Adolescent Assent Research Articles

Examining risk and protective factors for mental health among school-going tribal adolescents in Meghalaya, India: Insights from the communities that care youth survey [CTC-YS

Risk and protective factors play crucial roles in shaping problem behavior, substance use, and mental health outcomes among adolescents. The study aims to examine the risk and protective factors and their association with emotional and behavioral problems among school-going tribal adolescents in Meghalaya, India. This study employed a cross-sectional design, utilizing a simple random sampling method to select schools from the Ri-Bhoi district (Nongpoh town) and East Khasi Hills district (Shillong cantonment area) of Meghalaya. A total of 450 students participated in the survey, out of which 300 students belonged to tribal ethnicity. The study focused on school-going adolescents with tribal ethnicity, aged 13-19 years, encompassing both genders (male and female). Participation in the study required both parental consent and the adolescent's assent. The Communities That Care Youth Survey (CTC-YS) and the Strength and Difficulty Questionnaires (SDQ), scale were administered. The findings highlighted significant risk factors including laws and norms favorable to drug use, community disorganization, poor family management, and low school commitment. Protective factors such as opportunities for prosocial involvement were evident across all domains. Family conflict, family history of antisocial behavior, and parental overcontrol were significant contributors (P < 0.05) to total difficulty scores. Among individual risk factors, "Interaction with anti-social peers" (P = 0.009) and "Intentions to use substance" (P = 0.021) had significant associations with higher difficulty scores. The overall prevalence of mental health problems, as indicated by the total difficulty score, was 31.3% among school-going tribal adolescents. The high prevalence of mental health problems, especially among tribal adolescents, underscores the urgent need for targeted interventions. By addressing these factors, policymakers and stakeholders can work toward fostering healthier outcomes for tribal adolescents in Meghalaya and similar communities.

Understanding the process of adolescent assent for voluntary male medical circumcision in Zimbabwe: findings from a cross-sectional study

BackgroundVoluntary medical male circumcision (VMMC) is a method for combination HIV prevention for adolescents > 15 years in settings with generalized epidemics. In Zimbabwe, policy currently allows VMMC in adolescents > 15 years old, but there is consideration to lower the threshold to 13 years old. There is a need to understand current practices in assent/consent, and parents’ requirements for assent/consent to inform policy recommendations for the VMMC programme in lowering its age threshold.MethodsCross-sectional surveys were conducted in September 2022 using convenience sampling among three respondent groups: uncircumcised adolescents/young men (AYM) aged 13–16 years (n = 881), circumcised AYM aged 13–20 years (n = 247), and parents of uncircumcised adolescents aged 13–16 years (n = 443). Surveys asked about VMMC knowledge, experiences with mobilisers, circumcised AYM’s assent/consent experiences, and parents’ preferences for assent/consent processes.ResultsKnowledge of VMMC was significantly lower among younger adolescents aged 13–14 than their 15–16 year-old peers. 57% (142/247) of circumcised AYM had a one-to-one discussion with their provider before having the procedure, 32% (80/247) said they were not fully informed about VMMC prior to the procedure, and 54% (134/247) wanted more information about procedure-related pain. Over half (56%, 42/75) of circumcised AYM whose parents had not provided consent in-person for them to receive the procedure reported that their parents had never been contacted to verify consent.ConclusionsThere are gaps in the current assent/consent process for VMMC in Zimbabwe. Providers should be trained to give balanced information on risks and benefits of the procedure, including potential for pain. One-on-one discussions between providers and adolescents prior to the procedure, age-appropriate counselling, and tools for providers to ascertain adolescents’ understanding and ability to provide assent are essential processes, especially if the age threshold is lowered to include younger adolescents. it is also imperative to improve communication with parents, particularly to verify consent for their children has been given, per national guidelines.

Generating evidence to inform responsive and effective actions for Aboriginal and Torres Strait Islander adolescent health and well-being: a mix method protocol for evidence integration ‘the Roadmap Project’

BackgroundAustralia does not have a national strategy for Aboriginal and Torres Strait Islander adolescent health and as a result, policy and programming actions are fragmented and may not be responsive...

A Study on the Clinical Profile of Patients Presenting With Dengue Fever and the Precision Prediction of Dengue Severity Using Platelet Count at Presentation.

Background The most prevalent arbovirus infection in the world, dengue, has become a serious public health issue. This study aims to examine the clinical characteristics of individuals who present with dengue fever and use platelet count prediction to estimate the severity of dengue. Materials and methods This observational, cross-sectional study was conducted at Dr. D. Y. Patil Medical Hospital, Pune, Maharashtra, India, from February 2022 to May 2024. A total of 100 patients older than 12 years old who had dengue fever (presenting within three days of the first symptom)and were dengue NS1 antigen-positive in the laboratory were included. Patients under 12 years of age and pregnant women were excluded. Also excluded were patients with a history of prior dengue infection and patients on medications causing thrombocytopenia, such as antiplatelets (aspirin). Written informed consent was obtained from each patient. For adolescent boys and girls aged 13-18, consent was obtained from a parent or legal guardian along with the adolescent's assent. Data were collected through physical examinations and laboratory investigations. Statistical analysis was performed using IBM SPSS Statistics for Windows, Version 20 (Released 2011; IBM Corp., Armonk, New York), with descriptive statistics and tests for nonparametric data, setting the significance at p<0.05. Results The average age of the study participants was 29.48 ± 10.62 years, with 24% in the 0-20 year age group, 36% in the 21-30 age group, 24% in the 31-40 age group, 12% in the 41-50 age group, 3% in the 51-60 age group, and 1% in the 61-70 age group. Men comprised 65% of the population, with 35% being women. Weakness was the most prevalent symptom, followed by nausea and fever with chills. Patients with dengue fever without warning indications had a median platelet count of 114,000/µL upon admission; those with dengue fever with warning signs had a median count of 35,500/µL; and those with severe dengue had a median count of 25,000/µL. These distinctions attained statistical significance, underscored by p-values of <0.001. The predictive model for severe dengue using platelet count on presentation demonstrated a robust capacity to anticipate severe dengue with a noteworthy association (p<0.04), indicating an increased risk of severe dengue with a lower platelet count (<25,000/µL, odds ratio (OR) 7.5). Conclusion Dengue was more common in the young population, with a predominance of male patients. Weakness was the most common symptom. Patients with a platelet count less than 25,000/µL had 7.5 times more odds of developing severe dengue.

Empowering understanding: navigating consent to ketamine treatment in adolescent mental health.

The rising prevalence of mental health disorders in adolescents, compounded by treatment resistance, underscores the need for innovative interventions. Ketamine, recognized for its rapid antidepressant and anti-suicidal effects in adults, has recently emerged as a potential treatment for adolescents with treatment-resistant depression and suicidality. This paper aims to highlight key elements of the informed consent process, including obtaining parental consent and adolescent assent, and discussing the nature of ketamine treatment, its benefits, and potential risks. Obtaining informed consent for ketamine treatment in this demographic poses unique challenges. During the informed consent process, clinicians should balance an adolescent's growing autonomy with parental consent and address the distinct features of treatment, including ketamine's potential to induce psychedelic-like effects. Additionally, clinicians should highlight the "off-label" use in this population and the uncertainty inherent to treatment at this time, including the lack of data on repeated ketamine exposure on the developing brain. This paper also addresses challenging scenarios related to informed consent for this treatment, such as instances when parents are willing to consent but the adolescent refuses. Alternative treatment strategies such as transcranial magnetic stimulation (TMS) and electroconvulsive therapy (ECT) are also considered. In conclusion, while an emerging body of evidence suggests that ketamine shows potential for the acute treatment of adolescents with severe depression and suicidality, adherence to informed consent principles is paramount to ensure best clinical practices and uphold ethical standards amidst the current landscape of ongoing research.

The Tuberculosis Sentinel Research Network (TB-SRN) of the International epidemiology Databases to Evaluate AIDS (IeDEA): protocol for a prospective cohort study in Africa, Southeast Asia and Latin America

IntroductionTuberculosis (TB) is a leading infectious cause of death globally. It is the most common opportunistic infection in people living with HIV, and the most common cause of their morbidity...

Adolescent assent in research: a relational ethics approach.

Researchers often neglect adolescents' willingness to participate in research. The granting of permission by parents is sometimes not in accordance with the unwillingness of adolescents. Relational ethics is the right approach to overcome inconsistencies between legal and ethical agreements in granting parental permission and adolescent's assent. This is because relational ethics is based on building relationships among many parties. The focus of this case study is to improve understanding of the assent of adolescents through intensive study of research conflict, reinforced using existing research and to understand how relational ethics can be used as an approach in decision-making, especially in conflicts between parental permission and assent from adolescents.

93 Empowering the Next Generation of Clinical &amp; Translational Scientists

OBJECTIVES/GOALS: Biomedical research fields are facing the challenges of demand for skilled workers as well as challenges related to diversity in that workforce. It is important that the healthcare workforce reflect the population it serves. The Exposures Internship seeks to address this by building pathways for youth to pursue careers in research and medicine. METHODS/STUDY POPULATION: In 2021, the Yale Cultural Ambassadors expressed concern about the lack of free high quality, educational offerings for youth that summer. They asked YCCI to consider developing a summer program for students aged 15 and older that focused on spurring interest in careers in healthcare, medicine, and clinical and translational research. The result was a 4-week virtual learning experience for 34 interns who met daily via Zoom and participated in course work, lectures, journal clubs, group projects, and virtual lunches with internationally renowned clinical research and healthcare leaders. Sessions were designed to help interns gain knowledge of and exposure to current topics in clinical and translational science and to observe the various steps of proposing, designing, undertaking, and analyzing clinical trials. RESULTS/ANTICIPATED RESULTS: YCCI received over 900 inquiries from around the world with more than 200 completed applications for participation in the internship for the pilot year. Since then, YCCI leadership has worked with community partners to engage young scholars from 17 different states, Canada, Mexico and Puerto Rico. Of those, we estimate 75% are minority, ~50% female and 20% from rural areas with limited similar opportunities. During the four weeks of the program these highly motivated students worked on projects aimed at increasing participation in pediatric research through a revised Informed consent and adolescent assent process and a youth centered awareness campaign. Interns were so inspired that they requested the program be continued beyond the initial four weeks. As such, YCCI continued to offer sessions throughout the year. DISCUSSION/SIGNIFICANCE: In evaluation of the pilot program 95% of respondents strongly agreed that the program exposed them to new information about clinical and translational research. One intern shared, This program has unquestionably made me consider becoming a researcher in the future with the goal of becoming a principal investigator within my interest in medicine.

A novel method for evaluating physician communication: A pilot study testing the feasibility of parent-assisted audio recordings via Zoom.

Quality of physician consultations are best assessed via direct observation, but require intensive in-clinic research staffing. To evaluate physician consultation quality remotely, we pilot tested the feasibility of parents using their personal mobile phones to facilitate audio recordings of pediatric visits. Across four academic pediatric primary care clinics, we invited all physicians with a patient panel (n=20). For participating physicians, we identified scheduled patients from medical records. We invited parents to participate via text message and phone calls. During their adolescent's appointment, parents used their mobile phone to connect to Zoom for remote research staff to audio record. In Spring 2021, five of 20 (25%) physicians participated. During a nine-week period, we invited parents of all 54 patients seen by participating physicians of which 15 (28%) completed adult consent and adolescent assent and 10 (19%) participated. For 9 recordings, at least 45% of the conversation was audible. It was feasible and acceptable to directly observe physician consultations virtually with Zoom, although participation rates and potentially audio quality were lower. Patients used their cellular phone calling features to connect to Zoom where research staff audio-recorded their physician consultation to evaluate communication quality.

Cyberbullying perpetration and victimisation amongst adolescent psychiatric patients at Lentegeur Hospital, South Africa.

BackgroundCyberbullying is a type of harassment that is perpetrated or experienced by a person or groups of persons via the use of electronic devices, and it frequently occurs amongst young people. Research has shown that cyberbullying is associated with psychiatric comorbidity, which could indicate a need for screening adolescents who present for mental health services.AimThis study aimed to determine the prevalence of cyberbullying amongst adolescents. The secondary aim was to determine the Diagnostic and Statistical Manual of Mental Disorders (DSM)-5 psychiatric diagnoses associated with cyberbullying.SettingLentegeur Hospital Child and Adolescent Mental Health Service in the Western Cape, South Africa.MethodsThis cross-sectional study included a convenience sample of 97 participants (sampled from both inpatient and outpatient services) between the ages of 13 years and 18 years. Adolescent assent and parental consent were obtained. Demographic and clinical data were collected from patient folders, and the Revised Cyber Bullying Inventory II was used to assess cyberbullying behaviours.ResultsThe overall prevalence rate of some form of cyberbullying in this sample was 56.7%, of which 6.2% were cyberbullies, 20.6% were cyber-victims and 29.9% were cyberbullies and cyber-victims. Female participants were more likely to be involved in cyberbullying than males. The most prevalent primary psychiatric diagnoses in adolescents involved in cyberbullying included major depressive disorder (72.4%), schizophrenia (57.1%) and attention deficit hyperactivity disorder (22%). There was no significant association between cyberbullying and any psychiatric diagnoses.ConclusionThe high prevalence rate of adolescents involved in cyberbullying suggests that this behaviour is a cause for concern in the South African population. More screening and treatment programmes should be implemented to address this issue.

Qualitative inquiry into adolescents\u2019 experience of ethical challenges during enrollment and adherence to antiretroviral therapy (ART) in Temeke Regional Referral Hospital, Tanzania

BackgroundAdolescents living with human immunodeficiency virus (HIV) experience challenges, including lack of involvement in their care as well nondisclosure of HIV status, which leads to poor adherence to antiretroviral therapy (ART). Parents have authority over their children, but during adolescence there is an increasing desire for independence. The aim of the study was to explore adolescents’ experience of challenges identified by adolescents ages 10–19 years attending HIV care and treatment at Temeke Regional Referral Hospital in Tanzania.MethodsAn exploratory descriptive qualitative design was employed in the HIV Care and Treatment Centre (CTC) in the Out-Patient Department at the Temeke Regional Referral Hospital in Tanzania with adolescents living with HIV who were 10–19 years of age. A total of 22 adolescents participated in semi-structured face-to-face interviews after parental consent and adolescent assent were obtained. Participants were interviewed about their participation in decisions to be tested for HIV and enrolled in the CTC, concerns surrounding disclosure of their HIV status to the adolescent or to others, stigma and discrimination, and the effect of these challenges on their adherence to medication. All interviews were audio-taped, transcribed verbatim in Swahili, and back-translated to English. Data analysis included both inductive and deductive thematic analysis.ResultsQualitative themes identified included lack of participation in decisions about HIV testing, challenges to enrollment in care and treatment; issues around disclosure of HIV status, such as delays in disclosure to the adolescent and disclosure to other persons and benefits and harms of such disclosures; and factors supporting and interfering with adherence to ART, such as parental support, organizational (clinic) support and problems, and self-stigmatization and shame.ConclusionLack of adolescents’ involvement in their care decision making and delayed disclosure of HIV status to the adolescent were identified concerns, leading to poor adherence to ART among adolescents. Disclosure to others, especially teachers, helped adolescents at school to take their medication properly. Disclosure to others led to stigma and discrimination for some adolescents. More research is needed to better understand the role of disclosure and its benefits and challenges for HIV-positive adolescents in Tanzania.

Adolescent Assent and Reconsent for Biobanking: Recent Developments and Emerging Ethical Issues.

Research biobanks that enroll minors face important practical, ethical, and regulatory challenges in reconsenting participants when they reach the age of 18. Federal regulations governing research in the United States provide minimal guidance and allow for a range of practices, including waiving the requirement to obtain reconsent. Some commentators have argued that institutional review boards should indeed grant such waivers, given the low risks of biobank-based research and the impracticality of contacting all participants when they turn 18. There is also significant ethical debate about the age at which adolescents can make authentic, autonomous decisions regarding their research participation. This paper reviews these issues in detail, describes the current state of the ethical discussion, and outlines evidence-based policies for enrolling minors into research biobanks.

Effectiveness of the Adolescent Depression Awareness Program (ADAP) on Depression Literacy and Mental Health Treatment.

Analysis of data from a NIMH-supported study was conducted to evaluate the effectiveness of the Adolescent Depression Awareness Program (ADAP) in promoting depression literacy and help-seeking behavior. Eighteen Pennsylvania schools were matched on size, sex, race, test scores, median income, and free/reduced lunch status. Schools randomized to the intervention implemented ADAP as a compulsory part of the schools health curriculum, while control schools collected study measures. Post-randomization analysis revealed no significant differences by sex on the pre-assessments between intervention and control schools. In the intervention schools, a total of 1427 students received ADAP. Written parental consent and adolescent assent was obtained from 33.7% students. The online REDCap survey was completed by 41.78% of the consenting students. The Adolescent Depression Knowledge Questionnaire (ADKQ) findings suggest that ADAP significantly improved depression knowledge (Est. =1.07, SE =.25, p < .001), compared to those in the control group. ADAP was found to facilitate help-seeking behavior by student report in those participating in the REDCap survey 4 months following the ADAP curriculum. Results of the survey suggests that ADAP facilitates help-seeking behaviors in teens. This study supports the efficacy of a teacher delivered school-based universal prevention program, ADAP, on depression literacy.

Assessment of participation biases for a confidential non-anonymous adolescent study: A based population study

A prospective study often receives a low participation rate that may alter the results quality. This study assessed the participation bias for a confidential non-anonymous adolescent survey among 1559 middle-school adolescents from north-eastern France (mean age 13.5 ± 1.3). They completed an anonymous questionnaire gathering demographic/socioeconomic features as well as school, behavior and health-related difficulties, and adolescent's assent to participate with perceived parents’ consent (APC) if they were contacted for a confidential non-anonymous survey at home. Such a survey received an APC of 60%. The logistic model including all socioeconomic factors and school, behavior and health-related difficulties showed that the adolescents with APC were less often male (adjusted odds ratio = 0.77, p = 0.014), non-European immigrant (0.48, p = 0.016), living with a single parent (0.72, p = 0.046), in manual-worker families (0.69, p = 0.007), had less often low parents’ education (0.70, p = 0.002), body-mass-index measurement refusal (0.60, p = 0.010), no regular physical/sports activity (0.70, p = 0.035), poor social relationships (0.73, p = 0.046) and poor living environment (0.63, p = 0.007). The percentage of subjects with APC steadily decreased with the number of these criteria: from 74% for 0 criterion to 19% for 6–8 criteria. Because of these possible strong participation biases the construction of adolescent cohorts and the results interpretation should be made with prudence.

Using Photovoice to examine adolescents' experiences receiving mental health services in the United States.

In the U.S., fewer than half of children and adolescents who report mental disorders receive care and the needs of those who receive care have yet to be explored. There is a scarcity of studies examining the needs of adolescents with mental conditions and at risk for suicide. Learning directly from the adolescents can fill in this gap by providing insight that clinicians and researchers lack about adolescents' experience. This study uses Photovoice, a Community-Based Participatory Research method that involves focus groups and the use of cameras by participants to visually capture their reality and express their ideas through photographs. By using Photovoice, this study aims to provide an opportunity for adolescents to voice their own perspectives and for researchers and clinicians to gain an understanding of adolescents' life experience away from the treatment setting, as well as their experience as consumers of mental health services. Four participants, including two 15 year olds and two 17 year olds, were recruited from a mental health clinic in New York City. Parental consent and adolescent assent were collected per Institutional Review Board requirements. Thematic analysis was used to identify and report response patterns. Four themes emerged: (i) sense of self, (ii) family, (iii) suicidal ideation and (iv) treatment. Findings suggest that Photovoice is valued by adolescents and leads to critical thinking, self-reflection, discovering strengths and social support. Adolescents reported feeling empowered, which is the ultimate goal of Photovoice. Photovoice presents a powerful opportunity to be used as therapeutic strategy with adolescents that demands further research.

A cognitive approach for design of a multimedia informed consent video and website in pediatric research

ObjectivePoor participant comprehension of research procedures following the conventional face-to-face consent process for biomedical research is common. We describe the development of a multimedia informed consent video and website that incorporates cognitive strategies to enhance comprehension of study related material directed to parents and adolescents. Materials and methodsA multidisciplinary team was assembled for development of the video and website that included human subjects professionals; psychologist researchers; institutional video and web developers; bioinformaticians and programmers; and parent and adolescent stakeholders. Five learning strategies that included Sensory-Modality view, Coherence, Signaling, Redundancy, and Personalization were integrated into a 15-min video and website material that describes a clinical research trial. ResultsA diverse team collaborated extensively over 15months to design and build a multimedia platform for obtaining parental permission and adolescent assent for participant in as asthma clinical trial. Examples of the learning principles included, having a narrator describe what was being viewed on the video (sensory-modality); eliminating unnecessary text and graphics (coherence); having the initial portion of the video explain the sections of the video to be viewed (signaling); avoiding simultaneous presentation of text and graphics (redundancy); and having a consistent narrator throughout the video (personalization). DiscussionExisting conventional and multimedia processes for obtaining research informed consent have not actively incorporated basic principles of human cognition and learning in the design and implementation of these processes. The present paper illustrates how this can be achieved, setting the stage for rigorous evaluation of potential benefits such as improved comprehension, satisfaction with the consent process, and completion of research objectives. ConclusionNew consent strategies that have an integrated cognitive approach need to be developed and tested in controlled trials.

Ethical Barriers in Adolescent Oncofertility Counseling.

Adult survivors of pediatric cancers are at substantial risk for infertility. Oncofertility is an emerging field in medicine that has focused on the fertility preservation of these patients. As the field continues to develop, there are several areas in which our practice has improved. However, several ethical concerns still exist involving beneficence, nonmaleficence, informed consent, adolescent assent, and posthumous use of reproductive tissues. Because the field is still developing, great disparities exist in available options depending on age, ability to pay, and geographic location. Such discrepancies in access may lead to health disparities in the adolescent patient population. As the science continues to make future fertility more feasible, the ethical questions will continue to be more complex. The purpose of this article is to review some of the developments regarding oncoferility and address future directions for research and inquiry in specific areas.

A randomized study of a method for optimizing adolescent assent to biomedical research

ABSTRACTPurpose: Voluntary consent/assent with adolescents invited to participate in research raises challenging problems. No studies to date have attempted to manipulate autonomy in relation to assent/consent processes. This study evaluated the effects of an autonomy-enhanced individualized assent/consent procedure embedded within a randomized pediatric asthma clinical trial. Methods: Families were randomly assigned to remain together or separated during a consent/assent process; the latter we characterize as an autonomy-enhanced assent/consent procedure. We hypothesized that separating adolescents from their parents would improve adolescent assent by increasing knowledge and appreciation of the clinical trial and willingness to participate. Results: Sixty-four adolescent–parent dyads completed procedures. The together versus separate randomization made no difference in adolescent or parent willingness to participate. However, significant differences were found in both parent and adolescent knowledge of the asthma clinical trial based on the assent/consent procedure and adolescent age. The separate assent/consent procedure improved knowledge of study risks and benefits for older adolescents and their parents but not for the younger youth or their parents. Regardless of the assent/consent process, younger adolescents had lower comprehension of information associated with the study medication and research risks and benefits, but not study procedures or their research rights and privileges. Conclusions: The use of an autonomy-enhanced assent/consent procedure for adolescents may improve their and their parent's informed assent/consent without impacting research participation decisions. Traditional assent/consent procedures may result in a “diffusion of responsibility” effect between parents and older adolescents, specifically in attending to key information associated with study risks and benefits.

Parental Consent for Adolescent Research.

The purpose of this article is to increase understanding about how to obtain institutional review board approval to waive parental consent for adolescent research that involves minimal risk to subjects and/or that cannot be carried out practicably without the waiver. Because of IRB guidelines, the researchers were unable to use passive parental consent for a study of adolescent nonmedical prescription drug use (NMPDU). Without knowledge of waiver 45 C.F.R. §46.116 of the U.S. Department of Health and Human Services Code of Federal Regulations regarding the protection of human research subjects, the study design required active parental consent for survey administration. This requirement limited study participation and increased costs. Using the waiver, the study design could have waived parental consent with adolescent assent. By increasing awareness of the 45 C.F.R. §46.116 waiver and its subparts, the researchers hope to inform future researchers about reducing barriers to future adolescent research. Lessons learned include how using the waiver may decrease research costs, reduce participant selection bias, increase participant response rate, and expand data available to contribute to critical, emerging adolescent health issues such as NMPDU.

Empirically Derived Knowledge on Adolescent Assent to Pediatric Biomedical Research

Background: There has been a recent growth in empirical research on assent with pediatric populations, due in part to the demand for increased participation of this population in biomedical research. Despite methodological limitations, studies of adolescent capacities to assent have advanced and identified a number of salient psychological and social variables that are key to understanding assent. Methods: The authors review a subsection of the empirical literature on adolescent assent focusing primarily on asthma and cancer therapeutic research; adolescent competencies to assent to these studies; perceptions of protocol risk and benefit; the effects of various social context variables on adolescent research participation decision making; and the interrelatedness of these psychological and social factors. Results: Contemporary studies of assent, using multivariate methods and updated approaches to statistical modeling, have revealed the importance of studying the intercorrelation between adolescents’ psychological capacities and their ability to employ these capacities in family and medical decision-making contexts. Understanding these dynamic relationships will enable researchers and ethicists to develop assent procedures that respect the authority of parents, while at the same time according adolescents appropriate decision-making autonomy. Conclusions: Reviews of empirical literature on the assent process reveal that adolescents possess varying capacities for biomedical research participation decision making depending on their maturity and the social context in which the decision is made. The relationship between adolescents and physician-investigators can be used to attenuate concerns about research protocols and clarify risk and benefit information so adolescents, in concert with their families, can make the most informed and ethical decisions. Future assent researchers will be better able to navigate the complicated interplay of contextual and developmental factors and develop the empirical bases for research enrollment protocols that will support increased involvement of adolescents in biomedical research.