High-risk Teens Research Articles

Maltreatment and Parent-Child Attachment as Predictors of Dating Violence and Risky Sexual Behaviour Among High-Risk Teens.

A history of maltreatment can increase risk for dating violence (DV) and risky sexual behaviour (RSB) among adolescents. Secure parent-child attachment may reduce this risk, yet few studies have examined this as a protective factor. This study differentiated developmentally appropriate, exploratory sexual behaviours from RSB and examined whether maltreatment experiences and parent-child attachment in adolescence predicted DV and RSB reported five years later in a high-risk sample. Participants were 179 adolescents (46% girls; M age = 15.34, range = 12-18 years) at risk for aggressive and antisocial behaviour. Adolescents reported their maltreatment histories and attachment to their parents at Time 1; five years later, at Time 2, they reported their experiences with DV perpetration and victimization and engagement in RSB. Both bivariate correlations and structural analyses demonstrated that maltreatment was associated with DV perpetration and victimization but not RSB, and attachment avoidance was associated with fewer RSB but not DV. Attachment anxiety was associated with physical DV perpetration and greater condom use, but only at the correlational level; attachment anxiety was not associated with DV or RSB in the structural model. There were no significant interaction effects. Findings highlight the importance of considering key developmental factors such as maltreatment and parent-child attachment in understanding adolescent risk for DV and RSB, and may inform future research that accounts for contextual factors such as motivation for violence perpetration and contraceptive use with multiple and/or casual sex partners.

ProjectDRIVE: study protocol for a randomized controlled trial to improve driving practices of high-risk teen drivers with a traffic violation

BackgroundTeen drivers with a traffic violation are at increased risk for crashes and crash-related injuries; however, most parent-focused interventions target teen drivers with supervised learner’s permits. Very few interventions are implemented at the probationary driver's license stage or target high-risk teen drivers, such as those with traffic violations. This paper describes the protocol of ProjectDRIVE, A Randomized Controlled Trial to Improve Driving Practices of High-Risk Teen Drivers with a Traffic Violation, which targets improving parent-teen communication about safe driving practices to reduce unsafe driving behaviors and traffic violation recidivism of teen drivers cited for traffic violation.MethodsTeen drivers (ages 16 or 17) cited for a moving violation and the parent/legal guardian most involved with the teen’s driving are recruited from juvenile traffic courts following their required court hearing. After completing informed consent/assent, enrolled dyads are randomized into one of three groups using stratified block randomization: control, device feedback only, or device feedback plus parent communication training. Participating dyads are followed for 6 months with 3 months of active intervention. Using in-vehicle device and smartphone application technology, the study provides real-time and cumulative driving feedback to intervention teens and collects continually recorded, objectively measured driving outcome data throughout the teen’s study participation. Primary outcomes include rates of risky driving events and unsafe driving behaviors per 1000 miles driven. Secondary outcomes include traffic violation recidivism up to 12 months following study completion and frequency and quality of parent-teen communication about safe driving practices.DiscussionThrough partnership with the local juvenile traffic courts, this study integrates recruitment and randomization into existing court practices. Successfully completing this study will significantly impact juvenile traffic court’s practices and policies by informing judges’ decisions regarding the driving safety programs they refer to teens to prevent motor vehicle crashes and crash-related injuries and deaths.Trial registration The study was registered on ClinicalTrials.gov Registry (NCT04317664) on March 19, 2020, https://clinicaltrials.gov/study/NCT04317664 and updated on April 27, 2021. This protocol was developed per the SPIRIT (Standard Protocol Items: Recommendations for Interventional Trials) Checklist.

Project Inspire pilot study: A hospital-led comprehensive intervention reduces gun violence among juveniles delinquent of gun crimes.

Gun violence disproportionately affects young Black men, but the impact extends to families and communities. Those at highest risk are teens delinquent of gun crimes. While there is no nationally accepted juvenile rate of recidivism, previous literature reveals rearrest rates from 50% to 80% in high-risk youth, and some reports show that up to 40% of delinquent juveniles are incarcerated in adult prisons before the age of 25 years. We hypothesize that Project Inspire, a hospital-led comprehensive intervention, reduces recidivism among high-risk teens. Led by a level 1 trauma center, key community stakeholders including the juvenile court, city, and city police department joined forces to create a community-wide program aimed at curbing gun violence in high-risk individuals. Participants, aged 13 to 18 years, are selected by the juvenile gun court. They underwent a rigorous 3-week program with a curriculum incorporating the following: trauma-informed training and confidence building, educational/professional development, financial literacy, entrepreneurship, and career-specific job shadowing and mentorship. Rates of recidivism were measured annually. Project Inspire has hosted two classes in 2018 and 2019, graduating nine participants aged 14 to 17 years. Sixty-seven percent were Black. All were males. At 1 year, none of the graduates reoffended. At 2 years, one participant reoffended. At 3 years, no additional participants reoffended. No graduate reoffended as a juvenile. Thus, the overall rate of recidivism for Project Inspire is 11% to date. Eighty-nine percent of graduates received a diploma, general educational development, or obtained employment. Project Inspire is a hospital-led initiative that effectively reduces recidivism among juveniles delinquent of gun crimes. This sets the framework for trauma centers nationwide to lead in establishing impactful, comprehensive, gun-violence intervention strategies. Prognostic and Epidemiological; Level V.

Abstract B033: Increasing sexual transmitted diseases and promoting condom use among youth: Evaluation of year 2 data from the Proud Teens of Philly (PTOP) program

Abstract Background: Rates of sexually transmitted disease (STD) and teen pregnancy are much higher in Philadelphia than the national average. Proud Teens of Philly (PTOP) is a sexual health program aimed at reducing the high teen birth rate and STD cases in Philadelphia. The program provides sexual health education to high-risk youth ages 12-19 in the Greater Philadelphia area. The materials used to implement the PTOP program, “Making Proud Choices”, is an evidence-based curriculum that was reviewed and tailored for its cultural and age appropriateness, and medical accuracy. Methods: During the second year of the program, PTOP was implemented virtually and in-person to 411 youth in Philadelphia schools and community-based organizations. Community-based participatory research (CBPR) strategies and systems thinking approach were used in site and participant recruitment, program implementation, and evaluation. The educational content consisted of 8 modules of the “Making Proud Choices” curriculum. Pre and post surveys were administered to participants at the first and last implementation sessions, respectively. During Year 2, 391 pre-surveys and 208 post-surveys were collected. Results: There were significant increases in knowledge about fluids that transmit HIV (pre=23.47 post=25.07 t=4.65 p=<.0001), behaviors that transmit HIV (pre=10.86 post= 19.05 t=9.37 p=<.0001), condoms preventing pregnancy (pre=59.57 post=76.41 t=2.8 p=0.0057) and condoms preventing HIV (pre=46.29 post=68.92 t=2.98 p=0.0035). There was also significant increase in knowledge about affirmative consent before sexual behaviors (pre=20.05 post= 0.42 t=3.71 p=0.0003) and preparedness to use condoms (pre=39.34 post=59.19 t=2.43 p=0.0169) Conclusion: PTOP, a sexual health program was effective in increasing knowledge of STD and condom use among high-risk teens in Philadelphia. We will discuss the use of CBPR strategies and systems thinking in the design and implementation of this program. Citation Format: Jade A. Truehart, Ra'Ann Merceir, Aisha Bhimla, Yin Tan, Sabrina Liao, Min Qi Wang, Jane Sileo, Maya Allen, Grace X. Ma. Increasing sexual transmitted diseases and promoting condom use among youth: Evaluation of year 2 data from the Proud Teens of Philly (PTOP) program [abstract]. In: Proceedings of the 15th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2022 Sep 16-19; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr B033.

Healthcare Use and Case Characteristics of Commercial Sexual Exploitation of Children: Teen Victims Versus High-Risk Teens.

The overall goal of this study was to provide further information about the characteristics of commercial sexual exploitation of children (CSEC) victims by comparing the characteristics of a known victim pool to high-risk patients identified. The specific objectives of this study were to describe patient demographic characteristics, pediatric healthcare use, familial psychosocial characteristics, and child sexual abuse case characteristics present in youth identified as high risk for CSEC victimization compared with a sample of known victims. A retrospective chart review was conducted on patients presenting to the emergency department or Child Advocacy Center for a concern of sexual abuse/assault at a midwestern U.S. academic pediatric medical center. Adolescents aged 12-21 years were included in the study. In the current study, multiple CSEC risk factors were noted to increase odds for CSEC victimization: homelessness or life on the streets, runaway behavior, living with mother only, placement in a juvenile detention center, placement in a residential treatment center or group home, and number of living arrangements (four or greater). Multiple elements of high-risk sexual behavior increased odds of CSEC victimization: legally age-inappropriate sex, gonorrhea diagnosis, trichomonas diagnosis, other sexually transmitted infection (STI) diagnoses, number of STIs, and chlamydia diagnosis. These findings suggest that age of sexual partners and number and types of STIs are associated with CSEC and should be validated in other groups. In addition, these data suggest that use of cocaine and opiates could serve as an important, yet underrecognized, risk factor.

A Rebuttal-Based Social Norms-Tailored Cannabis Intervention for At-Risk Adolescents.

Many past cannabis prevention campaigns have proven largely ineffective due in part to the diversity of adolescents' cannabis-relevant beliefs. The current studies evaluated the impact of a sequential multiple message approach tailored to the usage norms of adolescents expressing negative attitudes toward a cannabis prevention appeal. A multiple-message strategy was implemented-initial unfavorable message evaluations were invalidated using attitudinal rebuttal feedback prior to presenting a third tailored communication. Participants were cannabis-abstinent middle and high school students (ages 11 to 16). Study 1 (N = 808) compared effects of gain- and loss-framed messages tailored to each student's normative usage perceptions. In Study 2 (N = 391), students were randomly assigned to receive a tailored or non-tailored message after receiving feedback meant to destabilize anti-message attitudes. For at-risk adolescents in Study 1 who perceived cannabis use as normative, a tailored gain-framed message resulted in the lowest usage intentions (p < .05). In Study 2, a conditional multiple-moderated mediation model showed that for high-risk teens with normative beliefs and pro-cannabis attitudes, exposure to a tailored gain-framed communication was associated with decreased cannabis attitude certainty, and lower usage intentions 2 months later (p < .05). Findings have implications for sequential messaging utilization in mass media campaigns and support the efficacy of tailored messages over a one-size-fits-all media approach. Further, results suggest that systematically weakening resistance to persuasive communications and tailoring messages consistent with individually perceived peer norms is an effective prevention strategy.

Improving Adolescent Sexual and Reproductive Health: Can Mobile Health Interventions Affect Behavior?

* Abbreviations: LGB+ — : lesbian, gay, bisexual, and other sexual minority mHealth — : mobile health SRH — : sexual and reproductive health In this issue of Pediatrics , Ybarra et al1 report the results of a national randomized controlled trial of Girl2Girl, a mobile health (mHealth) intervention aiming to reduce pregnancy rates among lesbian, gay, bisexual, and other sexual minority (LGB+) adolescent girls. Researchers randomly assigned 948 girls aged 14 to 18 to the theory-based, user-informed text messaging intervention versus an attention-matched control group. At trial end, 5 months post-enrollment, those in the Girl2Girl intervention group were significantly more likely to have condom-protected sex and use a birth control method other than condoms. The study allows us to reflect on the overall impact of mHealth interventions to date because few mHealth interventions have been successful in affecting adolescent sexual and reproductive health (SRH) to the level of Girl2Girl.2 Several reasons likely contribute to this variation. First, behavior change is multifactorial, especially SRH behaviors, affected by a variety of societal and contextual factors. These factors make behavior change challenging to comprehensively address within one intervention. Next, retention rates in mHealth trials can be suboptimal. Adolescents frequently change phone numbers and experience phone disconnections, making patient follow-up challenging and full intervention delivery problematic.3 Lastly, the adoption of any mHealth intervention competes with a host … Address correspondence to Lauren S. Chernick, MD, MSc, Division of Pediatric Emergency Medicine, Department of Emergency Medicine, Columbia University Irving Medical Center, 3959 Broadway, CHN 1-116, New York, NY 10032. E-mail: lc2243{at}columbia.edu

Personalized Depression Prevention: A Randomized Controlled Trial to Optimize Effects Through Risk-Informed Personalization

To evaluate whether evidence-based depression prevention programs can be optimized by matching youths to interventions that address their psychosocial vulnerabilities. This randomized controlled trial included 204 adolescents (mean [SD] age= 14.26 [1.65] years; 56.4% female). Youths were categorized as high or low on cognitive and interpersonal risks for depression and randomly assigned to Coping With Stress (CWS), a cognitive-behavioral program, or Interpersonal Psychotherapy-Adolescent Skills Training (IPT-AST), an interpersonal program. Some participants received a match between risk and prevention (eg, high cognitive-low interpersonal risk teen in CWS, low cognitive-high interpersonal risk teen in IPT-AST), others received a mismatch (eg, low cognitive-high interpersonal risk teen in CWS). Outcomes were depression diagnoses and symptoms through 18 months postintervention (21 months total). Matched adolescents showed significantly greater decreases in depressive symptoms than mismatched adolescents from postintervention through 18-month follow-up and across the entire 21-month study period (effect size [d]= 0.44, 95% CI= 0.02, 0.86). There was no significant difference in rates of depressive disorders among matched adolescents compared with mismatched adolescents (12.0% versus 18.3%, t193= .78, p= .44). This study illustrates one approach to personalizing depression prevention as a form of precision mental health. Findings suggest that risk-informed personalization may enhance effects beyond a one-size-fits-all approach. Bending Adolescent Depression Trajectories Through Personalized Prevention; https://www.clinicaltrials.gov/; NCT01948167.

Trends in Research on Adolescent Suicide Interventions

Purpose This study was designed to analyze recent trends in adolescent suicide intervention research in Korea and to suggest future research directions in this area. Methods Studies Thirty-four studies selected from http://www.riss4u.net over the for last 20 years were analyzed by field and design of the study, study participants, and the outcome variables used in intervention studies. Results Nineteen (55.9%) of the 34 studies were conducted in the fields of welfare (9), psychology (5) and nursing science (5). Ordinary adolescents were the most frequently studied participants. A nonequivalent control group pretest-posttest design was used in twenty one (61.7%) of the 34 studies. The most frequently measured outcome variables were depression, suicidal ideation and self-esteem. Conclusion These results suggest that research on adolescent suicide intervention programs is expanding with a focus on ordinary adolescents as and subjects. In order to prevent suicide, research on family, teachers, and friends, who all are important parts of a teenager’s support system, is needed. It is also necessary to develop a post-management intervention program to prevent recurrence in high-risk teenagers who have attempted suicide. Key words: ì²­ì†Œë „; 중재; 연구; 자살 Key words: Adolescent; Programs; Research; Suicide

Short‐term change and prediction of suicidal ideation among adolescents: a daily diary study following psychiatric hospitalization

Our understanding of suicidal ideation (SI) and its risk precursors is largely informed by studies spanning over wide time intervals (weeks, months, years). Little is known about SI as it occurs in daily lives of individuals at risk for suicide, the extent to which suicidal thoughts are dynamic over short periods of time, and the degree to which theoretically informed risk factors predict near-term SI. Thirty-four adolescents hospitalized due to last-month suicide attempt and/or last-week SI (76% female; ages 13-17) responded to daily surveys sent to their cell phones for four consecutive weeks after discharge (n=652 observations). There was notable variability in day-to-day SI, with half of ideation ratings changing at least one within-person standard deviation from one day to the next. Results of mixed effects models revealed concurrent (same-day), but not short-term prospective (next-day), associations between SI (frequency, duration, urge) and well-established predictors (connectedness, burdensomeness, hopelessness). However, synergistic effects of low connectedness with either high burdensomeness or high hopelessness were reliably associated with more severe same- and next-day suicidal ideation. This study adds to emerging literature indicating that suicidal thoughts fluctuate considerably among individuals at risk for suicide, further extending it by focusing on adolescents in the critical posthospitalization period. Fostering high-risk adolescents' sense of connectedness to others may be an especially promising intervention target. Frequent assessment of SI and its predictors, independently and in combination, could help identify promising predictors of short-term risk and meaningful intervention targets in high-risk teens.

Prevention versus Clinical Management of Suicide Attempts in Adolescents: What are the Costs?

Introduction: Suicide is a worldwide public health problem, and being the youth are among one of the most affected population groups. In Colombia there is no evidence available about the cost of suicide care or prevention. Or attention to those who make suicide attempts assistance or prevention of suicide. This type of analysis is necessary to guide decisions about resource distribution in mental health and to reduce suicideal rates amongst youths in our country. Thus, the purpose of this study is to estimate and compare the mean cost of in-patient care cost treatment cost of youth suicidal youth suicide attempts, with the mean cost of participation in a school-based suicide preventive prevention program in for adolescents. Materials and methods: Medical charts of adolescents hospitalized for suicideal attempts were reviewed, along with as well as registries from adolescent participants in a suicide preventive program in Bogotá in 2010. Resources used were identified and tariff costs were quantified. Results: The average in-patients cost of a teenage suicideal attempt was $1 814 000 Colombian pesos (cop) (n = 39) Colombian pesos, and of $10 307 000 cop (n = 5) Colombian pesos when intensive care was required. The average cost of participation in a prevention ve program was $113 000 cop (n = 24) Colombian pesos per high-risk teenager and of $47 000 cop (n = 101) Colombian pesos for teenagers without suicide such risk. Conclusion: With For the average in- patient cost of one suicidal suicide attempt, 16 high-risk teenagers could be enrolled in a suicide preventive prevention program.

Personality Traits of High-Risk Female Teenagers

Juvenile delinquency involving female teenagers is at an alarming rate. Many negative practices including illicit sex and babies born out of wedlock are on the rise. This paper aims to investigate the personality traits among high-risk teenagers. The sample was purposively selected from 13 high-risk female teenagers who were undergoing a rehabilitating process at a rehabilitation centre in Kelantan. Data were gathered using a set of questionaires to determine their personality traits. The Statistical Package of Social Sciences (SPSS) version 21.0 was used to analyse the data. Results showed that the high-risk female teenagers had dominant negative personality traits including frustration, disappointment, gullibility, and low self-esteem. Aggressive behaviours and violence will be used to cover their inferiority complex if untreated. Serious attention should be given therefore both by parents and the authorities to reduce the rate of juvenile delinquencies among teenagers.

Parental Self-Efficacy to Support Teens During a Suicidal Crisis and Future Adolescent Emergency Department Visits and Suicide Attempts

This study of adolescents seeking emergency department (ED) services and their parents examined parents’ self-efficacy beliefs to engage in suicide prevention activities, whether these beliefs varied based on teens’ characteristics, and the extent to which they were associated with adolescents’ suicide-related outcomes. Participants included 162 adolescents (57% female, 81.5% Caucasian), ages 13–17, and their parents. At index visit, parents rated their self-efficacy to engage in suicide prevention activities and their expectations regarding their teen’s future suicide risk. Adolescents’ ED visits for suicide-related concerns and suicide attempts were assessed 4 months later. Parents endorsed high self-efficacy to engage in most suicide prevention activities. At the same time, they endorsed considerable doubt in being able to keep their child safe if the teen has thoughts of suicide and in their child not attempting suicide in the future. Parents whose teens experienced follow-up suicide-related outcomes endorsed, at clinically meaningful effect sizes, lower self-efficacy for recognizing suicide warning signs, for obtaining the teen’s commitment to refrain from suicide, and for encouraging their teen to cope, as well as lower confidence that their teen will not attempt suicide; self-efficacy to recognize warning signs was at trend level. Despite endorsing high self-efficacy for the majority of suicide prevention activities, parents of high-risk teens expressed less confidence in their capacity to influence their teen’s suicidal behavior, which could undermine parents’ effort to implement these strategies. The relationship between parental self-efficacy and youth suicide-related outcomes points to its potential value in guiding clinical decision making and interventions.

Community Emergency Response Team (CERT) Training of High-Risk Teens in the Community of Watts, South Los Angeles, 2013-2014.

The Community Emergency Response Team (CERT) concept was initially developed for adult members of the community to help prepare for disasters and minimize damage when disasters occur. CERTs also served as a tool for building community capacity and self-sufficiency by supporting a diverse group of people working together in dealing with challenges affecting their communities. The novel approach to CERTs described here sought to involve high-risk youth from low-socioeconomic status communities in CERTs and first aid and cardiopulmonary resuscitation (CPR) training to help them build ties with communities, stay off the streets, and become leaders in the community. It also helped to provide different perspectives on life, while building more resilient communities better prepared to minimize damage when a disaster strikes. After the successful launch of the first high-risk teen CERT cohort in Watts (27 CERT-trained and 14 first aid/CPR-trained), the project was expanded to other community groups and organizations. Seven additional cohorts underwent CERT and first aid/CPR training in 2013 through 2014. This initiative increased CERT visibility within South Los Angeles. New partnerships were developed between governmental, nongovernmental, and community-based organizations and groups. This model can be used to expand CERT programs to other communities and organizations by involving high-risk teens or other high-risk groups in CERT training. (Disaster Med Public Health Preparedness. 2017;11:605-609).

Teens and seat belt use: What makes them click?

ProblemMotor vehicle crashes kill more adolescents in the United States than any other cause, and often the teen is not wearing a seat belt. MethodsUsing data from the 2011 Youth Risk Behavior Surveys from 38 states, we examined teens' self-reported seat belt use while riding as a passenger and identified individual characteristics and environmental factors associated with always wearing a seat belt. ResultsOnly 51% of high school students living in 38 states reported always wearing a seat belt when riding as a passenger; prevalence varied from 32% in South Dakota to 65% in Delaware. Seat belt use was 11 percentage points lower in states with secondary enforcement seat belt laws compared to states with primary enforcement laws. Racial/ethnic minorities, teens living in states with secondary enforcement seat belt laws, and those engaged in substance use were least likely to always wear their seat belts. The likelihood of always being belted declined steadily as the number of substance use behaviors increased. DiscussionSeat belt use among teens in the United States remains unacceptably low. Results suggest that environmental influences can compound individual risk factors, contributing to even lower seat belt use among some subgroups. Practical applicationsThis study provides the most comprehensive state-level estimates to date of seat belt use among U.S. teens. This information can be useful when considering policy options to increase seat belt use and for targeting injury prevention interventions to high-risk teens. States can best increase teen seat belt use by making evidence-informed decisions about state policy options and prevention strategies.

The first step in preventing suicide is to ask

Adolescent suicide is a significant public health problem, representing the second leading cause of death in youth 10-21 years of age. Further, a national survey revealed that 8% of 9th to 12th grade students reported attempting suicide within the past year (MMWR 2014;63:1-168). Suicide can be preventable, but in order for prevention strategies to be successful, it is imperative to identify high-risk teens. However, opportunities to screen adolescents for risk of suicide within the medical system are frequently missed. Ross et al performed a qualitative-methods study to determine the opinions of medically ill adolescent inpatients regarding suicide risk screening. The majority of the patients (83%) were supportive of nurses screening inpatients for suicide risk. The major salient themes that emerged from those supportive of screening were: the potential of suicide prevention, elevated risk of hospitalized patients, emotional benefit to being asked, provider responsibility, and lack of harm in asking. Despite the concerning prevalence of adolescent suicide, the authors found that 62% of their cohort reported that they never had been asked about suicide in any setting. This finding is concerning, yet one that is relatively easy to change. The report by Ross et al provides data that, overall, adolescents support screening for suicidal thoughts. In order to affect change in the rate of teen suicide, it is critically important to first identify the population at risk.Article page 295▶ Adolescent suicide is a significant public health problem, representing the second leading cause of death in youth 10-21 years of age. Further, a national survey revealed that 8% of 9th to 12th grade students reported attempting suicide within the past year (MMWR 2014;63:1-168). Suicide can be preventable, but in order for prevention strategies to be successful, it is imperative to identify high-risk teens. However, opportunities to screen adolescents for risk of suicide within the medical system are frequently missed. Ross et al performed a qualitative-methods study to determine the opinions of medically ill adolescent inpatients regarding suicide risk screening. The majority of the patients (83%) were supportive of nurses screening inpatients for suicide risk. The major salient themes that emerged from those supportive of screening were: the potential of suicide prevention, elevated risk of hospitalized patients, emotional benefit to being asked, provider responsibility, and lack of harm in asking. Despite the concerning prevalence of adolescent suicide, the authors found that 62% of their cohort reported that they never had been asked about suicide in any setting. This finding is concerning, yet one that is relatively easy to change. The report by Ross et al provides data that, overall, adolescents support screening for suicidal thoughts. In order to affect change in the rate of teen suicide, it is critically important to first identify the population at risk. Article page 295▶ To Ask or Not to Ask? Opinions of Pediatric Medical Inpatients about Suicide Risk Screening in the HospitalThe Journal of PediatricsVol. 170PreviewTo describe opinions about suicide risk screening in a pediatric medical inpatient sample. Full-Text PDF

Enhancing Family Communication: Examining the Impact of a Therapeutic Wilderness Program for Struggling Teens and Parents

Every year approximately 130 families participate in Intercept, a program for struggling teens and their families at the Voyageur Outward Bound School, because they are concerned about the loss of trust, poor communication, and/or other high-risk behaviors they are experiencing with their children. Though families hope for improvements in family functioning, little research has been done on the impact of this type of program on the parent/child relationship or how families function once they leave the program. This phenomenological study collected qualitative data from nine families to determine what positive relationship outcomes emerged between parent(s) and their adolescent child post-program, as well as what aspects of the program curriculum were helpful in improving the parent/child relationship. Results showed that communication among family members improved as a result of participation in the Outward Bound program, and families reported utilizing new skills they had learned, including the use of time-outs, improved listening, and other assertive communication tools. Families reported that the parent/child conference at the end of the program was the most helpful aspect of the Intercept curriculum for improving the parent/child relationship. Implications for family therapy include support for therapeutic wilderness programs as a viable intervention for families of high-risk teens struggling with communication.

Sibling teenage pregnancy and clinic-referred girls' condom use: The protective role of maternal monitoring.

Younger sisters of teenage parents have elevated rates of engaging in unprotected sex. This may result from changes in parenting behavior after a sibling becomes pregnant or impregnates a partner, and be particularly pronounced for girls seeking mental health treatment. The current study examines condom use over time in 211 African-American girls recruited from outpatient psychiatric clinics. Findings indicate that having a sibling with a teenage pregnancy history predicts less consistent condom use two years later. After accounting for earlier condom use and mental health problems, maternal monitoring moderates condom use such that for girls with a sibling with a pregnancy history, more vigilant maternal monitoring is associated with increased condom use, while for girls with no sibling pregnancy history, maternal monitoring is unrelated to adolescents' condom use two years later. Findings suggest that targeted interventions to increase maternal monitoring of high-risk teens may be beneficial for girls with a sibling history of teenage pregnancy.

Predictors of Early Discontinuation of Effective Contraception by Teens at High Risk of Pregnancy

Study ObjectiveIn the United States, teen pregnancy rates are declining. However, the United States still has the highest teen pregnancy rate among high-income countries. Understanding factors that predict discontinuation of effective contraception might help to further decrease teen pregnancy. We aimed to assess predictors of early discontinuation of effective contraception during typical use by high-risk teens. Design, Setting, Participants, Interventions, and Main Outcome MeasuresWe recruited 145 women aged 13-20 years (mean, 17.7 ± 1.8 years); 68% (99/145) Hispanic; 26% (38/145) black; 14% (20/145) ever pregnant; and 4% (6/145) high school dropouts who chose an effective contraceptive method during a health care visit and we prospectively assessed use of the method after 6 months. Contraceptive choices of the 130 participants who were reassessed at 6 months (90% retention) were: intrauterine device (IUD), 26% (34/130); depot medroxyprogesterone acetate (DMPA), 8% (10/130); combined oral contraceptives (COCs), 48% (62/130); transdermal patch (Patch), 13% (17/130); and intravaginal ring (Ring), 5% (7/130). ResultsAfter 6 months, only 49 of 130 (38%) continued their chosen method; 28 of 130 (22%) never initiated the method; and 53 of 130 (40%) discontinued. Users and nonusers at 6 months did not differ according to cultural and/or social characteristics (age, ethnicity, acculturation, education, health literacy) but differed according to contraceptive method type. For the 102 of 130 who initiated a method, 88% continued use of the IUD, 20% DMPA, 43% COC, 17% Patch and Ring (P < .001). Using Cox proportional hazards multivariable analysis, compared with IUDs, all other methods predicted discontinuation: DMPA (hazard ratio [HR], 5.6; 95% confidence interval [CI], 1.2-26.7; P < .05); COCs (HR, 6.6; 95% CI, 1.8-25; P < .01); Patch and Ring (HR, 12; 95% CI, 3.0-48; P < .001). Discontinuation was also predicted by past use of hormonal contraceptives (HR, 1.9; 95% CI, 1.0-3.6; P < .05) and high school dropout (HR, 8.2; 95% CI, 1.6-41; P < .01). ConclusionContraceptive method type is the strongest predictor of early discontinuation; compared with IUDs, all other methods are 6-12 times more likely to be discontinued. Cultural and/or social characteristics, with the exception of school dropout, are of little predictive value. Increasing the use of IUDs by high-risk teens could decrease discontinuation rates and possibly teen pregnancy rates.

Abstract A26: Relative influence of home and school environments on specific dietary behaviors among postpartum, high-risk teens

Abstract Background: Nearly one third of adolescent girls are overweight or obese, and this risk is significantly heightened for postpartum, high-risk teenagers. Interventions among this difficult to reach population are critical for the prevention of obesity and related health effects, including several types of epithelial cancers. Targeting the home and school environment, where teens spend most of their time, may be particularly effective at reducing behaviors associated with obesity. Previously, in a study of high-risk postpartum teens, we found a greater influence of the perceived home food environment (vs. school) on total calories consumed from food and beverage groups. Here we aim to build upon these findings, looking at consumption of specific food and beverage items and the relative influence of school and home food environments, and whether relationships vary by baseline body mass index (BMI). Methods: This is a cross-sectional, baseline analysis of 875 girls enrolled in the Balance Adolescent Lifestyle Activities and Nutrition Choices for Energy (BALANCE) study, a weight loss intervention designed to prevent obesity among postpartum, high-risk adolescents across 26 states. A total of 8 items were used to assess perceived healthful school and home food environments, respectively, on a 5-point Likert Scale. Ratings were averaged and dichotomized to generate an overall environment score. To assess the relative influence of home and school environment, we created the following categories: 0,“negative school &amp; home”; 1, “positive school only” 2, ”positive home only” 3, ”positive school &amp; home”. Frequency of specific food and beverage items were collapsed into binary categories to reflect infrequent (0-3 days/week) and frequent (4-7 days/week) consumption. Height and weight were obtained by trained staff and used to calculate BMI-for-age (dichotomized as normal [&amp;lt;85th %tile] and overweight/obese [≥85th %tile]). Relationships between environment and dietary behaviors were assessed using chi-square tests. To assess the relative influence of home and school environments, we used logistic regression with generalized estimating equations (GEE) to account for clustering within state. Regression models were adjusted for race, age, and postpartum status (results reported as GEE OR, 95% CI). All models were stratified by baseline BMI. Results: Among 875 postpartum teens, a positive home environment was significantly associated with decreased consumption of chips and increased consumption of fruit and vegetables (p &amp;lt;0.05). A positive school environment was associated with increased fruit consumption (p &amp;lt;0.05). In terms of beverage items, only a positive home environment was significantly associated with increased consumption of water and milk and a decreased consumption of regular soda (chi-sq p &amp;lt;0.05). Results from the regression analyses indicated significant relationships between a positive home, and both positive home &amp; school environments and healthy food items (i.e., fruit: 2.9, 1.6 – 5.6 and 2.9, 1.6 – 5.4, respectively) and decreased consumption of unhealthy food items (i.e., chips: 0.5, 0.3 – 0.8 and 0.8, 0.5 – 1.1, respectively). Similar findings were observed for beverage items (i.e., water: 2.6, 1.7 – 4.0 and 1.8, 1.2-2.6, respectively) and (i.e., regular soda: 0.5, 0.3 – 0.7 and 0.7, 0.5 – 1.0, respectively). In general, patterns did not differ significantly by baseline BMI. Conclusions: In this understudied population of postpartum teens, the home environment was associated with healthy dietary behaviors. Results indicated that having a positive home environment was enough to influence behavior and for many items, the added benefit of a positive school environment was relatively low. Improving the home environment may be particularly important among this population of teen moms who are at increased risk for obesity and who are in a position to pass down their food behaviors to their children. Citation Format: Megan A. Clarke, Rachel G. Tabak, Cynthia D. Schwarz, Debra L. Haire-Joshu, Corinne E. Joshu. Relative influence of home and school environments on specific dietary behaviors among postpartum, high-risk teens. [abstract]. In: Proceedings of the Thirteenth Annual AACR International Conference on Frontiers in Cancer Prevention Research; 2014 Sep 27-Oct 1; New Orleans, LA. Philadelphia (PA): AACR; Can Prev Res 2015;8(10 Suppl): Abstract nr A26.