Prevalence and correlates of mental health problems and treatment among adolescents seen in primary care

PurposeIn this study, we describe the characteristics of adolescents with mental health problems among those presenting to primary care clinics in urban areas.MethodsThe sample included 1,076 adolescents aged 12–18 years who presented to federally qualified community health clinics in urban cities in the Midwest. Bivariate and multivariate logistic regression analyses were conducted to examine the associations between having a mental health problem with demographic characteristics, health-related variables, and other risk and promotive factors. We also examined the use of health services and involvement in activities among those with mental health problems.ResultsApproximately 14% of adolescents screened positive for a mental health problem; among those with a mental health problem, 42.8% received mental health services in the past 3 months. In the multivariate logistic regression analysis, adolescents who were female, with poorer grades, fair to poor self-reported health, using drugs, and lower parental monitoring were more likely to have a mental health problem. In bivariate analyses, adolescents with mental health problems were less likely to participate in school activities and community activities and more likely to use emergency room services.ConclusionsAdolescents with mental health problems were more likely to have several other difficulties including poor grades, poor self-rated health, drug/alcohol use, and sexual activity. This study highlights the importance of screening youth with multidimensional needs and referring them to the appropriate services.     

Forced Intercourse,Individual and Family Context,and Risky Sexual Behavior Among Adolescent Girls

PurposeThis study tested the hypothesis that individual and family factors associated with adolescent risky sexual behavior (RSB) operate differently in their relationship to RSB among girls who have experienced forced sexual intercourse (FSI), as compared to those girls who have not.MethodsData were collected from 3,863 eighth-grade girls from a larger statewide sample. Different subgroups of participants received different sets of questions, so 655–2,548 students were included in each analysis. Multilevel modeling was used to examine relationships of individual (social negotiation skills, personal safety, depression, and sensation-seeking personality) and family factors (sibling deviance, parental monitoring, and quality of family relationships) to RSB. FSI was examined as a predictor of RSB and as a moderator of the relationship between individual and family variables and sexual risk.ResultsIn the case of individual predictors, social negotiation skills were associated with lower RSB for all girls, but these skills had a stronger relationship to RSB among girls who had experienced FSI. Depression and sensation-seeking tendencies had small positive relationships to RSB for all girls. In the case of family predictors, for girls without a history of FSI, parental monitoring was associated with lower RSB. However, among girls who had experienced FSI, parental monitoring was not significantly related to RSB, but sibling deviance was associated with lower RSB.ConclusionsResults suggest that social negotiation skills and parental monitoring may warrant further attention in research and intervention.     

A Nationally Representative Study of Sexual Orientation and High-Risk Drinking From Adolescence to Young Adulthood

PurposeTo determine whether peer drunkenness, parental knowledge about their adolescent's whereabouts and behaviors, and depressive symptoms contribute to sexual orientation disparities in high-risk drinking behaviors; if they do, they would be potential intervention targets.MethodsLongitudinal survey data from 2,051 adolescents who participated in the NEXT Generation Health Study were analyzed. Latent growth curve and longitudinal path analyses were used to test for indirect effects linking sexual orientation in 11th grade (3.4% males and 8.4% females were sexual minorities) to past 30-day heavy episodic drinking (HED) over 6 years and past year high-intensity binge drinking at 4 years after high school.ResultsSexual minority males were not more likely to engage in high-risk drinking than heterosexual males. In contrast, sexual minority females were more likely than heterosexual females to engage in HED when they were in 11th grade (Odds Ratio = 2.83, 95% confidence interval = 1.43, 5.61), in part because of lower parental knowledge. Sexual minority females also had higher depressive symptoms during the transition from adolescence to young adulthood, which in turn was associated with greater risk of high-intensity binge drinking in young adulthood. Peer drunkenness was a strong risk factor for HED and high-intensity binge drinking among both males and females.DiscussionSexual minority females reported lower levels of parental knowledge during adolescence and higher levels of depressive symptoms during the transition to young adulthood than heterosexual females. Both factors were associated with high-risk drinking behavior, suggesting developmentally sensitive opportunities to mitigate sexual orientation disparities in high-risk drinking.     

Profiles of violent youth: substance use and other concurrent problems.

OBJECTIVES: This study examined the prevalence of various violent behaviors among high school-age adolescents, the co-occurrence of teenage violence with other public health problems, and gender differences in violence. METHODS: Longitudinal data for more than 4500 high school seniors and dropouts from California and Oregon were used to develop weighted estimates of the prevalence of violent behavior and its co-occurrence with other emotional and behavioral problems. RESULTS: More than half the sample had engaged in violence during the last year, and one in four had committed predatory violence. Boys were more likely than girls to engage in most types of violence, but both were equally prone to violence within the family. Violent youth were more likely than their peers to have poor mental health, use drugs, drop out of school, and be delinquent. Violent boys were more likely than violent girls to commit nonviolent felonies and sell drugs, but less likely to have poor mental health or become a parent. Prevalence estimates for violence co-occurring with three or more other problems ranged from 4% to 21%. CONCLUSIONS: Teenage violence typically coexists with additional emotional and behavioral problems. Programs must consider the broader public health context in which violence occurs.     

Homelessness Experiences,Sexual Orientation,and Sexual Risk Taking Among High School Students in Los Angeles

PurposePrior studies reported homeless adolescents engage in more sexual risk than their housed peers. However, these comparisons are typically made post hoc by comparing homeless adolescent community-based samples with high school probability samples. This study uses a random sample of high school students to examine homelessness experiences and sexual risk behaviors.MethodsA supplemental survey to the Youth Risk Behavior Survey containing questions regarding homelessness and sexual health was administered to Los Angeles high school students (N = 1,839). Multivariate logistic regressions assessed the associations between demographics, past year homelessness experiences (i.e., place of nighttime residence), and being sexually active and condom use at last intercourse.ResultsHomelessness experiences consisted of staying in a shelter (10.4%), a public place (10.1%), and with a stranger (5.6%). Lesbian, gay, bisexual, transgender, questioning (LGBTQ), younger, and male adolescents were more likely to experience homelessness. LGBTQ adolescents were also more likely to report staying with a stranger and less likely to report staying in a shelter. Compared to adolescents who stayed in shelters, adolescents who stayed with strangers and in public places were more likely to engage in unprotected sex at last intercourse.ConclusionsAdolescents who report sexual activity and sexual risk taking are more likely to report homelessness experiences. With regard to sexual health, staying with strangers could be a particularly risky form of homelessness; LGBTQ and black adolescents are more likely to experience this form of homelessness. Efforts to reduce homelessness and sexual risk-taking need to recognize the specific vulnerabilities faced by these populations.     

Prevalence and psychosocial factors associated with being bothered by nonavailability of sexual partners among Hong Kong Chinese: a population-based study

This study investigated the prevalence of being bothered by sexual-partner non availability (SPNA), associated risk factors, and associations with mental health and sexual satisfaction using a computer-assisted telephone survey. A random sample of 3257 and 1568 Chinese male and female respondents (aged 18-59) were interviewed. Sexual partner non-availability was highest in the male nonmarried/noncohabitating group, (18.6%) and the prevalence ranged from 1.4% to 7.9% for other age-sex subgroups. Younger age and male gender were associated with SPNA. Being bothered by SPNA was significantly associated with mental health and vitality quality of life, general life satisfaction, and sexual satisfaction (OR = 1.41 to 5.21).     

Substance use and mental health problems as predictors of HIV sexual risk behaviors among adolescents in foster care

This study examined the relationship between substance use, mental health problems, and HIV sexual risk behaviors among a sample of foster care adolescents. Data were collected through structured baseline interviews with 320 adolescents (ages 15 to 18 years) who resided in foster care placements and participated in a larger evaluation study of an HIV prevention program. Final logistic regression models indicated that delinquent behavior and marijuana use were the most significant predictors of engaging in any one HIV risk behavior. Adolescents who reported delinquent behaviors, alcohol use, and marijuana use and who were female were more likely than their counterparts to engage in vaginal sex without using a condom. Future research is needed to further identify risk and protective factors for substance use, mental health problems, and HIV sexual risk behaviors among adolescents in foster care. HIV prevention efforts for these vulnerable adolescents should target those with substance use and delinquent behaviors.     

Challenges faced by homeless sexual minorities: comparison of gay, lesbian, bisexual, and transgender homeless adolescents with their heterosexual counterparts

OBJECTIVES: The goal of this study was to identify differences between gay, lesbian, bisexual, and transgender (GLBT) homeless youths and their heterosexual counterparts in terms of physical and mental health difficulties. METHODS: A sample of 84 GLBT adolescents was matched in regard to age and self-reported gender with 84 heterosexual adolescents. The 2 samples were compared on a variety of psychosocial variables. RESULTS: GLBT adolescents left home more frequently, were victimized more often, used highly addictive substances more frequently, had higher rates of psychopathology, and had more sexual partners than heterosexual adolescents. CONCLUSIONS: Homeless youths who identify themselves as members of sexual minority groups are at increased risk for negative outcomes. Recommendations for treatment programs and implications for public health are discussed.     

Sexual assault among North Carolina women: prevalence and health risk factors

STUDY OBJECTIVE: Sexual assault is traumatic at the time it occurs, but it also may have longlasting negative effects on physical health. Much of the research linking specific health problems to sexual assault victimization has used samples from special populations. The goals of this study are to estimate the prevalence of sexual assault in a representative sample of women in North Carolina and examine sexual assault in relation to specific health risk factors for leading causes of morbidity and mortality in women. DESIGN: The North Carolina Behavioral Risk Factor Surveillance System (BRFSS) is a household telephone survey of non-institutionalised adults, 18 years of age and older, conducted by random digit dialling. SETTING: This investigation focuses on the study participants in the 1997 survey. PARTICIPANTS: The sample includes 2109 women who responded to the sexual assault questions in the 1997 North Carolina BRFSS interview. MAIN RESULTS: The lifetime prevalence of sexual assault was 19% (95% CI 17% to 20%), of which 73% of victims experienced or were threatened with forced sexual intercourse. Sexual assault victims, particularly victims of forced intercourse or the threat thereof, were more likely to perceive their general health as being fair or poor (OR=2.3, 95% CI 1.5 to 3.4) and were more likely to have suffered poor physical and mental health in the past month (poor physical health, OR=2.1, 95% CI 1.6 to 2.8; poor mental health, OR= 2.6, 95% CI 1.9 to 3.5). After controlling for sociodemographic factors and health care coverage, victims of forced intercourse or the threat thereof were more likely to smoke cigarettes (OR=2.0, 95% CI 1.4 to 2.8), to have hypertension (OR=1.5, 95% CI 1.1 to 2.2), to have high cholesterol (OR=1.7, 95% CI 1.2 to 2.5), and to be obese (OR=1.7, 95% CI 1.3 to 2.4). CONCLUSIONS: This study shows associations between sexual victimization and health risk factors in a non-clinical statewide population of women. Future research should determine whether clinically screening for and identifying a history of sexual victimization among women seen in a variety of health care settings leads to the initiation of effective interventions that help women successfully cope with these violent experiences. There is also a need for further research to investigate the temporal sequence of assaults and subsequent health outcomes by assessing physical health status before and after victimization.     

Prevalence and correlates of smoking and sexual activity among Hong Kong adolescents.

PURPOSE: To report on the prevalence and correlates of smoking and sexual activity in a community sample of Hong Kong Chinese adolescents. METHODS: Participants (N = 4116) aged 13 to 18 years were surveyed regarding smoking and physical heterosexual activity, relationships with family members, family involvement, social support, school performance and emotional adjustment. Data were analyzed using logistic regression analyses. RESULTS: About 30% of participants reported ever smoking and 3.5% reported sexual intercourse. Current smoking was correlated with age, school performance and quality of relationship with mother. Sexual intercourse was correlated with age, gender, family involvement and social support. Smoking and sexual activity were significantly correlated with each other. Smoking and increasing levels of heterosexual physical contact were negatively correlated with emotional adjustment, even after controlling for common predictors to health-endangering behaviors and emotional adjustment. CONCLUSIONS: Smoking and sexual activity among adolescents are far less common in Hong Kong than in the West and their presence in a Hong Kong adolescent should alert the health practitioner to the possibility of significant psychosocial stress and maladjustment.     

社区居民性健康与婚姻态度的相关性研究

目的探讨社区居民性健康与婚姻态度的相关性及影响因素。方法采用便利样取样法选取某社区的312名居民,应用性健康量表、婚姻态度量表进行问卷调查。结果性健康总分为(35.00±10.21)分,性行为健康得分(55.00±9.42)分,性心理健康得分(20.00±6.87)分。不同年龄、文化程度、职业差异无统计学意义(P>0.05);性别差异有统计学意义(P<0.05),性健康与婚姻态度呈正相关;性健康与婚姻态度各维度(婚姻心理准备态度、家庭关系控制、婚姻控制态度)呈正相关;性健康各维度中性行为健康与婚姻态度及各维度呈正相关;性心理健康与婚姻态度及各维度相关,差异有统计学意义(P<0.05)。结论性健康能促进家庭的和谐,夫妻的美满。性健康能够增进夫妻双方对婚姻态度的理解及认识。     

Hypertension in Oman: distribution and correlates

BACKGROUND: International studies have reported increased prevalence of hypertension and other cardiovascular risk factors, Our aim was to study the distribution and the correlates of hypertension (HTN - systolic or diastolic) in a community based survey (National Health Survey, 2000). METHODS: A cross-sectional survey of the health status of Omani community was designed. Face to face interview including demographic data, blood pressure measurement, fasting blood glucose and serum cholesterol, weight, height, waist and hip measurement for 7011 Omani subjects with a response rate ranging between about 83% (for fasting blood glucose) to about 91% (for blood pressure measurement). RESULTS: The crude prevalence of HTN was 33.1%, while the age-adjusted prevalence was 38.3%. Older age groups, male gender, lower level of education, non- working, hypercholestremia, being married, obese, smoker, or having abnormal Waist Hip Ratio (WHR), or Total Impaired fasting glucose (TIFG) were found to be associated with hypertension in bivariate analysis. Logistic models were run to identify the adjusted Odds Ratio for the overall sample, for separate genders and age groups. For the overall sample, subjects aged 60 and above were 5.4 times more likely to be hypertensive than those below forty. Female gender was a protective factor in the overall sample, while it increased the risk by 1.4 times among those aged 60+. Obese or centrally obese subjects were also more likely to be hypertensive. Subjects with impaired fasting glucose, diabetes, or hyperchlosteremia were more likely to have hypertension than others in the majority of the logistic regression models. CONCLUSION: Hypertension is considered a major public health problem in Oman. Increasing the awareness of both health care providers and the community is crucial.     

A Systematic Review of Family Victimization Experiences Among Sexual Minority Youth

Sexual minority youth experience substantially higher rates of family victimization than their heterosexual peers. No systematic review has yet identified the predictors and consequences in this vulnerable population of childhood abuse, exposure to sibling abuse and domestic violence, and sibling aggression. This systematic review aims to (a) describe differences in these family victimization rates by sexual orientation, gender, and race/ethnicity; (b) identify potential sexual minority and non-sexual minority-specific risk factors; and (c) identify physical, mental, and behavioral health and extrafamilial victimization correlates. The systematic review, which followed PRISMA guidelines, yielded 32 articles that met study inclusion criteria. Rates of childhood physical, sexual, and emotional abuse were consistently higher for sexual minority youth than for their heterosexual peers. Bisexual youth appear to be at greater risk for physical abuse than their gay and lesbian peers. Younger age at sexual minority milestones (first awareness, disclosure, and same-sex sexual contact) and higher levels of sexual minority-specific (sexuality disclosure, gender non-conformity) and non-sexual minority-specific (delinquent behaviors, parental drinking) risk factors were associated with higher rates of family victimization. Sexual minorities who experienced some form of childhood abuse reported more frequent physical (higher rates of HIV, higher BMIs, lower levels of perceived health), mental (higher rates of depression, PTSD symptoms, experiential avoidance, internalized homophobia), and behavioral (higher rates of suicidality, substance misuse, earlier sexual debut, unprotected anal sex) health problems relative to heterosexual or non-abused sexual minority peers. Sexual minority females who experienced childhood physical or sexual abuse were at greater risk than abused sexual minority males for sexual assault later in life. We conclude this systematic review with recommendations for future research, including the necessity for longitudinal research that utilizes a poly-victimization conceptual framework to identify the developmental pathways connecting risk factors, different types of family victimization, and health and extrafamilial victimization consequences.     

Condom availability programs in Massachusetts high schools: relationships with condom use and sexual behavior

OBJECTIVES: This study assessed relationships between condom availability programs accompanied by community discussion and involvement and adolescent sexual practices. METHODS: Sexual practice and condom use differences were assessed in a representative sample of 4166 adolescents enrolled in high schools with and without condom availability programs. RESULTS: Adolescents in schools where condoms were available were more likely to receive condom use instruction and less likely to report lifetime or recent sexual intercourse. Sexually active adolescents in those schools were twice as likely to use condoms, but less likely to use other contraceptive methods, during their most recent sexual encounter. CONCLUSIONS: The strategy of making condoms available, an indication of socioenvironmental support for condom use, may improve HIV prevention practices.     

Well-Being and Suicidal Ideation of Secondary School Students From Military Families

BackgroundThe mental health of children is a primary public health concern; adolescents of military personnel may be at increased risk of experiencing poorer well-being overall and depressive symptoms specifically. These adolescents experience individual and intrafamilial stressors of parental deployment and reintegration, which are directly and indirectly associated with internalizing behaviors.PurposeThe present study sought to better understand the influence of parental military connectedness and parental deployment on adolescent mental health.MethodsData from the 2011 California Healthy Kids Survey examined feeling sad or hopeless, suicidal ideation, well-being, and depressive symptoms by military connectedness in a subsample (n = 14,299) of seventh-, ninth-, and 11th-grade California adolescents. Cross-classification tables and multiple logistic regression analyses were used.ResultsMore than 13% of the sample had a parent or sibling in the military. Those with military connections were more likely to report depressive symptoms and suicidal ideation. Controlling for grade, gender, and race/ethnicity, reporting any familial deployment compared with no deployments was associated with increasing odds of experiencing sadness or hopelessness, depressive symptoms, and suicidal ideation.ConclusionsFindings emphasize the increased risk of mental health issues among youth with parents (and siblings) in the military. Although deployment-related mental health stressors are less likely during peace, during times of war there is a need for increased screening in primary care and school settings. Systematic referral systems and collaboration with community-based mental health centers will bolster screening and services.     

Parenting Practices and Adolescent Risk Behavior: Rules on Smoking and Drinking Also Predict Cannabis Use and Early Sexual Debut

Previous research has provided considerable support for idea that increased parental support and control are strong determinants of lower prevalence levels of adolescent risk behavior. Much less is known on the association between specific parenting practices, such as concrete rules with respect to smoking and drinking and adolescent risk behavior. The present paper examined whether such concrete parental rules (1) have an effect on the targeted behaviors and (2) predict other, frequently co-occurring, risk behaviors (i.e., cannabis use and early sexual intercourse). These hypotheses were tested in a nationally representative sample of 12- to 16-year-old adolescents in the Netherlands. We found that both types of rules were associated with a lower prevalence of the targeted behaviors (i.e., smoking and drinking). In addition, independent of adolescent smoking and drinking behaviors, parental rules on smoking predicted a lower prevalence of cannabis use and early sexual intercourse, and parental rules on alcohol use also predicted a lower prevalence of early sexual intercourse. This study showed that concrete parental rule setting is more strongly related to lower levels of risk behaviors in adolescents compared to the more general parenting practices (i.e., support and control). Additionally, the effects of such rules do not only apply to the targeted behavior but extend to related behaviors as well. These findings are relevant to the public health domain and suggest that a single intervention program that addresses a limited number of concrete parenting practices, in combination with traditional support and control practices, may be effective in reducing risk behaviors in adolescence.     

Sociodemographic Patterns in Retrospective Sexual Orientation Identity and Attraction Change in the Sexual Orientation Fluidity in Youth Study

PurposeThis study examined sociodemographic patterns of retrospective fluidity in sexual orientation identity (i.e., any change from one identity to another) and attractions (i.e., any change in attractions to one or more gender(s)) in a large sample of US youth.MethodsParticipants were 4,087 youth (58% cisgender girls/women, 38% cisgender boys/men, 5% transgender or nonbinary individuals), ages 14–25 years, from across the United States, who were recruited from an online survey panel. Sexual and gender minorities and people of color were oversampled. Participants completed the Wave 1 survey of the longitudinal Sexual Orientation Fluidity in Youth study, which assessed sociodemographic characteristics and retrospective fluidity in sexual orientation identity and attractions.ResultsAcross the sample, 17% reported a retrospective change in identity and 33% reported a change in attractions. Participants who were most likely to report identity change were in the younger age group (14–17 years), were transgender or nonbinary, had a plurisexual identity (pansexual, queer), and reported attractions to more than one gender. Participants who were most likely to report attraction change were nonbinary, had a plurisexual identity (pansexual, queer, bisexual), and reported attractions to more than one gender.DiscussionThis study found retrospective changes in sexual orientation identity and attractions were common in this sample of youth, with the prevalence of these changes differing by sociodemographic characteristics. Results from this study inform future research on adolescent health and have implications for supporting and caring for this age group, for whom sexual fluidity is common.     

Sociodemographic differences in depressed mood: results from a nationally representative sample of high school adolescents

BACKGROUND: Research on adolescent mental health suggests that prevalence rates for depressed mood are not uniformly distributed across all populations. This study examined demographic difference in depressed mood among a nationally representative sample of high school adolescents. METHODS: The 2003 National Youth Risk Behavior Survey was utilized to examine the association between depressed mood and demographic variables. To examine demographic associations, chi-square and follow-up logistic regression models were created for the sample of high school adolescents (N = 15,214). RESULTS: Caucasians and African Americans were significantly less likely to report depressed mood when compared to Hispanics and Others. Women were also more likely than men to report depressed mood. No significant differences were observed among levels of urbanicity and age. CONCLUSIONS: An understanding of the difference in the prevalence and correlates of depressed mood among adolescents of various ethnic/racial and gender groups deserves increased attention. Given the fact that challenges with depressed mood in adolescents can be substantial and relatively unrecognized, there is an increased need to identify these adolescents early and intervene with culturally appropriate interventions.     

A Comparison of Two Models of Risky Sexual Behavior During Late Adolescence

Two models of risky sexual behavior (RSB) were compared in a community sample of late adolescents (N = 223). For the traumagenic model, early negative sexual experiences were posited to lead to an association between negative affect with sexual relationships. For the cognitive escape model, depressive affect was posited to lead to engagement in RSB as a way to avoid negative emotions. The current study examined whether depression explained the relationship between sexual trauma and RSB, supporting the cognitive escape model, or whether it was sexual trauma that led specifically to RSB, supporting the traumagenic model. Physical trauma experiences were also examined to disentangle the effects of sexual trauma compared to other emotionally distressing events. The study examined whether the results would be moderated by participant sex. For males, support was found for the cognitive escape model but not the traumagenic model. Among males, physical trauma and depression predicted engagement in RSB but sexual trauma did not. For females, support was found for the traumagenic and cognitive escape model. Among females, depression and sexual trauma both uniquely predicted RSB. There was an additional suppressor effect of socioeconomic status in predicting RSB among females. Results suggest that the association of trauma type with RSB depends on participant sex. Implications of the current study for RSB prevention efforts are discussed.     

Violence involvement, substance use, and sexual activity among Mexican-American and European-American adolescents

PURPOSE: This study examined longitudinal associations between violence involvement, substance use, and sexual activity. METHODS: A total of 302 urban Mexican-American and European-American adolescents were randomly selected and recruited from the membership lists of a large health maintenance organization. Data were obtained from interviews conducted when the mean ages of adolescents were 15, 18, and 19 years. RESULTS: Independent of age, gender, ethnicity, family socioeconomic status, and previous levels of health risk behavior, adolescents who had been victimized by violence at age 15 were more likely to use tobacco at age 19. Adolescents who had been victimized by or perpetrated violence at age 18 had a greater number of sexual partners and were more likely to use marijuana at age 19. In addition, adolescents who had perpetrated violence at age 18 engaged in greater alcohol use at age 19. A second set of analyses showed that independent of demographics and previous violence involvement, adolescents who had used marijuana at age 15 were more likely to report violence involvement at age 19. Adolescents who had used tobacco or who had a greater number of sexual partners at ages 15 or 18 were more likely to report violent victimization at age 19. CONCLUSIONS: Associations between violence involvement and other forms of health risk behavior are bidirectional. Adolescents involved with violence are at risk for increases in substance use and sexual behavior over time. Adolescents who engage in substance use and sexual behavior with multiple partners are also at risk for later violence involvement.