The association of non-insulin-dependent diabetes mellitus with perceived quality of life in a biethnic population: the San Luis Valley Diabetes Study.

OBJECTIVES: This study evaluated the association between quality of life and non-insulin-dependent diabetes mellitus (NIDDM) status, and whether this association differs between Hispanics and non-Hispanic Whites. METHODS: Between 1986 and 1989, cross-sectional data on perceived quality of life (PQOL) were collected from 223 persons with NIDDM and 753 non-diabetic subjects. RESULTS: After adjustment, persons with NIDDM rated their PQOL significantly lower than did control subjects. The relationship of diabetes and PQOL did not differ by ethnicity. The number of complications of diabetes was not associated with lower PQOL scores. CONCLUSIONS: Control and treatment strategies should reflect an understanding of the impact that diabetes has on social functioning, leisure activities, and physical and mental health.     

Predicting physical quality of life among a multiethnic sample of breast cancer survivors

Background  

This study aims to test the utility and applicability of the physical quality of life (PQOL) model based on the Contextual Model of Health-Related Quality of Life (HRQOL). Specifically, this study focuses on investigating the different patterns in the structural model of PQOL according to four major U.S. ethnic groups and the mediating effects of psychological well-being between the systemic-level constructs and PQOL.     

Examining Means of Reaching Adolescent Girls for Iron Supplementation in Tigray,Northern Ethiopia

Background: Iron deficiency is the most prevalent nutritional deficiency in adolescent girls from the developing world. One of the recommended interventions to improve iron status in adolescent girls is iron supplementation. Yet the provision of iron supplements to adolescent girls proved to be a challenging task for the health systems across the developing world. Objective: The objective of the study was to examine means of reaching adolescent girls for iron supplementation in Northern Ethiopia. Methodology: Analytical cross-sectional study consisting of both quantitative and qualitative approaches to data collection and analysis was used in this study. Stratified multi-stage systematic random sampling technique was adopted and primary quantitative data were collected from 828 (578 school attending and 250 non school attending) adolescent girls recruited from nine districts of Tigray. The primary quantitative data were analyzed using SPSS version 20 software. The qualitative data collected through key informant interviews and focus group discussions were transcribed verbatim and qualitatively analyzed. Results: The mean (SD) age of the girls was 16.7 (1.4) years. Four hundred forty seven (54%), 355 (42.9%) and 26 (3.1%) of the adolescent girls had low, medium and high diet diversity scores, respectively. More than half, 467 (56%), of the adolescent girls believed that adolescent girls were overloaded with household jobs everyday compared to boys from their respective communities. Key informants said that, there is no adolescent nutrition message promoted in the study area. Low community awareness, perceiving iron tablet as a contraceptive, religious and cultural influences, and lack of confidence in supplementation value of iron tablets, are some of the potential barriers mentioned by the key informant and focus group discussion participants. Schools (45%), health centers (27%) and health posts (26%) were the preferred public facilities for provision of iron supplements to student adolescent girls whereas schools (11%), health centers (47%) and health posts (41%) were the preferred public facilities for provision of iron supplements to adolescent girls who were not attending schools from the study communities. Conclusion: The health posts and health centers were the preferred health facilities for iron supplementation to adolescent girls who were not attending schools while the school was the preferred facility for iron supplementation of student adolescent girls.     

Rural Adolescent Health: The Importance of Prevention Services in the Rural Community

Context: Adolescence is a pivotal developmental period for the establishment of positive health and health practices. However, developmentally propelled risk behaviors coinciding with barriers to health services may increase the propensity for untoward health outcomes in adolescence. In addition, the sociocultural context of the rural environment can present challenges to the health of adolescents. Limited data on rural adolescent health, particularly among population subgroups, hinder the ability to adequately advocate for adolescent health prevention services. Methods: A secondary analysis of the 2005 California Health Interview Survey Adolescent questionnaire was conducted. Selected survey items corresponding to the Healthy Youth 2010 objectives were analyzed for 663 adolescents aged 12‐17 residing in rural regions of California. Adolescent subgroup analysis included race/ethnicity, age, and poverty level. Findings: Adolescent health issues of particular concern in this study include sexual health, substance use, mental health, and risk factors for obesity. Predictably, risk behaviors increase with the age of the adolescent. Minority and poor youth demonstrate the greatest vulnerability to untoward health outcomes. Conclusion: Significant risk behaviors and health concerns exist among the rural adolescent population, particularly among poor and minority youth, arguing for the creation and preservation of prevention services for youth in the rural community. Future research using alternative sampling methodologies may be necessary to adequately represent the higher‐risk adolescent in the rural community. More data are needed on vulnerable adolescent populations in the rural community in order to adequately advocate for prevention services.     

Social class gradients in health during adolescence

STUDY OBJECTIVE: To review existing data on social class gradients in adolescent health and to examine whether such gradients exist in new data concerning US adolescents. DESIGN: Review of relevant publications and unpublished data; regression analyses using adolescent self reported health status data to determine whether there are gradients by social class, using three classes categorised by adolescent reported parental work status and education. PARTICIPANTS: Adolescents of ages 11-17. MAIN RESULTS: Findings from the literature indicate the presence of social class gradients in some but not all aspects of adolescent health. Results from new data showed social class gradients in several domains of health and in profiles of health. The likelihood of being satisfied with one's health, of being more resilient (better family involvement, better problem solving, more physical activity, better home safety), having higher school achievement, and of being in the best health profiles were significantly and progressively greater as social class rose. Moreover, the probability of being in the poorest health profile type group was progressively higher as social class declined. CONCLUSIONS: The review of existing data and the new findings support the existence of social class gradients in satisfaction with one's health, in resilience to health threats, in school achievement, and in being in the best health overall (as manifested by the health profiles composed of four major domains of health). The study had two especially notable findings: (1) the paucity of studies using the same or similar indicators, and (2) the consistent existence of social class gradients in characteristics related to subsequent health, particularly intake of nutritional foods and physical activity. The sparseness of existing data and the different aspects of health investigated in the relatively few studies underscore the need for (1) the development of conceptual models specifically focused on adolescent health and social class; (2) additional inquiry into the measurement of social class and adolescent perceptions of class; (3) inclusion of contextual variables in study design; and (4) longitudinal cohort studies to better understand the specific determinants of health during adolescence.     

What Gets Measured Gets Done: Assessing Data Availability for Adolescent Populations

Objectives: To identify specific adolescent sub-populations; to evaluate the health data available regarding these populations related to 21 key national adolescent health objectives from Healthy People 2010; and to make recommendations for improving data capacity to further efforts to reduce health disparities among adolescents. Methods: Adolescent populations were identified through a consensus process. Academic and government literature was extensively reviewed using internet search techniques to identify available national data for each of these populations on each key national health objective. Results: 18 adolescent subpopulations were identified. These populations fit into four overlapping categories defined by demography, legal status, chronic health condition, or other special characteristics. Overall, national, population-based data regarding these sub-populations were located for 36% of the 21 health objectives. Within the sub-populations, most data was available for ethnic/racial groups, with 57–81% of each of the objectives having data. Data regarding rural/urban groups were found for about one-half of the 21 objectives, and data were located on all other groups for one-fourth or fewer of the objectives. Within the objectives, substance abuse objectives were the most widely measured, with data available for 56–78% of the various populations. For some objectives, such as drug-or alcohol-related motor vehicle deaths depression among the developmentally disabled, no national data were found. Conclusions: There are still too little data available regarding the specific health status or health objectives for different adolescent populations. A national adolescent data-priority agenda is needed to develop strategies to improve health data regarding adolescent sub-populations. Federal and state health monitoring agencies could create national health profiles of different populations, include more population markers in health studies, and develop tools for population-specific health assessment, particularly for those within the government’s care, including incarcerated and foster care youth.     

Development of adolescent self-report measures from the National Longitudinal Study of Adolescent Health.

PURPOSE: To present a set of multi-item indicators and associated reliability estimates derived from early research with survey data from adolescents participating in the National Longitudinal Study of Adolescent Health (Add Health). METHODS: Add Health provides information on the health and health-related behaviors of a nationally representative sample of U.S. adolescents, as well as on individual-level and contextual factors that either promote young peoples' health or increase their health risk. Specifically, the 135-page in-home adolescent survey instrument includes multiple items intended to measure individual-level and social-environmental constructs relevant to adolescent health and well-being. This article details the development of a set of multi-item scales and indices from Add Health in-home adolescent survey data. These steps include identification of inconsistent responders, use of a split-halves approach to measurement validation, and use of a deductive approach in the development of scales and item composites. RESULTS: Estimates of internal consistency reliability suggest that many of the multi-item measures have acceptable levels of internal consistency across grade, gender, and race/ethnic groups included in this nationally representative sample of adolescents. In addition, moderate to high bivariate correlations between selected measures provide initial evidence of underlying latent constructs. CONCLUSIONS: This article provides adolescent health researchers with a set of methodologic procedures and measures developed in early research on the Add Health core adolescent data set.     

Improving adolescent sexual and reproductive health. A view from Australia: learning from world's best practice

There is increasing awareness worldwide of the importance of sexual and reproductive health in adolescents. Australia's high rates of teenage pregnancy and increasing rates of sexually transmitted infections in young people reflect a failure to prioritise adolescent sexual and reproductive health on the public health agenda. This paper reviews adolescent sexual and reproductive health in Australia in comparison with international data, and examines the systemic, social and cultural factors that influence it. Based on comparisons with international best practice, recommendations are included for improvement in adolescent sexual and reproductive health within the Australian context.     

Priority Areas for Adolescent Health Measurement

PurposeWe establish priority areas for adolescent health measurement and identify current gaps, aiming to focus resources on the most relevant data to improve adolescent health.MethodsWe collected four critical inputs to inform priority setting: perspectives of youth representatives, country priorities, disease burden, and existing measurement efforts. Health areas identified from the inputs were grouped, mapped, and summarized according to their frequency in the inputs. Using a Delphi-like approach, international experts then selected core, expanded, and context-specific priority areas for adolescent health measurement from all health areas identified.ResultsAcross the four inputs, we identified 99 measurement areas relevant to adolescent health and grouped them under six domains: policies, programs, laws; systems performance and interventions; health determinants; health behaviors and risks; subjective well-being; and health outcomes and conditions. Areas most frequently occurring were mental health and weight status in youth representatives' opinions; sexual and reproductive health and HIV/AIDS in country policies and perspectives; road injury, self-harm, skin diseases, and mental disorders in the disease burden analysis; and adolescent fertility in measurement initiatives. Considering all four inputs, experts selected 33 core, 19 expanded, and 6 context-specific adolescent health measurement areas.ConclusionThe adolescent health measurement landscape is vast, covering a large variety of topics. The foci of the measurement initiatives we reviewed do not reflect the most important health areas according to youth representatives' or country-level perspectives, or the adolescent disease burden. Based on these inputs, we propose a set of priority areas to focus national and global adolescent health measurement.     

Is there value in using physician billing claims along with other administrative health care data to document the burden of adolescent injury? An exploratory investigation with comparison to self-reports in Ontario,Canada

Background  

Administrative health care databases may be particularly useful for injury surveillance, given that they are population-based, readily available, and relatively complete. Surveillance based on administrative data, though, is often restricted to injuries that result in hospitalization. Adding physician billing data to administrative data-based surveillance efforts may improve comprehensiveness, but the feasibility of such an approach has rarely been examined. It is also not clear how injury surveillance information obtained using administrative health care databases compares with that obtained using self-report surveys. This study explored the value of using physician billing data along with hospitalization data for the surveillance of adolescent injuries in Ontario, Canada. We aimed i) to document the burden of adolescent injury using administrative health care data, focusing on the relative contribution of physician billing information; and ii) to explore data quality issues by directly comparing adolescent injuries identified in administrative and self-report data.     

The relationship between active living and health-related quality of life: income as a moderator

This study used a moderator model to examine the relationship between active living and the physical components of health-related quality of life [i.e. overall physical component of quality of life (PQOL), physical functioning and ability to fulfill physical role] among a randomly selected sample of rural residents (n = 407) from the Midwestern US. Results showed that active living was associated with greater increases in health-related quality of life for those reporting lower income. The effect size of the relationship between active living and the PQOL for the low-income group was over 2 times the effect size for the high-income group. For physical functioning, the effect size of active living for the low-income group was greater than 3 times the effect size for the high-income group. Although active living behaviors have been demonstrated to be less prevalent among those of low socioeconomic status, this group may have the most to gain from these activities. Findings highlight the need for increased and specifically targeted promotion of active living interventions.     

主观社会地位和生活技能水平对青少年健康危险行为的影响

主观社会地位和生活技能水平是青少年健康危险行为的重要影响因素, 两者可能共同作用于青少年健康危险行为, 并在其中相互影响、制约, 使青少年健康危险行为的发生机制变得更加多样和复杂。该研究对主观社会地位、生活技能水平和青少年健康危险行为三者之间的关联进行综述, 探讨主观社会地位和生活技能水平对青少年健康危险行为的共同影响作用, 为进一步探索三者可能的关联机制提供线索, 为制订有效青少年健康危险行为预防策略提供新的视角与建议。     

The relationship between self-rated health status and the overall quality of dietary intake of US adolescents

The objective of this study was to compare the quality of overall dietary intake of US adolescents by self-rated health status. Using 2 nonconsecutive days of dietary recall data and responses to a single question describing self-rated health status from the Continuing Survey of Food Intakes by Individuals 1994-1996, linear regression analysis was used to detect differences in Healthy Eating Index (HEI) scores by self-rated health status for 1,504 adolescents, ages 11 to 18 years. After adjusting for factors related to both overall dietary quality and self-rated health status, overall HEI scores did not differ by self-reported health status. However, two individual HEI component scores were found to be significantly related to adolescent self-rated health status: the vegetables score (P=0.01) was higher among those with positive self-rated health status, and the total fat score (P=0.01) was higher among those with negative self-rated health status. Self-perception of health status is not related to the overall quality of the adolescent diet; therefore, food and nutrition professionals should focus on understanding motivators other than health status when exploring adolescent dietary behaviors.     

The Impact of Single Mothers’ Health Insurance Coverage on Behavioral Health Services Utilization by Their Adolescent Children

Adolescents living in single-mother households are more likely to have behavioral health conditions, but are less likely to utilize any behavioral health services. Using nationally representative mother-child pair data pooled over 6 years from the National Survey on Drug Use and Health, the study finds that when single mothers were uninsured, their adolescent children were less likely to utilize any behavioral health services, even when the children themselves were covered by insurance. The extension of health coverage under the Affordable Care Act (ACA) to uninsured single mothers could improve the behavioral health of the adolescent population.     

Were the mental health benefits of a housing mobility intervention larger for adolescents in higher socioeconomic status families?

Moving to Opportunity (MTO) was a social experiment to test how relocation to lower poverty neighborhoods influences low-income families. Using adolescent data from 4 to 7 year evaluations (aged 12–19, n=2829), we applied gender-stratified intent-to-treat and adherence-adjusted linear regression models, to test effect modification of MTO intervention effects on adolescent mental health. Low parental education, welfare receipt, unemployment and never-married status were not significant effect modifiers. Tailoring mobility interventions by these characteristics may not be necessary to alter impact on adolescent mental health. Because parental enrollment in school and teen parent status adversely modified MTO intervention effects on youth mental health, post-move services that increase guidance and supervision of adolescents may help support post-move adjustment.     

An exploratory study to evaluate the utility of an adapted Mother Generated Index (MGI) in assessment of postpartum quality of life in India

Background  

Given the postulated advantages of mother generated index (MGI) in incorporating the patients' viewpoint and in the absence of a validated India specific postpartum quality of life assessment tool we proposed to evaluate the utility of an adapted Mother-Generated-Index in assessing postpartum quality of life (PQOL) in India.     

The health and well-being of adolescents: a school-based population study of the self-report Child Health Questionnaire.

PURPOSE: To evaluate a new generic measure of adolescent health status, the self-report version of the Child Health Questionnaire (CHQ), and provide population-based data. Furthermore, we aimed to examine the impact of common adolescent illness and health concerns on their health and well-being. METHODS: A stratified, two-stage, random cluster sampling design was used to obtain a cross-sectional sample of subjects through schools. A written questionnaire included the 80-item 12-scale self-report CHQ and items measuring health concerns, illnesses/health conditions, and sociodemographics. RESULTS: A total of 2361 adolescents participated (response rate of 70%). Reliability was high: Tests of internal consistency and discriminant validity reported 90% of item-scale correlations >.4; all scales had Cronbach alpha coefficients >.7. Adolescents with illnesses/conditions or health concerns reported lower scores and larger differences for content-related scales, supporting content and construct validity. Statistically significant age and gender trends were observed for Mental Health, Self-Esteem, General Health, and Family Cohesion scales. Health status worsened as health concerns increased (X(2) linear trend, p =.00) with deterioration in health of 5-20% on all scales for emotional health concerns (40% of sample). CONCLUSIONS: The self-report CHQ is a reliable and seemingly valid measure of health and well-being for adolescent health research, although additional measures may be required where scales have high ceiling values. The significantly lower scores reported by adolescents with illness and/or health concerns lend support to the use of standardized health measures and longitudinal research to further examine the impact of adolescent comorbidities and their causal determinants.     

Adolescent cancer survivors: identity paradox and the need to belong

Adolescent cancer survivors face psychological effects that can include isolation, poor peer relations, anxiety, depression, and fear of recurrence, which can increase their risk for psychological late effects and poor health posttreatment. The purpose of this exploratory analysis was to understand the experiences of adolescent cancer survivors, with a particular focus on identity, health promotion, and meaning making. In-depth interviews were conducted with 12 adolescent cancer survivors. Constant comparative analysis was used to identify core themes from the data. Findings revealed that adolescent survivors might experience an identity paradox when making the transition to "survivor," which can contribute to their sense of isolation and risk of health-detracting behaviors. Health promotion, prevention, and supportive programs need to be developed for health care professionals to address the isolation and identity transition needs of adolescent cancer survivors.