Surveying adolescents: Focusing on positive development

Although risk behaviours can threaten healthy youth development, reducing risks alone is not sufficient to help youth successfully negotiate adolescence. Promoting protective factors that buffer risk, such as family and school connectedness, community engagement and positive peer support, are also important for helping youth to thrive. Since 1992, the Adolescent Health Surveys conducted by McCreary Centre Society (Vancouver, British Columbia) have monitored both risk behaviours and protective factors among high school students across British Columbia. They have shown that, contrary to media images and community perceptions, the majority of young people are not exposed to risk factors such as violence and abuse; most do not have unprotected sex, drink and drive, use illegal drugs or consider suicide. They have also documented key protective factors that are linked to lower rates of risk behaviours and more positive outcomes, even for youth who face unsafe environments, family problems and other stressors. The shift toward assessing and promoting protective factors is a major paradigm change in adolescent health care, and clinicians can be an important partner with families and schools to foster healthy youth development.     

Suicide attempts among American Indian and Alaska Native youth: risk and protective factors.

CONTEXT: American Indians and Alaska Natives have the highest suicide rates of all ethnic groups in the United States, and suicide is the second leading cause of death for American Indian and Alaska Native youth. OBJECTIVE: To identify risk and protective factors associated with suicide attempts among native male and female adolescents. DESIGN: The 1990 National American Indian Adolescent Health Survey. SETTING: Schools of reservation communities in 8 Indian Health Service areas. PARTICIPANTS: Eleven thousand six hundred sixty-six 7th- through 12th-grade American Indian and Alaska native youth. MAIN OUTCOME MEASURES: Responses were compared among adolescents with and without a self-reported history of attempted suicide. Independent variables included measures of community, family, and individual characteristics. Separate analyses were conducted for boys and girls. RESULTS: Ever attempting suicide was reported by 21.8% of girls and 11.8% of boys. By logistic regression done on boys and girls separately, suicide attempts were associated with friends or family members attempting or completing suicide; somatic symptoms; physical or sexual abuse; health concerns; using alcohol, marijuana, or other drugs; a history of being in a special education class; treatment for emotional problems; gang involvement; and gun availability. For male and female youth, discussing problems with friends or family, emotional health, and connectedness to family were protective against suicide attempts. The estimated probability of attempting suicide increased dramatically as the number of risk factors to which an adolescent was exposed increased; however, increasing protective factors was more effective at reducing the probability of a suicide attempt than was decreasing risk factors. CONCLUSIONS: A history of attempted suicide was associated with several risk and protective factors. In addition to targeting youth at increased risk, preventive efforts should include promotion of protective factors in the lives of all youth in this population.     

Violence risk and protective factors among youth held back in school.

OBJECTIVE: To identify risk and protective factors for violence perpetration among youth with a history of grade retention. DESIGN: Longitudinal analysis of in-home interviews of 13,781 adolescents in grades 7 through 12 conducted in 1995 and 1996. METHODS AND MEASURES: Serious interpersonal violence perpetration at time 2 by time 1 independent variables including measures of community and school context, family context, and individual characteristics. RESULTS: The 20% of girls and 28% of boys who had repeated 1 or more grades were more likely than those who had not to be in the top quintile of violence perpetration at time 2 (P <.001). For both girls and boys with a history of grade repetition, predictive risk factors with an odds ratio of 3 or greater (P <.001) included time 1 violence perpetration, violence victimization, weapon carrying, school problems, and alcohol and marijuana use. Although a high grade point average was a significant protective factor against violence perpetration for both girls (odds ratio, 0.36; P <.05) and boys (odds ratio, 0.23; P <.001), performance on a validated measure of verbal knowledge was not associated with violence perpetration over the study period. School connectedness, parent-family connectedness, and emotional well-being were also significant universal protectors against violence perpetration. CONCLUSIONS: Youth who are held back in school are at heightened risk for violence perpetration. Violence-related behaviors and substance use considerably increase the likelihood of this outcome. The findings suggest that schools can participate in violence prevention by providing youth with a positive community and academic experience.     

Staying in School: Connection,Cohesiveness, and Suspension

IntroductionIndividual-, school-, and neighborhood-level support and connectedness may help to mitigate against school suspensions, which have profound health and social consequences. Most research on social connectedness and suspension has focused only on school connectedness, and much less is known about the effects of individual social support and neighborhood-level connectedness on suspension.MethodsWe examined associations between all three levels of connectedness and suspension in a cross-sectional analysis of a population-based youth sample in Allegheny County, Pennsylvania. The Healthy Allegheny Teen Survey, a county-wide survey of 1813 male and female youth ages 14 to 19, assessed health risk/protective behaviors through random-digit-dialing in 2014. This survey included validated items evaluating each type of support as well as items assessing lifetime history of suspension. Logistic regression models examined associations between suspension and social support, school connectedness, and neighborhood-level cohesion.ResultsIn fully adjusted logistic regression models examining associations between suspension and each type of support, youth with high social support had 0.38 times the odds of school suspension compared to youth with low social support (95% confidence interval [CI] 0.19–0.74). High levels of school connectedness and neighborhood-level cohesion were also associated with significantly lower odds of suspension (odds ratio [OR] 0.31, 95% CI 0.18–0.53; OR 0.28, 95% CI 0.16–0.47, respectively). Examining all 3 types of support jointly, school connectedness and neighborhood-level cohesion were significantly inversely related to suspension (OR 0.41, 95% CI 0.24–0.71; OR 0.41, 95% CI 0.23–0.74, respectively).ConclusionsPrograms that foster connectedness at the individual-, school-, and neighborhood-level may help reduce school suspension.     

Violence perpetration among urban american Indian youth: can protection offset risk?

OBJECTIVE: To predict the likelihood of violence perpetration given various combinations of the most statistically salient risk and protective factors related to violence perpetration. DESIGN: Urban Indian Youth Health Survey, conducted from October 9, 1995, to March 30, 1998, consisting of 200 forced-choice items exploring values, cultural identity, relationships, decision-making skills, and health and well-being. SETTING: Urban schools and an after-school youth development program at an urban American Indian center. PARTICIPANTS: Five hundred sixty-nine urban American Indian youth enrolled in grades 3 through 12. MAIN OUTCOME MEASURES: Violence perpetration dichotomized in 2 ways: (1) level of violence perpetration (ie, hitting someone 1-2 times in the past year vs picking fights, hitting repeatedly, participating in group fights, or shooting or stabbing someone in the past year) and (2) having shot and/or stabbed someone during the past year. RESULTS: In the final multivariate models with age as a covariate, most protective against violence perpetration were connections to school (odds ratio [OR], 0.17), positive affect (OR, 0.29), and peer prosocial behavior norms against violence (OR, 0.35). School connectedness (OR, 0.01) and positive affect (OR, 0.46) were also protective against shooting and/or stabbing someone, as was parental prosocial behavior norms against violence (OR, 0.23). The strongest risk factors for violence perpetration were substance use (OR, 2.60) and suicidal thoughts/behaviors (OR, 2.71); for shooting and/or stabbing, it was substance use (OR, 5.26). The likelihood of violence perpetration increased markedly (from 10% to 85%) as the exposure to risk factors increased and protective factors decreased. For shooting or stabbing someone, the probabilities ranged from 3% (0 risks and 3 protective factors) to 64% (1 risk and 0 protective factors). CONCLUSION: The dramatic reduction in the likelihood of violence involvement when risk was offset with protective factors in the probability profiles suggests the utility of a dual strategy of reducing risk while boosting protection.     

A model for successful foster child-foster parent relationships.

INTRODUCTION: The purpose of this study was to explore successful relationships between foster children and foster parents. METHODS: Dyads of exemplary foster parents and foster children, identified by foster care experts, were interviewed to uncover the meaning of human bonding and attachment between the foster child and foster parent. Data were collected and analyzed with use of Colazzi's phenomenologic methodology. RESULTS: A sense of family/coming home was most important for both foster children and foster parents. The powerful desire of the foster child to attain family membership emerged from their experiences, both in and out of foster care. DISCUSSION: The combination of a caring foster parent who worked patiently with the child to help him or her establish membership and a foster child who not only recognized caring behaviors but also was willing to respond to them created the foundation for a successful relationship.     

Factors distinguishing youth who report self-injurious behavior: a population-based sample

ObjectiveTo identify factors distinguishing adolescents across 3 groups: no self-harm, nonsuicidal self-injury (NSSI) only, and NSSI and suicide attempt (NSSI + SA).MethodsData were from the 2007 Minnesota Student Survey. The sample included 61,330 students in grades 9 and 12. Logistic regression analysis determined factors that best distinguished adolescents who reported NSSI from those who reported no self-harm, and adolescents who reported NSSI + SA. Final models were developed over 3 stages of analysis that tested the importance of variables within risk factor, protective factor, and co-occurring health-risk behavior domains.ResultsFor male and female subjects, factors that consistently distinguished youth who reported NSSI from those who reported no self-harm included depressive symptoms, hopelessness, physical abuse, less parent connectedness, running away from home, and maladaptive dieting behavior. Factors that distinguished the NSSI + SA group from the NSSI only group for both sexes were a mental health problem, depressive symptoms, hopelessness, physical abuse, and running away from home. Other factors, such as sexual abuse, were significant in models for males or females only. Hopelessness constituted the leading factor to increase the likelihood that youth who self-injured also attempted suicide.ConclusionsYouth engaging in NSSI experience diverse psychosocial stressors and significant distress. Clinicians and school personnel are well-positioned to offer support to these youth. Furthermore, they can help address NSSI among youth by identifying those who self-injure early, assessing for hopelessness and suicidality, facilitating connections to prosocial adults, addressing maladaptive dieting behavior, and supporting runaway youth.     

The role of the pediatrician in preventing suicidal behavior

Suicidality is a serious cause of morbidity and mortality among young people. Important risk factors for suicidal behavior are mental illness, alcohol and other substance use disorders, previous suicide attempt, impulsive and/or aggressive behavior, history of abuse, and access to lethal means. Emotional well-being and connectedness to family and school act to buffer or protect young people from involvement in self-directed violence. Pediatricians can play a major role in suicide prevention by identifying emotional and behavioral problems and intervening appropriately, promoting positive parenting skills and family cohesion, and providing injury prevention education to reduce access to lethal means. As part of a comprehensive strategy to prevent youth suicidal behavior, child health professionals are uniquely positioned to promote resiliency among youth and families as well as identify and provide appropriate treatment and service coordination for risk factors before injuries occur. Adequate training is critical to ensure that pediatricians are prepared to provide effective assessment, prevention and intervention for suicidal behavior.     

Helping parents with the diagnosis of disability

The impact on parents and the wider family of caring for a disabled child depends on many factors, including the child's behaviours, available resources and the families' coping strategies. Optimal care requires careful management of every stage from diagnosis onwards. How the diagnosis of neurodevelopmental disability is communicated to the family has long-lasting effects. When clarification of the diagnosis takes a long time, this is particularly hard for child health professionals to manage well, and a joint understanding of the process with the family is important. This short review offers guidance for the conduct of the diagnostic consultation referring to the current best evidence and drawing from personal experience. It also explains how current theory and evidence can facilitate better understanding of families' reactions to a diagnosis, moving beyond a simple bereavement adjustment model towards a nuanced appreciation of parental reaction.     

The management of infants,children, and youth at risk for hepatitis C virus infection

Hepatitis C virus (HCV) infection affects 0.5% to 1.0% of the Canadian population. Most paediatric HCV infections are a consequence of vertical transmission or, among youth and young adults, the result of engaging in high-risk behaviours, such as injection drug use and unprotected sexual activity. It is now recommended that all infants, children, and youth with one or more risk factors be screened for HCV infection. Treating chronic HCV infection with direct-acting antivirals has been shown to achieve sustained virologic suppression in 97% to 100% of children as young as 3 years old. Paediatricians and family physicians have an important role in educating youth regarding HCV infection risks and prevention, and in advocating to government and public health authorities for comprehensive harm reduction interventions targeting at-risk youth, accessible treatments, and routine prenatal screening for HCV.     

Metabolic syndrome in obese adolescents

Bustos P, Saez K, Gleisner A, Ulloa N, Calvo C, Asenjo S. Metabolic syndrome in obese adolescents.
Childhood and adolescent obesity is highly prevalent and a relevant public health problem in Chile. Metabolic syndrome (MS), which is predictive of future cardiovascular disease and type 2 diabetes, has been associated with childhood obesity and insulin resistance.
The aim of this study was to determine the prevalence of MS in a non-consultant obese adolescent population and to assess the underlying factors for the MS in these subjects.
The nutritional status was evaluated for 25,102 students from 10 to 18 years of age living in Concepcin and Coronel, Chile. A total of 2,308 adolescents were found to be obese (BMI ≥ 95 percentile). Metabolic syndrome was defined as the presence of at least three of the following abnormalities: waist circumference ≥ 90^th percentile, blood pressure ≥ 90^th percentile, fasting glycaemia ≥ 100 mg/dL, HDL-cholesterol ≤ 40 mg/dL and triglycerides ≥ 110 mg/dL in a representative sample of 461 adolescents.
The results obtained indicate that the prevalence of obesity was 9.2% and that MS reached 37.5%. Only 4.1% of the adolescents failed to present any of the risk factors for MS. When compared with the adolescents without MS, the estimated odd ratios (OR) for the presence of the characteristics of MS were all statistically significant, with increased waist circumference reaching an OR of 21.56. A significant difference was found between adolescents with and without MS; the parameters indicated greater insulin resistance for adolescents with MS.
In conclusion, MS is highly prevalent among Chilean adolescents with obesity and its prevention beginning in childhood needs to be addressed.     

Depression and diabetes in children and adolescents

PURPOSE OF REVIEW: Diabetes and depression are each public health concerns. They frequently co-occur, compounding complications of each disease. This review provides recent information regarding the mechanisms of association between the disorders and the availability and effectiveness of interventions for youth with diabetes who are depressed. Implications for primary care physicians are considered, particularly in relation to recognition of depression, and also to preventive strategies that increase the patient's self-efficacy (evidence-based confidence in his/her ability to manage diabetes) and serve as protective factors in the development of depression. RECENT FINDINGS: Depressive symptoms are strongly associated with diabetes complications. To date, no studies have tested effectiveness of interventions with depressed youth with diabetes. Clinical trials with adults have shown the effectiveness of pharmacotherapy, but those with more complications show the least improvement, and health gains do not persist. In the absence of other data, these findings suggest that it would be prudent to identify and treat comorbid depression in children with diabetes early in the course of their illness, before medical complications develop. SUMMARY: Primary care physicians are in an important position to recognize early signs of depression in youth with diabetes and refer them for treatment. Furthermore, the literature provides numerous strategies that can be employed by primary care doctors that may enhance diabetes management as well as protect against depression.     

Resolution of diagnosis and parental attitudes among parents of adolescent kidney recipients

The diagnosis of a chronic illness is described as an upsetting event that implies an emotional crisis for parents. Some are able to come to terms with their child's chronic condition and feel a sense of resolution, but for others, strong negative emotions persist through time. The present study examines diagnostic resolution among parents of teenagers with a transplant. The design was qualitative and involved individual interviews with nine parents. Five were donor to their child. Data were analyzed according to the principles of IPA. Early reactions to the diagnosis suggest that parents with an unresolved status experienced trauma. Many factors seem to contribute to diagnostic resolution such as good communication between spouses, positive relationship with the medical staff, and being the parent donor. For all parents, concerns over adherence are central to their relationship with their youth. Results call attention to the support needs of all parents and particularly those with an unresolved status.     

Psychometric properties of questionnaires measuring associations between behavioral factors and diabetes care for youth with type 2 diabetes

BACKGROUND: Because of the recency of the large numbers of youth diagnosed with type 2 diabetes (T2D), measures of adherence behavior and family response to diabetes have not been developed or tested. OBJECTIVE: The objective of this study is to identify whether questionnaires on personal and family behaviors regarding the care of diabetes previously used with youth with type 1 diabetes (T1D) are reliable and related to metabolic control among youth with T2D. DESIGN/METHODS: During a regularly scheduled visit, youth with T2D and a parent/guardian were invited to participate in the study. Youth and a parent completed questionnaires and one 24-h dietary recall at the visit. During the following 2 wk, each youth completed two telephone dietary recalls and physical activity questionnaires. RESULTS: Child-reported scales measuring parental reminding, positive family behavior, self-care behaviors, and self-efficacy and maternal report of child self-care behaviors and maternal self-efficacy were found to have adequate internal consistency. Only parental reminding was related to metabolic control. Those youth reporting higher parental reminding were in poorer metabolic control. CONCLUSIONS: These scales appear to be reliable with youth with T2D in south Texas.     

Comparison of health-risk behaviours among students in alternative high schools from New Zealand and the USA

OBJECTIVES: To describe the prevalence of health-risk behaviours of New Zealand alternative education students, and to compare these behaviours to similar students in the USA. METHODS: Thirty-six alternative education schools in the northern region of New Zealand were surveyed. A total of 269 students completed a youth health questionnaire using laptop computers. These data were compared to data from an equivalent population of alternative education students in the USA. RESULTS: Alternative education students from New Zealand and the USA engage in similar high levels of health-risk behaviours. Female students in New Zealand are at particularly high risk of poor health and social outcomes due to high levels of alcohol and marijuana use, driving under the influence of alcohol and high prevalence of risky sexual behaviours. Such health-risk behaviours place alternative education students at greater risk of some of the leading causes of morbidity and mortality in both youth and adult populations. CONCLUSIONS: Findings from the present study support the need for specific health policies and programmes for alternative high school students. Providers of New Zealand alternative education should be aware that female students are at particularly high risk of many health-risk behaviours.     

Effects of varying pandemic restrictions on the health-related behaviours of Australian children

Aim

To explore the effects of COVID-19 pandemic restrictions varying in severity and duration on health-related behaviours in children aged 5–17 years.

Methods

We used data from the Royal Children's Hospital National Child Health Poll, an online cross-sectional survey of Australian caregivers. The survey assessed 1222 caregivers' perceived changes in health-related behaviours (physical activity, sleep, screen-time, diet, outdoor activity, family and peer connectedness) of 2011 children aged 5–17 years in a typical week from June to September 2020 (when jurisdictions experienced varying restriction severity and duration) compared to retrospective reports of behaviour before March 2020 (pre-pandemic). To compare the effects of varying restriction severity in Victoria, New South Wales (NSW) and other states and territories on health-related behaviours binary logistic regression was used, adjusting for caregiver demographics and weighted to reflect Australia's parent population.

Results

Compared to pre-pandemic, Victoria's restrictions had a greater impact on child health-related behaviours compared to NSW restrictions and an even stronger impact compared to other states and territories which experienced few or no restrictions. A greater proportion of Victorian children reported more recreational screen time (71.3%) than NSW (53.9%) and other states and territories (34.5%) and less physical activity (57.2%) than NSW (30.3%) and other states and territories (26.5%). Victorian children reported less outdoor activity (62.6%) than NSW (32.0%) and other states and territories (25.2%), and less social connectedness (68.0%) than NSW (35.4%) and other states and territories (27.3%).

Conclusions

More severe and longer COVID-19 pandemic restrictions are associated with greater impacts and predominantly more negative impacts to children's health-related behaviours. These should be mitigated through policies and programs to encourage healthier life-styles.     

Modifiable Family Factors Among Treatment-Seeking Families of Children With High Body Mass Index: Report of a Pilot Study

PurposeThe purpose of this pilot study was to explore parenting style and other potential family and social indicators of an obesogenic or weight-promoting family environment. Modifiable factors were sought on which to base a nursing behavioral intervention that could be combined with diet and exercise to reduce youth weight.MethodsTwenty-eight parents and their 9- to 18-year-old children who were seeking care for overweight responded to in-home surveys to characterize parenting style (warmth/responsiveness and control). We also examined the extent to which parent modeling of health behavior, child feeding practices, parent knowledge of nutrition, and family social characteristics differed by the control aspect of parenting style.ResultsNearly all youth and parents reported substantial parental love (responsiveness), suggesting little variability in the warmth aspect of parenting style. In contrast, considerable variability was found in the control (moderate versus high) aspect of parenting style. Large effect sizes indicated that mothers with moderate control perceived their lifetime weight to be higher, had more concern about their youth’s weight (p = .03), had better knowledge of nutrition, and had a lower body mass index (p = .02) than did mothers with high (firm or restrictive) control. Moderate effect sizes indicated that mothers with moderate control demonstrated better modeling behavior, higher perception of youth weight, practiced less pressure to eat, and had youth with lower body mass index and percent body fat than did mothers with high (firm or restrictive) control. Families who volunteered for the study kept their data gathering appointments, but we recommend a recruitment period of more than 4 months and the inclusion of several referral sites.DiscussionFurther study of how parent control is related to youth overweight and how appropriate control can be achieved among families with teens who are overweight is recommended.     

Home, school, and neighborhood environment factors and youth physical activity

This study examined the contributions of home, school, and neighborhood factors related to youth physical activity (PA). Adolescents (ages 12-18; N = 137) and parents of younger children (ages 5-11; N = 104) from three US metropolitan areas completed surveys. Youth PA was estimated from six items assessing overall physical activity. Bivariate analyses between environment factors and PA were significant correlations in each environmental setting for adolescents (r's:0.16-0.28), but for parents of children, only for the home and neighborhood settings (r's: 0.14-0.39). For adolescents, pieces of equipment at home, family recreation membership, equipment at school, and neighborhood aesthetics explained 15.8% of variance in PA. For younger children (based on parent report), pieces of equipment at home, neighborhood traffic safety, walking/cycling facilities, and street connectivity explained 21.4% of the variance in PA. Modifiable factors like increasing access to equipment at home and school, and improving neighborhood aesthetics may impact youth PA. To optimize explanation of youth PA, factors from multiple environments need to be considered.     

Problematic behaviours of 3-year-old children in Japan: relationship with socioeconomic and family backgrounds

AIM: The purpose of our study was to elucidate factors in socioeconomic and family backgrounds of 3-year-old children in Tokyo, Japan that were associated with problematic behaviours among the children. STUDY DESIGN: 670 eligible 3-year-old children underwent an evaluation of problematic behaviour by the Japanese Child Behaviour Checklist (CBCL/2-3) and of socioeconomic and family backgrounds. RESULTS: Stepwise multi-logistic regression analyses using all 28 variables showed that longer hours watching TV, smoking during pregnancy, coffee drinking during and after pregnancy increased, whereas higher family income, a larger number of older brothers/sisters, higher educational level of father decreased problematic behaviours. Maternal anxiety measured by trait anxiety using the STAI was associated with behaviour problems measured by CBCL, particularly with externalizing domains composed by aggressiveness, oppositional and attention domains. CONCLUSION: These results suggest that problematic behaviours among children may be increased by adverse socioeconomic and family backgrounds that may be associated with maternal anxiety.     

Youth and parent education about diabetes complications: health professional survey

Objective:  Avoiding complications is paramount in diabetes management, but little is known about how, when, and what diabetes professionals disclose to parents and youths about this topic.
Research design and method:  Pediatric diabetes experts (n = 534) were surveyed about their practices and attitudes regarding informing parents and youth about long-term diabetic complications.
Results:  Professionals reported giving more information to parents, older children, and children with longer diabetes duration than younger or newly diagnosed children. Principal components analysis was completed to identify measurement factors of the attitudes about information sharing and variables affecting decision-making sections of the survey. These factor scores served as predictor variables in hierarchical multiple regression analyses. More information sharing was associated with more diabetes clinical activity, stronger sense of professional responsibility to disclose this information, less sensitivity about the emotional impact of this teaching, greater concern about exposure to inaccurate information, and less consideration of the family context (R² = 0.282, p ≤ 0.0001). Greater propensity to share information about complications was found among health care providers who reported that they gave less consideration to such variables as the family's prior experience with diabetes in other family members or the child's duration of diabetes or the presence of psychiatric disorders in the child or family members.
Conclusions:  Patient characteristics and professionals' attitudes were associated with experts' willingness to inform families about long-term diabetic complications. Further research should explore how these practice variations affect coping with diabetes.