Jessamyn G. Perlus

Perspectives From Before and After the Pediatric to Adult Care Transition: A Mixed-Methods Study in Type 1 Diabetes

OBJECTIVE Among the many milestones of adolescence and young adulthood, transferring from pediatric to adult care is a significant transition for those with type 1 diabetes. The aim of this study was to understand the concerns, expectations, preferences, and experiences of pretransition adolescents and parents and posttransition young adults. RESEARCH DESIGN AND METHODS Participants completed questionnaires and responded to open-ended qualitative questions regarding self-management, self-efficacy, and their expectations and experiences with pediatric and adult care providers across the transition process. RESULTS At a mean age of 16.1 years, most pretransition adolescents had not yet discussed transferring care with their parents or doctors. Although many posttransition young adults reported positive, supportive interactions, several described challenges locating or establishing a relationship with an adult diabetes care provider. Qualitative themes emerged related to the anticipated timing of transfer, early preparation for transition, the desire for developmentally appropriate interactions with providers, the maintenance of family and social support, and strategies for coordinating care between pediatric and adult care providers. CONCLUSIONS Standardizing transition preparation programs in pediatric care and introducing transition-oriented clinics for late adolescents and young adults prior to adult care may help address patients’ preferences and common transfer-related challenges.

Trends in Bullying, Physical Fighting, and Weapon Carrying Among 6th- Through 10th-Grade Students From 1998 to 2010: Findings From a National Study

OBJECTIVES We examined trends from 1998 to 2010 in bullying, bullying victimization, physical fighting, and weapon carrying and variations by gender, grade level, and race/ethnicity among US adolescents. METHODS The Health Behavior in School-Aged Children surveys of nationally representative samples of students in grades 6 through 10 were completed in 1998 (n = 15,686), 2002 (n = 14,818), 2006 (n = 9229), and 2010 (n = 10,926). We assessed frequency of bullying behaviors, physical fighting, and weapon carrying as well as weapon type and subtypes of bullying. We conducted logistic regression analyses, accounting for the complex sampling design, to identify trends and variations by demographic factors. RESULTS Bullying perpetration, bullying victimization, and physical fighting declined from 1998 to 2010. Weapon carrying increased for White students only. Declines in bullying perpetration and victimization were greater for boys than for girls. Declines in bullying perpetration and physical fighting were greater for middle-school students than for high-school students. CONCLUSIONS Declines in most violent behaviors are encouraging; however, lack of decline in weapon carrying merits further attention.

Effectiveness of cell phone restrictions for young drivers,review of the evidence

This research summarized the effect of cell phone restrictions on the prevalence of cell phone use and motor vehicle crashes involving young drivers. Multiple databases were searched with the use of terms related to cell phone restrictions, the prevalence of cell phone use, crashes, and young drivers. Fifty-three abstracts were reviewed. Eleven studies met the inclusion criteria. Six studies examined changes in the prevalence of cell phone use before and after a restriction was imposed; five studies used changes in crash rates as the outcome. The majority of prevalence studies found no change in young drivers’ cell phone use following the introduction of a restriction. Crash studies using multistate samples reported significant reductions in fatal crashes; single-state studies reported no change or small increases in crashes. Restrictions appeared to have no long-term effect on the prevalence of cell phone use among novice drivers. Conflicting findings from crash studies reflected differences in analytical approaches, limitations of existing data, and the challenges of quantifying the effect of young-driver restrictions in the presence of all-driver restrictions. Overall, evidence of the effectiveness of young drivers’ cell phone restrictions is inconclusive. There are relatively few studies, and the methodological limitations of the existing studies revealed no clear pattern of effects. Additional studies are needed to distinguish novice drivers (16- to 17-year olds) from experienced young drivers and to use distraction-related crashes as an outcome.

Adolescent sleep insufficiency one year after high school

INTRODUCTION Sleep difficulties affect approximately 45% of adolescents and are associated with health consequences such as depression and obesity. Sleep duration immediately following high school is not well understood, especially for those not pursuing post-secondary education. We examined adolescent sleep insufficiency and its association with school and work status. METHODS Data were collected in 2012 and 2013 as part of the NEXT Generation Health Study (NEXT), a nationally representative, longitudinal study of U.S. adolescents. Self-reported sleep was compared with guidelines for healthy sleep. RESULTS On weekdays, 31% reported less than 7 h of sleep; which reduced to 6% on weekends. Average weekday sleep was 7.4 h and weekend sleep was 9.2 h. Few results emerged from interaction analyses comparing different work and school statuses. CONCLUSIONS This study captures sleep habits of adolescents one year after high school regardless of school and/or working status. Implications and future directions are discussed.

Are Perceptions About Driving Risk and Driving Skill Prospectively Associated with Risky Driving Among Teenagers

The objective of this study was to examine prospective associations of perceptions of driving risk and skill with teenage risky driving. The vehicles of 42 newly licensed teenage drivers were instrumented with a data acquisition system. Objective measures of risky driving [crash and near crash (CNC) and kinematic risky driving (KRD) rates] obtained from accelerometers were aggregated over three 6-month periods (T1, T2, and T3). The Checkpoints Self-Reported Risky Driving Scale (C-RDS) and perceptions of driving risk and driving skills were collected at corresponding 6-month intervals. The results indicated that CNC, KRD, and C-RDS were significantly correlated at T1 to T3. Perceptions of driving risk and skill were not significantly correlated with objective or self-reported measures of risky driving. No evidence was found that perceptions of risk or skill were prospectively associated with risky driving. It was concluded that perceptions of risk and driving skills may have limited utility as objectives of prevention efforts.