Teen perceptions of good drivers and safe drivers: implications for reaching adolescents.

OBJECTIVE: To understand definitions of the phrases "good driver" and "safe driver" among teen pre-drivers and early drivers in order to appropriately tailor messages about driving safety. DESIGN: Qualitative study using freelisting, an anthropological research technique, to explore nuances in the ways that teens define a good driver and a safe driver SETTING: Classes in six high schools each in a different state in the USA. SUBJECTS: 193 adolescent pre-drivers and early drivers, aged 15-17. MAIN OUTCOME MEASURES: Meaning of the phrase good driver and safe driver was identified for subgroups of adolescents. RESULTS: Teen pre-drivers and early drivers define a good driver and a safe driver as one who is cautious, alert, responsible, does not speed, obeys the law, uses seatbelts, and concentrates. There are subtle and potentially important differences in the way that subgroups define a good driver and a safe driver. CONCLUSIONS: Injury prevention experts need to attend closely to the implicit meanings that teens attach to everyday terms. Freelisting is a method that identifies perceptions about the meaning of health communication messages and suggests differences in meaning among subgroups.

Violence prevention in the emergency department: clinician attitudes and limitations.

OBJECTIVE: To assess emergency department (ED) clinicians' attitudes and behaviors regarding identification, assessment, and intervention for youth at risk for violence in the ED. DESIGN: Anonymous, cross-sectional written questionnaire. SETTING: The EDs of 3 urban hospitals. SUBJECTS: Emergency medicine residents and faculty, pediatric residents, pediatric emergency medicine fellows and faculty, and ED nurses. RESULTS: A total of 184 (88%) of 208 clinicians completed the questionnaire. Only 15% correctly recognized the lack of existing protocols for addressing youth violence. Clinicians reported being most active in identification of at-risk youth (93% asking context of injury and 82% determining relationships of victim and perpetrator), with pediatricians being more active than general ED clinicians (87% vs 68%; P<.01). Clinicians less often reported performing assessments or referrals of at-risk youth. Nurses and physicians were no different in their reported identification, assessment, or referral behaviors. Barriers identified include concern over upsetting family members, lack of time or skills, and concern for personal safety. Additional clinician training, information about community resources, and specially trained on-site staff were noted by respondents as potential solutions. CONCLUSIONS: Emergency department clinicians recognize the need for evaluation of youth at risk for violence. They are able to identify violently injured youth, but less often perform risk assessment to guide patients to appropriate follow-up resources. Further investigation should address clinician barriers to the complete care of violently injured youth in the ED.

Preventing HIV transmission: the perspective of inner-city Puerto Rican adolescents.

PURPOSE: To examine the development of HIV prevention strategies that address the concerns and needs of urban Puerto Rican adolescents. METHODS: The study included 542 Puerto-Rican adolescents, divided into age sets of 12 to 14 years and 15 to 19 years. Participants were recruited from community work programs, recreation centers, schools, drug rehabilitation programs, and directly from neighborhood streets in North Philadelphia. A hierarchical series of peer-facilitated group techniques and interviews allowed adolescents to generate, prioritize and explain strategies. The study question was developed in focus groups. Ideas were generated and prioritized in Nominal Technique Groups. The ideas with the highest priority were used to develop a survey that allowed participants to rank those they believed would be most effective. Participants then clarified the top-ranked ideas in open focus groups. RESULTS: In both age sets, the strategy perceived as the most effective in preventing HIV-risk behaviors was "Have people who are HIV-infected talk to teens." Similar ideas addressing this theme varied in perceived effectiveness. The second and third rated ideas among participants aged 12 to 14 years were "Teach teens how HIV infects them, " and "Show teens how people die from AIDS." The second and third rated ideas among participants aged 15 to 19 years were "Show teens what AIDS does to people " and "Have parents be more supportive of teens, so if they are having sex, they can encourage them to use condoms." Other top-ranked ideas included the development of community programs, increased efficacy and availability of condoms, and assessing partners for the risk of HIV infection. Three items revealed significant gender differences. Males were more likely to rate "Give out more free condoms" and "Educate teens in schools about AIDS." Females aged 15 to 19 years were more likely to rate "Teens should know their partner's background before having sex." CONCLUSIONS: To develop effective prevention strategies for youth, their views of the problems and interpretations of proposed solutions must be understood.

Violence prevention in the primary care setting: a program for pediatric residents.

OBJECTIVE: To measure the effect of a violence prevention program on pediatric residents' violence prevention guidance during well-child visits. DESIGN: Prospective study of an educational intervention. SETTING: Inner-city tertiary care hospital and satellite site. PARTICIPANTS: Pediatric residents. INTERVENTIONS: A 2(1/2)-hour violence prevention program, consisting of an introductory talk, role playing, a printed resident guide, and supplemental reading materials. MAIN OUTCOME MEASURES: Parent or guardian report of violence prevention guidance offered during the well-child visit, using a postvisit survey. RESULTS: Three hundred eight patient encounters were included in the survey: 93 prior to the program, 106 just afterward, and 109 after 6 months. Before the program, guns or violence was discussed at 9.7% of visits; this increased to 19.1% of visits after the program (odds ratio, 2.20; 95% confidence interval, 1.02-4.74). The improvement was sustained 6 months after the program. More than 80% of residents felt the program increased their fund of knowledge and taught them skills, and 93% stated that they would use these skills in the future. CONCLUSION: This one-time educational intervention significantly increased the amount of violence prevention guidance provided by pediatric residents to their patients and families. The effect was sustained after 6 months. Residents regarded the program as a successful method of providing the skills and knowledge needed to address the issue of interpersonal violence in their primary care encounters.

Factors affecting the decision to seek health care: the voice of adolescents.

OBJECTIVE: To learn from teenagers why they do, or do not, seek preventive health care. METHODS: A teen-centered methodology utilized focus groups, nominal group technique sessions, and surveys to allow adolescents to generate, prioritize, and explain their own responses. This article reports the qualitative explanations offered by youths in focus groups. In 21 groups, teenagers commented on the 15 factors that ninth graders in the School District of Philadelphia had determined most influenced their decision to seek care. Transcriptions were reviewed for consistent themes. Direct quotations are presented here to be representative of those themes. RESULTS: Two key points emerged. First, adolescents are more concerned about provider characteristics than site or system characteristics. Second, they worry deeply about disease transmission in the health care setting. Teenagers suggest some simple steps that may produce significant inroads toward developing an effective working relationship with them. A few examples include: to alleviate anxiety of disease transmission, providers should wash hands and remove instruments from sterile packaging in front of patients; to reassure teenagers of competence, providers should keep diplomas and certificates displayed; and to alleviate perceptions of racism, sites should post signs that clearly explain why patients are sometimes seen out of order. CONCLUSIONS: Adolescents know what draws them to services and what offends them. This study documents, in the words of youths, the factors contributing to their decisions to seek care. The results allow health professionals who care for adolescents to consider what they do well and where change may be needed.

Teen father participation in child rearing: family perspectives.

OBJECTIVES: To explore adolescent fatherhood from the perspectives of teen fathers, teen mothers, paternal grandmothers (PGMs), and maternal grandmothers (MGMs). To identify perceived barriers to and recommendations for the enhancement of teen father participation in child rearing. METHODS: A total of 61 teen parents participated in the design of a structured interview. A community-based sample of 173 teen fathers, 167 teen mothers, 76 PGMs, and 79 MGMs were interviewed by teenage assistants. Multiple logistic regression analysis using maximum likelihood estimation and the best subset algorithm identified barriers most predictive of paternal uninvolvement in child rearing. RESULTS: Fifty-four percent of teen fathers and 70% of partners of teen mothers' met the definition of involvement in child rearing. Disinterest in child rearing most consistently predicted uninvolvement. Fathers were less likely than mothers to report paternal disinterest as a barrier and more likely to attribute their lack of involvement to resistance from mothers and MGMs (p < 0.05). The best model predicting paternal involvement from the fathers' perspective included paternal disinterest [odds ration (OR) = 0.42, confidence interval (CI) = 0.19-0.92] and age (OR = 0.74, CI = 0.56-0.97). The best model from the mothers' perspective included paternal disinterest (OR = 0.16, CI = 0.07-0.36) and lack of time (OR = 0.31, CI = 0.15-0.91). Of those fathers who cited disinterest, there was an association with lack of money (p = 0.002) and lack of knowledge of child care (p = 0.069. While fathers and mothers disagreed on several interventions, they agreed (82% and 95%, respectively) that availability of jobs would promote paternal involvement. CONCLUSIONS: Most teen fathers in this study were involved and interested in child rearing. A young father's financial insecurity or confusion about child care was most likely to lead to a stated disinterest, and that disinterest predicted uninvolvement.

PIP: A community-based sample of 173 teen fathers, 167 teen mothers, 76 paternal grandmothers, and 79 maternal grandmothers was interviewed by teenage assistants to explore adolescent fatherhood from a range of differing perspectives. 54% of teen fathers and 70% of partners of teen mothers met the definition of involvement in child rearing. Disinterest in child rearing most consistently predicted uninvolvement. Fathers were less likely than mothers to report paternal disinterest as a barrier and more likely to attribute their lack of involvement to resistance from mothers and maternal grandmothers. The best model predicting paternal involvement from the fathers' perspective included paternal disinterest and age, while the best model from the mothers' perspective included paternal disinterest and lack of time. Of those fathers who cited disinterest, there was an association with lack of money and lack of knowledge of child care. While fathers and mothers disagreed upon several interventions, they agreed that an availability of jobs would promote paternal involvement.

A methodology to maximize resident input in improving a pediatric rotation.

OBJECTIVE: To develop a structured process to gain resident input into the improvement of their educational experience by (1) taking a small amount of resident time and effort, (2) fostering the generation of new ideas, (3) allowing the prioritization of ideas, (4) generating implementation plans for the ideas, and (5) offering the participants relative anonymity. DESIGN: Cross-sectional survey and group sessions. SETTING: Urban, university-based children's hospital. PARTICIPANTS: Members of the pediatric residency program in the 1993-1994 academic year. INTERVENTIONS AND RESULTS: The process was piloted for an emergency department rotation and borrows aspects of the Delphi Technique, Nominal Group Technique, and focus group methods. A survey regarding an emergency department rotation was distributed to all pediatric residents, and the 10 most commonly noted problems were compiled. These problems were brought to group sessions held for each level of training. Problems not listed were added if they were mentioned during the session; however, no problem was removed from the list. The sessions, designed to offer relative anonymity to the residents, included an initial clarification period, a round-robin prioritization of ideas, and an open discussion designed to generate solutions. Resident-generated solutions resulting from the group sessions were reviewed by the attending staff, and changes were implemented during the next year. CONCLUSION: The technique that we developed is a practical and time-efficient method of incorporating resident perspectives into the improvement of a rotation.

Depression screening in adolescents with somatic complaints presenting to the emergency department.

STUDY OBJECTIVE: To determine the frequency of documented depression screening for adolescents presenting with somatic chief complaints to a pediatric emergency department. METHODS: We conducted a retrospective chart review of 408 consecutive patients aged 11 to 17 years who presented to the ED with a chief complaint of chest pain, abdominal pain, headache, weakness/fatigue, dizziness/fainting, or hyperventilation. RESULTS: Documentation of depression screening was noted in 4.2% of cases (17 of 408). For patients charts listing both a somatic chief complaint and a similar nonspecific discharge diagnosis, the documentation rate for depression screening rose to 7.5%. No change in screening documentation was noted for chronically ill patients. We did detect a significant difference in screening frequency between black adolescents and adolescents of all other races (P = .021). CONCLUSION: Our findings demonstrate an extremely low frequency of documentation of depression screening in adolescents with somatic complaints presenting to the ED. Documentation of screening in black patients was still low but was performed at a significantly higher rate. These results indicate a need for education on the adolescent at risk for depression and suicide in the acute care setting.

Teen violence prevention: how to make a brief encounter make a difference.

Physicians with an interest in sports medicine often have contact with adolescents, many of whom are directly or indirectly involved in violent behavior. With appropriate techniques, such physicians can use brief contacts with adolescents to address issues of violent behavior. Ideally, counseling begins with a comprehensive psychosocial screen. However, in short office or training room visits, a three-question psychosocial screen can bring up relevant issues, and a violence screen can refine the history. The physician can then move to situation- and age-appropriate counseling and role-playing techniques as needed.

Unique needs of the teen in the health care setting.

Teenagers in the health care setting need age-appropriate services that target risk behaviors linked to adolescent morbidity and mortality. This article reviews the rationale and strategies for establishing preventive models of adolescent health services. The health needs and barriers to care, as perceived by both adult providers and adolescent consumers, are reviewed. This literature is then used to recommend how best to convey preventive messages in today's cost-conscious environment. The importance of program evaluation is discussed in conjunction with closely examining the effectiveness of preventive care in the promotion of adolescent health.

Adolescents' perceptions of factors affecting their decisions to seek health care.

OBJECTIVE: To have adolescents, rather than adults, identify characteristics of health care providers and sites that affect their decision to seek care. DESIGN: Five stages conducted over a 10-month period: (1) focus groups to frame the study questions; (2) nominal group technique to generate student responses; (3) three surveys to assess response importance; (4) one survey to link the most important responses with the decision to seek care; and (5) focus groups to explain the variables associated with the decision to seek care. SETTING: The Philadelphia (Pa) School District. PARTICIPANTS: The study population consisted of all ninth graders from 39 of Philadelphia's 42 public high schools. The 6821 students who returned the final survey comprised the study sample (69% of in-school youth). RESULTS: In the final survey, students used a Likert scale (1 to 5) to describe the impact of 31 ideas on their decision to seek care. The most important characteristics were provider hand washing, clean instruments, honesty, respect toward teens, cleanliness, know-how, carefulness, experience, seronegativity for the human immunodeficiency virus, equal treatment of all patients, and confidentiality. There was little variation in the order of the items by sex, race, or socioeconomic status. Factor analysis showed that the most important of four identified latent factors related to infection control and provider competency. CONCLUSION: Four of the top 10 characteristics that affect an adolescent's decision to seek care involve cleanliness and infection control. These findings offer providers and planners straightforward, modifiable factors that teens believe influence their decision to seek care.