Volume 25, Issue 1

No abstract available.

The risks of developing diabetes and dyslipidemia among adolescents with schizophrenia and bipolar disorder have not been well-characterized. This study was designed to characterize these risks and compare them among adolescents in the general population. Methods: This retrospective cohort study used claims data from a large U.S. health insurer to identify adolescents (13–17 years) with claims for schizophrenia or bipolar disorder from 1997 to 2006. Adolescents without evidence of schizophrenia or bipolar disorder were randomly selected for comparison. Study outcomes were new diagnoses of diabetes and dyslipidemia. Results: We identified 17,884 adolescents with schizophrenia or bipolar disorder and 188,059 for the general population cohort. The incidence rate per 100,000 person-years of diabetes was higher in the schizophrenia or bipolar disorder cohort [424.3 (95% CI: 344.5–517.3)] than in the general population cohort (90.0 [95% CI: 79.6–101.3]). The incidence rate per 100,000 person-years of dyslipidemia was 346.4 (95% CI: 274.9–431.0) in the schizophrenia or bipolar disorder cohort and 86.6 (95% CI: 76.4–97.7) in the general population cohort. The adjusted hazard ratios of developing diabetes and dyslipidemia in the schizophrenia or bipolar disorder cohort relative to the general population cohort were 1.76 (95% CI: 1.15–2.72) and 1.66 (95% CI: 1.22–2.28), respectively. Adolescents with schizophrenia or bipolar disorder treated with antipsychotics had a higher risk of developing diabetes and dyslipidemia than those who were untreated. Conclusions: Adolescents with schizophrenia or bipolar disorder had significantly increased risks of developing diabetes and dyslipidemia compared to adolescents without these disorders.

This study is a part replication of an earlier study by on health efficacy, educational attainment and well-being among 30 nations. It includes, however, data from these nations, as well as the latest Pisa results and update socioeconomic data and sociological variables which include divorce rate, number of persons/household, employment rates, and measures of physical and mental health (including new scales of well-being, e.g., mental health index, life satisfaction, suicide rates). More importantly, it includes measures of migrant rates among children and adults in each country, the focus of attention of this article. New material on health and educational expenditure are provided.

The current study sought to: 1) assess differences in levels of physical and mental health-related quality of life (HRQOL), illness uncertainty, and intrusiveness in adolescents and young adults (AYAs) with allergies and asthma, as well as 2) examine the effect of illness appraisals on HRQOL. Participants were undergraduate students with self-reported allergies (n=74) and asthma (n=74) who completed the Mishel Uncertainty in Illness Scale (MUIS), the Illness Intrusiveness Scale (IIS), and the SF-36 Health Survey Questionnaire. Paired t-tests indicated that AYAs with allergies reported higher levels of illness uncertainty and poorer mental HRQOL than AYAs with asthma; the groups did not differ on reported levels of illness intrusiveness or physical HRQOL. Hierarchical regressions were conducted to examine the relationship between illness appraisals and HRQOL. Results revealed that poorer mental HRQOL was associated with higher illness uncertainty in AYAs with allergies and higher illness intrusiveness in AYAs with asthma. Poorer physical HRQOL was associated with higher illness uncertainty in AYAs with asthma and higher illness intrusiveness in AYAs with allergies and asthma. The current examination suggests that illness appraisals may be differentially related to HRQOL in AYAs with allergies compared to those with asthma.

This study was carried out to identify the factors affecting resilience among street children. The study used a convenience sample of 366 male street children aged 14–17 years in Dhaka City, Bangladesh. The levels of resilience among the street children were mostly moderately low-low (54.1%), followed by low (29.0%), and moderately high-high resilience (16.9%). Multinomial logistic regression analyses indicated that the pre-street factors of education, economic constraint in the family, as well as experiencing and witnessing domestic violence were associated with resilience, with associated street characteristics being drug abuse, experiencing and witnessing violence on street, access to prevention services, and political involvement.

Physical examinations in childhood and adolescence have been recommended by various professional organizations. In order to assess the value of periodic physical examinations in identifying previously undetected conditions, we analyzed the results of school screening examinations of approximately 25,000 Israeli students. Methods: Entire student populations in the 1st, 5th, 7th, and 10th grades in the Tel Aviv-Yafo public school system were offered physical examinations during the 1996–1997 and 1997–1998 school years. Nine physicians performed these examinations. Referrals to the primary care physician were made for abnormal findings. The frequencies of the leading referrals were determined, and comparisons were made according to gender and grade. Results: A total of 24,846 students were examined. The overall referral rate was 7.8 per 100 examinations. Leading referrals included “overweight”, “heart murmur”, and “spinal structural abnormalities” at all grade levels, and “nevi” in grades 5, 7, and 10. Referral rates increased between various grade levels for “spinal structural abnormalities”, “nevi”, and “varicocele”, and decreased for “short stature” and “overweight”. Of the 196 diagnoses documented after referral, 182 (93%) fell into three categories, namely, spinal, hernia and scrotal, and short stature. Conclusions: A wide range of physical findings were detected or referred at each of the grade levels in this large population of schoolchildren. Many of these were triggers for preventive health counseling, while approximately 1% of the examinations yielded important findings requiring intervention. These results provide a measure of justification for the American Academy of Pediatrics’ recommendations for periodic physical examinations in childhood and adolescence.

Aim: It has been suggested that the decline in menarcheal age is associated with the increase of obesity prevalence. Objective: To examine the association between age at menarche and adiposity development from age 7 to 15 years. Subjects: A cohort of 109 schoolgirls from Viana do Castelo (Northern Portugal). Methods: Anthropometric measurements (height, weight, and triceps and subscapular skinfold thicknesses) were longitudinally obtained at 7, 8, 9, and 15 years. Waist circumference and self-reported age at menarche were obtained at age 15. Obesity was defined by the cut-off value of 30% body fat. Ages of <12 years, 12–13 years, and >13 years were classified as early menarche (EM), average menarche (AM) and late menarche (LM), respectively. Results: Median menarcheal age was 12.0 years (range, 8–15 years), with 26.6% of girls classified as EM. Compared with their LM peers, EM girls were always fatter (p=0.001) and had higher waist circumference at age 15 (p=0.009). All variables showed significant negative associations with age at menarche, except subscapular to triceps skinfold ratio at all ages and height at age 15. At both ages 9 and 15 years, LM girls had the lowest prevalence of obesity (4.5% and 9.1%, respectively). The 8-year incidence of obesity in EM girls was 24.1%, while that in the AM plus LM group was 13.8% (p=0.005). Conclusion: EM seems to be a risk factor for the development of obesity during adolescence. However, this vulnerability may start to be programmed before menarche as girls with precocious menarche were already fatter than their late-maturing peers at age 7 years.

Aim: Adolescents in the juvenile justice system are particularly susceptible to high rates of co-occurring health-risk behaviors, while at the same time lacking access to the healthcare system. Methods: A verbal questionnaire was administered from December 2009 to June 2010 to youth between the ages of 13–17 years old, who had previously been detained in an urban juvenile detention facility in California. Results: A total of 50 participants were enrolled in the study (40% female, 60% male, 16 years mean age, 80% Black, 18% Latino, 2% White). The mean time post-detention was 15 months, and the mean time in detention was 4 months. Our study provides evidence that adolescents exiting juvenile detention in the United States are interested in gaining access to healthcare providers but perceive lack of insurance and transportation as barriers to care. These barriers need to be addressed in order to facilitate access to healthcare services for this underserved and at-risk population of youth.

This study aimed at exploring adolescents’ perceptions of unwanted sexual experiences (USE) in order to set up definitions, categories, and boundaries on the continuum between consensual and non-consensual sex. Methods: We conducted a qualitative thematic analysis of four focus group discussions gathering a total of 29 male and female adolescents aged 16–20 years. Results: Analysis of participants’ discourse revealed three main characteristics that define USE, namely, regret, as most situations discussed were said to be acceptable or not in terms of whether there were regrets after the fact; misperception of sexual intent; and lack of communication between partners. Conclusions: Our findings revealed that health professionals should be aware of the subtle aspects identifying USE when screening for situations that can have adverse psychological consequences. Where prevention is concerned, it appears important to address these aspects of USE in sex education classes.

Background: The aim of this study is to measure the occurrences of the following risk factors: tobacco use, levels of physical activity, levels of physical inactivity, and body mass index (BMI) among adolescents in Trinidad. Methods: A two-stage random sampling process was used to select schools and students. Data were collected using a pretested self-administered questionnaire and included age, gender, ethnicity, tobacco use, levels of physical activity, levels of physical inactivity, BMI, and frequency of fast food consumption. Results: Overall, 44.6% of the 1896 adolescents already had more than two risk factors associated with cardiovascular disease (CVD). The most prevalent risk factor was the consumption of fast food (79.8%), while the least was smoking (12.0%). Out of the 75.4% physically active students, 47.6% spent more than 30 min in daily physical activity. In addition, 30.4% of the study population was overweight and obese, with the majority being 14 years of age (p=0.003). Overall, the overweight and obese students spent a significant amount of time watching television, playing video/computer games and talking on the phone, and frequently consumed fast food (p<0.001). Conclusion: The study found a significant number of teenagers in Trinidad presenting with more than two risk factors that may lead to CVD. Based on previous research, these findings have undoubtedly placed the students well within the models used to predict heart disease later in life.

Background: Studies from India consistently document the highest suicide rates in the world, and the majority of completed suicides had been within adolescents. Objective: To characterize the need and identify the predictive factors for preventive consultation or hospitalization for adolescent suicide in a community setting. Subjects: We prospectively collected data from 500 adolescents in a rural South Indian community with independent, trained raters. Methods: The need for suicide prevention was measured with the SAD PERSONS scale, socio-economic status with the Modified Kuppusamy Scale, depression and anxiety disorders with the Beck Depression Inventory and the Screen for Child Anxiety Related Emotional Disorders, respectively. The relationship between predictors and the need for preventive action was analyzed with univariate and multivariate regression analyses and a predictive model was built. Results: Of those investigated, 2% and 0.6% required emergency consultation and hospitalization, respectively. Males needed more preventive action (p=0.04). Age (OR=3.40, p=0.07), gender (OR=3.13, p=0.05), presence of anxiety (OR=16.35, p=0.001), or depressive (OR=42.59, p=0.001) disorder independently predicted a need for protective action and, together, contributed to a parsimonious predictive model. Conclusions: The majority of adolescents in the community do not require preventive steps to address suicide risk. These predictors could identify the high-risk adolescents for suicide prevention and reduce the burden of care in the community.

The objective of the study was to evaluate the link between tattoos and/or piercings and young people’s tobacco consumption. Methods: A total of 2587 students (1168 females and 1419 males) were asked about tattoos, piercings, and tobacco consumption. Results: Young men and young girls who had tattoos and/or wore piercings were more likely to report smoking behavior, earlier smoking behavior, and higher cigarette consumption per day. It was also found that both with men and women, the combined effects of piercings and tattoos were associated with an increase in smoking behavior. Conclusion: Piercings and/or tattoos as well as combined piercings and tattoos appeared as markers of tobacco consumption. Such marks could serve as signs for educators, parents, and physicians.

Adolescents with diabetes must learn to manage their own health plans. Support from family is typically associated with positive self-management outcomes, yet less is known about how healthcare teams can facilitate positive self-management. This study aims to investigate the associations between family and healthcare team support and adolescent emotional, behavioral and physical diabetes management. Method: A sample of 58 adolescents with type 1 diabetes completed self-report measures of their diabetes self-care management and their emotional distress or burden in relation to their diabetes. Adolescents’ diabetes clinic attendance and glycated hemoglobin (HBA1c) levels were also secured. Results: Perceived positive support from the healthcare team or family appeared to have little or negative effect on diabetes management. However, the study found that greater healthcare non-support was related to poorer self-care and poorer self-management of diabetes control (less clinic attendance, poorer dietary control, less glucose testing, and higher HBA1c levels), and greater feelings of being distressed or burdened by diabetes. Conclusions: These findings suggest that healthcare teams supporting adolescents should focus more on communicating and building relationships with adolescents in order to reduce perceived negative feelings of healthcare teams’ support.

Adolescence is an important stage of life when health behaviors and attitudes are established. The purpose of this research was to assess health risk behaviors among Guatemalan students in both an urban and rural school. Items were adapted from the Global School-based Student Health Survey and were used to measure and compare the prevalence of risk behaviors between these two demographically and culturally distant school-based samples. In general, the prevalence of adolescent health risk behaviors in both schools was lower than other Latin American countries. Many health risk behaviors were associated with location (urban vs. rural settings) and/or gender. Tobacco use, alcohol use, and sexual activity were higher among urban students. Boys were more likely than girls to use alcohol, use tobacco, and be sexually active. In addition, the prevalence of mental health problems was higher among girls and rural students. These findings imply that measures should be taken to design effective and appropriate health strategies for adolescents attending these schools. Health promotion programs in schools and communities should assist the youth in developing positive health behaviors and cultivating healthy lifestyles in an effort to reduce risk behaviors among adolescent populations. Further research is needed to extend our understanding of risk factors of health behavior in these adolescent populations and to identify effective preventative approaches and strategies that specifically cater to the location and culture of the students.