Hospitalization and the Adolescent Patient: A Review and Some Critical Questions

Fifty articles spanning a 30-year period were selected as representative of the literature concerning the effects of hospitalization on the nonpsychiatric adolescent patient Areas to emerge from this analysis were the effects of illness, visitor preference, sex and age differences, patient self-reports, posthospitalization behaviors, and methods of caring for the adolescent patient The direction in which the literature has moved as well as a number of critical areas for future research are presented.     

Hospitalization and the Adolescent Patient: A Review and Some Critical Questions

Fifty articles spanning a 30-year period were selected as representative of the literature concerning the effects of hospitalization on the nonpsychiatric adolescent patient Areas to emerge from this analysis were the effects of illness, visitor preference, sex and age differences, patient self-reports, posthospitalization behaviors, and methods of caring for the adolescent patient The direction in which the literature has moved as well as a number of critical areas for future research are presented.     

Perceived Parental and Peer Disapproval Toward Substances: Influences on Adolescent Decision-Making

This study investigated the relative influence of perceived parent and peer disapproval for using drugs on youth intentions to use drugs. In a cross-sectional design, sixth and eighth grade students (N = 1,649) completed surveys that included measures of parent disapproval, peer disapproval, and intentions to use drugs in the future. Parent influences were more salient for sixth graders, whereas peer influences were predominant for eighth graders. Peer disapproval was significantly evident in the sixth grade sample, as was parent disapproval in the eighth grade sample. Additionally, girls’ drug use intentions were higher than were boys’. These findings suggest that parents can have a robust protective role over and above peer influences and that girls’ intentions to use substances deserve increased attention. Editors’ Strategic Implications: These findings, if replicated, should help practitioners develop developmentally appropriate strategies and programs for substance use prevention.     

Social Decision-Making and Life Skills Development: A Critical Thinking Approach to Health Promotion in the Middle School

ABSTRACT: This article discusses a classroom-based social decision-making intervention for health promotion and prevention of problem behaviors. The social decision-making approach brings together social-cognitive, affective, behavioral, and social relationship areas with critical thinking skills important for academic achievement. These skills are the same ones needed to promote children's health and prevent substance abuse and related health-compromising behaviors. Key components of this program, its development, and theoretical background are discussed, focusing on implications for school-based health promotion. As such, social decision-making provides an approach to health promotion that enhances coordination among classroom and health education personnel. The middle school years, a time of increasing risk for negative health-related outcomes, are examined as a key period for intervention. Finally, empirical evidence supporting use of social decision-making and related approaches is discussed.     

When Behavioral Health Concerns Present in Pediatric Primary Care: Factors Influencing Provider Decision-Making

Primary care providers (PCPs) frequently encounter behavioral health (BH) needs among their pediatric patients. However, PCPs report variable training in and comfort with BH, and questions remain about how and when PCPs address pediatric BH needs. Existing literature on PCP decisions to address pediatric BH in-office versus referring to subspecialty BH is limited and findings are mixed. Accordingly, this study sought to examine parameters and contextual factors influencing PCP decisions and practices related to BH care. Qualitative interview results with 21 PCPs in Maryland indicated that decisions about how and when to address pediatric BH concerns are influenced by the type BH service needed, patient characteristics, the availability of BH services in the community, and possibly PCPs’ perceptions of BH care as a distinct subspecialty. Findings suggest that efforts to support individual PCPs’ capacity to address BH within primary care must be balanced by efforts to expand the subspecialty BH workforce.     

Smoking-Related Cue-Induced Brain Activation in Adolescent Light Smokers

PurposeTo examine using functional magnetic resonance imaging whether adolescents with low levels of nicotine exposure (light smokers) display neural activation in areas shown to be involved with addiction in response to smoking-related stimuli.Design/Setting/ParticipantsA total of 12 adolescent light smokers (aged 13–17, who smoked 1–5 cigarettes per day) and 12 nonsmokers (ages 13–17, never smoked a cigarette) from the San Francisco Bay Area underwent functional magnetic resonance imaging scanning. During scanning, the adolescents were shown photographic blocks of smoking and control cues. Smoking cues comprised pictures of individuals smoking cigarettes and smoking-related objects such as lighters and ashtrays. Neutral cues comprised images of everyday objects and individuals engaged in daily activities.FindingsFor smokers, smoking cues elicited greater activation than neutral cues in the mesolimbic reward circuit (left anterior cingulate: t = 7.04, p < .001; right hippocampus: t = 6.37, p < .001). We found activation from smoking cues versus neutral cues within both the left and right frontal medial orbital regions (t = 5.09, p < .001 and t = 3.94, p = .001, respectively). Nonsmokers showed no significant difference in activation between smoking-related cues and neutral cues.ConclusionOur finding that smoking cues produced activation in adolescent light smokers in brain regions, similar to that seen in adult and teenage heavy smokers, suggests that adolescents exhibit heightened reactivity to smoking cues even at low levels of smoking. This article adds to the existing published data by suggesting that nicotine dependence may begin with exposure to low levels of nicotine, thus underscoring the need for early intervention among adolescent smokers.     

Sleep Duration and Weight Gain: Reconsideration by Panel Data Analysis

Background

Inconsistent findings in previous studies of the association between sleep duration and changes in body mass index (BMI) may be attributed to misclassification of sleep duration fluctuations over time and unmeasured confounders such as genetic factors. The aim of the present study was to overcome these failings by using repeated measurements and panel data analysis to examine the sleep-BMI association.

Methods

Panel data were derived by secondary use of the data from mandatory health checkups at a Japanese gas company. Male non-shift workers aged 19–39 years in 2007 were annually followed until 2010 (n = 1687, 6748 records). BMI was objectively measured, and sleep duration was self-reported.

Results

Compared with 7-hour sleepers, panel analysis with the population-averaged model showed a significant increase in BMI among 5-hour (0.11 kg/m², P = 0.001), 6-hour (0.07 kg/m², P = 0.038), and ≥8-hour (0.19 kg/m², P = 0.009) sleepers. On the other hand, after adjustment for unobserved time-invariant confounders using the fixed-effects model, the magnitude of the association was considerably attenuated and no longer significant (5-hour, 0.07 kg/m², P = 0.168; 6-hour, 0.02 kg/m², P = 0.631; ≥8-hour sleepers, 0.06 kg/m², P = 0.460).

Conclusions

The longitudinal association between sleep duration and changes in BMI may be upwardly biased by unobserved time-invariant confounders rather than misclassified sleep duration. The net effect of sleep duration on weight gain may therefore be less than previously believed.Key words: longitudinal studies, sleep, obesity, weight gain, panel analysis     

Adolescent immunizations: A position paper of the Society for Adolescent Medicine

New vaccines are being targeted to help protect the adolescent population from disease. The Society for Adolescent Medicine strongly urges compliance with adolescent vaccination recommendations provided by the Advisory Committee on Immunization Practices. These vaccines will significantly impact the health and well-being of the adolescent population. To enhance vaccination compliance and access to prevention health care and promotion, the Society supports linking vaccination to the three distinct comprehensive preventive health care visits already recommended by multiple organizations during early, middle, and late adolescence. In addition, multiple provider strategies should be used to increase vaccination rates among adolescents.     

Decision-Making in People With Dementia or Mild Cognitive Impairment: A Narrative Review of Decision-Making Tools

ObjectivesThis review summarized the applicability of various decision-making tools for helping people with dementia or mild cognitive impairment (MCI) and their families make decisions.DesignThis study was a narrative literature review. The protocol of this review was registered in the International Prospective Register of Systematic Reviews (PROSPERO ID: CRD42020182259).Setting and ParticipantsPeople with dementia or MCI and their families were included in this study.MethodsThis review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. We searched the Cochrane Library, PubMed, Embase, Cumulative Index to Nursing and Allied Health Literature, and Chinese Electronic Periodical Services databases from inception to May 2021. The Joanna Briggs Institute Critical Appraisal Checklists for a variety of study designs were used.ResultsTopics related to decision-making were categorized as everyday activity decisions or medical treatment decisions. Various types of decision-making tools were identified, and we observed that decision aids can be modified and used for both everyday activity decisions and medical treatment decisions. In addition to highlighting decision aids for specific decisional issues and topics, we also elucidated other validated tools that can be used to facilitate the decision-making process.Conclusions and ImplicationsThis study highlighted the topics involved in decision-making and using decision-making tools. The current review provides information that can help individuals and health care professionals choose optimal decision-making tools. On the basis of our findings, future studies can determine the most appropriate tools for intervention or outcome measures.     

Linking Data to Decision-Making: Applying Qualitative Data Analysis Methods and Software to Identify Mechanisms for Using Outcomes Data

A multiple case study was conducted to examine how staff in child out-of-home care programs used data from an Outcomes Management System (OMS) and other sources to inform decision-making. Data collection consisted of thirty-seven semi-structured interviews with clinicians, managers, and directors from two treatment foster care programs and two residential treatment centers, and individuals involved with developing the OMS; and observations of clinical and quality management meetings. Case study and grounded theory methodology guided analyses. The application of qualitative data analysis software is described. Results show that although staff rarely used data from the OMS, they did rely on other sources of systematically collected information to inform clinical, quality management, and program decisions. Analyses of how staff used these data suggest that improving the utility of OMS will involve encouraging staff to participate in data-based decision-making, and designing and implementing OMS in a manner that reflects how decision-making processes operate.     

Pediatric Primary Care Providers and Adolescent Depression: A Qualitative Study of Barriers to Treatment and the Effect of the Black Box Warning

PurposeThe recent black box warning on antidepressants has drawn attention to controversies regarding the treatment of adolescent depression in primary care settings, but little is known about how providers decide to treat depressed youth and what resources are employed.MethodsWe conducted focus groups with 35 providers and staff in nine community-based pediatric practices in rural and urban settings of western Washington State. Discussion topics included perceived barriers to the treatment of depression in youth, how providers addressed these barriers, and the impact of the recent Federal Drug Administration (FDA) black-box warning. Focus groups were audiotaped and professionally transcribed. Qualitative content analysis was conducted using Atlas ti software and differences in coding were resolved via discussion by three independent reviewers.ResultsBased on analysis of interviews, a conceptual model was developed detailing factors influencing primary care providers’ (PCP) decisions about depression treatment. The three key themes that influenced doctors’ decisions about treating depression were lack of availability of mental health resources in the community, feeling responsible for helping based on long-standing relationships with patients and families, and patient and family beliefs and preferences regarding treatment. Most of the approaches to address barriers were not systemized and were physician dependent. Most providers expressed concern about recent antidepressant warnings, but many continued to treat and none had developed new strategies for closer monitoring of youth initiating treatment with antidepressants.ConclusionThe decision of when and how PCPs decide to treat adolescent depression is strongly influenced by PCP perceptions of their role in treatment, availability of other treatment resources, and family and patient preferences and resources. Few practices have developed changes in the approach to practice needed to meet FDA black-box recommendations regarding close monitoring of response to medications.     

Etiologic Studies of Adolescent Drug Use: A Compendium of Data Resources and Their Implications for Prevention

Etiological studies canvassing five major domains of risk are reviewed. The five domains reflect unique facets of risk that are central to many current prevention approaches and include: peer social influences, family (parenting) processes, expectancies (cognitive motivations), social skills and personal self-management strategies, and personality factors. Each domain is discussed with regard to major theoretical issues, important studies that help to clarify risk mechanisms, and major findings. A sixth area covering studies of multi-ethnic youth and ethnic-specific risk mechanisms also is reviewed in the context of augmenting previous empirical findings. A final section addresses two important concerns: (1) the need for a comprehensive model of developmental vulnerability; and (2) utilization of information stemming from a long tradition of developmental etiology to enhance the efficacy of drug abuse prevention.