to their sociodemographic and clinical characteristics. We used multivariable logistic regression analysis to examine sociodemographic and clinical correlates of any incidence of falls and negative binomial regression analysis to examine these correlates of the number of hospitalisations in the preceding 12 months. The rates of chronic physical illnesses, including cardiovascular disease, diabetes, gastrointestinal disease, lung disease and renal failure, were extremely high. The 41% of reported falls among the study sample was also higher than the rate among US older adults in general. More diagnosed physical illnesses, depression, chewing/swallowing problems, chronic/severe pain, activities and instrumental activities of daily living (ADL/IADL) impairments and ambulation assistive device use were associated with greater odds of falling. The rate of past‐year hospitalisation was 26%, and more diagnosed physical illnesses, ADL/IADL impairments, ambulation assistive device use and any fall incidence were positively associated with the number of hospitalisations. These findings indicate the need for fall prevention programmes for frail homebound older adults as well as health and social care services that help older adults better manage physical/mental health problems and reduce preventable health crises and hospitalisations.     

Associations between youth assets and sexual activity: does adult supervision play a role?

Background Youth participation in sexual risk behaviours continues to be a critically important public health topic. Additionally, as youth are frequently being left alone during the day without adult supervision, there are increased opportunities for sexual risk‐taking behaviour. This study examined how the relationships of nine youth assets and sexual activity may vary according to the stratification of youth into two groups: self‐care and supervised. Methods Data were collected through at‐home, in‐person interviews from a random sample of inner‐city youth (mean age = 15.4 years; 51.5% female; 48.8% White; 22.4% Black; 18.5% Hispanic; 10% Native American) and their parents (n = 1079 parent/youth pairs). Nine youth assets were analysed using multiple logistic regression. Examples of assets youth may possess are: positive role models, family communication, school connectedness, constructive use of time and aspirations for the future. The item used to assess sexual intercourse was ‘Have you ever had sexual intercourse (“done it”, “had sex”, “made love”, “gone all the way”)?’. Asset/risk behaviour associations that were unique to one of the two strata were the focus of the study. Results Thirty‐seven per cent of youth spent two or more hours per day home alone. Youth who were supervised had a greater number of unique significant associations between assets and sexual activity than youth who were in the self‐care group. Conclusions Youth in supervised settings may be less likely to participate in sexual activity because of the presence of assets. Certain assets may also be important in deterring sexual activity for youth who are in self‐care.     

The SOS Children's Villages : School Achievement of Subjects reared in a permanent Foster Care

This paper reports the long term effects of maternal deprivation and of a foster family care for siblings. In a permanent placement (children's villages) a single housemother cares for siblings until adulthood and receives the help of a psycho‐educative team. Investigation on school achievement and on level of education was made on all the subjects reared in a voluntary association of children's villages. It proves to be better compared with children in traditional foster care and children brought up by their parents from very disadvantaged backgrounds. A large part of school failure is lessened for children admitted before 6.     

Evaluation of a community based dental clinic for youth experiencing homelessness in Brisbane

The relationship between homelessness and ill health is complex, and many risk factors for homelessness such as unemployment, low income, and substance abuse are also risk factors for poor oral health. In order to overcome barriers to access dental care, previous studies have recommended integrating dental care, referral pathways, and information within the overall care provided by support services available to people at risk of homelessness. This study aimed to evaluate a dental service developed and implemented to improve access to oral health care of disadvantaged youth in Brisbane. A mobile dental clinic run by volunteer dental professionals was implemented into a community organisation for disadvantaged youth. Participants were clients of Brisbane Youth Services who were disadvantaged youth, ≤25 years and attended the dental clinic in a 1 year period. A questionnaire collected demographic information, a self‐assessment of oral health and an evaluation of their experiences with the dental clinic. Clinical data including DMFT, appointment attendance and items of service provided were collected. One hundred and twelve clients participated in the four dental clinic weeks and its evaluation. Cost was the greatest reported barrier to accessing dental care among participants. More than half (57%) of participants who pre‐booked an appointment failed to attend. A total of 640 services were delivered, with an estimated value of $48,000. The majority (69%, n = 444) of the services provided were preventative services. Almost all of the clients felt the service they received was suitable for them (97%, n = 98) and would use the service again (98%, n = 99). This dental clinic model is feasible and sustainable due to its integration into an existing homeless youth service, low running costs, acceptability to clients and an interest by dental practitioners to volunteer. It provides a useful model which could be scaled up and implemented in other regions.     

Health and well‐being among elderly persons in Israel: The role of social class and immigration status

Objectives. The purpose of the study was to compare three groups of Israeli elderly that differ in social class and immigration status on measures of health and psychosocial well‐being, and assess the factors which explain their self‐rated health (SRH).

Design. Based on a random sample of Israeli Jewish elderly (70 + ), data were collected from 1138 persons during 1994 by structured home interviews.

Results. Social class differences among Israeli veterans were mainly found with regard to psycho‐social characteristics. They were less conspicuous in health measures. New immigrants, who had a higher level of education than the veterans, but ranked lower on economic status, reported lower levels of health and psycho‐social well‐being than the veterans. Self‐rated health among the immigrants was mainly explained by objective measures of health, and economic status, while in the higher social class of veterans it was also explained by education and psycho‐social variables such as self‐esteem and social support.

Conclusions. These findings indicate that in contradiction to the convergence hypothesis, social class and immigration status affect health and well‐being also in old age. It is suggested that the immigration crisis and factors related to the standard of living and health services in the countries of origin, as well as the lower social and economic status of the immigrants in Israel, outweigh their relative advantage in age and education in influencing their health and well‐being. The differences found among the three groups in the factors that explain self‐rated health have implications for the use of economic status as a relevant indicator of social class when considering health status among the elderly, and for the interpretation of SRH, as a global measure of health, in different socio‐cultural groups.     

Childhood Poverty and the Transition to Adulthood

The authors used the Panel Study of Income Dynamics 2007 Transition to Adulthood data in combination with the 2002 Child Development Supplement to examine social class bifurcation in young adulthood. Results indicate that poor youth possibly take on adult roles “too early” at the same time that high‐income youth may be supported for a long period past their 18^th birthday. Although not all evidence is consistent with this bifurcated story, childhood poverty does play a key role. Young adults from poor families establish financial independence early (e.g., contributing to family bills during adolescence, considering themselves fully responsible for their finances as young adults), whereas young adults from more affluent homes are more likely to receive financial transfers from their parents (who often help them pay for college and other expenses). These findings highlight the ways in which socioeconomic inequality in childhood can differentiate youth's experiences of adolescence and young adulthood.     

Client attrition in the Nurse‐Family Partnership®: Revisiting metrics of impact in a home visitation program in the United States

The Nurse‐Family Partnership^® (NFP) is an evidence‐based home‐visiting program for low‐income, first‐time mothers. NFP^® has demonstrated benefits for reducing child maltreatment and improving parenting, child development and families' economic self‐sufficiency. It is now implemented widely in the US where, despite the use of home visits, which generally reduce barriers to program participation, only 35% of clients nationwide complete the 2.5‐year program. This concurrent mixed‐methods study was conducted in 2013 in an urban northeastern US NFP site and included administrative program data, surveys (n = 56), in‐depth interviews (n = 14) with nurse home visitors, and focus groups with nurse supervisors (n = 13). We explored associations between nurses' attrition rates and their perspectives on client attrition and retention strategies. We further conducted an inductive thematic analysis of the qualitative data. Findings indicate that nurses' attrition rates were not significantly associated with their views and strategies to retain clients. Nurses and supervisors noted that clients' competing priorities and ‘chaotic lives’ primarily explained attrition. They thought that clients often left the program upon receiving enough information and skills or achieving key milestones, which may reflect reaching a saturation point, albeit prior to the full completion of the program. We offer recommendations to assess performance based on client accomplishments rather than whether they participated until the prescribed endpoint.