The role of maturity in adolescent decision-making around HPV vaccination in France

Mothers are often responsible for vaccination decisions in the household. However, their confidence in certain vaccines such as Human Papillomavirus (HPV) vaccines is eroding in some countries. France is one of the countries with the lowest HPV vaccine uptake in Europe, with parents delaying or refusing the vaccine for their adolescent daughters due to safety- and effectiveness-related concerns. Although parental consent is required for vaccination, adolescents’ involvement in HPV vaccination decision-making could improve vaccine uptake, with self-consent procedures already introduced in some countries. Adolescents’ capacity to engage in decision-making is influenced by their maturity and autonomy in health. This study explored the role of maturity in decision-making around HPV vaccination in France through qualitative interviews with adolescent girls (n = 24) and their mothers (n = 21) and two focus groups with adolescent girls (n = 12). A codebook approach to thematic analysis revealed that adolescent girls’ involvement in HPV decision-making is a process that evolved with maturity. As adolescents progressed towards maturity at different speeds, some expressed childlike traits such as impulsive decisions and others described more rational, reflective decision-making. Despite these differences, most adolescents in this study described a passive role in HPV vaccination decision-making, following their parents’ lead. However, their expressed desire for information and involvement in discussions indicates that their lack of engagement may not only be due to a lack of maturity but also a result of mothers and doctors excluding them from getting involved. Furthermore, as health behaviours are shaped during adolescence, the influence of vaccine hesitant mothers on their daughters’ own views and beliefs could be significant, together with exposure to regular controversies in the mainstream media. Individualised approaches to engage adolescents in decision-making around their own health are needed, for example through strengthening discussions and information around HPV vaccination with parents and doctors.     

Consent, competence, and confidentiality related to psychiatric conditions in adolescent medicine practice

Health care for adolescents with psychiatric conditions plays out on a complex stage with considerable state variation, based on a mix of statutory and case law. Added to this are less defined factors such as level of trust in community providers, level of cooperation between generalists and specialists, and local regulatory stances toward adolescent health care and mental health care. And, of course, there is the great diversity in diagnosis and maturity level, as well as family cohesion, from patient to patient (and even within a given patient across time). Finally, this situation resides within a larger environment of stigma vis-a-vis mental health care, most notably evident in the United States in disparate insurance coverage of mental versus physical health treatment. With so complex and varied a picture, clinicians should consult with legal counsel to understand applicable state law and local regulatory guidance (if any)and should also seek out ethical consultation when law does not apply or is not decisive, leaving ongoing concerns. And, as with clinical decision-making, in law and ethics "facts matter" [4]. A growing body of law carves out exceptions to general requirements for parental consent, including in mental health care. Ethically informed discussion around capacity determinations, the consent process, and confidentiality can help engage adolescents as "emerging adults"while remaining mindful of risky behavior and "immediate future" orientation that can be hallmarks of adolescence [30]. Respect for the adolescent, parental responsibility toward their child's best interests, and the family unit generally are paramount. Respect--coupled with caution, greater disclosure and cultural sensitivity, and a participatory approach to decision-making that seeks out the least restrictive and coercive options-can help avoid potential legal traps. How best to proceed? It truly depends-with law and ethics the start (not end) of the discussion and analysis.     

Substitute decision making in medicine: comparative analysis of the ethico-legal discourse in England and Germany

Health care decision making for patients without decisional capacity is ethically and legally challenging. Advance directives (living wills) have proved to be of limited usefulness in clinical practice. Therefore, academic attention should focus more on substitute decision making by the next of kin. In this article, we comparatively analyse the legal approaches to substitute medical decision making in England and Germany. Based on the current ethico-legal discourse in both countries, three aspects of substitute decision making will be highlighted: (1) Should there be a legally predefined order of relatives who serve as health care proxies? (2) What should be the respective roles and decisional powers of patient-appointed versus court-appointed substitute decision-makers? (3) Which criteria should be determined by law to guide substitute decision-makers?     

Covert parental control: parent-adolescent interaction and adolescent development in a Chinese context

Although there are well-known theories of adolescent development in the West, there is a notable lack of theory and empirical support for understanding the process of Chinese adolescent development. This paper investigates the parental attitudes and practices of Chinese-Canadian immigrant parents and the reactions of adolescents in an effort to elucidate the pattern of parent-adolescent interaction and the process of adolescent development in the Chinese-Canadian cultural context. A qualitative study approach was used to explore the experiences and views of 19 adolescents and ten of their parents. The findings indicate that Chinese parents and adolescents co-construct the dominant theme of "covert parental control" in the adolescent development process. "Covert control," in this context, refers to a form of parenting characterized by parental guidance, family teaching, coaching, and monitoring, Parents, through "tact" and "skills," successfully influence and guide their adolescent children. Adolescents, motivated by their sense of loyalty to family and the concepts associated with parental guidance, reinforce their parents' covert control and the indigenous concept of "guan" in the practice of Chinese parenting.     

Adolescent risk behavior and the influence of parents and education

BACKGROUND: Adolescent involvement with alcohol, drugs, tobacco, sexual relationships, and gang violence begins at increasingly younger ages. Awareness of the dangers and consequences of risk-taking behavior has not had a profound or lasting impact on adolescent behavior, and there appears to be no relation between risk behavior and general knowledge concerning these topics. METHODS: Using paired anonymous questionnaires, we surveyed 215 seventh-grade students and their parents about their experience with and attitudes toward adolescent risk-taking behaviors. The results of each student questionnaire were compared with results of his or her own parents. The survey instrument contained questions concerning tobacco, alcohol, and drug use, sexual activity, gang membership, general knowledge concerning these topics, and parental guidance given. Data were analyzed using the chi2 test of significance. RESULTS: Parent and student recollection of issues discussed and guidance given differed widely, as did the students' understanding of their parents' guidance. Factors found to have a meaningful impact on the reduction of risk behavior in the adolescent population were (1) students perceiving a satisfactory relationship with their parents, and (2) parents successfully communicating their expectations regarding these behaviors to their children. CONCLUSIONS: Parental direction has a powerful effect on the reduction of risk behavior in young adolescents. A limited ability for abstract reasoning during early adolescence requires clear anticipatory guidance by parents and an active effort to maintain communication in the child-parent relationship.     

Mandatory parental involvement prior to adolescent abortion

The issue of parental involvement in an adolescent's decision to abort a pregnancy is complex and controversial. Consequently, the impact of legislation to mandate parental involvement is reviewed. Although the costs of such legislation are high, there are at least three important clinical benefits. First, a legal mandate will require many adolescents who would not otherwise involve their parents in this decision process to seek their counsel and emotional support. Second, parent's responsibility for the actions of their adolescent children is acknowledged within the legal system. Third, family unity may be promoted by allowing parents and adolescents an opportunity to deal more openly with the causes and implications of the pregnancy.     

Lifetime parental smoking history and cessation and early adolescent smoking behavior

BACKGROUND: Associations are examined between parental smoking and smoking onset by their children. Smoking parents are more likely to have children who start smoking in their teenage years; however, less is known about whether parental quitting is related to adolescent smoking. METHODS: A cross-sectional national sample of 2,206 adolescents, ages 10-14 years, living in two-parent households were interviewed for the DEFACTO annual report on Dutch youth smoking behavior. Adolescent smokers reported that they have tried smoking, even one puff. Respondents indicated whether their parents were never, former, or current smokers, and provided, in the case a parent had quit, their age at that time. RESULTS: Logistic regression analyses revealed that likelihood increased gradually: adolescents with both parents being current smokers were four times more likely to be a smoker compared to adolescents with parents who had never smoked. Additionally, within the group of adolescents whose parents quit smoking, the findings demonstrated that the earlier the parents stopped smoking in the life of their offspring, the less likely their children were to start smoking in adolescence. CONCLUSIONS: Parental smoking history is associated with smoking initiation in early adolescence. Parental cessation at an early age of their offspring reduces the likelihood of adolescent smoking initiation. Preventive efforts, therefore, should focus on the benefits of parental cessation as early as possible.     

Adolescents' proxy reports of parents' socioeconomic status: How valid are they?

STUDY OBJECTIVE: Children's proxy reports on indicators of their parents' socioeconomic status (SES) have either been used uncritically or dismissed as invalid. This paper examines the validity of young adolescents' reports of parental SES by comparing adolescent reports with parents' own reports of SES. DESIGN, SETTING AND PARTICIPANTS: In 1990, 924 13 year olds, along with 648 of their fathers and 735 of their mothers, participated in the baseline survey of The Norwegian Longitudinal Health Behaviour Study. Data on parental occupation were collected from both adolescents and parents at baseline, while data on parental education were collected at follow up from the adolescents at age 15 and from their parents when the adolescents were 19 years old. MAIN RESULTS: Three different ways of grouping the SES categories based on occupational data were investigated, and the strength of agreement was good for all three groups, with kappa statistics ranging from 0.65 to 0.86. There were no significant improvements of agreement when comparing adolescent data from age 15 to adolescent data from age 13. The strength of agreements between the adolescents' and parents' reports of parental education were fair; kappa statistics were 0.30 and 0.38 for fathers' and mothers' education, respectively. The proportions of unclassified answers or no responses from the adolescents were similar for questions on occupation and education, and ranged from 11% to 16%. CONCLUSIONS: The agreement between adolescents' and parents' reports of SES based on occupation was judged to be good, but adding a few specific questions may cue the adolescent to provide more detailed information, thereby reducing the numbers of unclassified answers or non-responders.     

Associations Between Parental Concern for Adolescent Weight and the Home Food Environment and Dietary Intake

ObjectiveExamine associations between parental concern about adolescent weight and adolescent perceptions of their dietary intake, home food availability, family mealtime environment, and parents' feeding practices.DesignCross-sectional study.SettingAdolescents, aged 12-15 years from 37 secondary schools in Victoria, Australia, and their parents completed surveys in 2004-2005.Participants1,448 adolescent–parent pairs.Main Outcome MeasuresParental concern about adolescent weight; adolescent perceptions of their food intake and home food environment.AnalysisChi-square tests, exploratory factor analysis, independent t tests (P < .01).ResultsAlthough 12% of parents perceived their adolescent as overweight, 27% were concerned about their adolescent's weight (under- or overweight). Adolescents of concerned parents reported lower intakes of energy-dense snacks and less home availability of these food items, and they perceived that their parents less often listened to and considered their food preferences when shopping and cooking, than did adolescents of unconcerned parents. Concerned parents were no more likely to provide fruits and vegetables in the home or a positive family mealtime environment than unconcerned parents, at least as reported by their adolescents.Conclusions and ImplicationsParental concern about adolescent weight was associated with lower intakes of energy-dense snacks among adolescents, less home availability of these food items, and less supportive parental feeding practices. Parents should be encouraged to listen to and consider their adolescents' food preferences, and provide supportive family mealtime environments and healthful food in the home.     

Household decision-making for the MenACWY vaccination: How parents and adolescents deal with an adolescent vaccination decision

ObjectiveBetween 2015 and 2018 The Netherlands experienced increases of invasive meningococcal disease (IMD) serogroup W (MenW), from 0.02 cases/100,000 people between 2010 and 2014 up to 0.5 cases/100,000 in 2017. Therefore in 2018 the MenACWY vaccination was introduced in the National Immunisation Programme (NIP) and a catch-up campaign was initiated among adolescents. This study aimed to gain insight into the decision-making process within households regarding the MenACWY vaccination. The focus was on the differences in the decision-making process of parents and adolescents and of those that had accepted the MenACWY vaccination and those that had not, in order to assess how these types of decisions are made within households.MethodWe conducted a total of 38 semi-structured interviews in 20 households (7 not vaccinated) with 20 parents and 18 adolescents (18 dyads) across The Netherlands concerning their decision-making process. Interview guides were constructed based on the Precaution Adaption Process (PAP) model. We performed thematic analysis using qualitative data analysis software (MAXQDA).ResultsParents are the main actors in the household decision-making process regarding the MenACWY vaccination. Parents start their decision-making process before adolescents are even aware of the issue. Households in the study took different approaches in involving the adolescent in the decision-making, resulting in three styles of household decision-making: parents decide without the adolescent, parents involve the adolescent, or parents leave it up to the adolescent to decide.ConclusionParents influence adolescent reasoning, engagement and involvement during the MenACWY vaccination decision-making. And this is the case both among those that have accepted and rejected the MenACWY vaccination. Adolescent engagement with the MenACWY vaccination decision-making is either short-lived or non-existent. However, the moment offers opportunities to engage adolescents on vaccinations and decision-making, with parents as key figures to promote this.     

Parents' and friends' smoking status as predictors of smoking onset: findings from six European countries

This study assessed the relationship between the smoking behavior of adolescents and the smoking status of their parents and friends among adolescents from six European countries. A longitudinal study collected data from 15 705 adolescents on their own smoking status, and that of their parents, best friend and friends in general. Cross-sectional regression analysis showed that adolescent smoking was most strongly associated with friends' smoking and best friend's smoking, explaining 38% of the variance in the total sample. Longitudinal regression analysis, however, showed that the beta coefficients of the smoking status of the best friend and friends in general were comparable to that of parental smoking. Parental smoking behavior was found to be as predictive of smoking onset after 1 year as friends' smoking status.     

Factors impacting parental uptake of COVID-19 vaccination for U.S. Children ages 5–17

COVID-19 vaccination of U.S. children lags behind adult vaccination, but remains critical in mitigating the pandemic. Using a subset of a nationally representative survey, this study examined factors contributing to parental uptake of COVID-19 vaccine for children ages 12–17 and 5–11, stratified by parental COVID-19 vaccination status. Among vaccinated parents, uptake was higher for 12–17-year-olds (78.6%) than 5–11-year-olds (50.7%); only two unvaccinated parents vaccinated their children. Child influenza vaccination was predictive of uptake for both age groups, while side effect concerns remained significant only for younger children. Although parents were more likely to involve adolescents in vaccine decision-making than younger children, this was not predictive of vaccine uptake. These results highlight the importance of addressing the unique and shared concerns parents have regarding COVID-19 vaccination for children of varying ages. Future work should further explore adolescent/child perspectives of involvement in COVID-19 vaccination decision-making to support developmentally appropriate involvement.     

Meeting the needs of young people

The International Planned Parenthood Federation (IPPF), recognizing its responsibility to assist young people in fulfilling their roles as parents, citizens, and leaders, seeks to improve the quality of life of young people by advocating and promoting, especially to governments and other organizations, measures that will respond to their total human needs, including the provision of education and employment opportunities. IPPF, as a family planning organization, can contribute directly to the preparation of young people for responsible parenthood and to meeting their fertility related needs. Family planning associations (FPAs) are encouraged to initiate, strengthen, or support programs which respond to the needs of young people. Priority should be given to meeting the needs of the most disadvantaged groups, with emphasis on out of school and rural youth, slum dwellers, youth in urban industrialized areas, and abandoned adolescents and children, with special attention to the early group adolescent age group. The involvement of young people as active partners in IPPF's work is essential for its efforts to promote and sustain commitment to family planning at policymaking and community levels in the years ahead and to prepare the next generation of leaders within the Federation. Population, family life, and sex education, including family planning and reproductive health management, provide in both formal and nonformal settings, are the cornerstone of youth programs. FPAs should look for ways to remove legal, administrative, and other barriers to the availability of adequate education and services. As pregnancy poses special hazards for adolescents, particularly those under age 16, services should cater to the special circumstances in which adolescent childbearing is taking place. No single contraceptive method can be regarded satisfactory for adolescents as a group, but each method may have a place in adolescent services. Several factors, such as age, parity, and other personal amd medical considerations, need to be carefully assessed in helping the individual adolescent to make a choice. IPPF affirms that meeting the needs of young people is a major objective for the Federation and that priority should be given to meeting the needs of the most disadvantaged young people. Parents have primary responsibility in the preparation of the young for responsible parenthood, and their participation in meeting the fertility related needs of young people as part of an improved quality of family life should be encouraged and supported. Education and counseling should respond to the needs of young people who engage in sex relations and those who do not. Research should be encouraged, particularly at the national and local level, in biomedical, social science, service delivery, and legal and policy areas.     

Making choices about medical interventions: the experience of disabled young people with degenerative conditions

Background Current western policy, including the UK, advocates choice for service users and their families, taking greater control and being more involved in decision making. However, children’s role in health decision making, especially from their own perspective, has received less research attention compared to doctors and parents’ perspectives. Objective To explore the perspective and experiences of disabled young people with degenerative conditions as they face significant medical interventions and engage in decision‐making processes. Design and methods Findings from a longitudinal qualitative study of 10 young people (13–22 years) with degenerative conditions are reported. Individual semi‐structured interviews were conducted with participants over 3 years (2007–2010); the paper reports data from all three interview rounds. Interviews focused on medical intervention choices the young people identified as significant. Results Although the young people in this study felt involved in the medical intervention choices discussed, findings demonstrate a complex and diverse picture of decision making. Results highlighted different decisional roles adopted by the young people, the importance of information heuristics and working with other people whilst engaging in complex processes weighing up different decisional factors. Discussion Young people’s experiences demonstrate the importance of moving beyond viewing health choices as technical or rational decisions. How each young person framed their decision was important. Recognizing this diversity and the importance of emerging themes, such as living a normal life, independence, fear of decisions viewed as ‘irreversible’ and the role of parents and peers in decision making highlights that, there are clear practice implications including, active practitioner listening, sensitivity and continued holistic family working.     

The Influence of Family Functioning and Parent‐Adolescent Acculturation on North American Chinese Adolescent Outcomes

Abstract: The present study investigated the associations between family functioning, acculturation between parents and their adolescents, and adolescent adjustment problems. Chinese adolescents and their parents (N= 41) living in the United States and Canada participated in this study. Results showed that differences in acculturation between parents and adolescents were related to adolescent depression and that family functioning was related to both depression and delinquency. Both parental and adolescent acculturation levels and their differences were important in predicting adolescent outcomes. Implications for conducting family therapy and parent education with Chinese North American adolescents and their parents are discussed.     

Swiss adolescents' and adults' perceptions of cannabis use: a qualitative study

Few studies have attempted to investigate the nature of adolescents' and adults' conceptions and perceptions of cannabis use. Our objectives were to explore adolescent and adult perception of use and misuse of cannabis, and their opinions and beliefs about the current legal context and preventive strategies. We used focus group discussions with four categories of stakeholders: younger (12-15 year old) adolescents, older (16-19 year old) adolescents, parents of teenagers and professionals working with young people. In some areas (legal framework, role of the media, importance of early preventive interventions), we found consensual attitudes and beliefs across the four groups of participants. In all four groups, participants did not have any consensual vision of the risks of cannabis use or the definition of misuse. In the area of the prevention of cannabis use/misuse, while parents focused on the potential role of professionals and the media, thus minimizing their own educational and preventive role, professionals stressed the importance of parental control and education. Within the Swiss context, we conclude there exists an urgent need for information and clarification of the issues linked with cannabis use and misuse directed at parents and professionals.