A Latent Class Analysis of the Co-occurrence of Risk Behaviors among Adolescents.

Objectives: In this study, we examined the co-occurrence of multiple health-risk behaviors to determine whether there are any differences in the pattern of co-occurrence by sex. Methods: We conducted latent class analysis using the national 2013 Youth Risk Behavior Survey data for the overall sample, and separately by sex (N = 13,583). Results: Over half of the sample (53%) belonged to the low risk subgroup (Class 1). Class 2 accounted for 15% of adolescents, and over 40% in this subgroup reported riding with a drunk driver, and 63% reported texting while driving a vehicle. Over 14% belonged to Class 3, which had a higher probability of being depressed and suicidal (81% and 64%, respectively). Class 4 accounted for over 9% of adolescents who reported high probabilities for current cigarette (97%), tobacco (99%), and alcohol use (73%); and over half reported current marijuana use (52%). Class 5 accounted for 8.5% of adolescents identified as high-risk polysubstance users. Analyses showed differences by sex in the pattern of co-occurrences. Conclusion: Several adolescent risk behaviors are interrelated regardless of sex. However, sex differences in the higher probability of depressive symptoms and suicidality among girls highlight the need for interventions that consider the demographic composition of adolescents.

Pediatric metabolic outcome comparisons based on a spectrum of obesity and asthmatic symptoms.

RATIONALE: Asthma and obesity are 2 of the most prevalent public health issues for children in the U.S. Trajectories of both have roughly paralleled one another over the past several decades causing many to explore their connection to one another and to other associated health issues such as diabetes and dyslipidemia. Earlier models have commonly designated obesity as the central hub of these associations; however, more recent models have argued connections between pediatric asthma and other obesity-related metabolic conditions regardless of children's obesity risk. OBJECTIVES: To examine the relationships between asthma, obesity, and abnormal metabolic indices. METHODS: We conducted a cross-sectional study of 179 children ages 7 to 12 years recruited from a rural, Appalachian region. Our model controlled for children's smoke exposure, body mass index percentile, and gender to examine the association between children's asthma (based on pulmonary function tests, medical history, medications, and parent report of severity), lipids (fasting lipid profile), and measures of altered glucose metabolism (glycosylated hemoglobin and homeostatic model assessment 2-insulin resistance). RESULTS: Our findings revealed a statistically significant model for low density lipids, high density lipids, log triglyceride, and homeostatic model assessment 2-insulin resistance; however, Asthma had a significant effect for the mean triglycerides. We also found an asthma-obesity interaction effect on children's glycosylated hemoglobin with asthmatic obese children revealing significantly higher glycosylated hemoglobin values than non-asthmatic obese children. CONCLUSIONS: Our findings support a connection between asthma and children's glycosylated hemoglobin values; however, this association remains entwined with obesity factors.

Constructing tailored parental monitoring strategy profiles to predict adolescent disclosure and risk involvement.

•Many parents use multiple monitoring strategies in different combinations over time to monitor their adolescents.•Adolescents of parents who use multiple strategies reported greater risk involvement.•Parents who solicited information only from adolescents had greater knowledge and adolescent disclosure.

Children's aerobic fitness and academic achievement: a longitudinal examination of students during their fifth and seventh grade years.

OBJECTIVES: We assessed children's potential differences in academic achievement based on aerobic fitness over a 2-year period. METHODS: The longitudinal study sample included 3 cohorts of students (n = 1725; 50.1% male) enrolled in a West Virginia public school system. Students received baseline fitness and academic assessments as fifth graders and at a 2-year follow-up assessment. We used FitnessGram to assess fitness in aerobic capacity and WESTEST, a criterion-based assessment, for academic performance. RESULTS: Students who stayed in the healthy fitness zone (HFZ) had significantly higher WESTEST scores than did students who stayed in the needs improvement zone (NIZ). Students who moved into or out of the HFZ occasionally had significantly higher WESTEST scores than did students who stayed in the NIZ, but they were rarely significantly lower than those of students who stayed in the HFZ. CONCLUSIONS: Students' aerobic capacity is associated with greater academic achievement as defined by standardized test scores. This advantage appears to be maintained over time, especially if the student stays in the HFZ.

Psychosocial Correlates of Dual Methods for Contraception and STI Protection in Urban Adolescents.

Purpose. To identify correlates of combined hormonal contraception and condom use (dual method use) compared with no methods, condoms only or hormonal contraception only. Data are from a baseline assessment of 335 youth (52% female) enrolled in an intervention trial. Multinomial logistic regression identified theory-based factors associated with dual method use. At last intercourse 47% of respondents used dual methods, 29% condom only, 14% hormonal contraception only, and 10% no methods. No method users were less likely than dual-method users to feel "dirty" about pregnancy, to have ask about historical condom use, to have more than two partners, to view condom use as normative for boys and more likely to perceive pregnancy risk as remote. Hormonal-contraception-only users were more likely to have sex weekly and perceive sex as pleasurable for girls, and less likely to view condom use as normative for boys and to ask a partner to use a condom. Condom-only users were more likely to perceive pregnancy chance as remote, and less likely to have more than two partners and to want peers to think they were virgins. Interventions should include benefits of dual methods while counseling about the negative impact of STI and unplanned teen pregnancy.

Universal versus targeted blood cholesterol screening among youth: The CARDIAC project.

OBJECTIVES: The goal was to determine the sensitivity and specificity of family history in identifying children with severe or genetic hyperlipidemias in a rural, predominantly white population. METHODS: A total of 20,266 fifth-grade children in West Virginia, from the Coronary Artery Risk Detection in Appalachian Communities (CARDIAC) Project, who completed a family history and fasting lipid profile were used in analyses. The relationship between hyperlipidemia and family history was determined, and the use of family history to predict the need for pharmacologic treatment among children with dyslipidemia was evaluated. RESULTS: A total of 71.4% of children met the National Cholesterol Education Program (NCEP) guidelines for cholesterol screening on the basis of positive family history. Of those, 1204 (8.3%) were considered to have dyslipidemia (low-density lipoprotein > or =130 mg/dL), and 1.2% of these children with dyslipidemia warranted possible pharmacologic treatment (low-density lipoprotein > or =160 mg/dL). Of the 28.6% who did not have a positive family history (did not meet NCEP guidelines), 548 (9.5%) had dyslipidemia, 1.7% of whom warranted pharmacologic treatment. Sensitivity and specificity data demonstrated that family history does not provide a strong indication as to whether pharmacologic treatment may be warranted. CONCLUSIONS: Results indicate that the use of family history to determine the need for cholesterol screening in children would have (1) missed many with moderate dyslipidemia and (2) failed to detect a substantial number with likely genetic dyslipidemias that would require pharmacologic treatment. The use of universal cholesterol screening would identify all children with severe dyslipidemia, allowing for proper intervention and follow-up and leading to the prevention of future atherosclerotic disease.

Perceptions of cardiovascular health in underserved communities.

INTRODUCTION: Cardiovascular disease is the leading cause of deaths and illnesses in US adults, and the prevalence is disproportionately high in underserved populations. In this study, we assessed respondents' understanding of context-specific differences in knowledge and perceptions of disease, risk, and prevention in 6 underserved communities, with the longer-term goal of developing appropriate interventions. METHODS: Thirty-nine small-group sessions and 14 interviews yielded data from 318 adults. Each site's researchers coded, analyzed, and extracted key themes from local data. Investigators from all sites synthesized results and identified common themes and differences. RESULTS: Themes clustered in 3 areas (barriers to cardiovascular health, constraints related to multiple roles, and suggestions for effective communications and programs). Barriers spanned individual, social and cultural, and environmental levels; women in particular cited multiple roles (eg, competing demands, lack of self-care). Programmatic suggestions included the following: personal, interactive, social context; information in language that people use; activities built around cultural values and interests; and community orientation. In addition, respondents preferred health-related information from trusted groups (eg, AARP), health care providers (but with noticeable differences of opinion), family and friends, and printed materials. CONCLUSION: Interventions to decrease barriers to cardiovascular health are needed; these strategies should include family and community context, small groups, interactive methods, culturally sensitive materials, and trusted information sources. New-immigrant communities need culturally and linguistically tailored education before receiving more substantive interventions.

L.I.F.E.: a school-based heart-health screening and intervention program.

This article describes the development and growth of Lifestyle Improvements in the Family Environment (L.I.F.E.), a school-based heart-health screening and intervention program. The primary goals of L.I.F.E. through three rounds of grant funding remained constant: (a) to identify cardiovascular risk factors in students and their families and (b) to provide counseling, education, and opportunities to change lifestyle routines that contribute to those risk factors. The program began with direct ties to a university-based research program and grew with evidence-based successes and development of community partnerships. Waves of growth were influenced by capacity-building efforts, partnership development, and resource availability. School nurses managed the screening component and partnered with appropriate others in the intervention programming. School nurses are appropriately positioned to assist families as well as school and community partners in decreasing the incidence of obesity and promoting healthy lifestyle behaviors.

Comparisons of parent cardiovascular knowledge, attitudes, and behaviors based on screening and perceived child risks.

Questionnaire reports and universal screening procedures from 244 children (kindergarten, 5th grade, and 9th grade) were used to explore differences in parent health knowledge and attitudes of cardiovascular risks among children and parental involvement in promoting healthy lifestyles relative to whether their children were identified as being overweight or at risk of being overweight. The knowledge, attitudes, and behaviors of the parents of children who were identified as being at risk or overweight were further examined based on their perceptions of their children's level of risk. Parents' reports demonstrated significantly greater parent encouragement and knowledge of issues related to eating healthier foods and ways to cut calories among parents of children who were identified as being at risk or already overweight. A significant portion of parents underestimated their children's weight risks. Differences in parents' appraisals of their children's overweight risks were associated with differences in their knowledge, attitudes, and behaviors. These findings illustrate the need to address inaccuracies in parents' assessments of their children's overweight risks to improve parent investment and involvement in children's health modification programs.

The extended relationship between child cardiovascular risks and academic performance measures.

OBJECTIVE: To examine the relationship between children's overweight status and other cardiovascular risk fitness factors and academic performance among fifth-grade students. RESEARCH METHODS AND PROCEDURES: Using a sample of 968 fifth-grade students (50.7% boys; mean age = 10.6 years), children's cardiovascular risks (BMI, blood pressure, acanthosis nigricans) and fitness measures were compared with their mean group performance scores across four subscales (mathematics, reading/language arts, science, and social studies) of a statewide standardized academic performance test. RESULTS: Of this sample, 39% were either at risk for being overweight or were already overweight; slightly over one half were of normal weight. Initial findings revealed a significant relationship between children's weight category and their reading/language arts, mathematics, and science test scores even after controlling for a proxy of socioeconomic status. When additional cardiovascular risk and fitness measures were included in the model, however, children's BMI status had no association. Instead, a composite fitness index, children's blood pressure, sex, and proxy of socioeconomic status were significantly associated with children's academic test scores. DISCUSSION: This study expanded our understanding of the connection between children's overweight risks and academic performance by examining the impact of other cardiovascular risk factors such as high blood pressure and measures of fitness. These findings support the development and implementation of childhood cardiovascular risk surveillance programs that evaluate not only children's overweight risks but also their fitness, risk for type 2 diabetes, and/or high blood pressure by showing a relationship between some of these risks and children's academic test performance.

Effective interviewing and counseling of the adolescent patient.

A vast number of successful recommendations are available to physicians who want to learn how to strengthen their interactions with adolescent patients. Understanding that the physician-patient relationship is dynamic is the first step toward building a strong repertoire within this patient sample. Therefore, physicians may assume that adolescent perceptions of the physician-patient relationship and the services provided will change as they change developmentally or as the situation is modified. Finding a balance between family and patient concerns while gaining increased experience with skills less-practiced (eg, communication about sensitive topics) will improve adolescent perceptions of your expertise, knowledge, and abilities. Finally, following up on changes across time in adolescents' concerns, perceptions, abilities, and the physician-patient relationship itself, will help to ensure continued satisfaction and service use by adolescents and their families.