Adolescence And Young Adulthood Research Articles

Health-related conditions among long-term cancer survivors diagnosed in adolescence and young adulthood (AYA): results of the SURVAYA study.

With 5-year survival rates > 85%, gaining insight into the long-term and late health-related conditions of cancer survivors diagnosed in adolescence and young adulthood is of utmost importance to improve their quantity and quality of survival. This study examined the prevalence of and factors associated with, patient-reported health-related conditions and their latency times among long-term adolescent and young adult (AYA) cancer survivors. AYA cancer survivors (5-20years after diagnosis) were identified by the population-based Netherlands Cancer Registry (NCR), and invited to participate in the SURVAYA questionnaire study. Participants reported the prevalence and date of diagnosis of health-related conditions. Clinical data were retrieved from the NCR. Three thousand seven hundred seventy-six AYA cancer survivors (response rate 33.4%) were included for analyses. More than half of the AYAs (58.5%) experienced health-related conditions after their cancer diagnosis, of whom 51.4% were diagnosed with two or more conditions. Participants reported conditions related to vision (15.0%), digestive system (15.0%), endocrine system (14.1%), cardiovascular system (11.7%), respiratory system (11.3%), urinary tract system (10.9%), depression (8.6%), hearing (7.4%), arthrosis (6.9%), secondary malignancy (6.4%), speech-, taste and smell (4.5%), and rheumatoid arthritis (2.1%). Time since diagnosis, tumor type, age at diagnosis, and educational level were most frequently associated with a health-related condition. A significant proportion of long-term AYA cancer survivors report having one or more health-related conditions. Future research should focus on better understanding the underlying mechanisms of, and risk factors for, these health-related conditions to support the development and implementation of risk-stratified survivorship care for AYA cancer survivors to further improve their outcomes. NCT05379387.

Effects of Cannabidiol in Adolescent and Young Adult Depressive and Anxiety Disorders: A Systematic Review of Clinical and Preclinical Research.

Adolescents and young adults may use cannabidiol (CBD) products in an attempt to reduce depression and anxiety symptoms, despite little research examining this use. This systematic review evaluated preclinical and clinical research on the effects of CBD on depressive and anxiety disorders in adolescence and young adulthood. To provide context, we discuss CBD's mechanism of action and neurodevelopmental effects. PubMed was searched for articles published through June 2022. Preclinical or clinical CBD administration studies with N > 1 that examined depressive and/or anxiety disorders were eligible. Initially, 224 publications were identified. After excluding duplicates and applying eligibility criteria, 6 preclinical (depression: n≈133; anxiety: n≈161) and 4 clinical (anxiety: n=113) articles remained. Due to the low number of studies, results were synthesized qualitatively. The Oxford Centre for Evidence-Based Medicine 2011 Levels of Evidence were used to rate each study's evidence. The preclinical effects of CBD on depression-like behavior appear to differ by sex, early life stress, and duration of use. Despite no evidence that CBD exerts anxiolytic effects in preclinical adolescent models, CBD may reduce anxiety symptoms in human adolescents and young adults with anxiety disorders. The existing evidence suggests that CBD may reduce symptoms of anxiety in adolescents and young adults. However, the evidence is sparse and limited by variations in samples and CBD dosing duration. Further research is needed to understand the potential benefits and/or harms of CBD for depression and anxiety disorders in this population. Implications for clinical practice and research are discussed.

Phase Angle and Body Composition As a Prognostic Factor in Acute Lymphoblastic Leukemia

Acute lymphoblastic leukaemia (ALL) is a malignant proliferation of lymphoid cells blocked at an early stage of differentiation that can invade bone marrow, blood, and extramedullary sites. Age specific incidence is highest in children aged 1-4 years, then drops sharply through childhood (5-14 years), adolescence and young adulthood (AYA) (15-39 years), reaching the lowest point between 25 years and 45 years. Bioelectrical impedance analysis (BIA) is a method used to estimate body composition and cell membrane integrity. BIA is a useful tool as it is non-invasive, relatively inexpensive, can be performed on nearly any patient, does not expose the patient to ionizing radiation, is painless, and has both high intra and inter observer precision (coefficient of variation = 2.7%-4.0%). Phase angle (PhA) is obtained by BIA and is associated with cellular function. It is considered a reliable marker of malnutrition. PhA has been shown to predict survival in solid malignancies and hematopoietic stem cell transplant patients. To date, no studies have evaluated the usage of PhA in ALL patients. Therefore, this retrospective study sought to establish the prognostic significance of baseline PhA and lean mass index on OS and LFS in newly diagnosed ALL patients receiving intensive chemotherapy. Retrospective, cross-section, observational and descriptive study. The records of patients who received intensive chemotherapy from January 2019 to January 2023 were reviewed. Statistical analysis The qualitative variables were studied in frequencies and proportions, the quantitative variables were grouped into medians and ranges. OS and LFS were determined using Kaplan-Meier survival curves with log-Rank with a significant p <0.05 value. Statistical analysis was performed with SPSS version 25 and GraphPad Prism version 9.5.0. Results 85 patients were included, 56.7% (48) men and 43.5% (37) women. 79 patients with ALL-B and 6 patients ALL-T. The mean age was 25 years. 68 were AYA population and 17 not-AYA. The CR was 89%, ND MRD was 57%. The chemotherapy for AYA was CALGB 10403, and not AYA was Hyper-CVAD. Relapse was documented in 38%. The mean body mass index was 26.98±5.27 kg/m 2. The mean PhA was 4.547±0.9983°. The mean lean mass index was 17.8 (12.9-35.5) kg/m 2. The mean fat mass index was 9.195±4.425 kg/m 2. The mean OS was 86% at 1 year and OS at 3 years was 64.5%. The results that were statistically significant in LFS compared by Kaplan Meier curves were: male vs female p=0.0344, PhA >4, p=0.0235, lean mass index ≥16, p=0.0111. Conclusions In conclusion, our findings suggest that in newly diagnosed ALL patients undergoing intensive induction chemotherapy, PhA may provide important prognostic information for LFS and OS. PhA is an objective, repeatable, high-precision measure in ALL patients and, unlike other prognostic factors in this population, is potentially subject to intervention. Future studies of PhA in ALL patients should address the content validity of phase angle while further exploring the promising findings of the effect of strength training and nutritional supplementation on PhA and patient outcomes.

Management of difficult-to-treat asthma in adolescence and young adults.

The period of adolescence and young adulthood (AYA) has been proposed to extend from 11 to 25 years of age as patients in this age group face similar challenges. AYA is a time of fast and great physiological and psychological growth, in which an individual transitions from a young dependent child to a mature independent adult. Behaviour patterns during adolescence, such as risk taking and desire for privacy, can challenge parents or healthcare professionals' (HCPs') ability to help adolescents to manage their asthma. Asthma itself tends to remit, become milder or worsen into a severe variant during adolescence. The pre-pubertal male predominance of asthma switches to a female predominance in late teen years. ∼10% of AYA with asthma have "difficult-to-treat asthma (DTA)", characterised by poor asthma control despite treatment with inhaled corticosteroids (ICS) and other controller medications. DTA management in AYA requires a multidisciplinary team approach and systematic assessment that can address the key questions of objective confirmation of diagnosis, severity assessment, phenotyping, comorbidities, asthma mimickers or other drivers of poor control such as non-adherence to treatment. A key task for HCPs is to establish the magnitude of the severe asthma component versus other non-asthma drivers of symptoms (e.g. inducible laryngeal obstruction or breathing pattern disorder). Severe asthma is a subset of DTA and is determined once asthma diagnosis and its severity have been confirmed and adherence to controller (ICS) treatment has been assured. Severe asthma is a heterogeneous disease and appropriate phenotyping is necessary for the management of treatable traits and consideration for biologic therapies. Finally, an important part of successful management of DTA in the AYA group is the provision of an effective transition of asthma care from paediatric to adult asthma services through setting up a well-designed asthma transition pathway tailored to the individual patient needs.

Adolescence and young adulthood: an untapped window of opportunity for obesity prevention.

Adolescence and young adulthood (AYA) are formative life stages, second only to the first 1000 days. Yet young people have historically been 'forgotten' in our health system. Major health risk factors, like adolescent obesity, have largely been left untreated, resulting in significant chronic disease burdens and health costs later in life. In Australia, strategies to address obesity have primarily been implemented disjointedly by different jurisdictions of government, which has meant that obesity responses across the country have been piecemeal. Current state-based interventions show modest effects on improving weight-related behaviours. Major fiscal and regulatory measures have yet to be implemented despite demonstrable public health benefits and public support. The new National obesity strategy 2022-2032, which recognises the importance of engaging with youth, is a welcomed approach to coordinating obesity prevention Australia-wide. The challenge remains to ensure that meaningful AYA engagement is followed through with future interventions. The digitalisation of society poses future health challenges for AYA because of the likelihood of greater physical inactivity and ease of access to junk foods.

A customized adherence enhancement program for adolescents and young adults with suboptimal adherence and bipolar disorder: Trial design and methodological report

BackgroundThe onset of bipolar disorder (BD) is common during late adolescence and young adulthood (AYA). Suboptimal medication adherence is a critical yet modifiable risk factor for negative outcomes among AYAs with BD. MethodsThis research used an iterative process (e.g., focus groups, advisory board, cognitive interviews) to modify an existing adherence intervention to address suboptimal adherence in AYAs with BD. The modified version of Customized Adherence Enhancement for Adolescents and Young Adults (CAE-AYA) will be compared to an Enhanced Treatment as Usual condition (ETAU) in 40 AYAs intervention using a 6-month prospective, randomized controlled trial (RCT) in a high-risk group of 16–21 year old AYAs with BD with demonstrated non-adherence to their prescribed BD medications. ConclusionsThis report describes the methodology and design of the ImprovinG adhereNce In adolescenTs with bipolar disordEr (IGNITE) study. If successful, the CAE-AYA approach has the potential to advance care for vulnerable youth with BD.

A364 Suicidal Risks in Adolescents Following Bariatric Surgery

Elevated suicidal risk for adult bariatric patients is concerning. Adolescence and young adulthood (AYA) are high risk periods for suicidal thoughts and behaviors (STBs). Understanding how STBs and associated risk factors unfold for adolescents following bariatric surgery is critical to inform care guidelines.

Abstract P050: Competing Health Priorities Lead Young Women to Worry Little About Heart Disease

Introduction: The American Heart Association (AHA) Go Red for Women campaign has substantially improved heart disease awareness among adult women. Little is known about how younger women in adolescence and young adulthood (AYA) perceive their risk of heart disease during this key time in the life course for primordial prevention. Methods: We used an explanatory sequential mixed method design consisting of the AHA National Women’s Health Study survey and follow-up focus groups. We surveyed a random convenience sample of 331 AYA women ages 15-24 years presenting for care at an urban academic medical center and a community health center. Survey results guided development of a qualitative guide used during eight online, semi-structured focus groups with 32 young women. We report descriptive statistics performed using Matlab (Mathworks, Inc.) and thematic analyses conducted to synthesize data from the online focus groups using NVivo 11. Results: Only 10% [n=33] of AYA identified heart disease as the leading cause of death in women. Very few identified it as the top health concern for women of all ages [16 (4.8%)] or women in their age group [3 (0.9%)]. Most young women surveyed worried little [131 (39.6%)] or not at all [123 (37.2%)] about getting heart disease. In contrast, mood disorders were the most commonly noted top health concern for women of all ages [66 (19.9%)] and women in their age group [59 (17.8%)] and many AYA [142 (42.9%)] worried a lot about getting depression or anxiety. AYA discussed age (“I feel like those are things I associate with older people like 40”), competing health priorities (“because we’re so pressured just to grow up and more focused on pregnancies or depression or our weight”), and lack of perceived risk (“I like to think that I’m conscious of what I eat and drink”) as personal reasons for not worrying about heart disease. At the end of the focus group discussions, AYA women expressed being more motivated to both learn about heart health and to perform heart healthy behaviors (“I am definitely more motivated because I wasn’t aware that it was the number one kill[er] so I will definitely make sure to start working out”). Many group participants also noted the importance of receiving heart health information as well as personalized risk information from doctors. Conclusions: Younger women are unaware that heart disease is the leading cause of death in women and express little worry about their future risk. As the antecedents of heart disease begin in childhood and adolescence, these findings demonstrate a major unmet need. Campaigns to promote heart healthy behaviors in young women should directly address low perceived risk, the importance of lifetime risk, and competing health priorities with both young women and their health care providers.

Childbirth after adolescent and young adult cancer: a population-based study.

Annually, > 45,000US women are diagnosed with cancer during adolescence and young adulthood (AYA). Since 2006, national guidelines have recommended fertility counseling for cancer patients. We examined childbirth after AYA cancer by calendar period, cancer diagnosis, and maternal characteristics. We identified a cohort of women with an incident invasive AYA cancer diagnosis at ages 15-39 during 2000-2013 in North Carolina. Cancer records were linked with statewide birth certificates through 2014. Hazard ratios (HR) and 95% confidence intervals (CI) for first post-diagnosis live birth were calculated using Cox proportional hazards regression. Among 17,564 AYA cancer survivors, 1989 had ≥ 1 birth after diagnosis during 98,397 person-years. The 5- and 10-year cumulative incidence of live birth after cancer was 10 and 15%, respectively. AYA survivors with a post-diagnosis birth were younger at diagnosis, had lower stage disease, and had less often received chemotherapy than those without a birth. The 5-year cumulative incidence of post-diagnosis birth was 10.0% for women diagnosed during 2007-2012, compared to 9.4% during 2000-2005 (HR = 1.01; 0.91, 1.12), corresponding to periods before and after publication of American Society of Clinical Oncology fertility counseling guidelines in 2006. Despite advances in fertility preservation options and recognition of fertility counseling as a part of high-quality cancer care, the incidence of post-diagnosis childbirth has remained stable over the last 15years. Our study uses statewide data to provide recent, population-based estimates of how often AYA women have biological children after a cancer diagnosis.

Adolescents and Young Adults With a "Rare" Cancer: Getting Past Semantics to Optimal Care for Patients With Germ Cell Tumors.

Because the tumors of adolescence and young adulthood (AYA) are distinct from those that occur earlier and later in life, the most common tumors in this age group are termed “rare.” We offer a collaborative, cross-disciplinary, evidence-based approach, advocated and funded by civil society, to advance the field of germ cell tumor and potentially to apply to other rare AYA tumors.

Childhood, adolescent and young adult cancer incidence in Japan in 2009–2011

Little is known about cancer incidence among children and youths in Japan. We aimed to describe cancer incidence in Japan focusing on childhood, adolescence and young adulthood (AYA). Cancer incidence data were obtained from the Monitoring of Cancer Incidence in Japan project. For the 2009-2011 incidence, the data were collected from 40 prefectures, of which data from 27 prefectures meeting quality standards were analyzed (population coverage: 38.6%). Cancers diagnosed in 0-39 years of age were classified according to the International Classification of Childhood Cancer (version 3). Crude incidence rates of cancer (including benign or behavior-unknown brain tumors) were 122.7, 142.2, 310.7, and 910.6 for the 0-14, 15-19, 20-29, and 30-39 age groups, respectively (per million population). Using the sex- and age-specific incidence rates, the national estimates of cancer incidence were 2055 for 0-14 years (1118 males and 937 females), 864 for 15-19 years (450 males and 414 females), 4246 for 20-29 years (1699 males and 2547 females), and 16 295 for 30-39 years of age (5101 males and 11 194 females). The five leading cancers were leukemia, cancer of the central nervous system (CNS), lymphoma, malignant germ cell and other gonadal tumors, and neuroblastoma in childhood cases (0-14 years old); leukemia, malignant germ cell and other gonadal tumors, lymphoma, CNS, and malignant bone tumors in adolescence (15-19 years old). The leading cancer in 20-29 years of age was malignant germ cell other gonadal tumors (mainly testis and ovary), whereas female breast cancer was most frequent in 30-39 years of age. These results provide an overall picture of childhood and AYA cancer in Japan.

Birth Rates after Adolescent and Young Adult Cancer in North Carolina, 2000–2014

Abstract Each year, >45,000 U.S. women are diagnosed with cancer during adolescence and young adulthood (AYA), defined by the National Cancer Institute as ages 15–39 years. ASCO first published guidelines on fertility counseling and preservation for cancer patients in 2006. Few studies have assessed birth rates after cancer among AYAs. We identified women with an incident cancer diagnosis at ages 15–39 during 2000–2013 in the North Carolina Cancer Registry. Cancer records were linked with statewide birth certificates through 2014 using a probabilistic algorithm. Hazard ratios (HR) and 95% confidence intervals (CI) for childbirth were calculated using Cox proportional hazards regression, with person-time accrued from cancer diagnosis until death, 46th birthday or December 31, 2014 and adjusted for age at diagnosis. Among 19,507 AYA cancer survivors, 2,343 had ≥1 post-diagnosis birth during 110,216 person-years. The 5- and 10-year cumulative incidence of post-diagnosis birth was 12% and 18%, respectively. The most common cancers were breast (25%), thyroid (14%), gynecologic (10%), melanoma (10%), and lymphoma (7%). The percent with a birth after diagnosis was lowest for breast and gynecologic cancer (6% for both) and highest for Hodgkin lymphoma (23%) and melanoma (24%). Survivors with a birth after diagnosis were more often younger, had not received radiation or chemotherapy, and had lower stage disease. African American women were less likely to have a post-diagnosis birth than white women overall (HR = 0.82; 0.73, 0.92), due in part to a higher proportion of breast cancers (35% vs. 23%). About 30% of births were <2 years from cancer diagnosis and 20% were >5 years after (mean = 3.5 years). Half (48%) were to women who were nulliparous at diagnosis. The 5-year cumulative incidence of post-diagnosis birth was 11.7% for women diagnosed during 2007–2012 (after ASCO's 2006 guidelines), compared to 11.6% during 2000–2005 (HR = 0.98; 0.89, 1.08) and varied little by cancer type. Despite advances in fertility preservation options and recognition of fertility counseling as a part of high quality cancer care, birth rates have remained stable over the last 15 years. Low implementation of fertility counseling and limited access to fertility preservation may be contributing factors.

Perceived impact of cancer among adolescents and young adults: Relationship with health-related quality of life and distress.

To examine whether perceptions of the impact of cancer are related to health-related quality of life (HRQoL) and psychological distress among survivors of cancer in adolescence and young adulthood (AYA). One hundred seventy-three AYA cancer survivors (aged 18-35 and 15-29years at time of diagnosis) completed a mailed survey assessing impact of cancer (IOC-AYA), HRQoL (SF-36), and distress (BSI-18). Hierarchical linear regression models analyzed the independent effects of perceived impacts of cancer on HRQoL and distress after controlling for clinical and sociodemographic characteristics. Multivariate analyses also examined the extent to which positive and negative perceptions attenuated the effects of control variables on HRQoL and distress. Being unemployed or not in school, and self-reported health problems were significantly associated with worse physical HRQoL. Mental HRQoL and psychological distress appeared as a function of reporting both positive and negative impacts of cancer; mental health outcomes were better in AYAs reporting more positive and less negative impact of cancer in their lives. Perceived impact of cancer, in both positive and negative ways, attenuated the effects of sociodemographic and clinical factors on mental HRQoL and psychological distress. Results suggest that mental HRQoL and psychological distress, but not physical HRQoL, are a function of survivors' perceptions of how cancer has affected them and continues to affect them in both positive and negative ways. Findings suggest that opportunities for AYA cancer survivors to reframe or better understand the context of cancer in their lives may result in improved mental health outcomes.

Cognitive Impairment in Survivors of Adolescent and Early Young Adult Onset Non-CNS Cancers: Does Chemotherapy Play a Role?

The development of complex cognitive functions including executive functions occurs during adolescence and early young adulthood. Survivors of cancers diagnosed during adolescence and young adulthood (AYA) may be at specific risk for chemotherapy-associated cognitive impairment; however, little data are available that specifically examine long-term cognitive outcomes in the AYA-onset cancer survivor population. A literature search was conducted between January 1991 to December 2015 using a variety of search terms pertaining to the AYA-onset cancer population and cognitive outcomes. Articles that described cognitive outcomes in AYA-onset cancer survivors without primary or secondary central nervous system lesions diagnosed at ages 14-25 years old were examined and reported. Three articles fulfilled the inclusion criteria. All three evaluated cognitive outcomes in AYA-onset cancer survivors at varying time points after receipt of systemic chemotherapy. Target groups and neuropsychological evaluation techniques differ across studies. All studies reported increased rates of objective or self-reported cognitive impairment in AYA-onset cancer survivors. AYA-onset cancer survivors experience cognitive impairment. Despite the nature of normal adolescent neurodevelopment, chemotherapy exposure during the AYA years may not significantly contribute to cognitive impairment. Chronic cognitive impairment may be associated with chronic complications of cancer therapy. Large-scale standardized, prospective, and longitudinal evaluations of cognitive outcomes specific to AYA-onset cancer survivor population are needed to better understand associated risk factors.

Psychosocial outcomes and interventions among cancer survivors diagnosed during adolescence and young adulthood (AYA): a systematic review.

A cancer diagnosis during adolescence or young adulthood (AYA; defined as ages 15-39) generates unique medical and psychosocial needs as developmental milestones are simultaneously impacted. Past research highlights that AYAs' experiences and psychosocial outcomes are different, and more research and attention is needed. We aimed to identify and synthesize literature regarding psychosocial outcomes, unique needs, and existing psychosocial interventions pertaining to individuals diagnosed with cancer exclusively during AYA, and to highlight areas for future research. A systematic literature search was conducted using MEDLINE (via PubMed), EMBASE, Cochrane, Web of Science, and PsycINFO (via OVID). Grey literature was searched using key term variations and combinations. Overall, 15,301 records were assessed by two independent reviewers, with 38 studies meeting inclusion criteria. Data synthesis of the 38 articles was organized by four main themes based on quality of life and survivorship: physical well-being (7 studies), psychological well-being (8 studies), social well-being (9 studies), and survivorship care (14 studies). The paucity of studies for such broad inclusion criteria highlights that this population is often combined or subsumed under other age groups, missing needs unique to these AYAs. AYA cancer survivors' experiences are nuanced, with interacting variables contributing to post-treatment outcomes. AYAs require age-appropriate and flexible care, informational needs and treatment-related education that foster autonomy for long-term survivorship, as well as improved follow-up care and psychological outcomes. By incorporating these findings into practice, the informational and unmet needs of AYAs can be addressed effectively. Education and programming is lacking specific and general subject matter specific to AYAs, incorporating ranging needs at different treatment stages.

Late new morbidity in survivors of adolescent and young-adulthood brain tumors in Finland: a registry-based study.

Brain tumors (BTs) in adolescence and young adulthood (AYA) differ from those in childhood or late adulthood. However, research concerning late effects in this particular survivor group is limited. This study evaluates late morbidity of survivors diagnosed in AYAs. We identified from the Finnish Cancer Registry all survivors diagnosed with BT at the ages 16-24 years between 1970 and 2004 (N = 315) and used data from the Hospital Discharge Registry to evaluate their late (≥5 y after diagnosis) morbidity requiring treatment in a specialized health care setting. A sibling cohort of BT patients diagnosed before the age of 25 years was used as a comparison cohort (N = 3615). The AYA BT survivors had an increased risk for late-appearing endocrine diseases (HR, 2.9; 95% CI, 1.1-8.0), psychiatric disorders (HR, 2.0; 95% CI, 1.2-3.2), diseases of the nervous system (HR, 9; 95% CI, 6.6-14.0), disorders of vision/hearing loss (HR, 3.6; 95% CI, 1.5-8.5), diseases of the circulatory system (HR, 4.9; 95% CI, 2.9-8.1), and diseases of the kidney (HR, 5.9; 95% CI, 2.5-14.1). Survivors with irradiation had an increased risk for diseases of the nervous system compared with non-irradiated survivors (HR, 3.3; 95% CI, 1.8-6.2). The cumulative prevalence for most of the diagnoses remained significantly increased for survivors even 20 years after cancer diagnosis. The AYA BT survivors have an increased risk of morbidity for multiple new outcomes for ≥5 years after their primary diagnosis. This emphasizes the need for structured late-effect follow-up for this patient group.

Emerging issues among adolescent and young adult cancer survivors.

To review the characteristics of cancer in the adolescence and young adult age group; the medical, psychosocial and behavioral late effects; survivorship care planning and transition; current research priorities; and practice implications. Published articles, research studies and position statements. Survivors of cancers that occurred during adolescence and young adulthood (AYA) are confronted with the dual demands of managing their transition to independent adulthood, concurrently with their transition from cancer patient to cancer survivors, with an associated reduction in support from medical services. AYA survivors also face complex medical, psychosocial and behavioral late effects, including fertility and mental health issues. An understanding of the impact of cancer diagnoses among this age group, including survivors' abilities to reintegrate into 'normal' life and potential long term consequences, is necessary to provide the best support. This care and support can be enhanced through multidisciplinary teams who work together to address the medical and psychosocial needs of AYAs diagnosed with cancer.

Psychosocial outcomes of alcohol involvement and dysphoria in women: a 16-year prospective community study.

Alcohol involvement, dysphoria, and their combined effects, may have long-term psychosocial consequences. However, because of weaknesses in existing literature, the exact relationships are unclear, as are the relative contributions of either construct or their combined effects to later psychosocial outcomes. This study tests the relationships between these conditions during late adolescence andyoung adulthood as predictors of adult marital, relational and job satisfaction; divorce; perceived opportunity; and job stability. We also test the influence of a change (increase or decrease) in alcohol involvement, dysphoria, or their combined association, on adult psychosocial functioning. This study used three waves of data from an ethnically diverse, longitudinal community sample (N = 305 women) assessed over a 16-year span. The measures used have established validity and reliability. Structural equation models revealed that a second-order factor reflecting alcohol involvement and dysphoria during young adulthood was a stronger predictor of psychosocial maladjusument in adulthood than either alcohol involvement or dysphoria alone, predicting decreased satisfaction in multiple psychosocial domains (marriage, relationships and employment). An increase in the shared association between alcohol involvement and dysphoria from late adolescence to young adulthood reduced adult perceived opportunity. Early intervention is crucial. Clinicians should emphasize the screening for and treatment of alcohol involvement, dysphoria, and their combined effects, in late adolescence and young adulthood. Psychoeducational and treatment efforts to raise awareness of long-term consequences of these conditions are critical.