The Effectiveness of Transition Strategies for Youth With Disabilities

This article reviews the effectiveness of the 10 main strategies used to provide transition education and planning services for youth with disabilities. The review suggests that multifaceted interventions are most effective. Integrated and comprehensive transition services should address skill instruction and self-awareness; provide customized informational, emotional, and instrumental supports to meet the needs of youth and families; provide direct opportunities and experiences for skill development; and address the welcoming nature of community activities and settings. The information can be used by rehabilitation managers and therapists in the design and delivery of transition services. Recommendations are made for future research with respect to strategies to facilitate youth transitions.     

Medical Service Utilization Among Youth with School-Identified Disabilities in Residential Care

Background

Behavioral, social, emotional, and educational risks among children and youth with school identified disabilities served in residential care have been well documented. However, the health care needs and medical service utilization of this high-risk population are less well known. Given the risks associated with children with disabilities, one might expect that medical care usage is elevated and will continue to be a need when children return home or age out of the system. The purpose of this study was to evaluate if medical service utilization differed between youth with and without school-identified disabilities in care, and whether certain correlates (e.g., demographic characteristics and mental health functioning) would be associated with medical service use among youth with disabilities.

Method

Hierarchical multiple regression models were used to explore the role of disability status in the utilization of medical services as well as to predict the effects of mental health functioning on utilization while controlling for other known factors.

Results

Results indicated that medical service usage for youth with school identified disabilities was statistically higher than usage for peers without disabilities after accounting for other factors associated with utilization, and internalizing and externalizing behavior severity were significantly related to medical service utilization for youth with disabilities.

Conclusions

As expected, the findings suggest that youth with disabilities use more medical services than peers without disabilities regardless of the presence of a physical health condition, but might be due to differences in the severity of the physical health conditions.

     

Medical Care Transition Planning and Dental Care Use for Youth with Special Health Care Needs During the Transition from Adolescence to Young Adulthood: A Preliminary Explanatory Model

The aims of the study were to test the hypotheses that youth with special health care needs (YSHCN) with a medical care transition plan are more likely to use dental care during the transition from adolescence to young adulthood and that different factors are associated with dental utilization for YSHCN with and YSHCN without functional limitations. National Survey of CSHCN (2001) and Survey of Adult Transition and Health (2007) data were analyzed (N = 1,746). The main predictor variable was having a medical care transition plan, defined as having discussed with a doctor how health care needs might change with age and having developed a transition plan. The outcome variable was dental care use in 2001 (adolescence) and 2007 (young adulthood). Multiple variable Poisson regression models with robust standard errors were used to estimate covariate-adjusted relative risks (RR). About 63 % of YSHCN had a medical care transition plan and 73.5 % utilized dental care. YSHCN with a medical care transition plan had a 9 % greater RR of utilizing dental care than YSHCN without a medical care transition plan (RR 1.09; 95 % CI 1.03–1.16). In the models stratified by functional limitation status, having a medical care transition plan was significantly associated with dental care use, but only for YSHCN without functional limitations (RR 1.11; 95 % CI 1.04–1.18). Having a medical care transition plan is significantly associated with dental care use, but only for YSHCN with no functional limitation. Dental care should be an integral part of the comprehensive health care transition planning process for all YSHCN.     

Changes in Ambulatory Health Care Use During the Transition to Young Adulthood

PurposeTo identify changes in ambulatory health care use during the transition from adolescence to young adulthood.MethodsWe analyzed data from health care encounters for adolescents (13–18 year olds) and young adults (19–24 year olds) in the National Ambulatory Medical Care Surveys or National Hospital Ambulatory Medical Care Surveys from 1997 through 2004. We present bivariate analysis of visit characteristics (including clinician specialty and health care setting, primary reason for the visit, and expected source of payment) for young adults as compared with those for adolescents, using weights provided by the National Center for Health Statistics to make national estimates.ResultsAdolescents and young adults used similar number of health care visits annually; however, a greater proportion of ambulatory care for young adults was delivered in emergency departments as compared with adolescents (20% vs. 14%; p < .001), a smaller proportion was delivered to males (27% vs. 46%; p < .001), and a smaller proportion was covered by private health insurance (58% vs. 67%, respectively; p < .001). Among young adults, preventive care was listed as the reason for 40% of non–emergency department visits for females, whereas it accounted for only 10% of visits for males.ConclusionsSignificant changes in ambulatory health care use occur during young adulthood. Improving health care during the transition to adulthood will necessitate attention to health care research and delivery agendas that are relevant to the young adult population.     

The Clustering of Risk Behaviors Among Caribbean Youth

Objective: To examine the relationships among risk behaviors for Caribbean youth; and to determine the correlations between initiation of sexual activity and other risk behaviors. Methods: The associations between cigarette smoking, alcohol and marijuana use, early initiation of sexual intercourse, involvement in violence and delinquency were examined using odds ratios on data from the Caribbean Youth Health Survey (n = 15,695). Survival analysis was then used to determine the association between initiation of sexual activity and the risk behaviors. Findings: There were statistically significant relationships between all pairs of risk behaviors for both male and female adolescents. Even though more males than females had engaged in each of the behaviors, the strengths of association were higher for females. From survival analysis, initiation of sexual activity was associated with gang involvement and weapon carrying among young adolescents and even more risk behaviors among the older adolescents. Conclusion: Health compromising behaviors cluster among Caribbean youth with associations being stronger for females. Initiating sexual activity was a predictor of other risk behaviors with the likelihood increasing among older adolescents and females.     

Neighborhoods and Infectious Disease Risk: Acquisition of Chlamydia during the Transition to Young Adulthood

Adolescents and young adults have the highest rates of sexually transmitted infections (STIs) in the USA despite national priority goals targeting their reduction. Research on the role of neighborhoods in shaping STI risk among youth has increased in recent years, but few studies have explored the longitudinal effects of neighborhoods on STI acquisition during the adolescent to young adult transition. The aims of this study were to examine: (1) the longitudinal relationships between the neighborhood context (poverty, residential instability, and racial/ethnic concentration) of exposure during adolescence and young adults’ acquisition of chlamydia, and (2) the extent to which sexual risk behaviors and depression over the transition from adolescence to young adulthood mediate the relationship between the neighborhood context of exposure during adolescence and young adults’ acquisition of chlamydia. A longitudinal observational design was employed using data from the National Longitudinal Study of Adolescent Health (Add Health), waves 1–3 (1994–2002). The sample was composed of 11,460 young adults aged 18 to 27 years. Neighborhood measures during adolescence were derived from the 1990 US Census appended to adolescents’ interview data. Chlamydia infection was measured via urine assay at wave 3 and 4.6 % of the young adults in the sample tested positive for chlamydia. Multilevel logistic regression analyses were conducted adjusting for numerous neighborhood and individual risk factors. Multivariate findings indicated exposure to neighborhood poverty during adolescence increased the likelihood of a positive urine test for chlamydia during young adulthood (AOR = 1.23, 95 % CI = 1.06, 1.42), and the association was not mediated by sexual risk behaviors or depression. Further research is needed to better understand the pathways through which exposure to neighborhood poverty contributes to chlamydia over the life course as are comprehensive STI prevention strategies addressing neighborhood poverty.     

A Systematic Review of the Role of Gender in Securing and Maintaining Employment Among Youth and Young Adults with Disabilities

Purpose There is a critical need for gender-specific vocational supports for young adults with disabilities as they transition to employment. We conducted a systematic review to explore the role of gender in securing and maintaining employment. Methods Systematic searches of seven databases identified 48 studies meeting our inclusion criteria. Using a narrative synthesis approach, these studies were analyzed in terms of the characteristics of the participants, methodology, results, and quality of the evidence. Results Among the 48 studies, 112,473 participants (56% male), mean age (of the total sample) was 21, represented across ten countries. Twenty-one studies reported that young men with disabilities had better employment outcomes than women with disabilities. Eight studies showed that females with disabilities had better employment outcomes than males. Five studies reported that there were no gender differences in employment outcomes for youth with various disabilities. With regards to maintaining employment, men with disabilities often work more hours and have better wages compared to women with disabilities. There are several gender-related barriers and facilitators to maintaining employment including social supports and gender role expectations. Conclusions Our findings highlight that there is a critical need for gender-specific vocational supports for young adults with disabilities.     

基本医疗保险重复参保现象研究

随着我国基本医疗保障体系逐步完善,新型农村合作医疗、城镇职工基本医疗保险和城镇居民基本医疗保险在各自的覆盖范围内发挥了重要作用,但由此也引发了重复参保的现象。文章从重复参保现状入手,分析了引起重复参保的原因以及所产生的消极影响,进而从实现基本医疗保险制度并轨、实现医保管理转移接续和建立完整的信息平台等角度提出了消除重复参保现象的路径选择。     

Supporting the Transition to Adulthood among High School Dropouts: An Impact Study of the National Guard Youth Challenge Program

Using a multi-year, random assignment design, this study evaluated the effects of the National Guard Youth Challenge Program (NGYCP), an intensive residential intervention program for youth ages 16–18 who have dropped out of high school. The sample included 1,173 youth (predominantly male) of diverse racial and ethnic backgrounds from ten NGYCP sites across the country. Positive impacts on educational and employment outcomes were sustained 3 years after entering the program, with older participants generally showing greater benefits than younger participants. Implications for research and practice are discussed.     

Asian American Problem Drinking Trajectories During the Transition to Adulthood: Ethnic Drinking Cultures and Neighborhood Contexts

Objectives. We aimed to identify problem drinking trajectories and their predictors among Asian Americans transitioning from adolescence to adulthood. We considered cultural and socioeconomic contextual factors, specifically ethnic drinking cultures, neighborhood socioeconomic status, and neighborhood coethnic density, to identify subgroups at high risk for developing problematic drinking trajectories.Methods. We used a sample of 1333 Asian Americans from 4 waves of the National Longitudinal Study of Adolescent to Adult Health (1994–2008) in growth mixture models to identify trajectory classes of frequent heavy episodic drinking and drunkenness. We fitted multinomial logistic regression models to identify predictors of trajectory class membership.Results. Two dimensions of ethnic drinking culture—drinking prevalence and detrimental drinking pattern in the country of origin—were predictive of problematic heavy episodic drinking and drunkenness trajectories. Higher neighborhood socioeconomic status in adolescence was predictive of the trajectory class indicating increasing frequency of drunkenness. Neighborhood coethnic density was not predictive of trajectory class membership.Conclusions. Drinking cultures in the country of origin may have enduring effects on drinking among Asian Americans. Further research on ethnic drinking cultures in the United States is warranted for prevention and intervention.Alcohol use disorders among Asian American young adults are important public health concerns. Although drinking prevalence is low for Asian Americans overall,1 Asian American young adults, particularly those in some ethnic groups such as Korean and Japanese, have higher rates of alcohol abuse and dependence than most other racial groups and other Asian ethnic groups such as Chinese.1–6 Asian Americans, including adolescents and young adults, are an underinvestigated population in alcohol research. Much of the small body of alcohol research, with college samples of mostly Korean and Chinese descent, has focused on genes involved in alcohol metabolism2,3,5,7,8 and the psychosocial moderators or mediators of their effects.2,9,10 Longitudinal studies on developmental trajectories of Asian American drinking are particularly rare.Past research indicates that alcohol consumption tends to escalate after high school in emerging adulthood (ages 18–25 years)11 and then begins to decline.12–14 Although problem drinking during emerging adulthood in itself is an important public health concern,15,16 continued or escalating problem drinking beyond this period is of even greater concern because of potential long-term health and social consequences. We aimed to identify developmental trajectories of problem drinking among Asian Americans transitioning from adolescence to adulthood that will help distinguish normative and problematic long-term drinking patterns. We also identified predictors of problematic drinking trajectories, with special attention to contextual factors concerning the broader cultural and socioeconomic environments of drinking, as these have received little research attention in this understudied population.Our investigation of ethnic drinking cultures addressed some of the documented limitations of acculturation research, including the common presumption that alcohol consumption and other risky health behaviors following an immigrant’s arrival in the United States are largely attributable to the influence of US culture,17 little understanding of ethnic cultures that may influence these behaviors,18 and the use of acculturation measures without clear bearings on the specific health issue at hand,19 which makes it difficult to elucidate the specific mechanisms through which acculturation influences health behaviors.20 In our view, the lack of understanding of the conditions within immigrant communities, along with preoccupation with how immigrant communities respond to US culture outside their communities, is critical.21 The approach we take here puts the focus squarely back on the cultural conditions within immigrant communities that specifically concern drinking—namely, ethnic drinking cultures, defined as cultural norms and behavioral practices of drinking in an immigrant’s country of origin.22 Our approach was informed by transnationalism theories, which suggest that immigrants often maintain socioeconomic ties with their homelands and retain elements of their cultural heritage, some of which may also appeal to their US-born descendants.23,24 In the context of drinking, transnationalism theories suggest that ethnic drinking culture from the country of origin may have enduring influence on immigrants and their children.A focus on ethnic drinking cultures has other significance in current research on immigrant health. Heterogeneity in drinking and other health outcomes across ethnic or national groups has been highlighted in recent research,25–27 which has used ethnicity as an implicit proxy of underlying yet undefined cultural or socioeconomic conditions that are assumed to vary across ethnic groups. Yet efforts to clarify the underlying conditions that may lead to diverse outcomes have been lacking.22 The 2 dimensions of ethnic drinking cultures used in this study, drinking prevalence and detrimental drinking pattern, express in quantifiable terms drinking-related cultural conditions that may explain the diverse drinking outcomes across Asian American subgroups. In our pioneering cross-sectional studies, we found robust associations of these dimensions with alcohol consumption among Asian American adults28 and young adults.22 Building on this research, in this longitudinal study, we examined the influence of ethnic drinking cultures on developmental trajectories of problem drinking among Asian Americans transitioning to adulthood in an effort to demonstrate their effects more conclusively.We also considered 2 neighborhood contextual factors as predictors of drinking trajectories, socioeconomic status (SES) and coethnic density. Neighborhood socioeconomic disadvantage may lead to problem drinking through several mechanisms including stress associated with a high level of poverty and often-accompanying social disorganization,29,30 a lack of social control on deviant behaviors associated with weaker community ties in disadvantaged neighborhoods,31,32 and increased density of bars and liquor stores in lower-income areas.33,34 Studies of effects of neighborhood disadvantage on substance use outcomes are decidedly mixed, as studies show less of an effect, or even an inverse association, of neighborhood disadvantage with adolescent substance use compared with adult substance use.35 Most adolescent substance users are in an experimental stage, and problematic trajectories of use are not evident until early adulthood, which is one impetus for the current study. Neighborhood coethnic density has been found to have protective buffering effects on health and health behaviors, including drinking,36 attributed to enhanced social cohesion, mutual social support, and a stronger sense of community and belongingness.37–41 Little research has been reported on the influence of these contextual factors on alcohol use over time among Asian American adolescents and young adults.Summarily stated, we addressed the following specific research question in this study: do ethnic drinking cultures, neighborhood SES, and neighborhood coethnic density predict problematic drinking trajectories for Asian Americans transitioning from adolescence to adulthood? We controlled for several key individual-level predictors of alcohol use during adolescence in our multivariate models—namely, US nativity, individual-level SES, age of drinking initiation, attachment to mother, and peer drinking in adolescence. This research helps identify specific profiles of subgroups at high risk for developing problematic, long-term patterns of drinking to guide prevention and intervention efforts targeted at the subgroups most likely to benefit. This is of great practical significance given the wide diversity among Asian Americans, both cultural42 and socioeconomic.43,44     

Transitioning Youth into Adult Mental Health and Addiction Services: An Outcomes Evaluation of the Youth Transition Project

The Youth Transition Project was designed to provide youth with mental health and addiction issues with individualized transitional care plans as they transition from Child and Adolescent Mental Health Services (CAMHS) to Adult Mental Health Services (AMHS). Over an 18-month period, a total of 127 (59.1%) youth were transitioned and seen by an AMHS provider, 41 (19.1%) remained on a waitlist for services and 47 (21.8%) canceled services. The average time to transition was 110 days (SD?=?100). Youth exhibited a wide range of diagnoses; 100% of the population was identified as having serious psychiatric problems. Findings demonstrate that the Youth Transition Project has been successful in promoting continuity of care by transitioning youth seamlessly from youth to adult services. Inconsistencies in wait times and service delivery suggest that further model development is needed to enhance the long-term sustainability of the Youth Transition Project.     

Health Care Transition Planning Among Youth with ASD and Other Mental,Behavioral, and Developmental Disorders

Maternal and Child Health Journal - To estimate the prevalence of health care transition components among youth with autism spectrum disorder (ASD) aged 12–17 using the 2016 National Survey...     

Depression and Sexual Orientation During Young Adulthood: Diversity Among Sexual Minority Subgroups and the Role of Gender Nonconformity

Sexual minority individuals are at an elevated risk for depression compared to their heterosexual counterparts, yet less is known about how depression status varies across sexual minority subgroups (i.e., mostly heterosexuals, bisexuals, and lesbians and gay men). Moreover, studies on the role of young adult gender nonconformity in the relation between sexual orientation and depression are scarce and have yielded mixed findings. The current study examined the disparities between sexual minorities and heterosexuals during young adulthood in concurrent depression near the beginning of young adulthood and prospective depression 6 years later, paying attention to the diversity within sexual minority subgroups and the role of gender nonconformity. Drawn from the National Longitudinal Study of Adolescent Health (N = 9421), we found that after accounting for demographics, sampling weight, and sampling design, self-identified mostly heterosexual and bisexual young adults, but not lesbians and gay men, reported significantly higher concurrent depression compared to heterosexuals; moreover, only mostly heterosexual young adults were more depressed than heterosexuals 6 years later. Furthermore, while young adult gender nonconforming behavior was associated with more concurrent depression regardless of sexual orientation, its negative impact on mental health decreased over time. Surprisingly, previous gender nonconformity predicted decreased prospective depression among lesbians and gay men whereas, among heterosexual individuals, increased gender nonconformity was not associated with prospective depression. Together, the results suggested the importance of investigating diversity and the influence of young adult gender nonconformity in future research on the mental health of sexual minorities.