Teen Club Research Articles

Presence of Teen Clubs and its Association with Clinic Attendance among Adolescents Living with HIV in Tanzania: A Retrospective Cohort Study.

Adolescent's living with Human Immunodeficiency Virus (HIV) are widely reported to have poor adherence to antiretroviral therapy (ART) due to stigma and fear of discrimination. A "Teen club" is an adolescent centered intervention designed to reduce social stigma and improve adherence and retention in HIV care. In this study we determined how the availability of teen clubs within routine HIV care and treatment facilities affects adolescents' clinic attendance. We conducted a retrospective cohort study using secondary data from routine clinic records on adolescents (10-19 years) who started ART between 2010 and 2016, and had documented clinic visits between March 2017 and September 2017 at HIV care and treatment clinics (CTC) in northern and central Tanzania. Good clinic attendance was defined as attending at least four monthly clinic visits during the 7-month follow-up period. A Poisson model with robust standard errors was used to assess the relationship between presence of a teen club at health facilities and good clinic attendance adjusting for other factors including sex, age at ART initiation, duration on ART, WHO clinical stage and health facility level. Of the 2839 adolescents, 73.1% had good clinic attendance. Good clinic attendance was independently associated with availability of a teen club at the health facility (aRR=1.16, 95%CI:1.09-1.21) and been on ART for >2 years (aRR=1.15, 95%C1.02-1.30). Adolescents aged 15-19 years during this study were less likely to have good clinic attendance (aRR= 0.93, 95%CI:0.88-0.98) than those aged <15 years. Sex and WHO clinical stage were not associated with good clinic attendance. Teen clubs improved visit adherence among adolescents in HIV care and treatment. Further qualitative research should be conducted to explore adolescents' perception of teen clubs as well as other enablers to clinic attendance.

Impact of a teen club model on HIV outcomes among adolescents in rural Neno district, Malawi: a retrospective cohort study

ObjectiveTo compare the impact of a teen club model to the standard care model on HIV treatment outcomes among adolescents (10–19 years of age).DesignRetrospective cohort study.SettingHIV clinics in Neno district,...

Retrospective Cohort Study Comparing Antiretroviral Treatment Outcomes Among Adolescents in Teen Clubs and Standard Care Clinics: Blantyre, Malawi.

This study investigated if the Teen Club model improves virological suppression and reduces virological failure. Viral load monitoring is a golden ART programme performance indicator. HIV treatment outcomes are poor among adolescents compared to adults. Different service delivery models are being implemented to address this; among them is the Teen Club model. Currently, teen clubs improve treatment adherence (short-term impact), but there is a knowledge gap regarding the long-term impact. The study compared the rate of virological suppression and failure among adolescents in Teen Clubs and those on the standard of care (SoC) model. This was a retrospective cohort study. A total of 110 adolescents in teen clubs and 123 adolescents in SOC from six health facilities were selected using stratified simple random sampling. The participants were followed for 24 months. STATA version 16.0 was used for data analysis. Univariate analyses were performed for both demographic and clinical variables. A Chi-squared test was used to assess the differences between proportions. Crude and adjusted relative risks were calculated using a binomial regression model. At 24 months, 56% of adolescents in the SoC arm had viral load suppression compared to 90% in the Teen Club arm. Of those who achieved viral load suppression at 24 months, about 22.7% (SoC) and 76.4% (Teen Club) achieved undetectable viral load suppression rates. Adolescents in the Teen Club arm had a lower viral load than those in the SoC arm (adjusted RR 0.23, 95% CI: 0.11-0.61; p = 0.002 adjusted for age and gender). Teen Club and SoC adolescents had virological failure rates of 3.1% and 10.9%, respectively. The adjusted RR was 0.16, 95% CI: 0.03-0.78; p = 0.023; those in Teen Clubs were less likely to have virological failure relative to those in SoC after adjusting for age, sex, and place of residence. The study found that Teen Club models are more effective at achieving virological suppression among HIV positive adolescents.

Factors associated with antiretroviral therapy adherence among adolescents living with HIV in the era of isoniazid preventive therapy as part of HIV care.

High levels of adherence to antiretroviral therapy (ART) are essential to promoting viral suppression and consequential good treatment outcomes. Adolescents living with HIV (ALHIV) in sub-Saharan Africa are less adherent to ART compared to adults, leading to lower rates of viral suppression and immunological recovery. We conducted a mixed-method study utilizing a convergent parallel approach to explore factors associated with ART adherence among ALHIV in the era of isoniazid preventive therapy (IPT) as part of HIV care. The quantitative data were collected from patient records from the period between 1 February 2017 and 31 January 2018 (6 months before and after IPT introduction), while qualitative data was collected from purposively selected patients and healthcare workers by in-depth interviews through a pretested interview guide. A total of 385 patient records (age 10-19 years) were analyzed in the two time periods, while 16 ALHIV (age 10-19 years) and three healthcare workers directly involved in adolescent care were interviewed. Quantitative data utilized logistic regression to measure the strength of association between IPT addition and ART adherence, whereas, qualitative data were analyzed using a thematic analysis approach. The mean age of participants in the quantitative section was 14.3 years (SD 2.7) and 178 were females, while the median age for adolescents interviewed was 14 (IQR 12-17) and 8 were females. Overall, we found an interaction of factors that influenced ART adherence. Added pill burden, on its own, did not affect ART adherence. Commonly reported factors that led to poor adherence were lack of status disclosure within the family, school pressure, and inadequate support from guardians and parents. According to retrospective patient records, complex ART regimens also worsened adherence (p = 0.0462). ART regimen was independently associated with adherence (OR 2.11 95% CI 0.97-4.53). Being on ART for a longer duration, enrolment into teen clubs, clinical psychosocial support, and self-reinforcement techniques were suggested to improve ART adherence. The interplay of multiple factors leads to poor rates of adherence. The introduction of IPT to ART packages may not independently affect ART adherence. Readily available psychosocial services and the presence of peer and guardian support is critical to optimal ART adherence. There is a need for ART centers that provide HIV care to adolescents to consider integrating psychosocial and other youth-friendly services into day-to-day clinic operations.

Stigma and mental health challenges among adolescents living with HIV in selected adolescent-specific antiretroviral therapy clinics in Zomba District, Malawi.

BackgroundOf the 1.8 million adolescents between the ages of 10 and 19 living with HIV globally in 2020; approximately 1.5 million of these live in sub-Saharan Africa. These adolescents living with HIV (ALHIV) are at higher risk of experiencing mental health problems than those without; in Malawi, 18.9% have a depressive disorder. ALHIV can face numerous psychosocial challenges, but little is known about how ALHIV in Malawi perceive these stressors. Understanding psychosocial challenges of ALHIV is a key step in ensuring good mental health care. The aim of this study was to assess the psychosocial challenges faced by ALHIV attending adolescent-specific ART program in Zomba, Malawi.MethodsBetween April and May 2019, we engaged a purposive sample of ALHIV ages 12–18 (n = 80) in a series of eight focus groups drawing from four Teen Clubs linked to an adolescent-specific ART program. Data were analyzed inductively and deductively to identify themes related to ALHIV psychosocial experiences.ResultsTwo themes that emerged from the study include: 1) stigma and discrimination within communities and families; 2) non-adherence to medications. HIV-related stigma was associated with increased psychological distress; physical and emotional/verbal abuse; low social support, isolation, and a feeling of rejection; and risky health behaviors such as medication hiding and non-adherence to ART. Discriminatory actions were manifested in a form of being given separate utensils for their meals and mistreatment at school. Furthermore, some parents did not allow their children to play with the participants out of fear that HIV transmission.ConclusionsStigma and discrimination are overlooked potential barriers to HIV treatment and care. If HIV services are to effectively meet ALHIVs' needs, mental health interventions are needed to prevent and manage depression and improve adherence to ART. These findings highlight the crucial need to develop culturally relevant mental interventions aimed at helping ALHIV to cope with these diverse challenges.

Barriers and facilitators to implementing the HEADSS psychosocial screening tool for adolescents living with HIV/AIDS in teen club program in Malawi: health care providers perspectives

BackgroundAdolescents living with HIV (ALHIV) are at high risk of experiencing mental health problems. Depression is a major contributor to the burden of HIV-related disease amongst ALHIV and is significantly linked to non-adherence to anti-retroviral therapy (ART), yet it is under-recognized. In 2015, the Baylor College of Medicine International Pediatric AIDS Initiative (BIPAI) recommended that the psychosocial screening tool Home, Education, Activities, Drugs, Sexuality, Suicide/Depression (HEADSS) be used to screen ALHIV in Malawi who were part of an adolescent antiretroviral therapy program termed “Teen Club”. However, the HEADSS tool has been substantially under-utilized. This study assessed barriers and facilitators to implementing HEADSS for ALHIV attending Teen Club Program in four selected health facilities in Malawi.MethodsWe conducted a qualitative study using semi-structured interviews at four program sites (one district hospital and one health center each in two districts) between April and May 2019. Twenty key informants were purposively selected to join this study based on their role and experiences. We used the five domains of the Consolidated Framework for Implementation Research (CFIR) to guide the development of the interview guides, analysis and interpretation of results.ResultsBarriers included inadequate planning for integration of the HEADSS approach; concerns that the HEADSS tool was too long, time consuming, lacked appropriate cultural context, and increased workload; and reports by participants that they did not have knowledge and skills to screen ALHIV using this tool. Facilitators to implementing the screening were that health care providers viewed screening as a guide to better systematic counselling, believed that screening could build better client provider relationship, and thought that it could fit into the existing work practice since it is not complex.ConclusionsA culturally adapted screening tool, especially one that can be used by non-clinicians such as lay health workers, would improve the ability to address mental health needs of ALHIV in many primary care and social service settings where resources for professional mental health staff are limited. These findings are a springboard for efforts to culturally adapt the HEADSS screening tool for detection of mental and risky behaviors among ALHIV attending ART program in Malawi.

Вплив соціально-педагогічної діяльності підліткового клубу на розвиток особистісної ідентифікації підлітків

The article considers the influence of the socio-psychological activities of the teen club by interests on the development of personal identification of teenagers. Personal identification plays an important role in the process of interaction between a psychologist, a teacher and a pupil, thus stimulating psycho-corrective changes. In this paper, we consider it appropriate to highlight and explore the impact of the club forms of work on the development of personal identification in the process of social and psychological activities. It is pointed out that there are hundreds of teen clubs that operate at the national, regional and local levels and implement a large number of different programs of socially significant direction in Ukraine nowadays. It has been proved that an important place in the system of education of the younger generation belongs to clubs. They are the social institutions that are designed to organize leisure time not only for adults and promote the diverse development of the growing individual. Therefore, all the activities of the club by interests consist of two interrelated parts such as purposeful educational, educational and organizational activities of employees and actve particpants of the club and leisure activities of adolescents. The study of personal identification of adolescents is based on theoretical analysis of existing research, which reveals a field of relevant aspects for further study, namely educational work with adolescents, social and cultural determinism, the connection with the experience of negative affect.

Социально-культурные аспекты приобщения детей к нематериальному культурному наследию в деятельности подростковых клубов

The paper reveals socio-cultural aspects of introducing children to non-material cultural heritage within teen clubs activities. Relying on developmental psychology conceptions proposed by D. B. Elkonin and D. I. Feldstein, the author identifies the specificity of teen clubs activities. The article analyzes the activities of local lore clubs, museums, educational and recreational institutions to introduce children to non-material cultural heritage, determines organizational and pedagogical conditions for improving teen clubs activities. Scientific originality of the research involves identifying contradictions arising due to incapability of the existing teen clubs to satisfy target audience aspirations to study non-material cultural heritage. The research findings are as follows: the author reveals shortcomings in teen clubs activities for introducing teenagers to non-material cultural heritage, justifies the necessity to develop integrated programs of teen clubs activities.

Attendance of psychosocial teen clubs and self-reported antiretroviral medication adherence: a cross section study of adolescents with perinatal HIV in the Kingdom of Lesotho.

BackgroundTo address the problem of poor adherence among adolescents with perinatal HIV (PHIV), all clinics in Lesotho offer adolescent-friendly services and psychosocial support to improve their overall health outcomes and adherence. As a result, most adolescents with PHIV attend Teen Clubs as part of the package of youth-friendly HIV services. This study set out to determine whether attending Teen Clubs facilitates treatment adherence among adolescents with PHIV.MethodsIn this cross-sectional study, data were collected from 130 adolescents aged 10–19 years who were aware of their HIV status and had attended three or more Teen Club sessions in selected clinics in rural district in Lesotho. Adherence was measured through self-report of last pills missed, based on the 7-days recall of pills taken. Descriptive statistics were used to analyse the data.ResultsThe median age of adolescents was 15 years, 56% were female, 37.7% were orphans, 41% were being cared for by their grandparents, 6.9% were living with siblings with no adult figure, and two were living on their own. The majority (93%) reported optimal adherence, 92% had not missed a clinic appointment in the past 30 days, and 74.4% knew that if they skipped doses, the viral load would increase and they would get sick. Over half (56%) had been reminded by their caregivers to take their medication and 96% talked to their caregivers regularly about their medication.ConclusionA supportive environment provided through the Teen Clubs and in the home were the main facilitators for adherence. Strategies to improve adherence among adolescents should consider the importance of the involvement of caregivers in the adolescents' visits to their clinic.

The Comparison of Teen Clubs vs. Standard Care on Treatment Outcomes for Adolescents on Antiretroviral Therapy in Windhoek, Namibia.

Background Adolescents living with HIV (ALHIV) are challenged to adhere to antiretroviral therapy (ART) and achieve and maintain virologic suppression. Group-based adherence support interventions, such as adherence clubs, have been shown to improve long-term adherence in ART patients. The teen club intervention was introduced in 2010 in Namibia to improve treatment outcomes for ALHIV by providing adherence support in a peer-group environment. Adolescents who have completed the full HIV disclosure process can voluntarily join the teen clubs. The current study compared treatment outcomes of ALHIV receiving ART at a specialized paediatric HIV clinic between 1 July 2015 and 30 June 2017 in Windhoek, Namibia. Methods A retrospective cohort analysis was conducted on routine patient data extracted from the electronic Patient Monitoring System, individual Patient Care Booklets, and teen club attendance registers. A sample of 385 adolescents were analysed: 78 in teen clubs and 307 in standard care. Virologic suppression was determined at 6, 12, and 18 months from study start date, and compared by model of care, age, sex, disclosure status, and ART regimen. Comparisons between adolescents in teen clubs and those receiving standard care were performed using the chi-square test, and risk ratios were calculated to analyze differences in ART adherence and virologic suppression. Results The average clinician-measured ART adherence was 89% good, 6% fair, and 5% poor amongst all adolescents, with no difference between teen club members and adolescents in standard care (p = 0.277) at 3 months. Virologic suppression over the 2-year observation period was 87% (68% fully suppressed <40 copies/ml and 19% suppressed between 40–999 copies/ml), with no difference between teen club members and those in standard care. However, there were statistically significant differences in virologic suppression levels between the younger (10–14 years) adolescents and older (15–19 years) adolescents at 6 months (p = 0.015) and at 12 months (p = 0.021) and between adolescents on first-line and second-line ART regimen at 6 months (p = 0.012), 12 months (p = 0.004), and 18 months (p = 0.005). Conclusion The teen club model delivering psychosocial support only did not improve adherence and virologic suppression levels for adolescents in a specialized paediatric ART clinic, neither were they inferior to standard care. Considering the limitations of this study, teen clubs may still hold potential for improving adherence and virologic suppression levels for older adolescents, and more robust research on adherence interventions for adolescents with higher methodological quality is required.

The effects of Teen Clubs on retention in HIV care among adolescents in Windhoek, Namibia.

BackgroundAdolescents living with HIV (ALHIV) are notably underserved by the national HIV programmes globally because of their unique needs. Of particular concern is limited access to and availability of adolescent-friendly antiretroviral therapy (ART) services, which contribute to poor retention in care in many sub-Saharan African countries. A Teen Club intervention was introduced in 2010 in Windhoek, Namibia, to improve retention in care among ALHIV through psychosocial support in a peer-group environment.ObjectivesTo compare the effects of the Teen Club intervention against standard care on retention in HIV care amongst adolescents at a Paediatric ART clinic.MethodA retrospective cohort analysis of adolescents aged 10–19 years receiving ART between July 2015 and June 2017 was conducted. Routine patient data were extracted from an electronic database and patient registers. A sample of 385 participants was analysed: 78 in the Teen Club and 307 in standard care. Retention was measured by assessing attendance to prescribed clinic visits up to 24 months. Comparisons were assessed with the Chi-square test, and Kaplan–Meier survival analysis was conducted to analyse differences in retention rates.ResultsThe overall retention rate at 24 months among all adolescents was 90.1%, with no statistically significant difference between those in Teen Club (91%) and those in standard care (89%) (p = 0.956). Younger adolescents (10–14 years) had better retention rates at 24 months compared to older adolescents (15–19 years) (94% vs. 86%; p = 0.016). Retention rates were significantly higher for adolescents on first-line ART regimen (vs. second line: hazard ratio [HR] = 0.333; 95% confidence interval [CI] = 0.125–0.889); on ART ≥ 12 months (vs. < 12 months: HR =0.988; 95% CI = 0.977–0.999); and those to whom their HIV status was disclosed (HR = 0.131; 95% CI = 0.025–0.686).ConclusionGroup-based adherence support interventions did not improve retention rates for younger adolescents in specialised paediatric ART clinics but may still hold the potential for improving retention rates of older adolescents.

ART Adherence Among Malawian Youth Enrolled in Teen Clubs: A Retrospective Chart Review.

To improve outcomes among HIV-positive adolescents, the Malawi Ministry of Health is supporting scale-up of "Teen Clubs," a facility-based antiretroviral treatment (ART) delivery model. Teen Clubs are monthly ART clinics for adolescents (10-19years old) that provide clinical services and peer psychosocial support. This paper assesses ART adherence among Teen Club attendees in Malawi. We performed a retrospective analysis of medical records and Teen Club attendance data on 589 HIV-positive adolescents at 16 Partners in Hope (PIH)-Extending Quality Improvement for HIV/AIDS in Malawi (EQUIP) supported facilities across Malawi, from January to June of 2017, who attended at least two Teen Club sessions. Multi-level logistic regression models were used to examine the role of gender and age on optimal ART adherence (≥ 95% based on pill count) among HIV-positive adolescents enrolled in Teen Clubs. The median age of adolescents in this sample was 14years, and 47% were male. Older adolescent males (15-19years) were 64% more likely to achieve ≥ 95% ART adherence (aOR 1.64, 95% CI 1.16-2.31, p < 0.01) compared to younger (10-14years) males. The effect of age on adherence was smaller and not significant among females (aOR 1.36, 95% CI 0.96-1.94, p = 0.08). In the full model including males and females, older adolescence was associated with higher odds of optimal adherence (aOR 1.48, 95% CI 1.16-1.90, p < 0.01). These results reinforce the need for age-specialized programming for adolescents, and future research should evaluate this in achieving optimal ART adherence.

Teen Club Prepares Youth for Volunteer Work

Teen Club Prepares Youth for Volunteer Work

Greater retention in care among adolescents on antiretroviral treatment accessing "Teen Club" an adolescent-centred differentiated care model compared with standard of care: a nested case-control study at a tertiary referral hospital in Malawi.

IntroductionThere are numerous barriers to the care and support of adolescents living with HIV (ALHIV) that makes this population particularly vulnerable to attrition from care, poor adherence and virological failure. In 2010, a Teen Club was established in Zomba Central Hospital (ZCH), Malawi, a tertiary referral HIV clinic. Teen Club provides ALHIV on antiretroviral treatment (ART) with dedicated clinic time, sexual and reproductive health education, peer mentorship, ART refill and support for positive living and treatment adherence. The purpose of this study was to evaluate whether attending Teen Club improves retention in ART care.MethodsWe conducted a nested case–control study with stratified selection, using programmatic data from 2004 to 2015. Cases (ALHIV not retained in care) and controls (ALHIV retained in care) were matched by ART initiation age group. Patient records were reviewed retrospectively and subjects were followed starting in March 2010, the month in which Teen Club was opened. Follow‐up ended at the time patients were no longer considered retained in care or on 31 December 2015. Cases and controls were drawn from a study population of 617 ALHIV. Of those, 302 (48.9%) participated in at least two Teen Club sessions. From the study population, 135 (non‐retained) cases and 405 (retained) controls were selected.ResultsIn multivariable analyses, Teen Club exposure, age at the time of selection and year of ART initiation were independently associated with attrition. ALHIV with no Teen Club exposure were less likely to be retained than those with Teen Club exposure (adjusted odds ratio (aOR) 0.27; 95% CI 0.16, 0.45) when adjusted for sex, ART initiation age, current age, reason for ART initiation and year of ART initiation. ALHIV in the age group 15 to 19 were more likely to have attrition from care than ALHIV in the age group 10 to 14 years of age (aOR 2.14; 95% CI 1.12, 4.11).ConclusionsThis study contributes to the limited evidence evaluating the effectiveness of service delivery interventions to support ALHIV within healthcare settings. Prospective evaluation of the Teen Club package with higher methodological quality is required for programmes and governments in low‐ and middle‐income settings to prioritize interventions for ALHIV and determine their cost‐effectiveness.

ARSH 7: Community Adolescent Health Care and Education: Experience of an Innovative Approach

The main objective of the project was to create a community adolescent health care and education initiative with an innovative approach of educating all community stakeholders involved in promoting adolescent health. Step 1: Conceptualization and strategy planning for combined training; Step II: Preparation of teaching module, flip charts and pamphlets in local language; Step III: Hands on training of community trainers; Step IV: Sensitization of the stakeholder leadership to ensure the cooperation of all stakeholders; Step V: Formation of Teen clubs; Step VI: The combined health education programs at community outlets; Step VII: Detection of adolescent health issues by ASHA and anganwadi workers; Step VIII: Setting up of Saturday adolescent clinics at CHCs as a community referral facility. Under 1,060 programs, 34,851 community stakeholders could be trained together including 15,777 mothers, 14,565 adolescents, 2,236 ASHA workers, 2,021 anganwadi workers, and 252 community leaders. The concept of combined training of community stakeholders was found to be feasible and acceptable to the participants. The experience of the CDC-NRHM-AHDP project has shown that ASHA workers and anganwadi workers could be important link persons between adolescents and the health providers.

A Panchayat Level Primary-care Approach for Adolescent Services

To develop a model for providing community adolescent care services in the primary care setting Need assessment was done among adolescents and perceived problems of adolescents were studied using qualitative and quantitative methods. Based on the results of these studies, a Family Life Education (FLE) module was prepared. Awareness programs were organized for all stakeholders in the community on adolescent issues. All anganwadi workers in the panchayat were trained to take interactive sessions for all the adolescents in the panchayat using the FLE module. Ward based Teen Clubs were formed in all the 13 wards of the Panchayat separately for boys and girls and FLE classes were given to them through anganwadi workers. An Adolescent Clinic was set up to provide necessary medical and counseling facilities. Adolescent Health Card was distributed to all Teen Club members and those who attended the adolescent clinics. The present approach stresses the need and feasibility of adolescent-centered, community-based interventions. The authors' experience showed that before starting any adolescent program, community awareness generation about the need and content of the program is very important for its success. The experience of this model has made it possible to up-scale the program to seven districts of southern Kerala as a service model. The experiences of the program gave a realistic picture of the needs and problems of adolescents and a simple feasible model for providing services to adolescents in the primary care setting that can be easily replicated in other parts of India.

CE FEATURE: The Effect of Positive Adolescent Life Skills Training on Long Term Outcomes for High-Risk Teens

This paper reports on long term follow-up data-12 months post intervention-from a clinical trial of an intervention designed to enhance teen resilience by supporting the development of social skills needed to make positive connections and overcome the influence of negative environmental influences. Sixteen adolescents aged 12 to 16 (10 boys and 6 girls) attending an inner city urban secondary school participated in a 32 week intervention study. Subjects were randomly assigned within sex to Teen Club plus Positive Adolescent Life Skills (PALS) or Teen Club intervention groups. The Problem Oriented Screening Instrument for Teenagers (POSIT) was used to measure the dependent variables (problems related to substance use, health, mental health, family relations, peer relations, education status, vocational status, social skills, leisure and recreation, and aggression). The small sample size limited the ability to determine statistical differences between the POSIT subscale scores for PALS plus Teen Club or Teen Club only interventions. Descriptive data suggest mixed results for both interventions and sex groups. Most important were reductions in mental health problems for all boys in both groups and only slightly increased numbers of problems in substance use for PALS boys and girls over time. Other trends by group and sex are reported.

Positive Adolescent Life Skills Training for High-Risk Teens: Results of a Group Intervention Study

This study tested the addition of a cognitive-behavioral skill-building component called Positive Adolescent Life Skills (PALS) training to an existing intervention for urban adolescents to enhance resiliency. In previous pilot work with the existing intervention, called "Teen Club," it was found that participants in group meetings and intensive case management reported an enhanced ability to connect with positive resources. Sixteen adolescents aged 12 to 16 years (10 boys and 6 girls) attending an urban secondary school were randomly assigned to Teen Club or Teen Club plus PALS. Boys and girls met separately in one of the two conditions for 30 weeks. The Problem-Oriented Screening Instrument for Teenagers (POSIT) subscale scores were measured at baseline and at the completion of the program. The sample consisted of 11 Black and five Hispanic teens. Between-group differences in the POSIT subscale scores were not significantly different in this small sample. Group interviews conducted at the conclusion of the intervention revealed that participants found the PALS intervention to be relevant and useful. Results suggest that the PALS component strengthened the existing intervention and lend preliminary support for the continuation of this combination of interventions. Future research with larger numbers is needed.

Paul Whiteman: Pioneer in American Music (review)

Reviewed by: Paul Whiteman: Pioneer in American Music Wayne Schneider Paul Whiteman: Pioneer in American Music. Volume I: 1890– 1930. By Don Rayno . ( Studies in Jazz, 43.) Lanham, MD: Scarecrow Press, Inc., 2003. [ xxviii, 775 p. ISBN 0-8108-4579-2. $49.95.] Illustrations, chronology, discography, bibliography, indexes. Paul Whiteman (1890-1967) was the most popular dance orchestra leader in America in the 1920s, and surely one of the most controversial figures in American popular music. Classically trained, Whiteman played viola in the Denver Symphony Orchestra, San Francisco Symphony, and Minetti String Quartet. Lured by syncopated dance music, ragtime, and the intoxicating rhythms of early jazz, Whiteman organized a successful dance orchestra in California in 1918, later moving to Atlantic City, and eventually settling in New York in 1920. Recording contracts with Victor and later Columbia spread the orchestra's popularity nationwide. Whiteman's recording of "Whispering" (1920) backed with "The Japanese Sandman"—only the eleventh one-million-record seller since the birth of the recording industry—sealed his fame. As the twenties roared, the Whiteman Orchestra swelled in size (from a few players to nearly thirty) and glory, dominating popular music entertainment. The orchestra headlined Broadway revues (George White's Scandals, Ziegfeld's Follies), held court in fabulous New York hotel ballrooms, and toured extensively in the United States and abroad. Paul Whiteman, Inc., sponsored "satellite" bands that played officially sanctioned concerts of authorized Whiteman musical arrangements. The orchestra was featured on radio (The Old Gold Hour), and in half a dozen films—most famously, The King of Jazz (1930). The Depression hit big bands hard in the 1930s, but Whiteman persevered with a smaller, brassier ensemble. Embracing the new technology of television in the 1940s, Whiteman conducted studio bands for pioneer broadcasts of Goodyear Revue, Paul Whiteman's TV Teen Club, and others. Whiteman was music director of ABC-TV until his retirement in the 1960s. In his heyday in the 1920s, Whiteman's musical recipe served up dance music, rhapsodic arrangements of popular songs, syncopated versions of light classics, and concert music—what Whiteman called "symphonic jazz." The highlight of Whiteman's career was his much-ballyhooed "Experiment in Modern Music," at Aeolian Hall in New York, 12 February 1924. This "educational" concert was designed to show the progress of jazz from its "crude" origins to the refined heights of 1924s popular music. The showstopper of the concert, of course, was the premiere of Rhapsody in Blue, for piano and jazz band, featuring its 26-year-old Tin Pan Alley composer George Gershwin at the piano. The same year, flushed with commercial success, Whiteman's publicity team resurrected the slogan "King of Jazz," first applied to Whiteman during a 1919 gig at the Maryland Hotel in Pasadena. Whiteman was uncomfortable with the title, but it stuck to him—for good or ill—for the rest of his life. Clearly, Whiteman knew what jazz music was, generally, and hired the best white "hot" jazz soloists he could find, often scooping them up from failed white jazz bands. Whiteman featured these hot soloists in spotlight sections of his arrangements, bookended (smothered, some say) by the entire ensemble. For years, jazz aficionados have blamed the Whiteman Orchestra's top salaries and bland stylings for the alcoholism and early death of cornetist Bix Beiderbecke (1903-1931), Whiteman's most famous hot soloist. Not surprising, then, that the "King of Jazz" publicity stunt has stuck in the collective craw of many jazz performers, fans, and writers for decades. So Don Rayno's enormous new biography of Whiteman begins on the defensive. Editor Norman P. Gentieu, in "Some Comments," describes jazz writers Marshall Stearns and Otis Ferguson as "early Whiteman bashers, whose eager-beaver epigones are still around today and still slicing the same stale baloney" (p. ix). William Youngren, in the excellent foreword, takes on the Beiderbecke fans, arguing that Beiderbecke loved the discipline of the [End Page 114] Whiteman Orchestra, was alcoholic before joining Whiteman, and succumbed in spite of Whiteman's efforts to keep him healthy. After those sour notes, Rayno's biographical narrative (pp. 1-250) follows Whiteman to May 1930. The chronicle unfolds year-by-year, always very...

The Buffering Effects of Connectedness: Teen Club Intervention for Children of Substance Abusing Families

This paper will trace the clinical evolution and demonstrated efficacy of Teen Club—a community-based nursing intervention designed to reduce high-risk behaviors in female teens who are children of substance abusing families. Special emphasis is on the relevance of connectednessas a theoretical underpinning for support group interventions. The paper also describes the clinical applications of this research for practice and the team's plans for further testing the Teen Club program in other inner city high-risk adolescent populations.