Supportive family relationships and adolescent health in the socio-cultural context of Iran: a qualitative study

Parents have a critical role in adolescent health. The association of adolescents'' perceptions of family relationships with adolescent health was investigated using a sample of 67 female adolescents who participated in eight focus group discussions, utilising a purposeful sampling method. All tape-recorded data were fully transcribed and content analysis was performed. Three themes were identified, namely emotional support, responsible parents and well-informed parents. With regard to some of the challenges in Iranian adolescents'' relationships with their parents, it is necessary to educate parents to be alert to their role in adolescent health.     

The Influence of the Family on Adolescent Sexual Experience: A Comparison between Baltimore and Johannesburg

The main objective of this paper is to understand the role of the family on the sexual experiences of adolescents from urban, disadvantaged settings in Baltimore and Johannesburg. Data were collected as part of the WAVE study, a global study of disadvantaged youth in five cities. Qualitative data were based on key informant interviews, a Photovoice exercise, community mapping, focus groups and in-depth interviews with adolescents. Quantitative data were gathered from an ACASI survey that was administered to approximately 450–500 adolescents per site. Results from the qualitative data revealed that while parents were viewed as important sources of information for sexual and reproductive health, they were often not present in the adolescents’ lives. This lack of parental presence was perceived to result in adolescents feeling an overall lack of adult support and guidance. The impact of parental presence and support on adolescent sexual experience was further examined from the quantitative data and revealed a complex picture. In both Baltimore and Johannesburg, female adolescents who were raised by other relatives were less likely to report having had sex compared to those raised by two biological parents, which was not observed for males. In Johannesburg, female adolescents who were paternal orphans were less likely to have had sex compared to non-orphans; the opposite was true among males. Finally, in both sites, female adolescents who had been exposed to violence were more likely to have had sex compared to those who had not; for males, there was no significant relationship. The study demonstrates the powerful influence of both context and gender for understanding the influences of the family on adolescent sexual behaviors. Programs aiming to reduce adolescent sexual risk behaviors the need to understand the complex influences on risk behaviors in different settings and in particular, the role of mothers and fathers. Prevention strategies need to also understand and incorporate gender-specific messages and interventions in order to address the high risk of sexual behaviors among adolescents in these settings.     

Do Parents Meet Adolescents’ Monitoring Standards? Examination of the Impact on Teen Risk Disclosure and Behaviors if They Don’t

In this study, we examined how adolescents compare monitoring efforts by their parents to those of a "good parent" standard and assessed the impact of these comparisons on adolescent self-disclosure and risk behavior and their perceptions of their parents'' monitoring knowledge. Survey responses from 519 adolescents (12–17 years) at baseline of a larger, longitudinal study examining parental monitoring and adolescent risk were examined. Adolescents’ “good parent comparisons” differed greatly by monitoring areas (e.g., telephone use, health, money); however, between 5.5% and 25.8% of adolescents believed their parents needed to monitor their activities more than they currently were monitoring. Alternatively, between 8.5% and 23.8% of adolescents believed their parents needed to monitor their activities less often. These perceptions significantly distinguished adolescents in terms of their level of disclosure, perceived monitoring knowledge, and risk involvement. Adolescents who viewed their parents as needing to monitor more were less likely to disclose information to their parents (p<.001), less likely to perceive their parents as having greater monitoring knowledge (p<.001), and more likely to be involved in a risk behaviors (p<.001) than adolescents who perceived their parents needed no change. Adolescent disclosure to a parent is a powerful predictor of adolescent risk and poor health outcomes. These findings demonstrate that adolescents'' comparisons of their parents'' monitoring efforts can predict differences in adolescent disclosure and future risk. Obtaining adolescent "good parent" comparisons may successfully identify intervention opportunities with the adolescent and parent by noting the areas of need and direction of monitoring improvement.     

A European project on health problems, mental disorders and cross-cultural aspects of developing effective rehabilitation procedures for refugee and immigrant youth

The project is an international comparative study on risk and protective factors of adolescent health and well-being, with particular focus on youth with immigrant (or refugee) experience. This is a comprehensive study on the quality of life and health outcomes of adolescent youth that looks at group-specific differences within different socio-cultural contexts across six European countries, including those of post-conflict communities. The research project combines both quantitative and qualitative methods, using a common set up across all countries involved with the goal of collecting data on 3500 adolescents that are strictly comparable to allow cross-country analyses. It is particularly aimed at increasing the understanding of acculturation processes of a particularly sensitive population of adolescent refugees and immigrants and of the influence that the interaction of contextual and developmental factors has on their mental health and psychological well-being. in COll. Antropol. 27 (2003) 2: 431–438     

A European project on health problems, mental disorders and cross-cultural aspects of developing effective rehabilitation procedures for refugee and immigrant youth

The present paper describes the conceptual framework, rationale and methods of an international comparative study on risk and protective factors of adolescent health and well-being, with particular focus on youth with immigrant (or refugee) experience. This is a comprehensive study on the quality of life and health outcomes of adolescent youth that looks at group-specific differences within different socio-cultural contexts across six European countries, including those of post-conflict communities. The research project combines both quantitative and qualitative methods, using a common set-up across all countries involved with the goal of collecting data on 3,500 adolescents that are strictly comparable to allow cross-country analyses. It is particularly aimed at increasing the understanding of acculturation processes of a particularly sensitive population of adolescent refugees and immigrants and of the influence that the interaction of contextual and developmental factors has on their mental health and psychological well-being.     

Parent- and adolescent-reported barriers to participation in an adolescent overweight and obesity intervention

This study explored reported barriers to treatment completion in a sample of adolescents and their parents who either completed or did not complete family-based cognitive behavioral lifestyle intervention for overweight and obese adolescents. The sample comprises 56 overweight or obese adolescents (52% female) aged 11.5-18.9 years (mean = 14.5, s.d. = 1.8) and a parent. 57% of families did not complete treatment and maintenance phases of the intervention. A telephone-administered questionnaire assessing barriers to participation was completed by 96% of adolescents and 91% of parent completers and 100% of adolescents and 94% of parent noncompleters. Adolescents and parents most commonly reported barriers to participation related to research demands, treatment approach, program components/strategies, practical barriers, and other individual/family demands. Parents also noted adolescent effort, parent-adolescent conflict, and adolescent unhappiness as barriers to participation. While both completers and noncompleters experienced barriers to participation, families who discontinued treatment reported experiencing more treatment barriers. Findings of the current study suggest that adolescents and parents may find it easier to participate in adolescent overweight and obesity interventions if research and out-of-session program demands are minimized, efforts are made to enhance adolescent motivation, and treatment is offered in a convenient location and scheduled around school holidays and other family demands. Results also suggest that targeting adolescent unhappiness, family stressors, and parent-adolescent conflict in treatment may improve retention. Future research should explore the impact of these modifications on treatment completion and outcomes.     

The relationship between body mass index and unhealthy weight control behaviors among adolescents: The role of family and peer social support

Adolescents classified as overweight or obese are more likely to use unhealthy weight control behaviors such as skipping meals or fasting than their healthy weight peers. Adolescents with low perceived social support may be at particular risk. Therefore, the purpose of the present study was to investigate the association between adolescent overweight and obesity, indices of perceived peer and family social support, and their interaction in the use of unhealthy weight control behaviors among adolescents. The present study used data from the 2001–2002 Health Behavior in School-Aged Children collaborative survey. Participants included 4598 adolescent girls and boys in the ninth and tenth grades. Results of binary logistic regression analyses showed that obese boys and girls were more likely to use unhealthy weight control behaviors than their healthy weight peers. Boys and girls who endorsed difficult communication with their parents, low levels of parent school support, or frequent bullying were more likely to engage in unhealthy weight control behaviors than relevant comparison groups. Among girls, poor classmate relationships were associated with increased use of unhealthy weight control behaviors whereas fewer friendships were associated with decreased use. Results suggest that adolescents are at high risk for use of unhealthy weight control behaviors and would benefit from interventions to increase knowledge and social support for achieving and maintaining a healthy weight.     

The Relationship between Parental Depressive Symptoms,Family Type,and Adolescent Functioning

It is evident that parental depressive symptoms negatively influence adolescent behavior and various psychosocial outcomes. Certain family types like families with a chronically ill parent and single parent families are more vulnerable to parental depressive symptoms. However, the relationship between these symptoms, family type, and adolescent functioning remains largely unclear. This study examined relations between self-report of parental depressive symptoms and adolescent functioning in 86 two-parent families including a parent with a chronic medical condition, 94 families with healthy single parents, and 69 families with 2 healthy parents (comparison group). Parents completed the Beck Depression Inventory. Adolescents filled in the Youth Self-Report measuring problem behavior, and other instruments measuring psychosocial outcomes (stress, grade point average, school problems, and self-esteem). Multilevel analyses were used to examine the effects of family type, parental depressive symptoms, adolescents'' gender and age, and interaction effects on adolescent functioning. The results indicated that adolescents with chronically ill and single parents had a lower grade point average (p<.01) than the comparison group. Adolescents of single parents reported more internalizing problems (p<.01) and externalizing problems (p<.05) than children from the other family types. Parental depressive symptoms were strongly related to child report of stress (p<.001). Adolescents of depressed chronically ill parents were particularly vulnerable to internalizing problems (interaction effect, p<.05). Older children and girls, and especially older girls, displayed more internalizing problems and stress. It can be concluded that growing up with a chronically ill parent in a family with 2 parents may have less impact on adolescent problem behavior than growing up in a single parent family. Health practitioners are encouraged to be attentive to the unique and combined influence of family type and parental depressive symptoms on adolescent functioning. Older and female adolescents deserve particular attention.     

The Controversy Over Pediatric Bariatric Surgery

Despite the reported limited success of conventional treatments and growing evidence of the effectiveness of adult bariatric surgery, weight loss operations for (morbidly) obese children and adolescents are still considered to be controversial by health care professionals and lay people alike. This paper describes an explorative, qualitative study involving obesity specialists, morbidly obese adolescents, and parents and identifies attitudes and normative beliefs regarding pediatric bariatric surgery. Views on the etiology of obesity—whether it should be considered primarily a medical condition or more a psychosocial problem—seem to affect the specialists’ normative opinions concerning the acceptability of bariatric procedures as a treatment option, the parents’ feelings regarding both being able to influence their child’s health and their child being able to control their own condition, and the adolescents’ sense of competence and motivation for treatment. Moreover, parents and adolescents who saw obesity as something that they could influence themselves were more in favor of non-surgical treatment and vice versa. Conflicting attitudes and normative views—e.g., with regard to concepts of disease, personal influence on health, motivation, and the possibility of a careful informed consent procedure—play an important role in the acceptability of bariatric surgery for childhood obesity.     

Mothers' Perceptions of Their Adolescents' Weight Status: Are They Accurate?

Objective: To evaluate the accuracy of mothers’ perceptions of adolescents’ weight status. Research Methods and Procedures: Parent interviews and adolescent surveys (755) were conducted in an ethnically diverse sample from Project EAT (Eating among Teens). Results: Adolescent weight status was accurately assessed by 60% of mothers, underestimated by 35% of mothers, and overestimated by 5% of mothers. In multivariate analyses, mothers of female adolescents were about half as likely to underestimate their adolescent's weight status as mothers of male adolescents. Nonoverweight mothers were about half as likely as overweight mothers to underestimate their adolescent's weight status. Discussion: Most mothers are able to accurately assess their adolescent's weight status; however, adolescent gender and mothers’ weight status are related to accuracy. Mothers were more likely to underestimate their sons’ weights than their daughters’ weights, and overweight mothers were more likely to be inaccurate in their assessments than nonoverweight mothers. Findings suggest that the majority of parents do not need to be told that their children are overweight; instead, messages to parents of overweight teens should focus on how to provide support for healthy weight management.     

Correlates of Pro-Drinking Practices in Drinking Parents of Adolescents in Hong Kong

Introduction and Aims

Parental alcohol-related practices are important risk factors of adolescent drinking, but little is known about the factors associated with these parental pro-drinking practices (PPDPs). We investigated the correlates of 9 PPDPs in drinking parents of adolescents in Hong Kong.

Methods

A total of 2200 students (age 14.8±2.0; boys 63.2%) participated in a school-based cross-sectional survey in 2012. Analysis was restricted to 1087 (61.8%) students with at least 1 drinking parent as PPDPs were much more common in these families. Logistic regression was used to identify correlates of each PPDP.

Results

Among 1087 students, the prevalence of PPDPs ranged from 8.2% for training drinking capacity to 65.7% for seeing parents drink. Only 14.8% of students had not experienced any of these practices. More frequent maternal drinking predicted parental training of drinking capacity. Older age predicted helping parents buy alcohol and parental encouragement of drinking. Adolescent girls were more likely to have received parental training of drinking capacity than boys. Higher perceived family affluence was associated with hearing parents saying benefits of drinking, and helping parents open bottle and pour alcohol.

Conclusions

PPDPs were associated with parental drinking frequency and various socio-demographic factors. These results have implications on alcohol control programmes involving parents to tailor messages for reducing PPDPs based on the characteristics of adolescents and parents.     

Predicting treatment initiation in a family-based adolescent overweight and obesity intervention

Little is known about factors associated with treatment initiation in overweight and obese adolescents. This study investigated parent-reported adolescent demographic, adolescent health, and parent motivation factors associated with initiation of a family-based adolescent overweight and obesity intervention. A telephone survey was completed by 349 parents calling to register their interest in participating in a cognitive behavioral lifestyle intervention for adolescent overweight and obesity. A total of 172 families (49.3%) returned their consent form to initiate treatment. A binomial logistic regression, with predictors entered in three blocks: (i) adolescent demographic (adolescent age, gender, adolescent BMI-for-age z-score, parent BMI); (ii) adolescent health (perceived adolescent physical and mental health, presence of an adolescent physical health problem or mental health problem, medication intake); and (iii) parent motivation (perceived adolescent weight category, concern about adolescent weight, importance of adolescent weight, confidence in adolescent capacity to change weight, priority of adolescent weight loss, discrepancy between adolescent current and ideal weight, previous weight loss attempts), was significant (χ2 (16) = 35.19, P = 0.004) accounting for 12.4-16.5% (95% confidence interval) of treatment initiation variance. Parent-reported adolescent physical health problem, parent perception of adolescent weight category, parent priority of adolescent weight loss, and parent perception of discrepancy between adolescent current and ideal weight were significant in the model. These findings indicate that data collected at intake are associated with treatment initiation and highlight the role of assessing and enhancing treatment motivation from initial contact.     

Mediators of Weight Loss in a Family‐Based Intervention Presented over the Internet

Objective: To assess the process variables involved in a weight loss program for African‐American adolescent girls. Several process variables have been identified as affecting success in in vivo weight loss programs for adults and children, including program adherence, self‐efficacy, and social support. The current study sought to broaden the understanding of these process variables as they pertain to an intervention program that is presented using the Internet. It was hypothesized that variables such as program adherence, dietary self‐efficacy, psychological factors, and family environment factors would mediate the effect of the experimental condition on weight loss. Research Methods and Procedures: Participants were 57 adolescent African‐American girls who joined the program with one obese parent; family pairs were randomized to either a behavioral or control condition in an Internet‐based weight loss program. Outcome data (weight loss) are reported for the first 6 months of the intervention. Results: Results partially supported the hypotheses. For weight loss among adolescents, parent variables pertaining to life and family satisfaction were the strongest mediating variables. For parental weight loss, changes in dietary practices over the course of 6 months were the strongest mediators. Discussion: The identification of factors that enhance or impede weight loss for adolescents is an important step in improving weight loss programs for this group. The current findings suggest that family/parental variables exert a strong influence on weight loss efforts for adolescents and should be considered in developing future programs.     

Adolescent Medicine: Attitudes,Training, and Experience Of Pediatric,Family Medicine,and Obstetric-Gynecology Residents

Purpose: Several studies have documented a deficiency in the delivery of preventive services to adolescents during physician visits in the United States. This study sought to assess and compare pediatric, family medicine (FM), and obstetrics and gynecology (OB/GYN) resident perceptions of their responsibility, training, and experience with providing comprehensive health care services to adolescents.Methods: A 57-item, close-ended survey was designed and administered to assess resident perceptions of the scope of their practice, training, and experience with providing adolescent health care across a series of health care categories.Results: Of the 87 respondents (31 OB/GYN, 29 FM, and 27 pediatric), most residents from all three fields felt that the full range of adolescent preventive and clinical services represented in the survey fell under their scope of practice. Residents from all three fields need more training and experience with mental health issues, referring teenagers to substance abuse treatment programs, and addressing physical and sexual abuse. In addition, OB-GYN residents reported deficiencies in training and experience regarding several preventive counseling and general health services, while pediatric residents reported deficiencies in training and experience regarding sexual health services.Conclusions: Our results indicate that at this time, residents from these three specialties are not optimally prepared to provide the full range of recommended preventive and clinical services to adolescents.     

Contemporary patterns of adolescent sexuality in urban Botswana

In Botswana, as in other areas in southern Africa, there is a growing concern about the risks associated with adolescent sexuality. To facilitate the design of policies that can address these problems, it is necessary to gain a thorough understanding of contemporary patterns of adolescent sexual behaviour, and the factors that affect them. This paper examines these issues using data from the 1995 Botswana Adolescent Reproductive Health Survey in conjunction with data from focus group discussions. The results suggest that adolescents become sexually active at an early age, and that many of them, males and females alike, have multiple sex partners. This early sexual initiation implies that adolescent reproductive health programmes should target youths aged 13 or younger. For school-based programmes this implies starting no later than Grade 6 or Standard 1, and preferably earlier. Young males appear to be a particularly vulnerable group that needs further attention. Adolescents perceive that teachers, peers and parents have the largest influence on their reproductive health attitudes. Schools appear to have the most potential for providing reproductive health information, because they reach youths both directly and indirectly by educating their peers. The results also show that male and female sexual behaviour is affected by different factors. Among males, having secondary education strongly increases the odds of being sexually active, presumably because such males make attractive partners. Among females, on the other hand, being in school significantly reduces the odds of being sexually active. This finding is consistent with the policy imposing a one-year school expulsion for pregnant schoolgirls, which was implemented as a deterrent to schoolgirl pregnancy.     

Mixed feelings of children and adolescents with unilateral congenital below elbow deficiency: an online focus group study

The existing literature is inconsistent about the psychosocial functioning of children and adolescents with Unilateral Congenital Below Elbow Deficiency (UCBED). The objective of this qualitative study was to explore the psychosocial functioning of children and adolescents with UCBED in terms of their feelings about the deficiency and what helps them to cope with those feelings. Additionally, the perspectives of prosthesis wearers and non-wearers were compared, as were the perspectives of children, adolescents, parents and health professionals. Online focus group interviews were carried out with 42 children and adolescents (aged 8-12, 13-16 and 17-20), 16 parents and 19 health professionals. Questions were asked about psychosocial functioning, activities, participation, prosthetic use or non-use, and rehabilitation care. This study concerned remarks about psychosocial functioning. Children and adolescents with UCBED had mixed feelings about their deficiency. Both negative and positive feelings were often felt simultaneously and mainly depended on the way people in the children's environment reacted to the deficiency. People staring affected the children negatively, while support from others helped them to cope with the deficiency. Wearing a prosthesis and peer-to-peer contact were also helpful. Non-wearers tended to be more resilient than prosthesis wearers. Wearers wore their prosthesis for cosmetic reasons and to prevent them from negative reactions from the environment. We recommend that rehabilitation teams make parents aware of their great influence on the psychosocial functioning of their child with UCBED, to adjust or extend the currently available psychosocial help, and to encourage peer-to-peer contact.     

Focus: Preventive Medicine: Assessing the Social Influences,Self-Esteem,and Stress of High School Students Who Vape

Adolescent vaping is rapidly rising in Canada, and e-cigarettes have become the most widely used tobacco product among high school students; 29% of students in grades 10 to 12 reported e-cigarette use in 2019. Vaping among adolescents is a problem because the long-term health consequences of e-cigarettes remain unknown, large numbers of teens are becoming addicted to the harmful drug nicotine, and vaping has been shown to increase risk of initiation of combustible tobacco product use. To address the gaps in the current understanding of adolescent e-cigarette use, this study aims to examine the role of social peer and family influence, self-esteem, and stress on teen vaping. Seventy-nine students in grades 10 to 12 at an independent, co-ed high school in Toronto, Ontario completed an online survey about factors that influence them to vape, and about their perceived self-esteem and stress. Survey data was analyzed using Chi-Square tests and T-tests. Common motivations for vaping included stress relief (70%) and peer influence (60%). Family history of smoking or vaping and the ability to vape indoors also influenced vaping habits. Notably, e-cigarette users reported higher stress levels than non-users, but self-esteem levels were comparable. Our findings suggest that high school vaping prevention strategies should focus on stress reduction and encourage healthy coping strategies. Similar research studies should be conducted in other high schools, and future research should further explore the correlation between stress and adolescent vaping.     

Work with youth--the basis of educational programs aimed at the prevention of HIV infection

During the recent 10 years, 1987-1997, syphilis morbidity was found to increase 60-fold in Omsk Province. In 1997 adolescents constituted 6.0% in the structure of persons who contacted the disease. In this year more than 500 adolescent using drugs were registered in the region. The introduction of drugs by injection was practiced by 9.6% of the adolescents. The program aimed mainly at changing the behavior of young people with orientation on the choice of a healthy mode of life and theirs information about risk factors associated with sex transmitted diseases particularly HIV infection is discussed.     

Neural correlates of parent–child HPA axis coregulation

Parents and children have been found to show coordination or coregulation of the hypothalamic–pituitary–adrenal (HPA) axis. This coordination may be reflected in adolescents' neural activation to parent stimuli, particularly in regions of the brain associated with social information processing.This study reports on 22 adolescents (13 males, mean age 17 years), recruited from a longitudinal study to participate in a functional MRI (fMRI) scanning protocol. Approximately 1.5 years before the scan, these same adolescents participated in a family conflict discussion in the lab with both parents, and all three family members provided samples of salivary cortisol five times, before and after the discussion. Multilevel models found positive cross-sectional and time-lagged associations between parents' and youth cortisol. Empirical Bayes (EB) coefficients, extracted from these models to reflect the strength of the relationship between parent and adolescent cortisol, were tested in conjunction with adolescents' neural activation to video clips of their parents taken from the conflict discussion. For both mothers and fathers, youth who showed stronger cortisol coregulation with each parent (both in cross-sectional and time-lagged analyses) showed more activation to that same parent in posteromedial regions (precuneus, posterior cingulate, and retrosplenial cortex) that have been linked with social cognition, e.g. mentalizing about others' emotions. Youths' adrenocortical coregulation with their parents may be reflected in their neural processing of stimuli featuring those same parents.     

Adolescent sleep misalignment: a chronic jet lag and a matter of public health

Sleep is a key element, both physiologically and psychologically, in adolescent development. The prevalence of sleep disorders in western countries is important, as with age the sleep–wake cycle of adolescents becomes irregular and delayed in relation with later sleep onset and waking time resulting in rhythm desynchronization. A large number of adolescents sleep for 7–8 h instead of 9–10 h per night, which can lead to a cumulative sleep debt with fatigue, behavioral problems and poor academic achievement. The effect of electronic media use (such as television, mobile phone, computer, and electronic gaming) on sleep has been the object of several international studies, though pubertal changes may also impact adolescent sleep. Adolescents and their parents should be educated by professionals, including physicians and nurses, on the key role of sleep in adolescent well being and quality of life. A number of basic rules are proposed to improve sleep in adolescents. The permanent social jet lag experienced by a number of adolescents should be considered as a matter of public health.