Validation of You're Welcome Quality Criteria for Adolescent Health Services Using Data From National Inpatient Surveys in England

PurposeRevised You're Welcome (YW) quality criteria for adolescent health services were published by the English Department of Health in 2011. These are the first national standards to include inpatient services and the first of their kind to be endorsed by the World Health Organization. This article investigates the relationship between the YW criteria and young people's overall satisfaction in national inpatient surveys.MethodsWe identified the most recent national surveys that contain adolescent data: the Inpatient Survey (IS) 2009 (ages 16–19 years) and the Young Patient Survey (YPS) 2004 (ages 12–17 years). Logistic regression was used to calculate the odds of increased overall satisfaction when YW criteria were met, adjusting for sex and use of health services. Spearman rank correlation coefficients were used to identify the 10 questions in each survey that best correlated with overall satisfaction. We assessed the degree to which these 10 items were included in the YW criteria.ResultsIn all, 7,657 (12–17 years old) and 988 (16–19 years old) adolescents completed the YPS and the IS, respectively. Twenty-eight of 29 questions that mapped to YW criteria were significantly associated with overall satisfaction (IS = 14/15; YPS = 25/25; all p < .01). Of the 10 questions that best correlated with overall care rating, 9 mapped directly to YW criteria in the YPS, as did all 10 in the IS. Provider characteristics were the strongest correlates of the overall care rating.ConclusionAlthough limited by lack of data relating to access, publicity, and confidentiality, our study provides strong support for the face validity and content validity of the remaining YW quality criteria in inpatient settings.     

青少年亚健康状态与烟酒使用的相关性研究

目的 评价<青少年亚健康多维评定问卷>对自杀心理行为的预测作用,为进一步采取干预措施提供依据.方法 采用定群研究,使用<青少年哑健康多维评定问卷>评定全国8座城市的17 622名在校生(初一、初二、高一、高二、大一、大二)的亚健康状况,随访3个月后在校生自杀心理行为的发生情况,共收回有效问卷16 171份.结果 在校生3个月内自杀意念、自杀计划及自杀未遂的检出率分别为5.1%,2.3%和1.4%;女生自杀意念的检出率高于男生,差异有统计学意义(P<0.01).随着基线调查中躯体、心理和身心亚健康症状数的增加,3个月内在校生自杀心理行为的检出率增加,差异均有统计学意义(P值均<0.01).结论 <青少年亚健康多维评定问卷>对青少年自杀心理行为具有较好的预测作用.早期筛查亚健康状况,对青少年自杀心理行为的防制具有重要意义.     

Current Tobacco Use Among Adults in the United States: Findings From the National Adult Tobacco Survey

Objectives. We assessed the prevalence and sociodemographic correlates of tobacco use among US adults.Methods. We used data from the 2009–2010 National Adult Tobacco Survey, a national landline and cell phone survey of adults aged 18 years and older, to estimate current use of any tobacco; cigarettes; cigars, cigarillos, or small cigars; chewing tobacco, snuff, or dip; water pipes; snus; and pipes. We stratified estimates by gender, age, race/ethnicity, education, income, sexual orientation, and US state.Results. National prevalence of current use was 25.2% for any tobacco; 19.5% for cigarettes; 6.6% for cigars, cigarillos, or small cigars; 3.4% for chewing tobacco, snuff, or dip; 1.5% for water pipes; 1.4% for snus; and 1.1% for pipes. Tobacco use was greatest among respondents who were male, younger, of non-Hispanic “other” race/ethnicity, less educated, less wealthy, and lesbian, gay, bisexual, or transgender. Prevalence ranged from 14.1% (Utah) to 37.4% (Kentucky).Conclusions. Tobacco use varies by geography and sociodemographic factors, but remains prevalent among US adults. Evidence-based prevention strategies are needed to decrease tobacco use and the health and economic burden of tobacco-related diseases.Tobacco use remains the single largest preventable cause of disease and premature death among both men and women in the United States.1 Health effects associated with tobacco use include heart disease, many types of cancer, pulmonary disease, adverse reproductive outcomes, and the exacerbation of multiple chronic health conditions.2 Cigarette smoking alone has been estimated to cause 443 000 deaths per year in the United States, including approximately 49 400 deaths attributed to secondhand smoke exposure.3 In addition, cigarette smoking has been estimated to cost the United States $96 billion in direct medical expenses and $97 billion in lost productivity per year.3 Despite significant progress over the past several decades,4 declines in the prevalence of cigarette smoking and the use of other tobacco products among US adults have stalled in recent years.5,6Monitoring the extent of the tobacco epidemic can assist in guiding decisions about tobacco control strategies for the overall population and high-risk subpopulations. The World Health Organization recognizes that monitoring tobacco use is an important and effective tobacco control approach in its MPOWER model and encourages the collection of data on tobacco use prevalence and consumption by demographic subdivisions, both nationally and regionally.7 In the United States, the report Key Outcome Indicators for Evaluating Comprehensive Tobacco Control Programs (KOI report) identified valid and reliable measures for tobacco-related indicators and provided a guide for tobacco control surveillance at the national, state, and local levels.8The National Adult Tobacco Survey (NATS) is the first adult tobacco use survey designed within the framework of the KOI report.9 NATS establishes a comprehensive standard for assessing the prevalence of tobacco use and the factors promoting and impeding tobacco use at both the national and state levels. We analyzed NATS data to determine the national prevalence and sociodemographic correlates of tobacco use among US adults, both overall and for multiple tobacco products. We also calculated state-specific estimates for overall tobacco use and for cigarette smoking.     

Daily Patterns of Caffeine Intake and the Association of Intake with Multiple Sociodemographic and Lifestyle Factors in US Adults Based on the NHANES 2007–2012 Surveys

Background

Caffeine increases alertness when consumed in single servings of various products including coffee, tea, soft drinks, and energy drinks. Although not a nutrient, caffeine is consumed by 90% of the adult population in the United States.

Monitoring Adolescents' Receipt of Time Alone From Two National Surveys

PurposeDespite professional endorsement and research supporting time alone with a clinician for adolescents, low rates and disparities persist. The purpose of the present analysis was to provide detailed monitoring of time alone estimates in two national surveys that assess time alone for adolescents aged 12–17 years: the National Survey of Children's Health (NSCH) and the Medical Expenditure Panel Survey (MEPS).MethodsTime alone assessments in the NSCH and the MEPS have different definitions. The NSCH assessed time alone within the most recent preventive visit, and the MEPS assessed it within the most recent health care visit. We analyzed these within the subsample of 12- to 17-year-olds who had any past-year preventive visit: MEPS 2016–2017, n = 2,689; and NSCH 2016–2017, n = 24,085. We developed time alone estimates for full and subgroup samples and conducted multivariable logistic regressions to determine differences by age, sex, race/ethnicity, income, insurance, and region.ResultsOverall time alone receipt was 49% (NSCH) and 29% (MEPS). Overall rates are not comparable because their definitions differ. Some subgroup differences were similar across datasets: younger adolescents (p < .01) and females (p < .05) had lower rates.ConclusionsAmong adolescents with a past-year preventive visit, time alone rates are low. Lower rates for females versus males and younger versus older adolescents persist. Detailed monitoring results can help to shape promising strategies including clinic-based interventions, such as provider training and educating parents, in efforts to improve the provision of time alone in clinical practice.     

Sociodemographic Patterns of Exclusive,Dual, and Polytobacco Use Among U.S. High School Students: A Comparison of Three Nationally Representative Surveys

PurposeThis study examines sociodemographic patterns of exclusive/dual/polytobacco use among U.S. high school students using multiple national surveys.MethodsUsing three national youth surveys (Population Assessment of Tobacco and Health [PATH] Wave 4 [2016–2017], 2017 Youth Risk Behavior Survey, and 2017 National Youth Tobacco Survey), we classified tobacco products into four groups: (1) electronic nicotine delivery systems (ENDS), (2) conventional cigarettes (CCs), (3) other combustible tobacco products, and (4) smokeless tobacco products. We created 16 categories of non/exclusive/dual/polytobacco use within the past 30 days using the four product groups and calculated weighted population prevalence by sex and race/ethnicity (all surveys) and parental education and income (PATH), based on variable availability.ResultsThe results from 9,331, 12,407, and 9,699 high school students in PATH, Youth Risk Behavior Survey, and National Youth Tobacco Survey, respectively, largely agreed and pointed to similar conclusions. ENDS was the most prevalent exclusive use product (3.8%–5.2% across surveys), with CCs falling to second or third (1.2%–2.0% across surveys). By sex, exclusive, dual, and poly smokeless tobacco product use were more common for males, whereas exclusive CC use was more common for females. By race/ethnicity, non-Hispanic Whites had a higher prevalence of exclusive ENDS use and ENDS/CC dual use than non-Hispanic Blacks. As income and parental education levels increased from low to high, the prevalence of exclusive CC use decreased, whereas the prevalence of exclusive ENDS use increased.ConclusionUnderstanding sociodemographic patterns of tobacco use can help identify groups who may be at greater risk for tobacco-related health outcomes.     

Tobacco Use Among Adolescent Students and the Influence of Role Models

Background:

Seventy per cent of premature deaths among adults are due to behavioral patterns that emerge in adolescence, including smoking.

Objective:

The objective was to study the prevalence of tobacco use among adolescent students in South Delhi and its epidemiological correlates.

Materials and Methods:

This was a cross-sectional study.

Setting:

Three schools and two colleges of South Delhi were chosen. There were 550 adolescent students aged 14-19.

Statistical Analysis:

Statistical analysis was done using proportions, the chi-square test, and multivariate logistic regression.

Results:

A total of 88 (16.0%) students reported having ever tried cigarette or bidi smoking. The prevalence of current smoking was 7.1%. Exactly 10% (55) of the students reported having ever used smokeless forms of tobacco. The prevalence of tobacco use overall was found to be 20.9%, and was significantly higher (P=0.016) among the males than the females. Tobacco use was found to be significantly associated with having seen a brother/sister smoke (OR 5.15), best friend smoke (OR 2.92), and belonging to a nuclear family (OR 1.96).

Conclusions:

Tobacco use is still an important risk behavior among adolescent students. This study found a strong association of tobacco use by the adolescents with their having seen various role models ever smoking.     

Longitudinal Patterns of Multiple Tobacco and Nicotine Product Use Among Texas College Students: a Latent Transition Analysis

Prevention Science - Diverse tobacco and nicotine products have altered the terrain of tobacco use behaviors. Limited research has examined contemporary patterns of use among young adults. This...     

Multiple Aspects of Sexual Orientation: Prevalence and Sociodemographic Correlates in a New Zealand National Survey

Sexual orientation consists of multiple components. This study investigated both sexual identity and same-sex sexual behavior. Data came from the New Zealand Mental Health Survey, a nationally representative community sample of New Zealanders aged 16 years or older, interviewed face-to-face (N = 12,992, 48% male). The response rate was 73.3%. Self-reported sexual identity was 98.0% heterosexual, 0.6% bisexual, 0.8% homosexual, 0.3% “Something else,” and 0.1% “Not sure.” Same-sex sexual behavior with a partner was more common: 3.2% reported same-sex sexual experience only and 1.9% reported both experience and a relationship. For analysis of childhood and lifecourse, five sexuality groups were investigated: homosexual, bisexual, and heterosexual divided into those with no same-sex sexual experience, experience only, and experience and relationship. The non-exclusively heterosexual groups were more likely to have experienced adverse events in childhood. Educational achievement and current equivalized household income did not differ systematically across the sexuality groups. Only 9.4% of the exclusively heterosexual lived alone, compared with 16.7% of bisexuals and 19.0% of homosexuals. Heterosexuals were more likely than bisexuals or homosexuals to have ever married or had biological children, with differences more marked for males than for females. Heterosexuals with no same-sex sexual experience were more likely to be currently married than the other two heterosexual groups. Restricting comparisons to heterosexual, bisexual, and homosexual identification ignores the diversity within heterosexuals. Differences between the bisexual and homosexual groups were small compared with the differences between these groups and the exclusively heterosexual group, except for sex (80.8% of bisexuals were female).     

Social Disaffection, Friendship Patterns and Adolescent Cigarette Use: The Muscatine Study

This study was undertaken to determine if adolescent social disaffection with school and family not only would be a significant predictor of cigarette use but would explain a significant amount of the association with friends who smoke. Eleven hundred and eighty ninth-12th grade students in Muscatine, Iowa, were surveyed in Spring 1984. Multiple regression analyses indicated several social disaffection variables were significant predictors of association with friends who smoke, explaining 20% of the variance. The combination of association with friends who smoke and social disaffection variables explained 48% of the variance in adolescent cigarette smoking. Variables related to adolescents' participation in school and related activities suggest prevention programs should recognize the impact of social disaffection on adolescents cigarette use.     

Relationship between Eating Habits,Physical Activity and Tobacco and Alcohol Use in Pregnant Women: Sociodemographic Inequalities

Pregnant women must maintain or acquire healthy habits during pregnancy to protect both their own health and their child’s. Such habits include an adequate eating pattern along with good adherence to the intake of certain supplements, practice of moderate physical activity and avoiding the consumption of toxic products such as tobacco and alcohol. The objective of this study is to assess the interrelation between such habits and their association with sociodemographic variables. To such end, a cross-sectional study was conducted with a representative sample of pregnant women who attended the scheduled morphology echography consultation at the 20th gestational week in their reference public hospital in the city of Seville (Spain). Results: Younger pregnant women and with lower educational levels are the ones that present the worst eating habits and the highest smoking rate. Pregnant women with lower educational levels are the least active. Non-smoking pregnant women present better eating habits than those who smoke. Pregnant women with lower educational levels are those who accumulate more unhealthy habits during pregnancy. This should be taken into account when planning the health care provided to pregnant women and in public health intersectoral policies.     

Associations Among Excess Weight Status and Tobacco,Alcohol, and Illicit Drug Use in a Large National Sample of Early Adolescent Youth

Adolescent substance use and overweight/obesity each are public health priorities, with unique prevalences based on race/ethnicity. Whether these biobehavioral risks are linked in today’s youth is unknown, leaving critical gaps in prevention science. Utilizing a national epidemiological sample of 10th grade students (N?=?19,678; M _age?=?16.09 years; 69.5 % White, 14.5 % Black, 16.0 % Hispanic; 2008–2009 Monitoring the Future), we examined adolescent substance use behaviors (current use, grade of first use, polysubstance use) for adolescents of overweight (OV), obese (OB), or severely obese (SO) status compared to adolescents of healthy weight (HW) for each race/ethnicity group. We also examined how engagement in smoking behaviors (current, early grade at first use) was linked to other substance use behaviors for youth of varying degrees of excess weight. Relative to HW youth, White youth of excess weight, particularly SO, had higher odds of early (<grade 9) substance use and use of some illicit substances (inhalants, cocaine, amphetamines) within the past year. Among White early smokers, OB and SO had higher odds of other substance use, whereas White OB and SO recent smokers had lower odds of other substance use. Few significant findings based on weight status were identified for Black or Hispanic youth. These findings suggest adolescent health risk behaviors co-occur uniquely for White youth, in particular those who are SO and by early adolescence. Understanding the downstream public health consequences and how risk pathways of excess weight, tobacco, and other substance use may uniquely unfold for each race/ethnicity group is imperative.     

Adolescent Substance Use and Other Illegal Behaviors and Racial Disparities in Criminal Justice System Involvement: Findings From a US National Survey

We used data from a national survey to examine arrest rate disparities between African American and White adolescents (aged 12–17 years; n = 6725) in relation to drug-related and other illegal behaviors. African American adolescents were less likely than Whites to have engaged in drug use or drug selling, but were more likely to have been arrested. Racial disparities in adolescent arrest appear to result from differential treatment of minority youths and to have long-term negative effects on the lives of affected African American youths.Racial disparities in the juvenile and criminal justice systems are important in both criminology and public health. African American youths have higher rates of arrest and detention than White youths.1–4 The US governmental policies known collectively as the War on Drugs have contributed significantly to increases in rates of arrest and incarceration, especially of African Americans,5–13 although rates of substance use and abuse among African Americans are either similar to14^,15 or even lower than those of Whites.16Two main hypotheses address the overrepresentation of racial/ethnic minorities in the juvenile and criminal justice systems: (1) the “differential offending” hypothesis (that this overrepresentation generally reflects racial and ethnic differences in the incidence, seriousness, and persistence of engagement in delinquent and criminal behavior) and (2) the “differential treatment” hypothesis (that this overrepresentation is attributable to inequities—intended or unintended—in justice system practices as they affect particular populations).2,17–20We used data from a nationally representative survey of youths to examine the relationship of substance use and other illegal behaviors with arrest among African American and White youths to better understand racial disparities in arrest by testing whether the differential offending hypothesis or the differential treatment hypothesis best explains observed disparities, and by examining the longitudinal impact of arrest in adolescence on educational attainment.     

Use of Design Effects and Sample Weights in Complex Health Survey Data: A Review of Published Articles Using Data From 3 Commonly Used Adolescent Health Surveys

Objectives. We assessed how frequently researchers reported the use of statistical techniques that take into account the complex sampling structure of survey data and sample weights in published peer-reviewed articles using data from 3 commonly used adolescent health surveys.Methods. We performed a systematic review of 1003 published empirical research articles from 1995 to 2010 that used data from the National Longitudinal Study of Adolescent Health (n = 765), Monitoring the Future (n = 146), or Youth Risk Behavior Surveillance System (n = 92) indexed in ERIC, PsycINFO, PubMed, and Web of Science.Results. Across the data sources, 60% of articles reported accounting for design effects and 61% reported using sample weights. However, the frequency and clarity of reporting varied across databases, publication year, author affiliation with the data, and journal.Conclusions. Given the statistical bias that occurs when design effects of complex data are not incorporated or sample weights are omitted, this study calls for improvement in the dissemination of research findings based on complex sample data. Authors, editors, and reviewers need to work together to improve the transparency of published findings using complex sample data.Secondary data analysis of nationally representative health surveys is commonly conducted by health science researchers and can be extremely useful when they are investigating risk and protective factors associated with health-related outcomes. By providing access to a vast array of variables on large numbers of individuals, large-scale health survey data are enticing to many researchers. Many researchers, however, lack the methodological skills needed for effective access to and use of such data. Traditional statistical methods and software analysis programs assume that data were generated through simple random sampling, with each individual having equal probability of being selected. With large, nationally representative health surveys, however, this is often not the case. Instead, from the perspective of statistical analysis, data from these complex sample surveys differ from those obtained via simple random sampling in 4 respects.First, the probabilities of selection of the observations are not equal; oversampling of certain subgroups in the population is often employed in survey sample design to allow reasonable precision in the estimation of parameters. Second, multistage sampling results in clustered observations in which the variance among units within each cluster is less than the variance among units in general. Third, stratification in sampling ensures appropriate sample representation on the stratification variable(s), but yields negatively biased estimates of the population variance. Fourth, unit nonresponse and other poststratification adjustments are usually applied to the sample to allow unbiased estimates of population characteristics.1 If these aspects of complex survey data are ignored, standard errors and point estimates are biased, thereby potentially leading to incorrect inferences being made by the researcher.     

Smokeless Tobacco and the Rural Teen: How Culture and Masculinity Contribute to Adolescent Use

Tobacco use is the leading preventable cause of disease, disability, and death in the United States. Smokeless tobacco (SLT) is primarily used by younger, rural males and often in the presence of other males. This formative study examined how hegemonic masculinity and male norms can lead to initiation and continued use of SLT by rural adolescent males and females. Survey data collected from high school sophomores in 4 rural high schools (n = 293) explores perceptions of masculinity and male norms’ contribution to SLT uptake and use. About 22.5% of total sample reported lifetime use (34.4% male, 13.7% female), 10.9% reported past-month use (20.0% male, 4.2% female). Logistic regressions show a one-unit increase in adherence to traditional perceptions of masculinity more than doubled the odds of ever using SLT and significantly increased odds of 30-day use. Having male household family members who uses SLT significantly increased the odds of lifetime and 30-day SLT use for both genders, while having male family members who smoke cigarettes was not a significant correlate. Recognition of health warnings on SLT packaging was negatively associated with SLT use for both genders. Implications for inclusion of masculinity and male role models in SLT prevention intervention strategies are discussed.     

Sociodemographic Differences Among U.S. Children and Adults Exposed to Secondhand Smoke at Home: National Health Interview Surveys 2000 and 2010

Objective

We examined the levels and change in prevalence of self-reported secondhand smoke (SHS) exposure at home, and analyzed sociodemographic differences in exposure among children (aged 0–17 years) and nonsmoking adults (aged ≥18 years) in the United States in 2000 and 2010.

Methods

We included 18,731 children and 44,049 adults from the 2000 and 2010 National Health Interview Survey Cancer Control Supplements. We used multivariate logistic regression to determine the factors associated with exposure.

Results

The prevalence of self-reported SHS exposure declined from 2,627 of 10,636 (24.7%) to 663 of 8,095 (8.2%) for children and from 2,863 of 23,665 (12.1%) to 897 of 20,384 (4.4%) for adults from 2000 to 2010. SHS exposure declined for all population subgroups between the two years, but differences were found. Compared with 2000, children aged 12–17 years in 2010 were no longer more likely than children aged 0–5 years to be exposed to SHS. Non-Hispanic black children and adults were more likely than non-Hispanic white children and adults to be exposed to SHS in 2010. In 2010, no differences were found for children whose parents had a higher level of education, and no differences were observed for children or adults with high family income vs. other levels of family income. Children living in the Midwest and South had higher levels of SHS exposure than children in other regions in 2010.

Conclusions

Self-reported SHS exposure at home declined for all population subgroups from 2000 to 2010, but socioeconomic differences existed for some subgroups in both years. Current tobacco control policies need to be improved to reach all population subgroups so that SHS exposure can be further reduced, especially among vulnerable populations.Secondhand smoke (SHS) exposure has been linked to numerous health conditions, including respiratory illness, cancer, and heart disease for adults;^1,2 and middle ear disease, asthma, respiratory symptoms, abnormal pulmonary function, and attention deficit hyperactivity disorder (ADHD) for children.^3,4 The health effects of SHS exposure also result in excess economic costs. One study estimated the total annual SHS-attributable medical cost in the United States at $6.9 billion in 2005.⁵ Another study reported that SHS exposure resulted in more than 42,000 deaths, nearly 600,000 years of potential life lost, and $6.6 billion of lost productivity in 2006 in the United States.⁶SHS exposure occurs in three main settings: at home, in the workplace, and in public places. The home setting is the primary source of SHS exposure for children and a major source of exposure for nonsmoking adults.³ The prevalence of SHS exposure in the United States has been declining in recent years.^3,7 Using data from the National Health and Nutrition Examination Surveys (NHANES), a recent Centers for Disease Control and Prevention (CDC) report found that the percentage of the U.S. nonsmoking population (aged ≥3 years) with cotinine-measured SHS exposure declined from 52.5% in 1999–2000 to 25.3% in 2011–2012.⁷ Previous studies have also reported socioeconomic differences in SHS exposure for both adults and children. A study using 1999–2010 NHANES data found that never-smoking adults (aged ≥20 years) in the lowest socioeconomic quintile were two to three times more likely than those in the highest quintile to be exposed to SHS at home.⁸ Another study that used the 2007 National Survey of Children''s Health in the United States found that, compared with children from higher socioeconomic backgrounds, children from lower socioeconomic backgrounds had higher odds of self-reported SHS exposure at home; and that non-Hispanic white, non-Hispanic black, American Indian, and mixed-race children had higher odds of SHS exposure at home than Hispanic children.⁹ CDC''s most recent report also found that cotinine-measured SHS exposure was highest among children aged 3–11 years, non-Hispanic black people, those living below the federal poverty threshold, and people living in rental housing during 2011–2012.⁷Many smoke-free policies were implemented from 2000 to 2010,¹⁰ which contributed to a decline in SHS exposure in the United States.⁷ To examine whether or not all population groups benefited from these policies, we examined the change in prevalence of self-reported SHS exposure at home for children and nonsmoking adults in the United States from 2000 to 2010, assessed the sociodemographic factors associated with SHS exposure, and compared the significant factors in the two years.