Adolescent development

Evaluation of person-centred care within the Stepstones transition program for adolescents with congenital heart disease - a document analysis

Background

Transition programs are pivotal in ensuring successful transition to adulthood and transfer to adult care for adolescents with chronic conditions. Healthcare providers must therefore support adolescents in increasing their empowerment to gain active participation in health and care. The Stepstones transition program is based on a person-centred care approach and has been evaluated in a randomized controlled trial. However, the extent to which the person-centred care approach was implemented needs further exploration.

Objective

To evaluate how a person-centred care approach was implemented based on a documentation analysis of the Stepstones transition program for adolescents with congenital heart disease.

Design

A deductive qualitative design employing analysis of the documentation used in the Stepstones transition program.

Settings

The documentation derives from the consultations in the two interventions centres in the Stepstones randomized controlled trial. The trial was conducted between 2017 and 2021. Data sources included in this study were: The adolescents' written narratives, documentation of the person-centred conversations, and goalsetting in the transition plans.

Participants

Documentation for adolescents with congenital heart disease, randomized to the intervention group (n = 59) at the two intervention centres was included.

Methods

Directed content analysis was used to evaluate how person-centred care was described in the documentation. The analysis was based on the three cornerstones of person-centred care: initiating, establishing and safeguarding partnership, in this study between the adolescent and the transition coordinator during the transition program. The data were deductively sorted into aspects of relevance for person-centred care and adolescent health. For the written narratives an inductive analysis was thereafter undertaken.

Results

A partnership between the transition coordinator and the adolescent was initiated through the adolescents' written narrative and established using a psychosocial interview guide. This outlined a spectrum of aspects important to person-centred and adolescent-oriented approach, such as resources, risks/obstacles, and needs. The goalsetting process describes goals commonly agreed upon and how to accomplish them. A solid foundation of self-awareness regarding personal capacities and learning needs contributed to the development of knowledge, understanding, and fostered independence to various degrees.

Conclusions

The Stepstones transition program for adolescents with congenital heart disease implemented several person-centred components, such as eliciting narratives, collaborative goal setting, and tailoring support needs. The documentation had limitations in fully reflecting the person-centred practices employed, highlighting opportunities for improvement in person-centred documentation.

Tweetable abstract

"The study delves into the implementation of person-centred care in the Stepstones transition program for adolescents with congenital heart disease, revealing strengths and areas for improvement in documentation."

Though Forced, Still Valid: Examining the Psychometric Performance of Forced-Choice Measurement of Personality in Children and Adolescents

Unveiling the roles personality plays during childhood and adolescence necessitates its accurate measurement, commonly using traditional Likert-type (LK) scales. However, this format is susceptible to various response biases, which can be particularly prevalent in children and adolescents, thus likely undermining measurement accuracy. Forced-choice (FC) scales appear to be a promising alternative because they are largely free from these biases by design. However, some argue that the FC format may not perform satisfactorily in children and adolescents due to its complexity. Little empirical evidence exists regarding the suitability of the FC format for children and adolescents. As such, the current study examined the psychometric performance of an FC measure of the Big Five personality factors in three children and adolescent samples: 5th to 6th graders (N = 428), 7th to 8th graders (N = 449), and 10th to 11th graders (N = 555). Across the three age groups, the FC scale demonstrated a better fit to the Big Five model and better discriminant validity in comparison to the LK counterpart. Personality scores from the FC scale also converged well with those from the LK scale and demonstrated high reliability as well as sizable criterion-related validity. Furthermore, the FC scale had more invariant statements than its LK counterpart across age groups. Overall, we found good evidence showing that FC measurement of personality is suitable for children and adolescents.

"I would love to say it's the fatigue but honestly it's not": Into Adulthood with Chronic Fatigue Syndrome/Myalgic Encephalomyelitis

Chronic Fatigue Syndrome/Myalgic Encephalomyelitis (CFS/ME) is a debilitating and poorly understood condition which interferes with adolescents' typical development. This study aimed to explore the experience of transitioning into adulthood from the perspective of adolescents and young adults (16-25yo) with CFS/ME. Thirteen young people recruited through a community allied health clinic in Victoria, Australia, participated in semi-structured interviews. Interviews were analysed using reflexive thematic analysis and produced the following themes: Independence: a different path or an inaccessible adulthood? Identity: who could I have been? Isolation and disconnection: being with people but not being like them. Our analysis of these themes suggests several avenues to support young people with CFS/ME and their families. Mental health professionals may have a specific role in helping foster assertiveness and confidence, assisting identity exploration and understanding, and supporting families in helping their adolescent to continue to develop psychologically.

Strong support systems foster positive self-image in patients with scoliosis

PURPOSE

Friend support and social support have been suggested to be beneficial for adolescents facing medical challenges; however, there is little research to identify who is providing emotional support for children and adolescents with scoliosis. Therefore, the purpose of this study was to investigate the sources of emotional support and to analyze a program designed to encourage social support, the Scolios-us Mentor Program (Mentor Program).

METHODS

This study consisted of a cross-sectional survey. The survey included the SRS-22r, BSSQ-Brace, and questions about demographics, mental health, the Scolios-us Mentor Program, and general scoliosis experience. The survey was distributed via email to Mentor Program participants and to scoliosis clinicians to provide to their patients. Descriptive statistics, Mann-Whitney U tests, and correlations (Cochran-Armitage, Pearson's correlation, and Spearman's correlation) were used to analyze responses.

RESULTS

A total of 46 participants with an age range was 8-18 were included in the final analysis. The median current age was 13 (IQR: 3), and the median diagnosis age was 10 (IQR: 4). Our results indicate that most participants (76.1%) received emotional support from at least two sources, including family, friends, healthcare providers, and support groups. Participants with two or more support sources had significantly higher self-image scores than those below this threshold (p =.042). Self-image scores were significantly higher for those who reported receiving emotional support from a healthcare provider (p =.027). Over 60% (29/46) of participants participated in the Scolios-us Mentor Program. No significant differences were noted in BSSQ-Brace or SRS- 22r scores between those who participate in the Mentor Program versus those who do not, but mentees scored lower for function, self-image, and management than mentors. Interestingly, as program satisfaction increased, BSSQ-Brace scores decreased (p =.012).

CONCLUSIONS

Having a strong emotional support system is important for self-image in children and adolescents with scoliosis. Healthcare providers appear to play an important role in promoting a positive self-image in their scoliosis patients. To help patients foster a strong support system, healthcare providers should be knowledgeable of the available psychosocial resources, including scoliosis support groups, for children and adolescents with scoliosis.

Prediction of first attempt of suicide in early adolescence using machine learning

BACKGROUND

Suicide is the second leading cause of death among early adolescents, yet the first onset of suicide attempts during this critical developmental period remains poorly understood. This study aimed to identify key characteristics associated with the first suicide attempt in early adolescence and to develop a predictive model for assessing individual risk.

METHODS

We used data from the Adolescent Brain Cognitive Development Study, a longitudinal, population-based study in the US. The analysis focused on a cohort of 4,238 early adolescents (aged 11-12 years) who had no prior history of suicide attempts. To predict the onset of a first suicide attempt over the subsequent two years (2020-2022), we developed an extremely randomized tree model, incorporating 87 potential predictors from diverse bio-psycho-social domains pertinent to adolescent development.

RESULTS

Among the 4,238 adolescents, 163 (3.8%) reported their first suicide attempt within the subsequent two years. Our predictive model demonstrated good discriminative ability, achieving an AUC of 0.82 (95% CI [0.79, 0.85]), with a sensitivity of 0.82 and a specificity of 0.69 at the optimized threshold. Key predictors included sex assigned at birth, sexual orientation, negative affect, internalizing and attention problems, and lifetime suicidal ideation, along with other significant factors from multiple domains.

CONCLUSIONS

These findings highlight the utility of machine learning algorithms in identifying predictors of suicide attempts among early adolescents. The insights gained from this study may contribute to the development of tailored screening tools and preventive interventions aimed at mitigating suicide risk in this vulnerable population.

Factors associated with attrition in a longitudinal study of health risk behaviours and conditions among adolescents in Ibadan, Nigeria

BACKGROUND

Use of longitudinal design in research improves understanding of adolescent health. In this paper, we present factors associated with attrition in a pilot longitudinal study among adolescents in Ibadan, Nigeria.

METHODS

Adolescents were recruited from private and government-owned junior secondary schools using multi-stage sampling and interviewed over three data collection waves (2017, 2018 and 2019).

RESULTS

A total of 1067 (99.4%) of the 1073 adolescents recruited were willing to participate and were interviewed in wave one. Mean age at baseline was 11.9 ± 1.2 years and 34.9% owned a personal mobile phone. Of the 1067 adolescents, 192 (18.0%) were not willing to be followed up while 875 (82.0%) were willing to be followed up by home visit (70.2%), phone call (21.3%), text message (14.3%) or online chat-based message (4.8%). Overall attrition rate (proportion of adolescents lost to follow-up during waves two and/or three compared with the baseline sample) was 66.5% with 396 (37.1%) and 315 (46.9%) respondents lost to follow-up during waves two and three respectively. Common reasons for attrition were use of pseudonyms instead of real names, which many adolescents could not remember during subsequent data collection waves, relocation to a different school or neighborhood, school drop-out and closure of two schools. Adolescents in private versus government-owned schools (AOR = 3.35; CI =  2.39 - 4.69), those who did not have personal mobile phones (AOR = 1.43, CI =  1.03 - 1.98) and those engaging in remunerated work (AOR =  2.04, CI =  1.19 - 3.49) were more likely to be lost to follow-up.

CONCLUSIONS

Attrition was high despite high willingness to participate in the study. Whereas technology has made follow-up of study participants in high-income countries easier, multiple, and cost intensive methods to minimize attrition may be required in low-resource settings.

A personal reflection: What I learned about diversity, inclusivity and equity because of a young homeless man and his dog

Who are homeless youths? This is the question I asked after observing a young man and his dog in the lobby of a bank on a cold January evening in Montreal. In attempting to answer this question I found that a universally accepted definition for "homeless youth" does not exist. Nonetheless, research exist that define who they are, the issues associated with homelessness and the health risks they face on the street. This led me wo ask what I could have done to help the young man. My experience help me realize that the street in unfortunately not only diverse, but also potentially inclusive of everyone, but like the rest of society it is not necessarily equitable.

Social Media and Development of Sexual and Gender Identity in Adolescents

Sexual and gender development are key components of adolescence. As social media becomes increasingly ingrained in youth culture, it is essential to understand its impact on these developmental pathways. Social media provides a novel avenue for adolescents to explore identity, sexuality, and intimacy-as well as newfound autonomy and risk taking. Adolescents typically use social media for age-appropriate interactions and many find mental health benefits, alongside potential risks to mental and physical health. Clinicians should use a nonjudgmental tone to inquire about adolescent online behaviors and to counsel patients on safe and developmentally appropriate identity and relationship development.

Exploring the Association Between ADHD, Sleep, and Homework Problems: The Role of Behavioral Indicators of Neuropsychological Functioning

OBJECTIVE

Around 70% of adolescents with ADHD experience sleep and/or homework problems. Both impairments have been previously associated with neuropsychological deficits but have not been simultaneously examined in adolescents with ADHD and clinical sleep problems. Therefore, this study investigated how sleep problems are associated with homework problems and how parent-rated behavioral indicators of neuropsychological functioning are part of this association in adolescents with ADHD.

METHOD

Parental ratings of homework problems (HPC) and behavioral indicators of neuropsychological functioning (CAMEL) of adolescents with ADHD and comorbid sleep problems (ADHD/sleep; n = 53), adolescents with ADHD only (n = 24), and neurotypical adolescents (NT; n = 53) were collected. Homework problems and behavioral indicators of neuropsychological functioning were compared between the three groups. A path analysis was performed to investigate whether the behavioral indicators of neuropsychological functioning are part of the relation between sleep problems in ADHD and homework problems.

RESULTS

We found no differences for either homework problems or behavioral indicators of neuropsychological functioning between the ADHD/sleep and ADHD only groups, except for a small significant difference in arousal regulation, but both ADHD groups showed more homework problems and behavioral indicators of weaker neuropsychological functioning compared to the NT group. Behavioral indicators of weaker neuropsychological functioning were related to the increased homework problems experienced in the ADHD/sleep and ADHD only groups compared to NT.

CONCLUSION

In adolescents with ADHD, sleep problems were not associated with more homework problems by weaker behavioral indicators of neuropsychological functioning. However, regardless of sleep problems, the behavioral indicators of neuropsychological functioning relate to the homework problems in adolescents with ADHD.

Bridging the Gap: Communication Strategies for Wound, Ostomy, and Continence (WOC) Nurses Working With Adolescents: A Narrative Review

PURPOSE

To examine effective communication strategies for wound, ostomy, and continence (WOC) nurses working with adolescent patients and provide evidence-based recommendations for improving patient-provider interactions that consider adolescent developmental needs, cultural factors, and privacy concerns.

METHOD

A narrative review of literature examining adolescent development, healthcare communication, and WOC nursing care was conducted to identify key principles and strategies for effective communication with adolescent patients.

APPROACH

ST prevalence data were collected concurrently with the quarterly Pressure Injury Prevalence Survey over a period of 12-months (beginning the third quarter of 2017 through the second quarter of 2018) by the Pressure Injury Prevalence Survey Skin Care Champions using the revised Payne-Martin classification system for STs. A data collection form developed by the Wound, Ostomy, and Continence nurse was also completed for the patients with ST(s).

SEARCH STRATEGY

Literature was reviewed from nursing, psychology, and healthcare communication databases focusing on adolescent development, WOC care, nurse-patient communication, and cultural competency in adolescent healthcare settings.

FINDINGS

Key findings include: (1) understanding adolescent development is crucial for effective communication; (2) cultural background significantly influences how adolescents perceive and communicate about WOC care; (3) technology and social media offer both opportunities and challenges for patient engagement; (4) privacy and confidentiality are paramount concerns requiring specific protocols; and (5) developmental-informed communication techniques improve patient outcomes and treatment adherence.

IMPLICATIONS FOR PRACTICE

WOC nurses can enhance care delivery and patient outcomes by employing developmentally appropriate communication strategies, respecting cultural differences, maintaining privacy, and leveraging technology appropriately. These approaches help build trust, promote self-management skills, and establish foundations for long-term health behaviors in adolescent patients.

Health-Related Quality of Life of Individuals with Physical Disabilities in Childhood

Background: The use of patient-reported outcomes is essential to understand and manage health-related quality of life (HRQOL) in youth with lifelong disabilities. This study evaluated HRQOL in youth with physical disorders and examined its relationship with mobility. Methods: We conducted an IRB-approved retrospective study in which we administered the parent-reported Pediatric Outcomes Data Collection Instrument (PODCI) and Gross Motor Function Measure section D (GMFM-D) to ambulatory youth aged 2-18 years with cerebral palsy (CP; Gross Motor Function Classification System II; n = 258), arthrogryposis (n = 138), achondroplasia (n = 102), and Morquio syndrome (n = 52) during clinical visits to a gait lab. The PODCI has two validated versions, child and adolescent, that assess perceptions about mobility, happiness, and pain. Differences in HRQOL between diagnostic groups, between age groups, and compared with non-disabled youth were examined using non-parametric tests. The relationship between GMFM-D and PODCI scores was analyzed with Pearson's correlations. Results: Both age cohorts within all diagnosis groups demonstrated higher pain and lower mobility compared with non-disabled youth (p < 0.015). Happiness was lower for both age groups with CP and arthrogryposis, and for the child group with Morquio syndrome compared with non-disabled youth (p < 0.002). In diagnostic groups in both age spans, Global Function was higher (p < 0.0001) for those with achondroplasia compared with other groups. Despite functional differences, there were no significant differences between diagnostic groups in pain scores (p > 0.10). Happiness was lower in the group with CP compared with that with achondroplasia (p = 0.01). GMFM-D was related to PODCI mobility scores for all diagnoses (r = 0.31 to 0.79, p < 0.03) but was not correlated with happiness (r = -0.16 to 0.092; p > 0.14); GMFM-D and PODCI pain scores were associated only for the child group with achondroplasia (r = 0.355; p < 0.001). Conclusions: Significant limitations in HRQOL are present in youth with physical disabilities. Pain levels were higher than those of non-disabled youth, but pain was not related to lower motor function. Happiness was not related to gross motor function, suggesting the need to examine other factors when mental health concerns are present in youth with disabilities.

The importance of friendship: influence of peer relationships on physical and mental health in youth with spina bifida

OBJECTIVE

To evaluate associations between peer relationship factors (i.e., quality and quantity) and mental and physical health outcomes in youth with spina bifida (SB).

METHODS

One hundred and forty youth with SB (Mage = 11.43; 53.6% female) were recruited as part of a larger longitudinal study. Families of youth with SB were invited to ask the child's closest friend to participate. The study included questionnaire (youth- and parent-report) and observational peer interaction data.

RESULTS

Observational peer interaction data were associated with mental and physical health in youth with SB. The number of friends was negatively associated with withdrawn/depressed behavior. Self-reported friendship quality and peer emotional support were not associated with physical health outcomes in youth with SB. However, peer emotional support was positively associated with emotional quality of life.

CONCLUSIONS

Friendship quality, particularly observed peer interaction characteristics, was associated with better mental and physical health adjustment. The quantity of friendships was not associated with physical health outcomes but was associated with mental health outcomes. Findings have implications for clinical interventions geared toward improving social functioning in youth with SB.

Mapping the Burden of Conduct Disorder in the Middle East and North Africa: Global Burden of Disease Study 2021

This study aims to investigate the prevalence, incidence, and Years Lived with a Disability (YLDs) caused by conduct disorder in 21 countries of the Middle East and North Africa (MENA). Sex and age differences in conduct disorder were investigated as well as the trend of conduct disorder from 1990 to 2021. Data from the MENA were used for this study. This super region includes 21 countries. All-age count estimates and age-standardized rate (Per 100,000) were calculated for prevalence, incidence, and YLDs. Each of the disease burden indicators was examined in the period of 1990-2021, stratified by sex, age, and location, and the % change between 1990 and 2021 was reported. The 95% uncertainty interval was reported for each of the reported estimates. In 2021, there were 41 million cases of conduct disorder, globally. In 2021, there were 3.5 million cases of conduct disorder in MENA; the conduct disorder count had a significant growth from 1990. At the national level, the highest conduct disorder was in Iran. The lowest age-standardized prevalence rate (ASPR) per 100,000 conduct disorder was in Syria. Of the total cases of conduct disorder in the MENA, 2.350 million were males and 1.100 million were females. The findings of this study showed an increase in the burden of conduct disorder over the past three decades in the MENA. Considering the demographic changes and population increase compared to three decades ago, as well as social, health, and economic developments, it is necessary to pay more attention to the health of children and adolescents in health-related policies.

Pathways linking loneliness and depressive symptoms among Chinese adolescents: The mediating role of sleep disturbance

BACKGROUND

Despite growing evidence linking loneliness and depressive symptoms, the underlying pathways remain unclear. This study aims to assess the impact of loneliness on depressive symptoms among Chinese adolescents and investigate the potential mediating role of sleep disturbance.

METHODS

A cross-sectional study was conducted between November and December 2021. Loneliness, depressive symptoms, and sleep disturbance were assessed using the UCLA Loneliness Scale, the 9-item Patient Health Questionnaire, and the Pittsburgh Sleep Quality Index questionnaire, respectively. Baron and Kenny's causal steps method and the Karlson-Holm-Breen method were applied to explore the mediating role of sleep disturbance. Subgroup analysis by gender was also conducted.

RESULTS

A total of 6838 adolescents were included, with 52.2 % boys and a mean age of 14.5 (SD = 1.6) years. Approximately 15.8 % of the adolescents reported depressive symptoms. Loneliness was positively associated with depressive symptoms after controlling for covariates (OR = 1.34, 95%CI = 1.31-1.36). After incorporating sleep disturbance into the model, the association was still significant (OR = 1.28, 95%CI = 1.25-1.31). Sleep disturbance partially mediated this association, contributing to 18.89 % of the total effects. The associations and mediation effects were consistent across both genders, with no moderating effect of gender observed.

LIMITATIONS

The cross-sectional design limits the ability to establish causality.

CONCLUSION

Loneliness was significantly associated with depressive symptoms in Chinese adolescents and this association was partially mediated by sleep disturbance. Interventions aimed at reducing loneliness and improving sleep quality may help lower the risk of depressive symptoms in Chinese adolescents, regardless of genders. Nevertheless, further randomized controlled trials are needed to confirm these findings.

Effect of Growth Trajectories in Communication Skills on Juvenile Recidivism

Increasing numbers of children with behavior problems in school are recognized as having language and communication difficulties. However, communication limitations have not been assessed adequately as a risk factor for juvenile recidivism. Furthermore, few studies have used longitudinal data to link the change in communication skills and subsequent engagement in crime. To address this seriously understudied question, this study used four waves of longitudinal data of youth who were placed in juvenile justice residential facilities to investigate how the growth trajectories of communication skills impacted recidivism. Group-based trajectory and multivariate regression analyses were conducted, which revealed heterogeneous growth in communication skills among residential youth. More interestingly, the scale of growth predicted recidivism. Implications for juvenile justice programming were discussed.

"I'm Not Experienced … Please Send Advice": Teens Seeking Information and Advice About Sexual Behaviors on Reddit

Teens commonly use the internet for seeking information about sex and sexual relationships, particularly in the absence of comprehensive sex education from offline sources. The social media platform, Reddit, has become a popular forum for teens seeking information about sex from peers, due to its culture of anonymity. To explore teens' use of Reddit for this purpose, we asked: What advice/information about sexual behaviors are teens seeking out on Reddit? We performed qualitative content analysis with secondary, publicly available social media posts (n = 180) from a large community on Reddit (r/teenrelationships) designed for teens to ask questions about relationships. Five primary, non-mutually exclusive categories of advice/information were identified, with 26 subcategories: 1) Sexual issues within their relationship (42%; e.g., differences in desire, past trauma); 2) Identifying/responding to "red flag" or abusive behaviors (41%; e.g., sexual coercion, harassment); 3) Responding to cheating or jealousy issues (27%; e.g., partners' past sexual behaviors; porn use); 4) Making decisions about having sex (19%; e.g., timing, anxiety over first time); and 5) General sex education (10%; e.g., concerns about being pregnant). These findings emphasize the importance of including information on socioemotional dynamics and healthy relationship building in comprehensive sex education for teens.

Adolescents' Self Perceptions: Connecting Psychosocial Competencies to the Sexual Self-Concept

Adolescence is a crucial period for the development of the sexual self-concept. While existing research shows that adolescents' sexual self-concept varies, few studies have examined its relation with psychosocial competencies such as the general self-concept, interpersonal skills, and self-control capacities. The objective of this study was to examine the association between dimensions of the sexual self-concept (sexual self- and body esteem, self-efficacy, and anxiety) and psychosocial competencies among Canadian adolescents. Self-reported data from 1584 adolescents aged between 14 and 18 years (49.7% girls) were analyzed using path analysis. Results show that adolescents whose general self-concept was characterized by more internally consistent self-beliefs and greater self-worth, and who perceived their interpersonal skills as more developed, displayed higher sexual self- and body esteem, higher sexual self-efficacy, and lower sexual anxiety. Self-control capacities were positively correlated with sexual body-esteem and negatively correlated with sexual anxiety. These associations were, however, minimal and, when significant, exhibited a counterintuitive relationship with the sexual self-concept in the path model. Age, gender and sexual experience did not moderate these associations. Findings from the study highlight the need to pursue research on the interface between sexuality and psychosocial functioning to increase current understanding of adolescent development.

Looking beyond body structure and function: a scoping review of non-impairment impacts of stroke on adolescents

BACKGROUND

Much of the childhood stroke literature has not distinguished impacts for adolescents from those of younger children. Research has also focused on body impairments. With adolescence being a unique period, this scoping review aimed to identify the impacts of childhood stroke on activity, participation, and quality of life for adolescents 13-18 years, and identify how these impacts were determined.

METHOD

This review adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). Data pertaining to non-impairment impacts of childhood stroke for adolescents, participant and study characteristics, and measurement instruments were extracted.

RESULTS

Following screening, 79 articles were included, and 33 measurement instruments identified. Only 6 studies reported separate data for adolescents, identifying difficulties with daily activities, social and academic impacts, and reduced quality of life. Impacts of post-stroke communication difficulties on daily activities and schooling were also noted. Measurement instruments developed specifically for adolescents with stroke are lacking.

INTERPRETATION

The review identified limited research reporting non-impairment impacts of childhood stroke for adolescents. Further research specific to this population and the development of measurement instruments for adolescents who have experienced childhood stroke is required to support future research and clinicians working with this population.

Interparental and Parent-Teen Relationships during Adolescence as Predictors of Intra- and Interpersonal Emotion Regulation in Young Adulthood

Parents' contributions to their children's emotion regulation during adolescence has been a relatively understudied interpersonal context of development, even though parents' roles as sources of social and emotional learning persist from childhood into adolescence and the complexity of teens' lives grows during this time. This study aims to investigate the differential predictive utility of qualities and behaviors in interparental and parent-teen relationships during adolescence for predicting youths' development of intra- and interpersonal emotion regulation over a 13-year period. To assess these hypotheses, data were obtained from a longitudinal, multi-method, multi-informant study of 184 adolescents (107 Caucasian, 53 African American, and 24 mixed/other ethnicity; median family income of USD 40,000-60,000/year in 1999, equivalent to about USD 75,000-112,000/year when accounting for inflation) and their parents. The results provide support for a differential pattern of prediction; qualities of interparental relationships in early adolescence were significant predictors of young adult interpersonal emotion regulation, whereas behaviors in interparental and parent-teen relationships in late adolescence were significant predictors of both young adult positive intra- and interpersonal emotion regulation. Notably, some father-reported relationship predictors during late adolescence had unexpected relations with later intrapersonal emotion regulation. The results are discussed in terms of the helpfulness of these specific relationship factors during each part of adolescence for supporting positive intra- and interpersonal emotional regulation development.

Advancing patient care: novel scales for assessing adherence and attitudes toward medication among adolescents with psychiatric disorders and their parents

Adolescents with psychiatric disorders may struggle with medication adherence and this can lead to ineffective treatment. Subjective factors, such as attitudes, beliefs, experiences, have a greater impact on adherence in adolescents than objective factors. To better understand these subjective attitudes, self-evaluation rating scales should be developed. The study aimed to develop two scales - Pediatric Medication Adherence Scale (PMAS) and Pediatric Attitudes toward Medication Scale (PAMS) - to assess adherence and attitudes toward medication for pediatric patients and their parents. Total of 288 pediatric patients (67% female) between the ages of 12-18 (mean [standard deviation] age of 15.25 [1.59] years) with psychiatric disorders and 255 parents (83.53% mothers) were administered the scales. The validity of the scales was evaluated through the content validity index and explanatory factor analyses. To evaluate reliability, Cronbach's alpha, and test-retest methods were utilized. The validity and reliability of the PMAS (9 questions for patients, 6 questions for parents) and PAMS (18 questions for patients, 20 questions for parents), Cronbach's alpha values and intraclass correlation coefficients were found above 0.7 for each scale and showed well establishment for this particular population. Analysis revealed that anxiety scores had a greater impact on total attitude scores than necessity scores (p < 0.05). Parent and patient adherence scores were similar, and negative parental attitudes toward medication were associated with lower patient adherence. The present study represents a novel attempt to design a medication adherence and attitude questionnaire for adolescents with psychiatric disorders, along with a parental version.

Understanding the Association Between Neighborhoods and Adolescent Sleep: Evidence from Add Health

Introduction

Research suggests that perceived neighborhood social environments (PNSE) may contribute to gender and race/ethnicity-based sleep disparities. Our study aimed to examine associations between PNSE factors and adolescents' sleep patterns. As a secondary aim, we examined how gender and race/ethnic groups might moderate these associations.

Method

Data came from the National Longitudinal Study of Adolescent to Adult Health (n=5158; mean age=15.34 years). Four self-reported sleep outcomes were created: 1) sleep duration (hours/night), 2) short sleep (≥8 hours [reference] vs <8 hours), 3) parental set bedtime (10:00 PM/earlier [reference] among girls vs by 11:00PM vs by/after 12:00AM), and 4) sleep satisfaction (enough sleep [reference] vs not enough sleep). PNSE included total scores for contentedness, social cohesion, and safety. Weighted linear and generalized logistic regressions were used to examine the relationship between each PNSE factor and sleep outcomes, adjusting for covariates. Associations were stratified by gender and race/ethnicity, separately.

Results

Neighborhood contentedness was associated with longer sleep duration and lower odds of short sleep, parental set bedtime by/after 12:00 AM, and not enough sleep. Neighborhood social cohesion was related to lower odds of a parental set bedtime by/after 12:00 AM. Neighborhood safety was related to lower odds of short sleep and not enough sleep. Gender and race/ethnic-specific results were mixed.

Conclusion

Positive perceptions of neighborhood social environments served as a protective factor against adverse sleep outcomes among adolescents. Efforts to improve adolescent sleep should consider the role of the neighborhood social context, gender, and racial and ethnic groups.

Acceptance and commitment therapy as a transdiagnostic approach to adolescents with different anxiety disorders: study protocol

Adolescence increases vulnerability to mental ill-health, particularly anxiety disorders like Social Anxiety Disorder (SAD) and Generalized Anxiety Disorder (GAD). Still, the understanding of Psychological Flexibility/Inflexibility (PF/PI) as a transdiagnostic framework relevant to explaining these difficulties and the efficacy of Acceptance and Commitment Therapy (ACT) in addressing adolescent SAD and GAD remains limited. Hence, this study has two aims: examining the role of PI/PF on adolescents' mental health and assessing ACT's efficacy for adolescent SAD and GAD. We will collect data from 400 community adolescents and employ network analysis to explore connections between PI/PF processes, anxiety, and flourishing. We will also investigate pathways linking PI/PF processes with flourishing and anxiety across samples (clinical SAD, clinical GAD, and mentally healthy groups), expecting to find similar patterns. Furthermore, a Randomized Controlled Trial with three groups (control, SAD experimental and GAD experimental), each comprising 29 participants, and four assessment moments (pre- and post-intervention and 3- and 6-months follow-up) will be conducted. Similar improvements are anticipated in both experimental groups, driven by changes in PI/PF processes. Findings from this work will provide valuable evidence to PI/PF as accurate conceptualizations of human suffering and expand the transdiagnostic application of ACT to adolescents with anxiety disorders.

Psychometric evaluation of the spiritual perspective scale for adolescents and young adults with cancer

Objective

To evaluate the reliability and validity of the spiritual perspective scale (SPS) for adolescents and young adults with cancer.

Methods

The study was conducted with 277 adolescents and young adults with cancer aged 10-24 years who were recruited from Taiwan and Korea. The reliability of the SPS was assessed using Cronbach's α. Its factor structure was determined by exploratory factor analysis. Known-group validity was tested by comparing resilience scores between two groups and between countries using t test.

Results

Cronbach's α values for the SPS was 0.94, and item-total correlation values ranged from 0.53 to 0.84. Factor analysis generated two factors (spiritual behaviors and spiritual beliefs) that explained 78.02% of the total variance, with factor loadings ranging from 0.51 to 0.94. Participants with lower resilience had significantly lower spirituality scores compared to those with higher resilience (t = 3.13, P = 0.002). The SPS scores were not significantly different between participants in Taiwan and Korea (t = 1.09, P = 0.276). However, the spiritual beliefs subscale scores did show a significant difference between these groups (t = 2.74, P = 0.007).

Conclusions

The spiritual perspective scale is a valid and reliable tool for measuring the spirituality of adolescents and young adults with cancer in Taiwan and Korea. The SPS showed sensitivity in detecting variations in spiritual beliefs between adolescents and young adults with cancer in Taiwan and Korea.

Adolescent and Young Adult Development in Transplant Recipients

Solid organ transplantation (SOT) is the gold standard of therapy for individuals with end-organ dysfunction. Improved survival outcomes after SOT can help adolescent and young adult (AYA) recipients lead long and healthy life. However, successful SOT during adolescence and young adulthood is often complicated by the innate developmental challenges of this age group. The psychosocial tasks of adolescence include identity development, autonomous decision-making, establishing social networks, educational and vocational preparation, and navigating romantic relationships. These goals may be amplified or delayed for pediatric SOT recipients. Adolescence is also marked by rapid physical changes in linear growth and the development of secondary sexual characteristics. Yet AYA may experience physical and pubertal delays related to transplantation, as well as exaggerated body image dissatisfaction due to medication side effects. Strict adherence to medication and post-transplant regimens may interfere with adolescents' desire for normalcy and fitting in with peers. Healthcare providers should be aware that AYA value education and self-empowerment in transplant care. Transplant success needs to be defined by both medical and psychosocial outcomes, particularly when it relates to the vulnerable AYA population. Fortunately, investment from the patient, family, and care team can aid in transplant recovery and success. This article will identify the developmental challenges faced by AYA undergoing solid organ transplantation as well as strategies to engage positive outcomes.

Factors Influencing Post-Traumatic Growth in Surviving Students of the Sewol Ferry Disaster: A Long-Term Follow-Up Study

OBJECTIVE

Disaster survivors often experience negative impacts on their mental health, but some may also exhibit posttraumatic growth, overcoming adversity, and finding positive outcomes. This study aimed to identify psychological factors influencing posttraumatic growth (PTG) among students who survived the Sewol ferry disaster.

METHODS

The study used a longitudinal design. Data were collected at 6-month intervals between high school graduation and 6 years after the ferry disaster. Data were obtained from 48 adolescents who completed self-report measures of rumination, meaning in life, coping, PTG, family adaptability and cohesion. Generalized estimating equation models were fitted to 11 waves of follow-up data.

RESULTS

Intrusive rumination (coefficient [coef]=0.165; p<0.001; 95% confidence interval [CI] 0.081-0.250) and deliberate rumination (coef=0.554; p<0.001; 95% CI 0.376-0.732) were significantly associated with PTG. Concerning meaning in life, the presence of meaning (coef=0.312; p<0.001; 95% CI 0.189-0.435) and the search for meaning (coef=0.216; p=0.001; 95% CI 0.093-0.340) were also significantly associated with PTG. Finally, the problem-focused (coef=0.682; p=0.011; 95% CI 0.153-1.210) and emotion-focused (coef=0.736; p=0.009; 95% CI 0.186-1.285) coping strategies both showed significant associations with PTG.

CONCLUSION

The results of this study indicate that rumination, meaning in life, and adaptive coping (including cognitive and emotional coping) were protective factors for mental health problems among adolescents who survived the Sewol ferry disaster. These psychological factors may promote PTG over time.

Associations between antimony exposure and glycated hemoglobin levels in adolescents aged 12-19 years: results from the NHANES 2013-2016

Objective

This study aimed to investigate the association between antimony (Sb) exposure and glycated hemoglobin (HbA1c) levels in adolescents.

Methods

A cross-sectional study of 751 adolescents aged 12-19 years was conducted via the National Health and Nutrition Examination Survey (NHANES, 2013-2016). Survey-weighted linear regression and restricted cubic spline (RCS) analyses were applied to evaluate the relationship of urinary Sb exposure with HbA1c.

Results

A significant relationship was observed between urinary Sb concentrations and HbA1c levels (percent change: 0.93; 95% CI: 0.42, 1.45) after full adjustment. After converting urinary Sb levels to a categorical variable by tertiles (T1-T3), the highest quantile was associated with a significant increase in HbA1c (percent change: 1.45; 95% CI: 0.38, 2.53) compared to T1. The RCS models showed a monotonically increasing relationship of urinary Sb with HbA1c. Subgroup analyses revealed a sex-specific relationship between urinary Sb exposure and HbA1c with a significant positive association in males and a non-significant positive association in females. Sensitivity analyses further confirmed the relationship between urinary Sb and HbA1c, even after excluding participants who were overweight or obese (percent change: 1.58%, 95% CI: 0.88, 2.28) and those with serum cotinine levels ≥ 1 ng/mL (percent change: 1.14%, 95% CI: 0.49, 1.80).

Conclusion

Our findings indicated that increased Sb exposure may correlate with higher HbA1c levels, especially in male adolescents. More studies are needed to further explore and validate the potential mechanisms.

Dorsal CA3 overactivation mediates witnessing stress-induced recognition memory deficits in adolescent male mice

Witnessing violent or traumatic events is common during childhood and adolescence and could cause detrimental effects such as increased risks of psychiatric disorders. This stressor could be modeled in adolescent laboratory animals using the chronic witnessing social defeat (CWSD) paradigm, but the behavioral consequences of CWSD in adolescent animals remain to be validated for cognitive, anxiety-like, and depression-like behaviors and, more importantly, the underlying neural mechanisms remain to be uncovered. In this study, we first established the CWSD model in adolescent male mice and found that CWSD impaired cognitive function and increased anxiety levels and that these behavioral deficits persisted into adulthood. Based on the dorsal-ventral functional division in hippocampus, we employed immediate early gene c-fos immunostaining after behavioral tasks and found that CWSD-induced cognition deficits were associated with dorsal CA3 overactivation and anxiety-like behaviors were associated with ventral CA3 activity reduction. Indeed, chemogenetic activation and inhibition of dorsal CA3 neurons mimicked and reversed CWSD-induced recognition memory deficits (not anxiety-like behaviors), respectively, whereas both inhibition and activation of ventral CA3 neurons increased anxiety-like behaviors in adolescent mice. Finally, chronic administration of vortioxetine (a novel multimodal antidepressant) successfully restored the overactivation of dorsal CA3 neurons and the cognitive deficits in CWSD mice. Together, our findings suggest that dorsal CA3 overactivation mediates CWSD-induced recognition memory deficits in adolescent male mice, shedding light on the pathophysiology of adolescent CWSD-induced adverse effects and providing preclinical evidence for early treatment of stress-induced cognitive deficits.

Translating scientific recommendations into reality: a feasibility study using group-based high-intensity functional exercise training in adolescents with cerebral palsy

PURPOSE

To examine the feasibility and effects of a functional high-intensity exercise intervention performed in a group-setting on functionality, cardiovascular health and physical performance in adolescents with cerebral palsy (CP).

METHODS

Ten adolescents with a diagnosis of CP (2 females; 16.6 ± 3.4 years; GMFCS: I-II) participated in a 12-week training intervention, containing progressive resistance training using free weights and high-intensity workouts twice a week. The six-minute walking test, arterial stiffness and physical performance (strength and power tests) were measured before and after the intervention.

RESULTS

No adverse events were reported. We measured small increases in the six-minute walking test (Δ = 28.8 m, 95% CI [-1.78;52.7]; g = 0.34 [-0.04;0.72]) and a small reduction in arterial stiffness (Δ = -4.65% [-10.90;1.25]; g = -0.46 [-1.36;0.21]). All measures of physical performance increased (0.24 ≤ g ≤ 0.88).

CONCLUSION

Functional training with free weights in high-functioning adolescents with CP is safe and effective in increasing parameters of physical performance and cardiovascular health. Positively influenced indicators of everyday independence (i.e. strength parameters) showed a transfer into movements of daily life. Concerns about adverse events through high-intensity training in adolescents with CP appear unjustified when training is performed progressively, following basic training principles.

Trends in Adolescent Health: Successes and Challenges From 2010 to the Present

PURPOSE

This review considers trends in some of the major adolescent health outcomes and contextual influences since 2010, and explores the relevance of recent cultural, societal, and public health developments on adolescent well-being.

METHODS

Based on a review of major reports published since 2010, we identified key topics of impact on adolescent health and development across several domains (education, economic opportunity, sexual and reproductive health, nutrition, and mental health) and ecological levels (from individual- to macro-level influences). Within these areas, we synthesized findings to describe recent trends, noting variation across countries/regions, gender/sex, and other social stratifications when possible.

RESULTS

Since 2010, progress in several areas of sexual and reproductive health has been most striking, with notable global declines in female genital mutilation/cutting, child marriage, HIV transmission, and adolescent childbearing. Participation and retention in school has increased, although the COVID-19 pandemic interrupted positive progress for many adolescents and contributed to social isolation and economic insecurity. The mental health and nutrition domains have clear challenges. Increased internalizing mental health issues have been observed cross-culturally, especially among girls. The prevalence of anemia has remained stagnant, while overweight and obesity rates are rising. Within domains, we highlight uneven progress across and within countries.

DISCUSSION

Based on recent successes and emerging challenges in adolescent well-being, we find that more and better research is needed that consistently takes an intersectional perspective, and critically, action must be taken to consolidate the gains in sexual and reproductive health and extend them to other areas of adolescent health.

Sex Differences in Risk Factors for Generalized Anxiety Disorder in Korean Adolescents

Objectives

This study aimed to examine sex differences in the risk factors associated with generalized anxiety disorder (GAD) among Korean adolescents to provide insights for drafting more effective prevention strategies.

Methods

Data from 51845 middle and high school students in the 18th Korea Youth Risk Behavior Web-based Survey were analyzed. GAD was assessed using the 7-item Generalized Anxiety Disorder tool, and factors such as grade, academic performance, economic status, living arrangements, smoking, drinking, sexual experience, and physical activity were included. The prevalence of GAD and its association with these factors were compared between male and female students using chi-square tests and logistic regression. Odds ratios were compared statistically to identify sex-specific differences.

Results

GAD prevalence was higher among girls (42.1%) than boys (30.1%). Both sexes showed increased GAD risk with lower academic performance, lower economic status, smoking, drinking, and sexual experience. Boys living apart from their families had a higher GAD risk, but this was not significant for girls. Additionally, smoking and drinking were associated with a higher increase in GAD risk in girls than in boys.

Conclusion

This study underscores the importance of considering sex differences in the prevention of GAD among adolescents. Tailored sex-specific interventions are crucial for effective prevention and management of GAD in Korean adolescents.

Loneliness and posttraumatic stress in U.S. adolescents: A longitudinal study

BACKGROUND

Loneliness and posttraumatic stress (PTS) are common in adolescence. However, there has been little longitudinal research on their association. To address this deficit, this study examined the longitudinal association between these phenomena in a sample of U.S. school students while also exploring if gender was important in this context.

METHODS

Data were analysed from 2807 adolescents (52.1 % female; age at baseline 11-16 years (M = 12.79)) who were followed over a one-year period. Information was obtained on loneliness in year 1 using a single-item question, while PTS was assessed with the self-report Child Post-Traumatic Stress - Reaction Index (CPTS-RI). A full path analysis was performed to assess the across time associations.

RESULTS

Almost one-third of the students reported some degree of loneliness while most students had 'mild' PTS. In the path analysis, when controlling for baseline PTS and other covariates, loneliness in year 1 was significantly associated with PTS in year 2 (β = 0.06, 95%CI: 0.02, 0.09). Similarly, PTS in year 1 was significantly associated with loneliness in year 2 (β = 0.19, 95%CI: 0.15, 0.23). An interaction analysis further showed that loneliness was higher in girls with PTS than in their male counterparts.

LIMITATIONS

The use of a single-item measure to assess loneliness that used the word 'lonely' may have resulted in underreporting.

CONCLUSION

Loneliness and PTS are bidirectionally associated in adolescence. Efforts to reduce loneliness in adolescence may help in combatting PTS, while clinicians should intervene to address loneliness if detected in adolescents with PTS.

Cross-Cultural Adaptation and Validation of the Listening Inventory for Education-Revised in Italian

BACKGROUND

Listening difficulties may frequently occur in school settings, but so far there were no tools to identify them for both hearing and hearing-impaired Italian students. This study performed cross-cultural adaptation and validation of the Listening Inventory for Education-Revised for Italian students (LIFE-R-ITA).

METHODS

The study procedure followed the stages suggested by the Guidelines for the Process of Cross-cultural Adaptation of Self-Report Measures. For the content validation, six cochlear implanted students (8-18 years old) pre-tested the initial version. Whenever any situation did not occur in Italy, the item was adapted to more typical listening situations in Italy. The final version of LIFE-R-ITA was administered to a sample of 223 hearing students from different school settings and educational degrees in order to collect normative data.

RESULTS

For the LIFE-R-ITA, hearing students showed an average score of 72.26% (SD = 11.93), reflecting some listening difficulties. The subscales (LIFE total, LIFE class, and LIFE social) indicated good internal consistency. All items were shown to be relevant. Most challenging situations happened when listening in large rooms, especially when other students made noise. LIFE social scores were significantly worse than those of LIFE class (p < 0.001).

CONCLUSIONS

The present study provides cross-cultural adaptation and validation for the LIFE-R-ITA along with the normative data useful to interpret the results of students with hearing loss. The LIFE-R-ITA may support teachers and clinicians in assessing students' self-perception of listening at school. Such understanding may help students overcome their listening difficulties, by planning and selecting the most effective strategies among classroom interventions.

Violence against children and later substance use in low- and middle-income countries

BACKGROUND

Globally, one in two children experience violence; experiences which may lead to later risky behaviors such as substance use. In low- and middle-income countries (LMICs), however, the association between childhood violence and substance use remains underexplored.

OBJECTIVE

This study assessed the association between childhood violence and substance use among LMIC youth.

PARTICIPANTS

Data from the Violence Against Children and Youth Surveys (VACS) in eight LMICs (2017-2019) were analyzed, comprising 33,408 children and young adults (ages 13-24).

METHODS

Exposure variables included the experience of childhood violence (physical, sexual, emotional) and polyvictimization (experience of two or more types). Outcomes were current smoking and past-month alcohol and drug use. Multivariable logistic regressions with country-fixed effects were estimated. Stratified analyses were performed based on participant's sex and age, and effect modification analyses examined whether associations differ by the presence of peer support.

RESULTS

Childhood physical violence was the most prevalent type of violence (40.7 %), and about 10 % of the participants experienced polyvictimization. All types of violence increased the odds of smoking, binge drinking, and drug use, and polyvictimization elevated the risk substantially. Stronger associations were observed in young women with a history of childhood sexual violence (current smoking aOR: 1.5, 95 % CI: 1.2-1.9; binge-drinking aOR: 2.1, 95 % CI: 1.7-2.5; and drug-use aOR: 2.3, 95 % CI: 1.5-3.5) compared to young men. Additionally, the associations between childhood sexual violence and substance use were more pronounced among adolescents (current smoking aOR: 1.7, 95 % CI: 1.2-2.2; binge-drinking aOR: 2.3, 95 % CI: 1.8-2.9; and drug-use aOR: 2.4, 95 % CI: 1.5-3.9), relative to young adults. Lack of peer support significantly increased the likelihood of drug use.

CONCLUSION

Childhood violence prevention programs can reduce substance use in LMICs, and they should take into account the survivor's sex and age. Our findings suggest that peer support can mitigate risky behaviors among the survivors of childhood violence.

Solidarity through food: Coping with food insecurity among adolescent migrants in transit through Mexico and Central America

BACKGROUND

The food choices of migrants are frequently limited by lack of access to sufficient and adequate food. Food insecurity (FI) during adolescence has potential negative health consequences, however the experiences of FI of adolescent in-transit migrants have seldom been reported.

OBJECTIVE

To explore the experiences of FI of adolescent in-transit migrants and their ways of coping with it.

METHODS

Qualitative study, with 19 semi-structured interviews with adolescents (ages 13-19 years), in shelters for migrants in Mexico in 2022-2023. We followed a reflexive thematic analysis strategy.

RESULTS

Most participants had experienced FI during the journey, and responded by limiting intake, choosing food according to price, seeking temporary work or asking for food or money in the streets. We defined "solidarity through food" as a central theme that summarized participants' experiences of sharing food with other migrants, as givers or recipients. Solidarity through food was a response to FI, benefitting the more disadvantaged (e.g. young children, those who had been robbed). Despite their young age, interviewees took part in this, giving their food to others and restricting their intake to prioritize younger siblings.

DISCUSSION/CONCLUSIONS

Solidarity through food was a form of generalized reciprocity, enacted not only among family members or friends, but extended to other migrants sharing the route. In further studies, it will be important to explore the role and nuances of food sharing as a practice of social exchange of responsibility and care, on adolescent migrants' health, and in their psychological and relational development into adulthood.

Testing the modifiability of episodic future thinking and episodic memory among suicidal and nonsuicidal adolescents

Background

Despite increased attention on treatment and prevention for suicidal adolescents, we know little about potential intervention targets. Episodic future thinking-the ability to imagine detailed, personal, and future-oriented events-is a modifiable cognitive process that has been linked with suicidal ideation (SI) in adolescents. However, until now its modifiability has only been tested in adults.

Method

Adolescents (N = 176, ages 15-19; 71% SI) completed performance-based measures of episodic future thinking (i.e., Experimental Recombination Paradigm) and memory immediately before and after an Episodic Specificity Induction (ESI).

Results

Adolescents produced a greater number of future episodic details after (vs. before) the ESI but showed no change in non-episodic details (e.g., semantic information). Patterns of change in episodic future thinking were not moderated by SI history. Adolescents overall did not demonstrate change in past episodic detail counts after the ESI. However, there were select moderating effects of SI history on this effect.

Conclusion

Results show that episodic future thinking can change immediately following an episodic specificity induction among adolescents, regardless of whether they have previously experienced SI. This demonstration of within-person change constitutes a foundational first step in examining malleability of episodic future thinking in adolescents and offers preliminary evidence of a cognitive mechanism that may be leveraged in service of reducing adolescents' SI.

Cannabidiol or ketamine for preventing the impact of adolescent early drug initiation on voluntary ethanol consumption in adulthood

Background

Few studies have previously evaluated the long-term impact of initiating the combined use of alcohol and cocaine early-in-life during adolescence. Our preclinical study characterized changes in affective-like behavior and/or voluntary ethanol consumption emerging later on in adulthood induced by a prior adolescent drug exposure, as well as tested therapeutical interventions (i.e., cannabidiol or ketamine) to prevent the observed effects.

Methods

We performed three independent studies with male and female Sprague-Dawley rats, treated in adolescence (postnatal days, PND 29-38) with non-contingent paradigms of ethanol, cocaine, their combination or vehicle. Later on, adult rats were (1) scored for their affective-like state (forced-swim, elevated-plus maze, novelty-suppressed feeding, sucrose preference), (2) allowed to freely drink ethanol for 6 weeks (two-bottle choice), or (3) treated with cannabidiol or ketamine before given access to ethanol in adulthood.

Results

No signs of increased negative affect were observed in adulthood following the adolescent treatments. However, adolescent ethanol exposure was a risk-factor for later developing an increased voluntary ethanol consumption in adulthood, both for male and female rats. This risk was similar when ethanol was combined with adolescent cocaine exposure, since cocaine alone showed no effects on later ethanol intake. Finally, rats exposed to adolescent ethanol and pretreated in adulthood with cannabidiol (and/or ketamine, but just for females) reduced their ethanol voluntary consumption.

Conclusion

Our data provided two therapeutical options capable of preventing the impact of an early drug initiation during adolescence by decreasing voluntary ethanol consumption in adult rats.

Experiences of siblings and parents of children with congenital heart disease and exploration of siblings' support needs

Research with siblings of children with congenital heart disease (CHD) is scarce, although more than one-third of them experience limitations on their quality of life. This interview study aims to explore the diagnosis-associated experience of German siblings of children with CHD, their interest in a potential intervention, and potential key topics and contextual conditions of such an intervention. Interviews with 10 siblings aged 10 to 21 and a respective parent were conducted from August to October 2021, resulting in 20 interviews. Negative experiences associated with CHD included concerns regarding hospitalization, health deterioration, and the death of the child with CHD, as well as burdens including reduced family activities, less parental attention and support, and extended family meals. Positive experiences included perceived positive consequences of CHD, such as strong family cohesion and empathy toward people with chronic illnesses. Furthermore, siblings experienced enhanced coping mechanisms, such as having conversations with friends and family about the high prevalence of CHD and successful treatment or using distractions such as entertainment or study. Siblings' reported interest in a future intervention included empathy, peer support, and studying medical information on CHD. These findings should be used for counseling and developing tailored interventions to support these siblings.

Sleep duration is associated with appetitive traits in school-age years - results from the Generation XXI birth cohort

Sleep may influence appetite regulation through physiological and neurocognitive pathways. However, the association between sleep and appetite in childhood has been scarcely reported, particularly using a prospective design. We aimed to test associations between sleep duration at 7 years of age (y) and appetitive traits at both 7 and 10 y. Participants are from the population-based birth cohort Generation XXI (Porto, Portugal), at 7 (n = 2437) and 10 y (n = 1938) follow-ups. Data on sleep was gathered at 7 y and, considering bedtime and get-up time, total mean sleep duration was calculated and further categorized according to the 10th and 90th percentiles. Appetitive traits were assessed at 7 and 10 y using the parent-reported Children's Eating Behaviour Questionnaire. Associations were tested through Generalized Linear Models (co-variates: child's sex; maternal age, education and pre-pregnancy body mass index at 7 y). At 10 y, associations were further adjusted for the respective appetitive trait at 7 y. Children slept a mean of 10.2 h/night, and 13% and 9% slept ≤9.5 and ≥ 11.0 h/night at 7 y, respectively. For each additional hour in sleep duration, children scored 0.078 (99%CI: -0.145; -0.011) lower on Food Responsiveness, 0.065 (99%CI: -0.129; -0.002) lower on Emotional Undereating and 0.096 (99%CI: -0.161; -0.032) lower on Food Fussiness. Lastly, children sleeping ≤9.5 h/night scored higher on Food Responsiveness (β = 0.145 99%CI: 0.020; 0.271); while those sleeping ≥11.0 h/night scored lower on Food Fussiness (β = -0.255 99%CI: -0.370; -0.079). No significant prospective associations were found. In conclusion, in 7 y children, sleep duration was cross-sectionally associated with lower scores on food approach (Food Responsiveness) and avoidant traits (Emotional Undereating and Food Fussiness). However, the magnitude of the associations was small and further studies are warranted.

Social Media Use During Coronavirus Disease 2019 and the Impact on Adolescent Health

During the coronavirus disease 2019 lockdown, adolescents spent a great deal of time using social media. There have always been a host of positives and negatives associated with social media use. The negatives are more notable with heavier use. Once restrictions lifted and normalcy returned, social media usage appears to be returning to prepandemic rates in adolescents. Adolescents are reporting mostly positive and neutral personal effects of social media on their postpandemic lives.

Photos Sculpt the Stories of Youth: Using Photovoice to Holistically Capture the Lived Experiences and Pain of Youth Who Underwent Spinal Fusion Surgery

Spinal fusion surgery is one of the most common major surgical procedures in youth. Adolescent idiopathic scoliosis (AIS) is the most frequent reason for corrective spinal fusion. AIS (∼25%-47% of cases) and spinal fusion surgeries are associated with pain, including the development of new onset chronic pain for up to 15% of youth. This research used photovoice approaches to explore the journeys of youth from before, during, and after spinal fusion surgery, to demonstrate their experiences both of and beyond pain. Twenty participants were recruited from a previous study conducted by the senior author's lab. Participants captured photos/videos in their daily life (Phase 1); collected previously taken photos/videos from before/during/after their surgery (Phase 2); and participated in individual interviews to reflexively discuss the meaning behind photos/videos (Phase 3). Before interviews, a questionnaire was administered to assess pain characteristics. Nineteen girls/women with scoliosis and one boy/man with kyphosis (12-19 years old, Mage = 16 years) participated; they identified as white (80%), other (15%), and Southeast Asian (5%). The researchers used a reflexive thematic analysis approach, which generated five themes: (1) body aesthetic versus machine; (2) expectations and anticipation of surgery/outcomes; (3) desire of normalcy and freedom; (4) navigating a hoped-for positive surgery experience; and (5) the journey sculpts identity formation and sense of self. Findings support youth advocacy, underscoring the need to validate youth concerns and inform healthcare professionals of the importance of individualized care. Youth perspectives highlighted opportunities for optimizing surgery/healthcare experiences and the psychosocial impacts of scoliosis on body image and appearance.

Disenfranchised Grief: Which Grieving Rules Do German Mid-adolescents Hold?

Every society adheres to grieving rules that govern how people experience loss and grief. These are rarely communicated explicitly, which can lead to insecurities in dealing with one's own grief and the grief of others. This is particularly true for adolescents. Based on Doka's concept of disenfranchised grief, this study explores the grieving rules of mid-adolescents. Cross-sectional data collection took place in November and December 2022 at six secondary schools in Germany. A total of 226 adolescents predominantly aged between 14 and 16 years completed the questionnaire. The analysis of the data shows that in some respects, mid-adolescents have similar grieving rules as adults. However, they are more inclusive when it comes to losses of ex-partners, pets and people with intellectual disabilities. Possible sources of (self-)disenfranchisement are parasocial relationships and the duration of grief. Open communication about grieving rules is suggested to prevent possible disenfranchisement.

Emphasizing symbolic capital: its superior influence on the association between family socioeconomic status and adolescent subjective well-being uncovered by a large-scale multivariate network analysis

Background

Family socioeconomic status (FSES) serves as a significant determinant for subjective well-being. However, extant research has provided conflicting evidence on the correlation between FSES and adolescent students' subjective well-being (SSWB).

Methods

Data were collected from 12,058 adolescent students (16 years of age) by the Programme for International Student Assessment (PISA) 2018. Multivariate canonical correlation and Mantel test were utilized to investigate the specific connection between FSES and SSWB. Furthermore, a Gaussian EBICglasso graph-theoretical model was used to capture the topological properties of the FSES-SSWB network and reveal the interplay among multifarious components of FSES and SSWB.

Results

FSES was positively correlated with SSWB. In the FSES-SSWB network, parental educational attainment and occupation status demonstrated the highest centrality values, thereby contributing significantly to the relationship between FSES and SSWB. However, family wealth, along with educational and cultural resources, displayed lower centrality values, signifying their weaker roles in this relationship.

Conclusion

Our findings suggest that symbolic capital, rather than family affluence, exerts a dominant influence on adolescent SSWB. In other words, SSWB may not be detrimentally influenced by a deficiency in monetary resources. However, it is more susceptible to being unfavorably impacted by inferior parental educational attainment and occupational standing.

Ready to leave? - Adolescents' and parents' perceptions of transition from paediatric to adult rheumatology care

BACKGROUND

In Sweden, approximately 2000 children live with Juvenile Idiopathic Arthritis (JIA). About half of them continue to have an active disease and need to transfer to adult rheumatology care. This study aimed to investigate Swedish adolescents' and parents´ perceptions of readiness for transition from pediatric to adult rheumatology care.

METHODS

The study was a cross-sectional quantitative study. Patients at the pediatric rheumatology clinic at a university hospital in Sweden and members of The Swedish National Organization for Young Rheumatics aged 14-18 and their parents were invited to participate in the study. Data was collected with the Readiness for Transition Questionnaire (RTQ) focusing on adolescents' transition readiness, adolescents' healthcare behaviors and responsibility, and parental involvement. Data were analyzed with descriptive statistics. Comparative analyses were made using non-parametric tests with significance levels of 0.05 as well as factor analyses and logistic regression.

RESULTS

There were 106 adolescents (85 girls, 20 boys) and 96 parents answering the RTQ. The analysis revealed that many adolescents and parents experienced that the adolescents were ill-prepared to take over responsibility for several healthcare behaviors, such as booking specialty care appointments, calling to renew prescriptions and communicating with medical staff on phone and to transfer to adult care. Parents and adolescents alike stated that it was especially difficult for the adolescents to take responsibility for healthcare behaviors meaning that the adolescents had to have direct interaction with the healthcare professionals (HCPs) at the paediatric rheumatology clinic, for example to renew prescriptions. It was evident that the adolescents who perceived they were ready to take responsibility for the aspects related to direct interaction with HCPs were more overall ready to be transferred to adult care.

CONCLUSION

Adolescents need more support to feel prepared to transfer to adult care. With the results from this study, we can develop, customize, and optimize transitional care programs in Sweden for adolescents.

The Effect of Two Health Education Packages on Nutritional Knowledge, Practices, and Physical Activity Levels Among School-Going Adolescents in Rishikesh: A Cluster Randomized Trial

Introduction Adolescence is a critical period known for presenting specific challenges in disease treatment and health promotion. Studies have highlighted that increased nutritional awareness is associated with healthier eating habits, while regular physical activity aids in controlling and preventing non-communicable diseases. Equipping adolescents with health education in schools prepares them to adopt and maintain healthy lifestyles throughout their lives. To assess and compare the efficacy of health education packages targeting nutrition knowledge, practices, and physical activity levels, a cluster-randomized trial was conducted among school-going adolescents. Methodology Two distinct health education packages were developed for the two intervention groups. In group 1, a health talk supported by a flip chart was delivered, followed by pamphlet distribution. In contrast, in group 2, only information pamphlets were distributed. The study was conducted in government schools in Rishikesh, with four schools selected. Two schools were randomly allocated to each intervention arm. In each school, a questionnaire was administered to assess the students' nutrition knowledge, practices and physical activity levels. This was followed by the intervention, and the students were reassessed for the same parameters after two weeks. Result The pre-intervention and post-intervention comparisons within the same group- the mean scores for nutrition knowledge, food practice, sleep duration, and recreational screen time were comparable in the intervention group 1 (p>0.05). There was a decrease in the mean physical activity score and screen time for studies in intervention group 1, and these differences were statistically significant (p<0.05). The mean scores for nutrition knowledge, physical activity, sleep duration, and screen time for studies were comparable in the intervention group 2 (p>0.05). There was an increase in the mean food practice score and a decrease in recreational screen time in intervention group 2, and these differences were statistically significant (p<0.05). On comparing the groups with each other, it was found that Group 2 exhibited a significantly higher mean food practice score compared to group 1 post-intervention. While there was a statistically significant decrease in the mean physical activity score in intervention group 1, this group still had higher physical activity levels than group 2. Post-intervention, group 2 exhibited a higher screen time for studies compared to group 1. Both groups had comparable sleep durations at baseline and post-intervention, with intervention group 1's mean sleep duration falling within the recommended range set by the American Academy of Sleep Medicine. Regression analysis provided valuable insights into the relationship between baseline values of various variables and their post-intervention values, aiding in understanding the impact of the health education packages. Conclusion The findings emphasize the significance of incorporating nutrition and physical activity education into the curriculum of students.

Young adults' perception of transition from paediatric to adult care

AIM

Medical advancements will lead to more children with long-term illnesses and/or disabilities undergoing the transition to adult care. Previous studies show that many young adults are unprepared for this transition, and might suffer from loss of follow-up. This study aimed to investigate the post-transfer experiences of the transition among young adults with long-term illnesses and/or disabilities.

METHODS

A qualitative descriptive design was used. Three semi-structured focus group interviews were conducted with 15 participants (18-25 years of age) recruited via patient organisations focusing on children and young adults with disabilities and/or long-term illnesses. The interviews were analysed with conventional content analysis.

RESULTS

One theme emerged: limbo, defined as an indefinite experience without knowing when or even if something would happen, or whether they would be overlooked. The theme rested on four categories: transition experiences, organisational aspects, influence on daily life, and self-management.

CONCLUSION

Areas for improvement were identified across the entire transition that is, in the preparation, transfer, and post-transfer stages. Our findings indicate a limited understanding among healthcare providers (HCPs) that the transition continues until the young adult has been fully integrated into adult care.

Long-lasting effects of disturbing the circadian rhythm or sleep in adolescence

Circadian rhythms are endogenous, near 24-hour rhythms that regulate a multitude of biological and behavioral processes across the diurnal cycle in most organisms. Over the lifespan, a bell curve pattern emerges in circadian phase preference (i.e. chronotype), with children and adults generally preferring to wake earlier and fall asleep earlier, and adolescents and young adults preferring to wake later and fall asleep later than their adult counterparts. This well-defined shift speaks to the variability of circadian rhythmicity over the lifespan and the changing needs and demands of the brain as an organism develops, particularly in the adolescent period. Indeed, adolescence is known to be a critical period of development during which dramatic neuroanatomical changes are occurring to allow for improved decision-making. Due to the large amount of re-structuring occurring in the adolescent brain, circadian disruptions during this period could have adverse consequences that persist across the lifespan. While the detrimental effects of circadian disruptions in adults have been characterized in depth, few studies have longitudinally assessed the potential long-term impacts of circadian disruptions during adolescence. Here, we will review the evidence that disruptions in circadian rhythmicity during adolescence have effects that persist into adulthood. As biological and social time often conflict in modern society, with school start times misaligned with adolescents' endogenous rhythms, it is critical to understand the long-term impacts of disrupted circadian rhythmicity in adolescence.

Development and Validation of a Ready-to-Talk Measure for Use in Adolescents and Young Adults Living With Advanced Cancer

BACKGROUND

In the era of evolving and emerging therapies, adolescents and young adults (AYAs) living with advanced cancer experience a high degree of uncertainty, making palliative care and end-of-life (PCEOL) discussions difficult. Clinical conversations determine values/preferences that guide shared decision-making and goals of treatment, including end-of-life care when cancer progresses. Initiating PCEOL conversations is challenging for clinicians.

OBJECTIVE

This study describes the development and validation of an instrument that measures AYA readiness to engage in PCEOL clinical conversations.

METHODS

A Ready-to-Talk Measure (R-T-M) was developed, guided by the revised conceptual model of readiness across 3 domains (awareness, acceptance, and willingness). Content experts evaluated validity, and 13 AYAs with advanced cancer participated in cognitive interviews. Acceptability (item applicability, clarity, interpretation, sensitivity, missingness) and experiences (benefit, burden) were analyzed.

RESULTS

The scale content validity index was ≥0.90 for each domain. Forty-two of the 55 R-T-M items were acceptable without any change. Three items were deleted. Ten items were modified, and 3 were added. Adolescents and young adults wanted more items about friends/siblings and about AYA unique qualities for clinicians to know them better. Adolescents and young adults acknowledged benefit through talking about difficult, relevant topics.

CONCLUSION

Ready-to-Talk Measure validity was strengthened by deleting or modifying unclear or misinterpreted items and by adding items. Next steps include psychometric analysis to determine reliability/dimensionality and stakeholder input to make the R-T-M a clinically useful tool.

IMPLICATIONS FOR PRACTICE

Ready-to-Talk Measure assessment of readiness to engage in PCEOL conversations while identifying unique preferences of AYAs holds promise for facilitating ongoing discussions.

Prediction of adolescent weight status by machine learning: a population-based study

BACKGROUND

Adolescent weight problems have become a growing public health concern, making early prediction of non-normal weight status crucial for effective prevention. However, few temporal prediction tools for adolescent four weight status have been developed. This study aimed to predict the short- and long-term weight status of Hong Kong adolescents and assess the importance of predictors.

METHODS

A population-based retrospective cohort study of adolescents was conducted using data from a territory-wide voluntary annual health assessment service provided by the Department of Health in Hong Kong. Using diet habits, physical activity, psychological well-being, and demographics, we generated six prediction models for successive weight status (normal, overweight, obese and underweight) using multiclass Decision Tree, Random Forest, k-Nearest Neighbor, eXtreme gradient boosting, support vector machine, logistic regression. Model performance was evaluated by multiple standard classifier metrics and the overall accuracy. Predictors' importance was assessed using Shapley values.

RESULTS

442,898 Primary 4 (P4, Grade 4 in the US) and 344,186 in Primary 6 (P6, Grade 6 in the US) students, with followed up until their Secondary 6 (Grade 12 in the US) during the academic years 1995/96 to 2014/15 were included. The XG Boosts model consistently outperformed all other model in predicting the long-term weight status at S6 from P4 or P6. It achieved an overall accuracy of 0.72 or 0.74, a micro-averaging AUC of 0.92 or 0.93, and a macro-averaging AUC of 0.83 or 0.86, respectively. XG Boost also demonstrated accurate predictions for each predicted weight status, surpassing the AUC values obtained by other models. Weight, height, sex, age, frequency and hours of aerobic exercise were consistently the most important predictors for both cohorts.

CONCLUSIONS

The machine learning approaches accurately predict adolescent weight status in both short- and long-term. The developed multiclass model that utilizing easy-assessed variables enables accurate long-term prediction on weight status, which can be used by adolescents and parents for self-prediction when applied in health care system. The interpretable models may help to provide the early and individualized interventions suggestions for adolescents with weight problems particularly.

Storylines of family medicine VII: family medicine across the lifespan

Storylines of Family Medicine is a 12-part series of thematically linked mini-essays with accompanying illustrations that explore the many dimensions of family medicine as interpreted by individual family physicians and medical educators in the USA and elsewhere around the world. In 'VII: family medicine across the lifespan', authors address the following themes: 'Family medicine maternity care', 'Seeing children as patients brings joy to work', 'Family medicine and the care of adolescents', 'Reproductive healthcare across the lifespan', 'Men's health', 'Care of older adults', and 'Being with dying'. May readers appreciate the range of family medicine in these essays.

Anxiety and depression symptoms in adolescents and young adults with juvenile idiopathic arthritis: results of an outpatient screening

BACKGROUND

Previous studies have shown that growing up with rheumatic conditions can fuel dissatisfaction and psychological distress, which in turn affects disease self-management and treatment adherence. Primary objective of this study was to estimate the prevalence of anxiety and depression symptoms in adolescents and young adults (AYA) with juvenile idiopathic arthritis (JIA) and to identify correlates of conspicuous screening results.

METHODS

Initiated as part of the COACH multicenter observational study, outpatients aged 12 to 21 years participating in the National Pediatric Rheumatological Database (NPRD) were prospectively screened for mental health using the Patient Health Questionnaire-9 (PHQ-9) and the Generalised Anxiety Disorder Scale-7 (GAD-7).

RESULTS

Data from 1,150 adolescents with JIA (mean age 15.6 ± 2.2 years; mean disease duration 7.2 ± 4.9 years, 69% female, 43% oligoarthritis, 26% polyarthritis) were analysed. Overall, 32.7% (n = 316) of AYA showed conspicuous screening results, of whom 30.4% reported clinically relevant suicidal or self-harm thoughts. About 19% of screened patients showed moderate to severe depressive or anxious symptoms. AYA with conspicuous screening results were older (15.8 vs. 15.2 years; p < 0.0001), more often female (81% vs. 64%; p < 0.0001) and more often overweight (25% vs. 17%; p = 0.006). They had higher disease activity (physician global assessment on NRS 0-10; 1.7 vs. 1.2; p < 0.0001), more functional limitations (CHAQ; 0.44 vs. 0.14; <0.0001) and rated their health status worse (NRS 0-10; 3.5 vs. 1.8; p < 0.0001) than AYA with inconspicuous screening results. Females (OR 2.33 [CI 1.53-3.56]; p < 0.0001), older age (OR 1.09 [CI 1.01-1.18]; p = 0.026), patients with more functional limitations (OR 3.36 [CI 1.98-5.72]; p < 0.0001), and patients with worse subjective health status (OR 1.17 [CI 1.07-1.27]; p < 0.0001) were more likely to have a conspicuous screening result. Regular sports participation was associated with a lower likelihood of conspicuous screening result (OR 0.69 [CI 0.49-0.98]; p = 0.039).

CONCLUSIONS

A large-scale outpatient screening of AYA with JIA in Germany shows a high prevalence of anxiety and depression symptoms. The need for routine screening for early detection of mental health problems became apparent.