Child Health And Illness Profile-Adolescent Edition Research Articles

Nutritional status, body image satisfaction, and self-esteem in adolescents from the SI program for secondary school trial

Abstract Funding Acknowledgements Type of funding sources: Other. Main funding source(s): 1. SHE Foundation and "la Caixa" 2. Fondo de Investigación Sanitaria - Instituto de Salud Carlos III. Background/Introduction Adolescence is a sensitive period regarding self-esteem and body image. In particular, nutritional status could affect self-esteem levels and body image satisfaction. Purpose To evaluate the distribution of body image satisfaction by nutritional status, and to assess the relationship between body image satisfaction and self-esteem over adolescence. Methods 1315 adolescents from the SI! Program for Secondary Schools trial were assessed at baseline (12.5 (0.4) years, 48.2% girls), first follow-up (1-FU) (13.9 (0.4) years, 47.6% girls) and second follow-up (2-FU) (15.8 (0.4) years, 48.4% girls). Adolescents were classified as having underweight, normal weight or overweight/obesity according to Center for Disease Control (CDC) standards for body mass index (BMI). Body image satisfaction and self-esteem were assessed with Stunkard's figure rating scale and self-esteem domain of the Child Health and Illness Profile-Adolescent Edition (CHIP-AE) questionnaire, respectively. The association between both variables was estimated using linear and logistic mixed models. Results Overall, only 14.6% of adolescents were systematically satisfied with their body image. Most adolescents with overweight/obesity desired to lose weight (89.7% at baseline, 84.9% at 1-FU, and 83.9% at 2-FU), while most adolescents with underweight desired to gain weight (76.3% baseline, 80.0% 1-FU, 84.0% 2-FU). The percentage of girls with normal weight desiring to lose weight increased from 33.4% at ~12 years of age to 45.9% at ~16 years of age, while the desire to gain weight increased in boys with normal weight (32.3% at baseline vs 38.2% at 2-FU) (Figure 1). Satisfied adolescents consistently presented higher self-esteem over time compared to unsatisfied adolescents, especially girls (Table 1). Conclusion(s) Body image satisfaction was consistently related to nutritional status over adolescence. The desire to lose weight in girls with normal weight increased over time, while the desire to gain weight increased in boys with normal weight. Data suggests that body image satisfaction could determine self-esteem levels. These results show how gender stereotypes may affect body image and self-esteem, and therefore eating and exercise behaviors, highlighting the importance to reinforce body acceptance through school-based health promotion interventions.

Measuring Development of Adolescent and Young Adult Cancer Patients: An Integrative Review of Available Instruments.

Adolescents and young adults (AYAs) 15-39 years old face unique challenges during cancer treatment as developmental and social needs are often disrupted to achieve cure. Developmentally appropriate supportive care for AYAs across the cancer trajectory is needed. The purpose of this review is to identify and describe instruments that measure AYA development across physical, psychological, and social domains, commenting on the instruments' psychometric properties and usefulness in clinical practice and research. A computerized literature search published in English from 1950 to January of 2017 was conducted utilizing the following databases: Mental Measurements Yearbook (MMY), Health and Psychosocial Instruments, PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), PsycINFO, and Google Scholar. The following instruments were identified and described: the Child Health and Illness Profile-Adolescent Edition (CHIP-AE); the Course of Life Questionnaire; the Developmental Task Questionnaire (DTQ); the Impact of Cancer scale for childhood survivors and AYAs (IOC-CS and IOC-AYA); the McCleery Scale of Adolescent Development (MSAD); and the Minneapolis-Manchester Quality of Life Adolescent and Young Adult Form (MMQL-AF and MMQL-YA). Among currently available instruments, the IOC-AYA and MMQL-AF were relevant to AYAs undergoing or completing cancer therapy. However, validation for the IOC-AYA occurred in cancer survivors off treatment so further psychometric evaluation is needed in AYAs currently undergoing cancer treatment. Furthermore, the MMQL-AF has been validated for use during active cancer treatment, but is limited to adolescents 13-20 years. Further research may be needed to create or refine instruments measuring the developmental impact in AYAs, particularly emerging adults undergoing active cancer treatment.

Health and well‐being in adolescent survivors of early childhood cancer: a report from the Childhood Cancer Survivor Study

With the growing number of childhood cancer survivors in the US, it is important to assess the well-being of these individuals, particularly during the transitional phase of adolescence. Data about adolescent survivors' overall health and quality of life will help identify survivor subgroups most in need of targeted attention to successfully transition to adulthood. This ancillary study to the Childhood Cancer Survivor Study focused on children 15-19 years of age who had been diagnosed with cancer before the age of 4 years. A cohort of siblings of pediatric cancer survivors of the same ages served as a comparison sample. Adolescent health was assessed using the Child Health and Illness Profile-Adolescent Edition (CHIP-AE) survey. The teen survey was sent to 444 survivor teens and 189 siblings. Of these, 307(69%) survivors and 97 (51%) siblings completed and returned the survey. The overall health profiles of siblings and survivors were similar. Among survivors, females scored significantly below males on satisfaction, discomfort, and disorders domains. Survivors diagnosed with central nervous system tumors scored less favorably than leukemia survivors in the global domains of satisfaction and disorders. In general, adolescent survivors fare favorably compared to healthy siblings. However, identification of the subset of pediatric cancer survivors who are more vulnerable to medical and psychosocial disorders in adolescence provides the opportunity for design and implementation of intervention strategies that may improve quality of life.

Autoreporte de salud y enfermedad en la adolescencia: Cuestionario CHIP-AE en adolescentes escolarizados chilenos

Objective: To describe and analyze values obtained from the application of the Child Health and Illness Profile-Adolescent Edition (CHIP-AE) in school chilean adolescents. Method: The questionnaire was applied to a sample of 531 school adolescents of Antofagasta (249 were men and 282 women), with a mean of age of 15.44 years. Means and deciles for each of the domains and subdomains of the instrument, separated by sex and range of age were calculated. Results: Men presented significantly highest median level of satisfaction and resistance (p < 0.01 y p < 0.05) and women highest score in welfare (p < 0.01). By ge 16 to 18 vs 13 to 15 years old group, had significantly highest scores in welfare and resistance (p < 0.001 and p < 0,05), and less in risk and performance (p < 0.05 and p < 0.05, respectively). Conclusion: Results are not different for spanish study, except on welfare were men obtained lower scores and women highest. These results can be use as comparison pattern in longitudinal studies and to compare with others populations or interventions studies in adolescent health.

Salud en la adolescencia: propiedades psicométricas del perfil de salud y enfermedad (CHIP-AE) en adolescentes chilenos Adolescent's health: psychometric properties of health and illness profile (CHIP-AE) in chileans youths

We evaluated the psychometric properties of the adapted version for Chile of Child Health and Illness Profile - Adolescent Edition (CHIP-AE) in a sample of 527 adolescents from public and private institutions. Internal consistency, seen as a factorial structure of the scale, and its ability to distinguish the groups were assessed. The findings confirmed the factorial structure of the original version. Internal consistency of the dimensions ranged between .83 and .89. The instrument is able to discriminate between age groups and between healthy and unhealthy individuals. Evidence allows proposing this instrument as a reliable measurement of public health assessment to measure adolescent's health in several domains.

Effects of atomoxetine on self-reported high-risk behaviors and health-related quality of life in adolescents with ADHD

Objective:This study measured the effects of atomoxetine HCl on high-risk behaviors and health-related quality of life in adolescents with attention-deficit/hyperactivity disorder (ADHD), using a subgroup analysis of data from a previous clinical trial.Research design and methods:In the base study, which was conducted at 26 sites in the United States, patients ages 13–16 years were randomized in a double-blind manner to atomoxetine treatment by one of two dose titration schedules for 8 weeks. Patients who responded to treatment were rerandomized to atomoxetine at a daily dose of 0.8 or 1.4 mg/kg for 40 weeks. Patients in the highest-risk quartile for each category of behavior or domain were included and the dosing groups combined.Main outcome measures:Efficacy measures included the Youth Risk Behavior Surveillance (YRBS) and Child Health and Illness Profile – Adolescent Edition (CHIP-AE). The YRBS has six categories of behavior, and the CHIP-AE has six domains. Data for mean change from baseline were analyzed using a last-observation-carried-forward analysis.Results:A total of 267 patients were randomized, but the high-risk subgroup analyzed in the present study was much smaller (range of n = 5–68 per group). YRBS scores for tobacco use, unhealthful dietary behaviors, inadequate physical activity, and behaviors contributing to unintentional injuries showed statistically significant improvements (p < 0.05) by atomoxetine treatment at Week 8. At the end of the 40-week maintenance period, unhealthful dietary behaviors, inadequate physical activity, and behaviors contributing to unintentional injuries continued to show statistically significant improvements (p < 0.001). When the highest-risk quartile of the CHIP-AE data was analyzed, there were statistically significant improvements on all six domains after atomoxetine treatment at 8 weeks (p < 0.001) and on five of the six domains at 40 weeks (p ≤ 0.01).Conclusions:Atomoxetine improved self-reported high-risk behaviors and overall health-related quality of life in adolescents with ADHD. Potential limitations of this study include small sample sizes and the fact that it involved a subgroup analysis, which is by nature hypothesis-generating. Further, well-controlled, prospective studies in larger and more heterogeneous ADHD populations, including older patients, are warranted to confirm or reject these findings.

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Quality of life of adolescents with end-stage renal disease and kidney transplant

The health-related quality of life (HRQOL) of adolescents with end-stage renal disease (ESRD) is an important marker of disease burden. Our aims were to investigate HRQOL in a group of children and adolescents with ESRD and to compare them with the reference population norms. Ours was a cross-sectional study of 81 patients aged 10 years to 21 years with ESRD (68 with kidney transplants and 13 on dialysis) at five Spanish paediatric nephrology centres. HRQOL was investigated with the Spanish version of the child health and illness profile, adolescent edition (CHIP-AE). Clinical variables such as underlying diagnosis, number of rejection episodes, pre-emptive transplantation, anaemia and height were also analysed. No differences were found between patients with kidney transplants and their healthy peers in any domain or sub-domain of CHIP-AE. The group on dialysis scored lower than healthy controls and patients with transplants for satisfaction with health. Discomfort was higher in patients with transplants who had suffered one rejection episode. Physical discomfort was increased in anaemic patients with transplants. Short patients scored less in the satisfaction domain, with lower self-esteem and lower satisfaction with health. Adolescents with kidney transplants had better satisfaction with health than the group on dialysis, which matched the level of a healthy population. Further long-term prospective research is warranted.

Validity of the Health Profile-Types of the Spanish Child Health and Illness Profile-Adolescent Edition (CHIP-AE)

Objective To develop and validate a simplified, easy to interpret scoring system based on the health profile-types taxonomy for the Spanish version of the Child Health and Illness Profile-Adolescent Edition (CHIP-AE). Methods The CHIP-AE was administered to a 1453 Spanish adolescents. Hierarchic and nonhierarchical cluster analyses, as well as conceptual considerations, were used to identify exhaustive, mutually exclusive health profile-types based in four CHIP-AE domain scores: Satisfaction, Discomfort, Resilience, and Risks. Validity of the health profile-types was assessed by testing expected differences among adolescents according to sex, age, socioeconomic status, and self-reported conditions. Logistic models were built. Results A total of 13 health profile-types (10 that best fitted the data and three additional considered conceptually necessary) were identified. The largest group of adolescents was in the “Excellent health” or “Good health” types (43.4%), although 11.2% were in the “Worst health” profile. According to a priori hypotheses, being a girl (OR = 1.81; 95% CI = 1.26–2.60), older age (OR = 1.80; 1.26–2.57), and self-reported recurrent (OR = 2.49; 1.72–3.60) and psychosocial disorders (OR = 4.38; 2.92–6.56) were associated to the likelihood of a “Worst health” profile-type. Conclusions The Spanish CHIP-AE health profile-types offer a simplified method to describe adolescents' patterns of health, which is valid and similar to the original US taxonomy. This can facilitate interpreting the instrument scores and using it for needs assessment, although additional research is required.

The Relationship Between the Use of Health Clinics in Rural Mississippi Schools and the CHIP-AE Adolescent Health Profile

School health clinics are one way to meet the objectives in Healthy People 2010 for adolescent health. To determine the relationship between adolescent health status and use of the school health clinics in four Mississippi high schools, the Child Health and Illness Profile-Adolescent Edition (CHIP-AE) was used. The CHIP-AE identifies health status, giving scores on resilience, comfort, risks, and satisfaction, resulting in health profiles. One hundred seventy-one 9th-graders participated in this descriptive study. Students with the highest discomfort and risk scores had no use of the school health clinic. Students with fair health profiles were the highest users of the school health clinic when compared to all other profiles. Of those students with very poor health status, 60% reported the school health clinic was their only source of health care. In this study, the term school health clinic refers to the health office staffed by a nurse without an advanced degree.

Self-reported social class in adolescents: validity and relationship with gradients in self-reported health.

BackgroundAnalyzing social differences in the health of adolescents is a challenge. The accuracy of adolescent's report on familial socio-economic position is unknown. The aims of the study were to examine the validity of measuring occupational social class and family level of education reported by adolescents aged 12 to 18, and the relationship between social position and self-reported health.MethodsA sample of 1453 Spanish adolescents 12 to 18 years old from urban and rural areas completed a self-administered questionnaire including the Child Health and Illness Profile-Adolescent Edition (CHIP-AE), and data on parental occupational social class (OSC) and level of education (LE). The responsible person for a sub-sample of teenagers (n = 91) were interviewed by phone. Kappa coefficients were estimated to analyze agreement between adolescents and proxy-respondents, and logistic regression models were adjusted to analyze factors associated with missing answers and disagreements. Effect size (ES) was calculated to analyze the relationship between OSC, LE and the CHIP-AE domain scores.ResultsMissing answers were higher for father's (24.2%) and mother's (45.7%) occupational status than for parental education (8.4%, and 8.1% respectively), and belonging to a non-standard family was associated with more incomplete reporting of social position (OR = 4,98; 95%CI = 1,3–18,8) as was agreement between a parent and the adolescent. There were significant social class gradients, most notably for aspects of health related to resilience to threats to illness.ConclusionAdolescents can acceptably self-report on family occupation and level of education. Social class gradients are present in important aspects of health in adolescents.

Self-Perceived Health, Functioning and Well-Being of Very Low Birth Weight Infants at Age 20 Years

To examine the self-perceived health of very low birth weight (VLBW; <1.5 kg) infants during young adulthood. The population included 241 VLBW and 232 normal birth weight (NBW) controls who completed the Child Health and Illness Profile: Adolescent Edition (CHIP-AE) at 20 years of age. The CHIP-AE includes six domains: Satisfaction, Comfort, Resilience, Achievement, Risk Avoidance, and Disorders, and 13 profiles that characterize patterns of health. Results were compared between VLBW and NBW subjects adjusting for sex and sociodemographic status. VLBW subjects did not differ from NBW controls in the domains of Satisfaction or Comfort but reported less Resilience (effect size [ES] -0.19, P < .05), specifically in physical activity and family involvement. They reported better Achievement, specifically in work performance (ES 0.28, P < .05), more Risk Avoidance (ES 0.43, P < .001), and significantly more long-term medical, surgical, and psychosocial disorders. Similar proportions of VLBW and NBW subjects reported Excellent (15% vs 11%), Average (27% vs 34%), and Poor (12% vs 13%) profiles of health. VLBW subjects report similar health, well-being, and functioning compared with NBW controls and greater risk avoidance. However, we are concerned that their lesser resilience may prove detrimental to their future adult health.

57: Health risk behaviors in adolescent girls: Effects of childhood maltreatment and psychopathology

Health risk behaviors (HRBs), such as risky sex and substance use are more prevalent in teens with conduct disorder (CD). The mechanisms for this association are unknown, but exposure to childhood maltreatment may be a factor. The purpose of this pilot study was to test this hypothesis in girls with CD, compared to girls who were depressed or anxious and those who had no psychiatric problems. 82 girls (15-16 years old) were recruited from the community as part of a large study of psychoneuroendocrine function and psychopathology. Psychiatric diagnoses were made with the Diagnostic Interview Schedule for Children, Parent and Youth Versions (DISC) and each girl was placed into one of three groups: conduct disorder (CD) (n= 53), mood/anxiety disorder (DEP) (n= 11), or no disorder (ND) (n= 18). The groups differed in socioeconomic status (SES) (CD girls were lower) and racial composition (fewer Caucasian girls in the CD group). HRBs were assessed with the Individual Risks (IRISK) sub-scale of the Child Health and Illness Profile-Adolescent Edition (CHIP-AE) and exposure to childhood maltreatment was measured with the Childhood Trauma Questionnaire (CTQ). Girls with CD had significantly lower scores on the IRISK than girls in the other groups (CD=3.80, DEP=4.58, NC=4.63); the two comparison groups did not differ from each other. The CD group also had significantly higher scores than the NC group on every type of maltreatment assessed on the CTQ. The DEP group also had significantly higher scores than the NC girls on sexual abuse and physical neglect; there was no difference between the CD and DEP groups. All analyses controlled for race and SES. In testing our hypothesis, we found that IRISK score and two types of maltreatment were significantly correlated: emotional neglect (r= −0.32; p= 0.002) and emotional abuse (r= −0.18; p= 0.05). Separate regression equations using group status and each of these CTQ sub-scale scores, controlling for race and SES, indicated that the only significant predictor of IRISK was membership in the CD group. This pilot study indicates that girls with CD engage in more HRBs than other girls and that they have more exposure to childhood maltreatment than girls in the NC group. Girls in the DEP group also had higher rates of some types of maltreatment than the girls in the NC group, but did not engage in high rates of HRBs. Our hypothesis that childhood maltreatment is a mechanism explaining the association between CD and HRBs was not borne out. This may have been due to the small sample size. Our future work will include more girls. If a larger sample size confirms these findings, however, we must look at other possible explanations for the CD-health risk behavior link than in childhood histories of maltreatment. Our finding that girls in the DEP group also have high rates of maltreatment, but no CD or HRBs, suggest that there may be at least two adolescent outcomes for abuse and neglect in girls. This merits replication and further investigation.

Assessing Health Status and Health Care Utilization in Adolescents with Chronic Kidney Disease

Few validated health status measures have been assessed in children with chronic kidney disease (CKD). The objective was to assess the validity of a generic health status measure, the Child Health and Illness Profile-Adolescent Edition (CHIP-AE), in adolescents with CKD. A case-control study was performed (1) to assess scores on the CHIP-AE in adolescents with CKD compared with two control groups of age-, socioeconomic-, and gender-matched peers and (2) to compare health of patients who had chronic renal insufficiency (CRI), were on dialysis, and were posttransplantation. Seven pediatric nephrology centers recruited 113 patients (mean age, 14 yr; 39 CRI, 21 dialysis, 53 posttransplantation). Compared with 226 control subjects, patients with CKD had lower overall satisfaction with health and more restriction in activity. Positively, patients with CKD had more family involvement, better home safety and health practices, and better social problem-solving skills and were less likely to participate in risky social behaviors or socialize with peers who engaged in risky behavior. Patients who received dialysis were less physically active and experienced more physical discomfort and limitations in activities than did transplant or CRI patients. It is concluded that patients with CKD have poorer functional health status than age-matched peers. Among CKD patients, dialysis patients have the poorest functional health status. These results suggest that the CHIP-AE can be used to measure functional health status in adolescent patients with CKD.

Emotional quality-of-life and outcomes in adolescents with asthma

Examine the association between emotional quality-of-life (QOL) and asthma morbidity in adolescents with asthma. Cross-sectional survey of 185 adolescents with asthma 11 to 17 years of age cared for in three managed care organizations (MCOs) in the United States. The asthma-specific Pediatric Asthma Quality of Life Questionnaire (PAQLQ) and a short version of the generic Child Health and Illness Profile-Adolescent Edition (CHIP-AE) were used to assess emotional QOL. Asthma morbidity measures were: asthma control, emergency department (ED) visits, hospitalizations, doctor visits for worsening asthma, and missed school because of asthma. Of the adolescents surveyed, 45% reported feeling depressed, 41% had ED visits, and 30% missed >or=1 day of school because of asthma. Poorer asthma-specific emotional QOL was associated with poorer control of asthma symptoms ( P < .0001), missed school (OR 7.1, P < .05), and doctor visits for worsened asthma (OR = 7.0, P < .05). Emotional symptoms related to asthma are common in adolescents with persistent asthma and asthma-specific QOL is related to increased asthma morbidity, healthcare use, and school absenteeism. Adolescents with high morbidity from asthma exhibit poorer QOL. Therefore, the evaluation of asthma-specific emotional QOL should be included in the assessment of adolescents with asthma.

Assessing Child Well-Being in Non-Relative Foster Care with a New Outcome Measurement Tool

ABSTRACT The Child Health and Illness Profile–Adolescent Edition (CHIP-AE), a recently developed standardized instrument, was administered to 49 adolescents living in non-relative family foster care under the auspices of the child welfare system in Illinois. Youth reported high levels of satisfaction with their health, academic progress, resiliency and risk resistance, but low levels of work performance. These youth also reported higher levels of psychosocial problems, major and minor adverse effects from injuries, migraines, and chronic medical conditions such as epilepsy, diabetes and sickle-cell anemia. This study demonstrated the potential usefulness of the CHIP-AE as a tool for involving youth living in non-relative foster care in assessing their own health and well-being. Suggestions for future use of the CHIP-AE are discussed.

The Spanish version of the Child Health and Illness Profile-Adolescent Edition (CHIP-AE).

The aim of the study was to obtain a conceptually equivalent Spanish version of the Child Health and Illness Profile-Adolescent Edition (CHIP-AE), and to test its feasibility, reliability and preliminary construct validity. The methodology used for adaptation was forward-back translation, including two focus groups with adolescents and a panel of experts. Reliability and validity were assessed in healthy convenience samples from school settings (n = 417). Three different illness groups (n = 67) were used to examine differences in health status between healthy, acutely ill, chronically ill and mentally ill adolescents. Preliminary construct validity was examined by comparing mean scores for each of the subdomains to determine if they differed in predicted ways according to age, gender and illness group. The majority of items (154 out of 203) were conceptually equivalent to the original version. Some items (46) had to be modified to increase clarity and/or to adapt them for use in Spain and 3 items were considered not applicable. Single construct subdomains achieved alpha coefficients between 0.65 and 0.92, and intraclass correlation coefficients (ICC) between 0.57 and 0.93. The mentally ill group presented the worst scores in most domains. The Spanish CHIP-AE is acceptable for Spanish adolescents and shows adequate metric characteristics, which are similar to those reported in the US version.

The impact of asthma on the health status of adolescents.

To identify a characteristic pattern of health and illness for adolescents with asthma, we compared the health status of teenagers with asthma to those without asthma using a recently developed generic health status instrument, the Child Health and Illness Profile, Adolescent Edition (CHIP-AE). This was a cross-sectional survey using a school sample of 3109 teenagers. Participants completed the CHIP-AE during school in northern Baltimore City, rural western Maryland, and rural Arkansas. The health and functioning scores of teens without asthma ("well" group) were compared with those with asthma with and without recent wheezing. Of the 12% who reported that a physician had ever told them they had asthma, 50% had problems with wheezing in the past 28 days. Compared with well teenagers, those with asthma and recent wheezing had lower perceived well-being, more physical and emotional symptoms, greater limitations in activity, more comorbidities, and more negative behaviors that threaten social development. These findings held true in multivariable regression models that controlled for sociodemographics and sites of data collection. Teenagers with asthma without recent wheezing reported a greater number of comorbidities than well teens and showed similar trends in health status as those with recently symptomatic asthma. Multiple aspects of adolescent health status are affected by asthma, particularly if it is recently symptomatic. These results argue for incorporating a generic health status instrument, such as the CHIP-AE, in studies that document the health needs or outcomes of medical care for populations of teenagers with asthma.

Health status of well vs ill adolescents.

Accountability of health services in meeting needs and assessing outcomes is hampered by the absence of tools to assess health, especially in children and youth. Because it is no longer adequate to assess health by a narrow focus on biological and physiological measures, instruments that assess functional status, person-focused general health status, and overall well-being in a more comprehensive way are needed. To examine whether a health status instrument we have developed discriminates between teenagers in schools and teenagers attending clinics for acute or chronic conditions. Teenagers (aged 11-17 years) in schools and in general medical and specialty clinics completed a questionnaire The Child Health and Illness Profile-Adolescent Edition (CHIP-AE), comprehensively covering aspects of health in 6 domains: discomfort, satisfaction with health, disorders, achievement of social expectations, risks, and resilience. Acutely ill teenagers reported more physical discomfort, minor illnesses, and lower physical fitness; chronically ill teenagers reported more limitations of activity, long-term medical disorders, dissatisfaction with their health, and less physical fitness than teenagers in the school samples. Age, sex, and social class did not explain the differences. Teenagers within the acutely and chronically ill clinic populations differed substantially in their health status. Availability of a comprehensive instrument (CHIP-AE) to assess adolescent health provides a means of documenting health needs and outcomes in populations of teenagers with acute or chronic illness. The heterogeneity within these groups provides support for a person-focused (rather than a disease-focused) approach to assessing both needs for care and the influence of care on promoting health.