Longitudinal patterns and predictors of multiple health risk behaviors among adolescents: The TRAILS study. Behavioral Problems and Service Utilization in Children with Chronic Illnesses Referred for Trauma-Related Mental Health Services Predictors of good adherence of adolescents with diabetes (insulin-dependent diabetes mellitus) Sex, drugs and chronic illness: health behaviours among chronically ill youth. Multiple behavioral risk factors among adolescent survivors of childhood cancer in the Survivor Health and Resilience Education (SHARE) program. Does ADHD predict substance-use disorders? A 10-year follow-up study of young adults with ADHD. Correlates of depression in a representative nationwide sample of adolescents (15-19 years) and young adults (20-24 years). Generational continuity and change in British Asian health and health behaviour. Depressive symptoms in adolescence: the association with multiple health risk behaviors. Developmental and environmental factors supporting the health and well-being of Aboriginal adolescents Sexual behavior of adolescents with chronic disease and disability. Meeting recommendations for multiple healthy lifestyle factors. Prevalence, clustering, and predictors among adolescent, adult, and senior health plan members. Psychosocial correlates of physical activity and sedentary leisure habits in young adolescents: the Teens Eating for Energy and Nutrition at School study. Time for an Adolescent Health Surveillance System in Saudi Arabia: Findings From "Jeeluna".
BACKGROUND Most studies on multiple health risk behaviors among adolescents have cross-sectionally studied a limited number of health behaviors or determinants . PURPOSE To examine the prevalence , longitudinal patterns and predictors of individual and multiple health risk behaviors among adolescents . METHODS Eight health risk behaviors  ( no regular consumption of fruit , vegetables or breakfast , overweight or obesity , physical inactivity , smoking , alcohol use and cannabis use ) were assessed in a prospect i ve population study ( second and third wave ) . Participants were assessed in three waves between ages 10 and 17 ( 2001 - 2008 ; n=2230 ) .  Multiple linear regression was used to assess the influence of gender , self-control , parental health risk behaviors , parental monitoring and socioeconomic factors on the number of health risk behaviors adjusted for preceding multiple health risk behaviors ( analysis : 2013 - 2014 ) . RESULTS Rates of > 5 health risk behaviors were high : 3.6 % at age 13.5 and 10.2 % at age 16 . Smoking at age 13.5 was frequently associated with health risk behaviors at age 16 . No regular consumption of fruit , vegetables and breakfast , overweight or obesity , physical inactivity and smoking predicted the co-occurrence of health risk behaviors at follow-up . Significant predictors of the development of multiple health risk behaviors were  adolescents ' levels of self-control , socioeconomic status and maternal smoking . CONCLUSIONS Multiple health risk behaviors are common among adolescents . Individual and social factors predict changes in multiple health risk behaviors , showing that prevention targeting multiple risk behaviors is needed . Special attention should be paid to adolescents with low self-control and families with low socioeconomic status or a mother who smokes Objective : Given its prevalence and impact on health and well-being , children 's exposure to traumatic experiences is of growing importance to pediatricians and other medical providers . Little is known , however , about the traumatic experiences profiles , trauma-related sequelae , and service use patterns of youth with chronic or recurrent medical problems/disabilities . This study aim ed to fill this research gap . Method : Participants were children less than 18 years of age who were referred for assessment and /or treatment services at one of the 56 National Child Traumatic Stress Network centers from 2004 to 2010 across the United States and had experienced at least one of 13 types of traumatic experience(s ) ( n = 9885 ; mean = 11 years , SD = 4.3 ; 52.3 % girls ) . Generalized linear mixed models were used to examine associations among types of trauma , emotional and behavioral problems , and rates of service utilization adjusting for treatment center-level r and om effects , demographic characteristics , and the total number of types of trauma exposures . Results : Among children seeking treatment for traumatic stress , those with comorbid medical problems/disabilities had different demographic characteristics , different types of trauma exposure , and more service utilization in multiple sectors before trauma treatment entry than those without comorbid medical problems/disabilities . Those without comorbid medical problems/disabilities had higher levels of some types of traumatic exposures , associated symptoms , and higher levels of behavioral problems at home , school , or day care . Those with medical disorders/disabilities were at 30 % to 40 % higher odds of meeting clinical criteria for hyperarousal and re-experiencing posttraumatic stress disorder symptoms , used more medical and mental health services for trauma , and had more emotional and behavioral concerns . Conclusion : Given that pediatricians are more likely to see children with medical disabilities and concerns than those without , there is an opportunity to ask directly about traumatic exposures and associated symptoms and provide support and interventions to promote resilience . Integrating trauma screening and mental health services into medical care could be especially beneficial for children with chronic medical conditions Objectives : The purpose of this study was to identify the factors that predict good adherence to health regimens by adolescents with diabetes ( insulin-dependent diabetes mellitus ) . Methods : Altogether , 300 individuals aged 13—17 years were r and omly selected from the Finnish Social Insurance Institution 's register . Ninety-seven per cent ( N=289 ) of the selected adolescents returned the question naire . The data were analysed using the SPSS ( Statistical Package for Social Sciences ) for Windows software package . Logistic regression was used to find the factors that predict good adherence to health regimens . Results : About one-fifth ( 19 % ) of the respondents with diabetes felt that they complied fully with the health regimens , while 75 % placed themselves in the category of satisfactory adherence , and the remaining 6 % reported poor adherence . The most powerful predictor was the threat to mental wellbeing . The likelihood that adolescents who felt the disease to be a threat to their mental wellbeing would comply with health regimens was 7.68-fold as compared to those who did not regard the disease as a threat to their mental wellbeing . The next most powerful predictor was support from physician . The support from nurses , and the motivation , energy and willpower to take care of themselves and the threat to physical wellbeing , also predicted good adherence . The logistic regression model explained 82 % of the variance , and the model predicted correctly 88 % of the adolescents with good adherence . Discussion : This paper shows that adolescents with diabetes show quite good adherence . It also indicates the factors that predict good adherence to health regimens . To improve adherence , these factors should be given special attention in the care of adolescents BACKGROUND A growing body of literature indicates that adolescents with chronic conditions are as likely , or more likely , to take risky behaviours than their healthy peers . The objective of this research was to assess whether adolescents with chronic illness in Catalonia differ from their healthy peers in risk-taking behaviour . METHODS Data were drawn from the Catalonia Adolescent Health data base , a survey including a r and om school-based sample of 6952 young people , aged 14 - 19 years . The index group ( IG ) included 665 adolescents ( 450 females ) reporting several chronic conditions . The comparison group ( CG ) comprised 6287 healthy adolescents ( 3306 females ) .  Personal , family and school-related variables were analysed to ensure comparability between groups . Sexual behaviour , drug use ( tobacco , alcohol , cannabis , cocaine and synthetic drugs ) and perception of drug use among peers and in school were compared . Analysis was carried out separately by gender . chi-square , Fisher 's and Student 's tests were used to compare categorical and continuous variables . RESULTS The prevalence of chronic conditions was 9.6 % , with females showing a higher prevalence than males . The IG showed similar or higher rates of sexual intercourse and risky sexual behaviour . For most studied drugs , IG males reported slightly lower rates of use than CG males , while IG females showed higher rates for every drug studied . No differences were found in the perceptions of drug use among peers or in their school . CONCLUSIONS Similar to previous research , chronically ill adolescents in our sample are as likely , or more likely , to take risky behaviours than their healthy counterparts and should receive the same anticipatory guidance BACKGROUND Health-compromising behaviors among survivors of childhood cancer may increase their risks of cancer recurrence and the onset of chronic disease in adulthood . Regardless of whether such behaviors occur singly or in combination with one another , multiple behavioral risk factors must be identified and addressed early to promote better health outcomes within this special population . Adolescent survivors may be especially vulnerable , as reported rates of smoking and other risky behaviors are at or near levels of their healthy peers . The psychological literature suggests stress may play a role in risk behavior initiation and maintenance , including multiple behavioral risks , and that adolescent survivors are stress-prone . This report focuses on the prevalence and co-occurrence of three behavioral risk factors ( cigarette use , insufficient physical activity , and non-adherence to sun protection recommendations ) and describes stress-health behavior relationships in this special population . PROCEDURE All patients in this study ( n = 75 ) were adolescent survivors of childhood cancer and completed a baseline assessment of their  health behaviors and stress  as part of a r and omized controlled trial of health promotion . RESULTS Twenty-eight percent of the patients reported one of three risk factors , 12 % reported two of three risk factors , and 7 % reported all three risk factors . Non-adherence to sun protection was the single most common risk factor ; physical inactivity and non-adherent sun protection were the most common co-occurring risk factors . Greater age and stress were significantly associated with the presence of more behavioral risk factors . CONCLUSIONS The evidence suggests interventions to reduce multiple health-compromising behaviors in these patients are warranted , and that efforts to address these patients ' personal and family stress levels are important as well OBJECTIVE High rates of substance-use disorders ( SUD ) have been found in sample s of adolescents and adults with attention-deficit/hyperactivity disorder ( ADHD ) . Predictors of SUD in children with ADHD who are at risk for the development of SUDs remain understudied . The main aims of this study were to identify clinical ly meaningful characteristics of children that predicted the future development of SUDs and to see whether the role of these characteristics varied by sex . METHOD Subjects were children and adolescents with ( n = 268 ; mean age ± st and ard deviation = 10.9 ± 3.2 years ) and without ( n = 229 ; mean age 11.9 ± 3.3 years ) DSM-III-R ADHD followed prospect ively and blindly over a 10-year follow-up period onto young adult years . Subjects were assessed with structured diagnostic interviews for psychopathology and SUDs . RESULTS Over the 10-year follow-up period , ADHD was found to be a significant predictor of any SUD ( hazards ratio 1.47 ; 95 % confidence interval 1.07 - 2.02 ; p = .01 ) and cigarette smoking ( 2.38 ; 1.61 - 3.53 ; p < .01 ) . Within ADHD , comorbid conduct disorder ( 2.74 ; 1.66 - 4.52 ; p < .01 ) and oppositional defiant disorder ( 2.21 ; 1.40 - 3.51 ; p < .01 ) at baseline were also found to be significant predictors of SUDs . Similar results were found for cigarette- , alcohol- , and drug-use disorders . There were few meaningful sex interaction effects . No clinical ly significant associations were found for any social or family environment factors or for cognitive functioning factors ( p > .05 for all comparisons ) . CONCLUSIONS These results indicate that ADHD is a significant risk factor for the development of SUDs and cigarette smoking in both sexes BACKGROUND The authors investigated correlates of depression in a general population sample of adolescents ( 15 - 19 years ) and young adults ( 20 - 24 years ) . METHODS As part of the Finnish Health Care Survey a r and om sample of 509 adolescents ( 281 females , 228 males ) and 433 young adults ( 224 females , 209 males ) was interviewed in 1996 .  DSM-IIR major depressive episode ( MDE ) was assessed by the University of Michigan Composite International Diagnostic Interview Short Form ( UM-CIDI SF ) . RESULTS In multivariable regression analysis , current smoking ( odds ratio ( OR ) 5.54 ; 95 % confidence interval ( CI ) 1.44 , 21.3 ) and chronic illness ( OR 3.77 ; 95 % CI : 1.04 , 13.7 ) associated with MDE among adolescents . Among young adults , drunkenness at least twice a month ( OR 4.48 ; 95 % CI : 1.44 , 14.0 ) or once a month ( OR 2.79 ; 95 % CI : 1.14 , 6.83 ) , not being married nor cohabiting ( OR 3.50 ; 95 % CI : 1.35 , 9.08 ) and infrequent physical exercise ( OR 4.01 ; 95 % CI : 1.18 , 14.0 ) were related to MDE . Female MDE associated with not being married nor cohabiting ( OR 3.56 ; 95 % CI : 1.23 , 10.1 ) and living in southern Finl and ( OR 2.30 ; 95 % CI : 1.06 , 5.02 ) . Drunkenness at least twice a month was related to MDE among males ( OR 4.54 ; 95 % CI : 1.27 , 16.3 ) . CONCLUSIONS Attention should be paid to compromised health and health-related behaviour associating with MDE in youth . Specifically , the association between smoking and major depression in early adolescence should be borne in mind , and drinking habits or frequency of drunkenness should be carefully noted OBJECTIVES : To trace patterns of health and health behaviour in those with ancestry in the Indian subcontinent ( British Asians ) compared with the general population of their age ( 1 ) in the younger generation age 14 - 15 mainly born in the UK and ( 2 ) in the older mainly migrant generation . DESIGN : Cross sectional r and om sample surveys of two age groups in Glasgow . SAMPLE S : 334 British Asians ( 86 % born in the UK ) and 490 non-Asians , all aged 14 - 15 ; 173 British Asians aged 30 - 40 ( mean age 35 , 93 % born abroad ) , and 344 general population aged 35 . MEASURES : Health : self assessed health/fitness , longst and ing/limiting illness , chronic phlegm , accidents , symptoms , tooth loss . Health behaviour : smoking , alcohol , drugs , exercise .  RESULTS : At age 14 - 15 , compared with non-Asian counterparts : fewer British Asian girls reported limiting illness ( p < 0.05 ) or chronic phlegm ( p < 0.01 ) , fewer boys reported accidents ( p < 0.01 ) , and fewer of both sexes had lost second teeth ( p < 0.05 ) ; more of both sexes reported not smoking , drinking alcohol , or using drugs ( p < 0.01 or below ) , fewer reported frequent exercise ( p < 0.05 or below ) . Smoking patterns were consistently related to ethnic differences in chronic phlegm , and patterns of alcohol consumption to those in accidents . In health , British Asian girls aged 14 - 15 generally compared more favourably with non-Asian counterparts than did those aged 30 - 40 . The reverse was true for British Asian male subjects . In health behaviour , British Asians of both sexes aged 14 - 15 showed strong continuities with those aged 30 - 40 . CONCLUSIONS : Favourable health behaviour has brought a health advantage to young British born Asians , even though this was not the case in the migrant generation . Female health disadvantage is also much less marked than in migrants aged 30 - 40 , but may re-emerge between ages 15 - 30 . Migrant Asian male subjects may have had misleadingly high respiratory health levels because of positive selection OBJECTIVE Although multiple studies of adolescents have examined the association of depression with individual health risk behaviors such as obesity or smoking , this is one of the few studies that examined the association between depression and multiple risk behaviors . METHODS A brief mail question naire , which screened for age , gender , weight , height , sedentary behaviors , physical activity , perception of general health , functional impairment and depressive symptoms , was completed by a sample of 2291 youth ( 60.7 % response rate ) aged 13 - 17 enrolled in a health care plan . A subset of youth who screened positive on the two-item depression screen and a r and om sample of those screening negative were approached to participate in a telephone interview with more in-depth information obtained on smoking and at-risk behaviors associated with drug and alcohol use . RESULTS Youth screening positive for high levels of depressive symptoms compared to those with few or no depressive symptoms were significantly more likely to meet criteria for obesity , had a poorer perception of health , spent more time on the computer , got along less well with parents and friends , had more problems completing school work and were more likely to have experimented with smoking and a wide array of behaviors associated with drug and alcohol use . CONCLUSIONS Because many adverse health behaviors that develop in adolescence continue into adulthood , the association of depressive symptoms with multiple risk behaviors and poor functioning suggest that early interventions are needed at an individual , school , community and primary care level Little progress has been made in the past 30 years in closing the gap between Aboriginal and non-Aboriginal Australians in terms of their educational outcomes , rates of incarceration , risks for chronic illnesses and reduced life-expectancy . The Western Australian Aboriginal Child Health Survey is the first population based survey of its kind developed specifically to inform policy and planning to improve the developmental health of Aboriginal children and youth . A r and om representative sample of 5,289 Aboriginal children aged 0 - 17 years , including 1,480 adolescents aged 12 - 17 years was surveyed through household based interviews with carers and adolescents , question naire data from schools and consensual record linkage to health service and education system data . The findings describe the prevalence and relative impact of developmental and environmental factors associated with the health and mental outcomes of Aboriginal adolescents . The major portion of the overall burden of disorder is now evident in the more urbanised living setting s of Aboriginal families . Some health risk behaviours such as poor dietary intake , smoking , unprotected sex and insufficient physical exercise are more common in Aboriginal adolescents . However , others such as alcohol and marijuana use and suicidal behaviour occur at similar levels to those seen in non-Aboriginal youth PURPOSE This study aim ed to assess sexual behaviors , sexual orientation , pregnancy , and abuse history among adolescents with and without chronic conditions . METHODS Analyses were based on a statewide survey of 36,284 young people in the 7th through 12th grade s for analytic purpose s ; subsets were defined using a specialized cohort design including adolescents with visible and nonvisible conditions plus controls . Principle outcome measures included self report of ever having sexual intercourse , age of sexual debut , reasons for not having intercourse , ever causing or having a pregnancy , ever having a sexually transmitted disease ( STD ) , contraceptive use and reasons for their nonuse , history of sexual abuse , and sexual orientation . RESULTS No differences were evident between adolescents with and without chronic conditions in the proportion ever having intercourse , age of sexual debut , pregnancy involvement , patterns of contraceptive use , or sexual orientation . No differences were evident among girls or boys with visible compared with invisible conditions . A significantly greater proportion of girls and boys with invisible conditions than controls reported a history of sexual abuse . More index boys than controls reported ever having an STD , whereas more girls with visible conditions than controls reported this . CONCLUSIONS Adolescents with chronic conditions are at least as sexually involved as their peers , and significantly more likely to have been sexually abused . Visibility of chronic conditions does not appear to affect the sexual behaviors of adolescents . The need for comprehensive sexuality education in this population is high , and discussion of sexuality , contraception and abuse must be part of st and ard psychosocial assessment and anticipatory guidance for all teenagers , including those with chronic conditions BACKGROUND Whereas much is known about single lifestyle-related health risk factor prevalence and covariates , more research is needed to eluci date the interactions among multiple healthy lifestyle factors and variables that may predict adherence to these factors . Such data may guide both clinical and health policy decision making and person-centered approaches to population health improvement . METHODS We document the prevalence and cluster patterns of multiple healthy lifestyle factors among a r and om sample of adolescents ( n = 616 ) , adults ( n = 585 ) , and seniors ( n = 685 ) from a large Midwestern health plan . Modifiable , lifestyle-related health factors assessed included  physical activity , nonsmoking , high- quality diet , and healthy weight for all subjects ; adults and seniors were also asked about their alcohol consumption . Second , we sought to identify characteristics associated with the likelihood of meeting recommendations for healthy lifestyle factors . The healthy lifestyle factors sum score was categorized into three levels , that is , 0 to 2 , 3 , or 4 to 5 healthy lifestyle factors ( 4 for adolescents ) , and we used ordinal logistic regression to estimate the odds of meeting each of these criteria from several demographic characteristics and disease states . RESULTS Overall , only 14.5 % of adolescent , adult , and senior health plan members meet recommended guidelines for four common healthy lifestyle factors . Only 10.8 % of adults and 12.8 % of seniors met all five behavior-related factors . For adolescents , only being nondepressed was associated with an increased likelihood to be in adherence to multiple healthy lifestyle factors  ( odds ratio [OR]=2.15 ; p < 0.05 ) . For adults , being in the 50- to 64-year-old cohort ( OR=1.46 , p<0.05 ) , having a college degree ( OR=1.65 ; p < 0.05 ) , and having no chronic disease ( OR=1.92 ; p < 0.05 ) were all associated with an increased likelihood to be in adherence to multiple healthy lifestyle factors . For seniors , having a college degree ( OR=1.61 ; p < 0.05 ) , was the only variable associated with an increased likelihood to be in adherence to multiple healthy lifestyle factors . CONCLUSIONS A small proportion of health plan members meet multiple recommended healthy lifestyle guidelines at once . This analysis identifies population subgroups of specific interest and importance based on adherence to multiple healthy lifestyle factors , and predictors for increased likelihood to be in adherence to multiple healthy lifestyle factors . It presents a potentially useful summary measure based on person-centered measures of healthy lifestyle factors . Clinicians may derive meaningful information from analyses that address adherence to multiple healthy lifestyle factors . Health systems administrators may use this information to influence health policy and re source allocation decisions . Further studies are needed to assess the usefulness of this comprehensive lifestyle-related health measure as a metric of progress toward public health goals , or as a clinical metric that conveys information on future health status and directs interventions at the individual level BACKGROUND Low levels of physical activity ( PA ) and highly sedentary leisure habits ( SLH ) in youth may establish behavioral patterns that will predispose youth to increased chronic disease risk in adulthood . The purpose of this paper was to examine associations of demographic and psychosocial factors with self-reported PA and SLH in young adolescents . METHODS A general linear mixed model predicted self-reported PA and SLH in the spring from demographic and psychosocial variables measured the previous fall in 3798 seventh grade students . RESULTS  PA and SLH differed by race , with Caucasian students reporting among the highest PA and lowest SLH . Perceptions of higher academic rank or expectations predicted higher  PA  and lower SLH . Depressive symptomatology predicted higher SLH scores but not PA .  Higher self-reported value of health , appearance , and achievement predicted higher PA  and lower SLH in girls . Girls who reported that their mothers had an authoritative parenting style also reported higher PA  and lower SLH . CONCLUSIONS Determinants of  PA  and SLH appear to differ from each other , particularly in boys . Development of effective programs to increase  PA  and /or decrease SLH in young adolescents should be based on a clear underst and ing of the determinants of these behaviors PURPOSE With the increasing burden of noncommunicable disease , adolescence is viewed as an opportune time to prevent the onset of certain behaviors and promote healthy states . Although adolescents comprise a considerable portion of Saudi Arabia 's population , they have received insufficient attention and indicators of their health status , as a first step in a prevention cycle are unavailable . This study was carried out with the aim of identifying the health risk behaviors and health status of adolescents in Saudi Arabia . METHODS This cross-sectional , school-based study was carried out in all 13 regions of Saudi Arabia . Through multistage , cluster , r and om sampling , intermediate , and secondary school students were invited to participate . Data were collected by means of a self-administered question naire addressing health risk behaviors and health status , clinical anthropometric measurements , and laboratory investigations . RESULTS A total of 12,575 adolescents participated . Various health risk behaviors , including dietary and sedentary behaviors , lack of safety measures , tobacco use , bullying , and violence were highly prevalent . Twenty-eight percent of adolescents reported having a chronic health condition , 14.3 % reported having symptoms suggestive of depression , 30.0 % were overweight/obese , and 95.6 % were vitamin D deficient . CONCLUSION Behaviors and conditions known to persist into adulthood and result in morbidity and premature mortality are prevalent among adolescents in Saudi Arabia . Preventive measures and local health policies are urgently needed and can impact adolescents and future adults . Establishing adolescent health surveillance is necessary to monitor trends and impacts of such measures
Background Adolescents living with chronic illnesses engage in health risk behaviors ( HRB ) which pose challenges for optimizing care and management of their ill health .
Frequent monitoring of HRB is recommended , however little is known about which are the most useful tools to detect HRB among chronically ill adolescents .
Aims This systematic review was conducted to address important knowledge gaps on the assessment of HRB among chronically ill adolescents .
Its specific aims were to : identify HRB assessment tools , the geographical location of the studies , their means of administration , the psychometric properties of the tools and the commonest forms of HRB assessed among adolescents living with chronic illnesses globally .