Population Sample Of Adolescents Research Articles

Examination of Accelerometer Reactivity Among a Population Sample of Children, Adolescents, and Adults.

To examine whether accelerometer-measured physical activity-based reactivity was present in a nationally representative sample of U.S. children (6-11 yrs), adolescents (12-17 yrs), and adults (≥20 yrs). Data from the 2003-2006 National Health and Nutrition Examination Survey (N = 674, 6-85 yrs) were used. Physical activity (PA) was assessed using the ActiGraph 7164 accelerometer, with PA assessed over 7 days of monitoring. Two PA metrics were assessed, including activity counts per day (CPD) and time spent in moderate-to-vigorous PA. Evidence of reactivity was defined as a statistically significantly change in either of these 2 PA metrics from day 1 of monitoring to days 2 or 3, with day 1 of monitoring being a Monday. Suggestion of reactivity was observed only for the adult population where CPD from days 2 and 3 (297,140.6 ± 7920.3 and 295,812.9 ± 8364.9), respectively, differed significantly from day 1 (309,611.5 ± 9134.9) over the monitoring period (4.0% to 4.5% change). The analysis was conducted 2 additional times with differing start days (Tuesday and Wednesday), and this approach failed to demonstrated a reactive presence. In this national sample of U.S. children, adolescents and adults, we did not observe sufficient evidence of accelerometer reactivity.

Effect of family structure and TPH2 G-703T on the stability of dysregulation profile throughout adolescence

BackgroundTwo different polymorphisms (TPH2 G-703T and 5-HTTLPR) involved in the serotonergic pathway have been reported to play a role, both alone and in interaction with the environment, in early and adult emotion regulation. As most of these studies are cross-sectional, we know little about the impact of these polymorphisms over time, particularly during adolescence. MethodsBecause we were interested in the effects of these polymorphisms and environment (i.e., family structure) at different time-points on the emotional dysregulation profile, we performed a path analysis model in a general adolescent population sample of a five-year follow-up study. ResultsWe found a high stability of Dysregulation Profile problems independently from the examined allelic variants. We also found that early family structure directly influences the levels of dysregulation problems in early adolescence, both alone and in interaction with TPH2, suggesting the presence of a gene-environment interaction effect. Furthermore, we found that in adolescents homozygous for the TPH2 G allele, the effect of the early family structure remains active during late adolescence, albeit mediated by earlier emotional problems. LimitationsThe high attrition rate, the use of only one source on behavioral problems of adolescents, and the focus on a single polymorphism in the investigated genes could limit the generalizability of the present results. ConclusionsThese results suggest that early family structure could play a significant role in the development and maintenance of emotional and behavioral problems not only in early adolescence but also in late-adolescence, although this effect was mediated and moderated by behavioral and genetic variables.

The longitudinal association between psychotic experiences, depression and suicidal behaviour in a population sample of adolescents.

PurposeWhilst psychotic experiences are associated with suicidal behaviour in a number of studies the value of psychotic experiences for the prediction of suicidal behaviour and the role of depressive symptoms in this relationship is not clear. We examined the association between psychotic experiences and subsequent suicidal behaviour and examine the role of depressive symptoms in this relationship.MethodsPsychotic experiences and depressive symptoms at age 12 and 16 years, and suicidal behaviour at age 16 years were assessed in participants (prospective analysis n = 3171; cross-sectional analysis n = 3952) from a population-based cohort.ResultsPsychotic experiences (OR 1.75 95 % CI 1.20, 2.54) and depression (OR 3.97 95 % CI 2.56, 6.15) at 12 years were independently associated with suicidal behaviour at 16 years after adjustment for confounding. There was no evidence that the relationship between psychotic experiences and suicidal behaviour was stronger in participants who were also depressive. A ROC analysis showed that adding information on psychotic experiences to measures of depressive symptoms had hardly any effect on improving prediction of suicidal behaviour (AUC increased from 0.64 to 0.65). Whereas adding a measure of depressive symptoms to the measure of psychotic experiences improved prediction substantially (AUC 0.56–0.65).ConclusionsPsychotic experiences and depression are independently associated with suicidal behaviour although the association with depression is substantially stronger. Psychotic experiences alone are not a strong predictor of later suicidal behaviour and add little to predicting the risk of suicidal behaviour over and above the information provided by depressive symptoms.

Weight perceptions in a population sample of English adolescents: cause for celebration or concern?

Objectives:To examine the proportion of normal-weight adolescents who consider themselves to be too heavy (size overestimation), and the proportion of overweight or obese adolescents who consider themselves to be about the right weight or too light (size underestimation), in large population-based samples collected over 8 years in England.Methods:Data were from the Health Survey for England between 2005 and 2012: an annual survey of households representative of the English population. We analysed data from 4979 adolescents (2668 boys, 2311 girls) aged 13 to 15 years old whose weight status was defined as normal weight or overweight/obese based on body mass index standard deviation scores (BMI-SDS) derived from objective measurements of height and weight and using International Obesity Task Force standards. Weight perception was based on the adolescent's choice from the following descriptors: ‘about the right weight', ‘too heavy' or ‘too light'.Results:The majority of normal-weight adolescents (83% of boys, 84% of girls) correctly identified themselves as ‘about the right weight'. Overestimation was uncommon, with only 7% of normal-weight teens (4% of boys, 11% of girls) identifying themselves as ‘too heavy'. In contrast, only 60% of overweight/obese adolescents (53% of boys, 68% of girls) correctly identified themselves as ‘too heavy', whereas 39% (47% of boys, 32% of girls) underestimated, identifying themselves as ‘about the right weight' or ‘too light'. There were no significant changes in BMI-SDS or body size estimation over time (2005–2012).Conclusions:Overestimation of body weight among normal-weight adolescents is relatively uncommon; potentially a cause for celebration. However, almost half of boys and a third of girls with a BMI placing them in the overweight or obese BMI range perceived themselves to be about the right weight. Lack of awareness of excess weight among overweight and obese adolescents could be a cause for concern.

Prevalence of Eating Disorder Risk and Associations with Health-related Quality of Life: Results from a Large School-based Population Screening.

The objective of this study was to investigate the prevalence of eating disorder (ED) risk as well as associated psychopathology and health-related quality of life (HrQoL) in a large population sample of Austrian adolescents. A sample of 3610 adolescents aged 10-18 years was recruited from 261 schools representative for the Austrian population. The SCOFF questionnaire was used to identify participants at risk for EDs, and the Youth Self-Report and KIDSCREEN were used to assess general psychopathology and HrQoL. In total, 30.9% of girls and 14.6% of boys were screened at risk for EDs. SCOFF scores were significantly associated with internalising and externalising behavioural problems as well as HrQoL after controlling for sex, age and body mass index. The SCOFF score further turned out to be an independent predictor of HrQoL. The high prevalence of ED risk among Austrian adolescents points out the need for prevention in this field. Variables indicating eating pathology should be included in general mental health screenings.

Adolescent health and adaptation in Canada: examination of gender and age aspects of the healthy immigrant effect.

IntroductionA longstanding and widely held assumption is that immigrants suffer from ill health and adaptation problems. Yet recent studies show that immigrants report the same or better state of health compared to their native-born counterparts. This phenomenon, known as the healthy immigrant effect, has been found in studies of specific health conditions of adults. The present study focuses instead on adolescents and extends its examination of the healthy immigrant effect, measuring both health and adaptation.MethodsUsing data from population samples in the Canadian Community Health Survey (2007), foreign-born immigrant adolescents (n = 920) were compared to non-immigrant adolescents (n = 13,572) for their self-report to questionnaire items for health (general health, mental health, chronic illnesses with psychosomatic symptoms, and psychological illnesses) and adaptation (daily life stress, life satisfaction, and sense of belonging). Adolescents’ gender, age, and length of residence were analyzed for the effects.ResultsImmigrant adolescents were better than non-immigrant peers on the four health measures, and did not differ from non-immigrants on the three adaptation measures despite having less household income and more family members in the household. Immigrant girls exhibited more resilient adaptability, while young immigrant boys and older non-immigrant girls displayed some potential vulnerability. Length of residence, on the other hand, did not contribute to differences for the health and adaptation of immigrant adolescents.ConclusionsThe healthy immigrant effect was confirmed in a community population sample of adolescents in Canada. Foreign-born immigrant adolescents experience better health, as well as good adaptation equal to their native-born peers. These outcomes call for further research on sustaining good health and adaptation of the immigrant population, in particular by providing age-related effective services and prevention strategies.

Adolescent loneliness and psychiatric morbidity in the general population: Identifying “at risk” groups using latent class analysis

Background: Previous research has shown that loneliness is strongly associated with both physical and psychological ill health, particularly among adolescents. Factor analytic research has also shown that loneliness is a multi-dimensional construct, characterized by e.g. feelings of isolation, and relational and collective connectedness. While factor analytic representations of the phenomenon effectively illustrate the structure and form of the loneliness construct, they may not adequately capture its expression in the population within, among and across individuals. Method: The current study modelled the expression of loneliness among a population sample of Northern Irish adolescents using latent class analysis. Data from the Young Life and Times Survey (2011) was used to identify the fewest groups of adolescents in the population characterized by discrete and shared loneliness profiles based on their responses to the UCLA Loneliness Scale (UCLA-LS). Individual “at risk” status for psychiatric morbidity was then assessed on the basis of LCA-group membership. Results: Four groups of adolescents were identified: 1) high loneliness, characterized predominantly by feelings of isolation, 2) intermediate loneliness (two groups), and a baseline group with low levels of loneliness. While all groups were more likely to screen positive for psychiatric morbidity compared with the baseline group, notable risk, however, was attributable to specific isolation experiences or disconnectedness, that characterized both the profiles of the high loneliness group and the similar, but less severe, intermediate loneliness group. Conclusions: Loneliness is distributed throughout the adolescent population; however, among a significant minority, loneliness is predominantly characterized by feelings of isolation and is strongly indicative of psychological ill health.

Self-Esteem in a German Population Sample of Children and Adolescents: Association with Demographic and Psychosocial Variables

Research has shown that high self-esteem (SE) is a core feature of psychological health and well-being. A population sample of German youths (11-16 years, n = 3509) was surveyed in 2 waves regarding SE and various demographic and psychosocial variables assumed to be related. Parents’ reports were also gathered about their children. Mean SE-scores indicated a generally high level of SE in the sample. Girls displayed significantly lower SE than boys with an effect size of d=0.34. Moderate to strong associations were found with satisfaction in different domains of life, with the highest correlation found for appearance and the lowest for health. Girls were in general more dissatisfied with life. Internalizing and also externalizing were negatively correlated with SE, particularly in girls. Also a higher level of somatic symptoms was associated with lower SE. A prospective analysis revealed that dysfunctional parenting and family climate significantly predicted SE explaining more than 20% of variance in SE in girls, but only 10% in boys. Structural social data (e.g. SES) did not impact SE. The study confirmed the significant role of SE for psychological and somatic well-being and the relevance of familial interaction in its formation. The observed gender differences underline the necessity to undertake sex specific analyses in this area of research. Prospective research should be expedited.

Effect of the serotonin transporter gene and of environment on the continuity of anxiety and depression traits throughout adolescence

Aims. Many studies of various stress reactive phenotypes suggest that 5-HTTLPR short allele carriers (S-carriers) are characterised by the stable trait of negative affectivity that is converted to psychopathology only under conditions of stress. In this study, we examined the moderating role of the 5-HTTLPR on the relationship between two objective chronic risk factors, i.e. socioeconomic status (SES) and family structure, and internalising symptoms across adolescence. Methods. A multigroup path analysis was employed in a general adolescent population sample of a 5-year follow-up study. Results. Internalising problems were significantly more stable in the S-carriers. The focus on the main dimensions of internalising problems, i.e. anxiety and depression, revealed two different developmental patterns. In the S-carriers Anxiety problems seemed to be more stable and to predict a possible evolution towards the development of Depressive problems. In the long allele homozygotes (LL-subjects) the anxiety trait was significantly less stable, and, in late-adolescence, seemed to be significantly predicted by SES, suggesting a possible gene-environment interaction (G×E). Family structure seemed to play a role in a G×E perspective only until early-adolescence, while during late-adolescence SES seemed to play a pivotal role in interaction with 5-HTTLPR, with the S-allele playing a protective role. Conclusions. Future models of the developmental link between environmental adversities and internalising behaviour therefore need to consider that the effect of G×E interaction, may be associated with internalising behaviour via different mechanisms during different time frames and that shifts in the strength of this effect should be expected across development.

Characterization of Psychotic Experiences in Adolescence Using the Specific Psychotic Experiences Questionnaire: Findings From a Study of 5000 16-Year-Old Twins

We aimed to characterize multiple psychotic experiences, each assessed on a spectrum of severity (ie, quantitatively), in a general population sample of adolescents. Over five thousand 16-year-old twins and their parents completed the newly devised Specific Psychotic Experiences Questionnaire (SPEQ); a subsample repeated it approximately 9 months later. SPEQ was investigated in terms of factor structure, intersubscale correlations, frequency of endorsement and reported distress, reliability and validity, associations with traits of anxiety, depression and personality, and sex differences. Principal component analysis revealed a 6-component solution: paranoia, hallucinations, cognitive disorganization, grandiosity, anhedonia, and parent-rated negative symptoms. These components formed the basis of 6 subscales. Correlations between different experiences were low to moderate. All SPEQ subscales, except Grandiosity, correlated significantly with traits of anxiety, depression, and neuroticism. Scales showed good internal consistency, test-retest reliability, and convergent validity. Girls endorsed more paranoia, hallucinations, and cognitive disorganization; boys reported more grandiosity and anhedonia and had more parent-rated negative symptoms. As in adults at high risk for psychosis and with psychotic disorders, psychotic experiences in adolescents are characterized by multiple components. The study of psychotic experiences as distinct dimensional quantitative traits is likely to prove an important strategy for future research, and the SPEQ is a self- and parent-report questionnaire battery that embodies this approach.

C-reactive protein and substance use disorders in adolescence and early adulthood: A prospective analysis

BackgroundDysregulated immune function and elevated inflammation markers are seen in adults with chronic diseases, including some psychiatric disorders, but evidence on inflammation in the case of drug abuse is conflicting. ObjectiveTo test the concurrent and predictive relations between C-reactive protein (CRP) and use and abuse of alcohol, nicotine and cannabis in a longitudinal, population sample of adolescents and young adults, at the period of highest increase in drug use. MethodsData from the prospective population-based Great Smoky Mountains Study (N=1420) were used, covering children in the community assessed at ages 9–16, 19, and 21. Structured interviews were used to assess substance abuse symptoms and DSM-IV substance use disorders. Bloodspots were collected at each assessment and assayed for CRP. ResultsCRP levels were higher in the presence of nicotine, alcohol, and cannabis use and nicotine dependence. In prospective analyses, higher CRP levels predicted cannabis use and nicotine dependence, and nicotine use predicted higher CRP levels, once covariates were included in the models. Significant covariates were age, race (American Indian), and obesity. ConclusionsThe inter-relationship of CRP and substance abuse has implications for the later health risks associated with early drug and alcohol use and abuse.

Corticotropin (ACTH)-reactive immunoglobulins in adolescents in relation to antisocial behavior and stress-induced cortisol response. The TRAILS study

Elevated levels of corticotropin (ACTH)-reactive immunoglobulins (ACTH IgG) were found in males with conduct disorder, suggesting their involvement in the biology of antisocial behavior. We first aimed to confirm these findings in a large general population sample of adolescents. Secondly, we studied the association between ACTH IgG levels and hypothalamic-pituitary-adrenal (HPA) axis response to stress. Free and total ACTH IgG levels were measured in sera of 1230 adolescents (15-18 years). HPA axis activity was determined by measuring salivary cortisol before, during, and after a social stress test. Antisocial behavior was assessed using the Antisocial Behavior Questionnaire. ACTH peptide and IgG affinity kinetics for ACTH were assayed in a subsample of 90 adolescents selected for high or low ACTH IgG levels. In boys, higher total ACTH IgG levels were associated with higher antisocial behavior scores (β=1.05, p=0.04), especially at high levels of free ACTH IgG. In girls, antisocial behavior was associated with low free ACTH IgG levels (β=-0.20, p=0.04). Stress-induced cortisol release was associated with free ACTH IgG in boys (βareaunderthecurve=-0.67, p<0.01), and with total ACTH IgG in girls (βrecovery=0.84, p=0.05). The affinity kinetics assay showed that ACTH IgG association rates were lower in both boys and girls with high ACTH IgG levels. These data show that ACTH IgG levels are related to antisocial behavior and HPA axis response to stress in adolescents. The mechanisms behind these associations, including different ACTH binding properties of IgG in subjects with antisocial behavior, deserve further attention.

Physical activity and onset of depression in adolescents: A prospective study in the general population cohort TRAILS

Although it has often been suggested that physical activity and depression are intertwined, only few studies have investigated whether specific aspects of physical activity predict the incidence of major depression in adolescents from the general population. Therefore the aim of this study was to investigate the effects of nature, frequency, duration and intensity of physical activity during early adolescence on the onset of a major depressive episode in early adulthood. In a population sample of adolescents (N = 1396), various aspects of physical activity were assessed at early adolescence (mean age 13.02, SD = 0.61). Major depressive episode onset was assessed using the Composite International Diagnostic Interview. A Cox regression model was performed to investigate whether physical activity characteristics and their interactions with gender predicted a major depressive episode onset up until mean age 18.5 (SD = 0.61). The individual characteristics of physical activity (nature, frequency, duration and intensity) or their interactions with gender did not predict a major depressive episode onset (p values >0.05). So far, there is no prospective evidence that physical activity protects against the development of adolescent depressive episodes in either boys or girls.

Does the Revised Child Anxiety and Depression Scale (RCADS) measure anxiety symptoms consistently across adolescence? The TRAILS study

We assessed if the Revised Child Anxiety and Depression Scale (RCADS) measures anxiety symptoms similarly across age groups within adolescence. This is crucial for valid comparison of anxiety levels between different age groups. Anxiety symptoms were assessed biennially in a representative population sample (n = 2226) at three time points (age range 10-17 years) using the RCADS anxiety subscales (generalized anxiety disorder [GAD], obsessive-compulsive disorder [OCD], panic disorder [PD], separation anxiety [SA], social phobia [SP]). We examined longitudinal measurement invariance of the RCADS, using longitudinal confirmatory factor analysis, by examining the factor structure (configural invariance), factor loadings (metric invariance) and thresholds (strong invariance). We found that all anxiety subtypes were configural invariant. Metric invariance held for items on the GAD, OCD, PD and SA subscales; yet, for the SP subscale three items showed modest longitudinal variation at age 10-12. Model fit decreased modestly when enforcing additional constraints across time; however, model fit for these models was still adequate to excellent. We conclude that the RCADS measures anxiety symptoms similarly across time in a general population sample of adolescents; hence, measured changes in anxiety symptoms very likely reflect true changes in anxiety levels. We consider the instrument suitable to assess anxiety levels across adolescence.

Working Memory Capacity and Psychotic-Like Experiences in a General Population Sample of Adolescents and Young Adults

Working memory (WM) impairment is a common feature in individuals with schizophrenia and high-risk for psychosis and a promising target for early intervention strategies. However, it is unclear to what extent WM impairment parallels specific behavioral symptoms along the psychosis continuum. To address this issue, the current study investigated the relation of WM capacity with psychotic-like experiences (PLEs) in a large Swedish population sample (N = 1012) of adolescents and young adults (M = 24.4 years, range 12–35). WM was assessed with two online computer tasks: a task where participants had to identify and remember the location of an odd shape and a task of remembering and following instructions. PLE scores were derived from a translated symptom questionnaire (Community Assessment of Psychic Experiences), which includes positive, negative, and depressive symptom scales. Positive and negative symptom scales were further subdivided into symptom clusters based on factor analyses. The results showed that low WM capacity was modestly associated with increased reports of bizarre experiences (BE) and depressive symptoms, after controlling for age, gender, and global symptom scores. Interestingly, when analyses were repeated for separate age groups, low WM was exclusively associated with a higher frequency of BE for young adults (20–27 years) and with depressive symptoms for older adults (28–35 years). These findings suggest that specific PLEs can be indicative of reduced WM capacity in early adulthood, which in turn may reflect an increased risk for psychosis and a greater need for targeted intervention. In contrast, during adolescence individual differences in cognitive development may influence the strength of the relationships and thereby mask potential vulnerabilities for psychopathology.

How does emotional wellbeing relate to underachievement in a general population sample of young adolescents: a neurocognitive perspective

Underachievement in school during early adolescence predicts future economic and personal difficulties. Particular neurocognitive skills on the domain of executive functions start to mature during adolescence. This fact and the physical and psychological changes typical for the transition from childhood to adulthood make adolescents vulnerable to emotional problems. The current study investigated the relationship between mild emotional problems which are highly prevalent among adolescents and underachievement in school, and the role of neurocognitive functioning in this relation. This study was conducted in a substantial sample of typical developing young adolescents who just made the transition to secondary education. Pupils were on average 12.5 years old (standard deviation 0.5), and 45% of the included sample were girls. Emotional wellbeing was associated with underachievement [Odds ratio (OR) 5.15, 95% confidence interval (CI) 3.06–8.68] after adjusting for background variables. Self-reported neurocognitive functioning partly explained the relation between emotional wellbeing and underachievement (OR 2.22, 95% CI 1.23–3.99), yet, emotional wellbeing remained statistically associated with underachievement after correcting for additional confounders (OR 1.99, 95% CI 1.08–3.66). The observed findings suggest that emotional wellbeing plays an essential role in underachievement during the first year of secondary education.

Neurocognitive performance of a community-based sample of young people at putative ultra high risk for psychosis: Support for the processing speed hypothesis

Introduction. A wide variety of neurocognitive deficits have been reported for help-seeking individuals who are at clinical or ultra high risk for psychosis based on fulfilling set criteria for prodromal syndromes/at risk mental states. We wished to extend this research by conducting the first population-based assessment of prodromal syndromes and associated neurocognition. Methods. A sample of 212 school-based adolescents were assessed for prodromal syndromes using the criteria of prodromal syndromes from the Structured Interview for Prodromal Syndromes. The MATRICS consensus neurocognitive battery was used to assess cognitive functioning in this sample. Results. A total of 8% of the population sample of adolescents met criteria for a prodromal syndrome. These adolescents performed significantly more poorly than controls on two tests of processing speed—Trail-Making Test Part A, F=4.54, p < .01, and the Brief Assessment of Cognition in Schizophrenia Symbol Coding task, F=8.26, p < .0001—and on a test of nonverbal working memory—the Wechsler Memory Scale Spatial Span task, F=3.29, p < .05. Conclusions. Adolescents in the community who fulfil criteria for prodromal syndromes demonstrate deficits on a number of neurocognitive tasks. Deficits are particularly pronounced in symbol coding performance, supporting processing speed as a central deficit associated with psychosis risk.

A Test of the Theory of Planned Behavior to Predict Physical Activity in an Overweight/Obese Population Sample of Adolescents From Alberta, Canada

To examine the utility of the theory of planned behavior (TPB) for explaining physical activity (PA) intention and behavior among a large population sample of overweight and obese adolescents (Alberta, Canada), using a web-based survey. Secondary objectives were to examine the mediating effects of the TPB constructs and moderating effects of weight status. A subsample of 427 overweight and 133 obese participants (n = 560), completed a self-administered web-based questionnaire on health and PA behaviors, including assessment of attitude, subjective norm, perceived behavioral control (PBC), and intention to participate in regular PA. Structural equation models were examined using AMOS 17.0. Overall, 62% of the variance in intention was accounted for by attitude, subjective norm, and PBC; whereas 44% of the variance in PA behavior was explained by PBC and intention. When examining the TPB separately in overweight and obese subsamples, 66% and 56% of the variance for PA intention was explained for overweight and obese subsamples, respectively; and 38% and 56% of the variance in PA behavior were accounted for in the overweight and obese subsamples. Overall, attitude was the strongest predictor of PA intention, whereas PBC was the strongest predictor for PA behavior. Intention was not predictive of PA behavior. These results provide partial support for the utility of TPB in explaining PA behavior in a sample of overweight and obese adolescents. In particular, strong associations regarding attitude and PBC were evident across each subsample. These findings have implications for tailoring PA programs in this population.

Developing Adolescent-Specific Health State Values for Economic Evaluation

The way that health is measured and valued is fundamental to economic evaluation. To date, adult health state values have been routinely used in the calculation of QALYs for the economic evaluation of healthcare treatment and preventive programmes, including those targeted at adolescents. The main objective of this study was to apply profile case best-worst scaling (BWS) discrete-choice experiment (DCE) methods to obtain adolescent-specific values for the Child Health Utility 9D (CHU9D), a new generic preference-based measure of health-related quality of life developed specifically for application in cost-effectiveness analyses of treatments and interventions targeted at young people. A secondary aim was to assess the feasibility of a web-based method of data collection for the valuation of health states defined by the CHU9D. A web-based survey was developed including the CHU9D instrument and a series of BWS DCE questions. Specifically, respondents were asked to indicate the best and worst attribute levels from a series of ten health states defined by the CHU9D, presented one at a time. The survey was administered to a community-based sample of consenting adolescents (n = 590) aged 11-17 years. A conditional logistic regression model was applied to estimate values (part-worth utilities) for each level of the nine attributes relating to the CHU9D. A marginal utility matrix was then estimated to generate an adolescent-specific scoring algorithm on the full health = 1 and dead = 0 scale required for the calculation of QALYs. The results indicate that participants were able to readily choose 'best' and 'worst' attribute levels for the CHU9D health states. Large differences in value were found between the first and fifth levels (indicating 'no problems' and 'severe problems', respectively) for all nine attributes relating to the CHU9D. In general, there was little differentiation between the middle levels of all attributes indicating only limited additional value for adolescents of moving between these levels. Comparison of the adolescent-specific algorithm and the existing adult scoring algorithm for the CHU9D revealed some significant differences in values for identical health states, which may have important implications for the application of the CHU9D to value adolescent treatment and service programmes particularly for mental health. In general, adolescents appeared to place more weight upon the CHU9D attributes relating to mental health (worried, sad and annoyed) than would be implied by application of the existing algorithm based upon adult values. This study provides preliminary indications that there may be potentially important and systematic differences in the valuations attached to identical health states by adolescents in comparison with adult population groups. The study findings lend support to the potential future application of profile case BWS DCE methods to undertake large-scale health state valuation studies directly with young adolescent population samples and provide support for the feasibility and acceptability of a web-based mode of administration for this purpose.

Headache Disorders in Children and Adolescents: Their Association With Psychological, Behavioral, and Socio‐Environmental Factors

This cross-sectional study on a randomly drawn population sample of children and adolescents (n = 3399; aged 9 to 15) aimed at the assessment of patterns of associations between psychosocial variables and primary headache disorders like migraine (MIG) or tension-type headache. A headache-free group served as a control. Data on headache and psychological trait variables (eg, internalizing symptoms), behavioral factors (eg, physical activities), and socio-environmental factors (eg, life events) were gathered by questionnaire. Logistic regression analyses were conducted with headache types (MIG, tension-type, and non-classifiable headache) as dependent variables. The pattern of correlations was largely congruent between the headache disorders. Associations were closest regarding maladaptive psychological traits (in particular internalizing symptoms with an odds ratio > 4 regarding MIG) compared with socio-environmental factors and particularly the behavioral factors. Unfavorable psychological traits and socio-environmental strains demonstrated distinctly stronger associations with MIG than tension-type headache and explained more variance in the occurrence of pediatric headache disorders than parental headache. Sex-specific analyses showed similarities as well as differences regarding the correlations, and in general, the associations were stronger in girls than boys. A common path model as posited by several researchers in the field may explain the parallelism in biopsychosocial vulnerability regarding the different headache disorders.