Leslie R. Walker

Health Care Transition: Youth, Family, and Provider Perspectives

Objective. This study examined the process of health care transition (HCT) posing the following questions: What are the transition experiences of youths and young adults with disabilities and special health care needs, family members, and health care providers? What are promising practices that facilitate successful HCT? What are obstacles that inhibit HCT? Methods. A qualitative approach was used to investigate these questions. Focus group interviews were conducted. Content and narrative analyses of interview transcripts were completed using ATLAS.ti. Results. Thirty-four focus groups and interviews were conducted with 143 young adults with disabilities and special health care needs, family members, and health care providers. Content analysis yielded 3 content domains: transition services, which presents a chronological understanding of the transition process; health care systems, which presents differences between pediatric and adult-oriented medicine and how these differences inhibit transition; and transition narratives, which discusses transition experience in the broader context of relationships between patients and health care providers. Conclusion. This study demonstrated the presence of important reciprocal relationships that are based on mutual trust between providers and families and are developed as part of the care of chronically ill children. Evidence supports the need for appropriate termination of pediatric relationships as part of the transition process. Evidence further supports the idea that pediatric and adult-oriented medicines represent 2 different medical subcultures. Young adults’ and family members’ lack of preparation for successful participation in the adult health care system contributes to problems with HCT.

Medication-assisted treatment of adolescents with opioid use disorders

Opioid use disorder is a leading cause of morbidity and mortality among US youth. Effective treatments, both medications and substance use disorder counseling, are available but underused, and access to developmentally appropriate treatment is severely restricted for adolescents and young adults. Resources to disseminate available therapies and to develop new treatments specifically for this age group are needed to save and improve lives of youth with opioid addiction.

Cigarette Smoking Among Youth With Attention-Deficit/Hyperactivity Disorder: Clinical Phenomenology, Comorbidity, and Genetics

Cigarette smoking and other forms of tobacco use among children and adolescents is a significant public health concern. The negative consequences of prolonged exposure to such substances are numerous, and include higher prevalence rates of cardiopulmonary dysfunction and certain cancers, and may lead to other forms of drug use. Identifying subgroups of youth who may be at greater risk than others to develop a nicotine habit is an important step forward in preventing smoking initiation, and controlling tobacco use. One such subgroup is children with attention-deficit/hyperactivity disorder (ADHD). This is because the prevalence of smoking among these youngsters is nearly twice as high as it is among those who are unaffected with ADHD. However, the etiology of this association is not known. It is possible that a constellation of social, behavioral, and biological factors influences this process, resulting in higher prevalence rates. To further our understanding of this problem, we reviewed each of these factors in relationship to smoking and to ADHD. Using the primary care population as a model, we then discuss clinical research methods that may shed additional light on this topic, as well as the strengths and limitations of current smoking prevention and cessation options for ADHD-affected youth who are assessed and treated in medical settings.

Cigarette smoking among adolescents with type 1 diabetes: Strategies for behavioral prevention and intervention

Smoking is the leading preventable cause of death in the U.S. and preventing smoking initiation among adolescents is a public health priority and a central element of comprehensive tobacco control. While cigarette smoking is harmful to all youths, those with special healthcare needs are particularly vulnerable to the negative health consequences of smoking, and adolescents with type 1 diabetes (T1D) urgently stand out as a high-risk group. Available literature suggests the prevalence and risk factors for smoking among adolescents with T1D are strikingly similar to the general population. Moreover, smoking negatively affects T1D management and increases risk for and progression of adverse health outcomes related to T1D. Adolescents with T1D are also influenced by disease-related social and behavioral factors that affect decisions about smoking. Pediatric health care providers (HCPs) are optimally-positioned to screen and counsel adolescents with T1D to avoid smoking, as they have well-established relationships with young patients and regularly scheduled visits surrounding T1D management. However, several barriers inhibit HCPs from screening/counseling adolescents with T1D for smoking on a regular basis. Well-established strategies for behavioral counseling for smoking in the healthcare setting may be effective to prevent and reduce smoking among adolescents with T1D. HCPs who care for these young patients can tailor proven counseling approaches to the context of T1D to address smoking alongside other behavioral factors that are central to disease management. Empirical research is also needed to inform the development and deployment of healthcare-based interventions and maximize their impact within this population.

Adolescent Caffeine Use, ADHD, and Cigarette Smoking

The purpose of this study was to describe the prevalence of adolescent caffeine use and its association with attention deficit hyperactivity disorder (ADHD) and cigarette smoking. A total of 448 adolescents between the ages of 13 and 21 years consecutively presenting for routine, well-child care were studied. Twenty-four percent had a pre-existing diagnosis of ADHD, and 47% reported a positive lifetime history of cigarette smoking. Eighty-five percent of participants reportedly consumed a caffeinated beverage within the past 30 days; 38% had consumed 1+ cups of caffeinated coffee, and 78% had consumed 1+ glasses of another caffeinated beverage other than coffee (e.g., tea or soft drinks). After controlling for sociodemographic and other potential confounding factors, an ADHD diagnosis and a positive lifetime smoking history were significantly associated with caffeine use: Adolescents with ADHD were nearly twice as likely to use more caffeine than were adolescents without ADHD (odds ratio [OR] = 2.08; 95% confidence interval [CI] = 1.23, 3.50, p = .006); lifetime smokers were 80% more likely to use more caffeine than were adolescents who had never smoked (OR = 1.80; 95% CI = 1.16, 2.79, p = .009). Caffeine use is elevated among adolescents diagnosed with ADHD and those who have ever tried cigarette smoking. Although caffeine is a non-illicit psychostimulant, these findings add to the emerging data on substance use behaviors among adolescents with ADHD. Health care professionals who work with adolescents with ADHD should regularly screen for both cigarette and caffeine use among their patients.

Relationships of Pubertal Development Among Early Adolescents to Sexual and Nonsexual Risk Behaviors and Caregivers’ Parenting Behaviors

Using a school-based sample of fifth graders (mean age = 10.38, SD = 0.66) and their parents (N = 408) from Washington, D.C., the authors examine associations of pubertal development with early adolescents’ sexual and nonsexual risk behaviors and their caregivers’ parenting behaviors and of these risk behaviors with parenting behaviors. Results indicate that youths reporting signs of pubertal development were more likely to engage in these risk behaviors than were students reporting no signs. Pubertal development is not related to parenting behaviors; however, parents of youths who reported multiple nonsexual risk behaviors reported more parent–child communication about sexual topics. These results highlight the need to begin risk prevention efforts early, prior to pubertal development. Research is needed to understand how parents can help youths better cope with pubertal development to avoid involvement in sexual and nonsexual risk behaviors.

Adolescent Substance Use and Abuse Prevention and Treatment: Primary Care Strategies Involving Social Networks and the Geography of Risk and Protection

The use and abuse of licit and illicit substances in adolescence is a national public health concern. This behavior impairs healthy development for many adolescents in the United States. Although not every adolescent who becomes a regular user of licit and illicit substances will develop a substance abuse disorder, all adolescents using these substances can experience a life-threatening outcome. Understanding the epidemiology and social profile of adolescent substance use, namely the risk and protective factors and the environmental and genetic factors, is essential to the development of strategies for prevention. There are many methods that can be employed to better assess environments in which adolescents live. The method discussed in this paper is descriptive and utilizes Geographic Information Systems (GIS) technology. The primary goal of this paper is to illustrate and describe an analysis of substance using and non-substance using adolescents, their social networks, the risky and protective settings where they socialize, and the relationship of these variables to health outcomes such as substance use, depression, and stress. Published data from the researchers’ recent investigation examine the effect of social network affiliations and geographical risk factors on drug involvement and illustrate how these factors may then be incorporated into prevention and intervention planning, especially in medical settings.

Adolescence as a Critical Stage in the MCH Life Course Model: Commentary for the Leadership Education in Adolescent Health (LEAH) Interdisciplinary Training Program Projects

The Life Course Perspective (LCP), or Model, is now a guiding framework in Maternal and Child Health (MCH) activities, including training, supported by the Health Resources and Services Administration’s Maternal and Child Health Bureau. As generally applied, the LCP tends to focus on pre- through post-natal stages, infancy and early childhood, with less attention paid to adolescents as either the “maternal” or “child” elements of MCH discourse. Adolescence is a distinct developmental period with unique opportunities for the development of health, competence and capacity and not merely a transitional phase between childhood and adulthood. Adequately addressing adolescents’ emergent and ongoing health needs requires well-trained and specialized professionals who recognize the unique role of this developmental period in the LCP.

Child and Adolescent Tobacco and Substance Use within the Context of ADHD: Implications for Prevention and Treatment

Tobacco, alcohol, marijuana, and other forms of substance use among children and adolescents is a significant public health concern. At present, one high-risk population of great concern is those affected with Attention-Deficit/Hyperactivity Disorder (ADHD) and those with subthreshold ADHD-like symptoms. The prevalence of tobacco and substance use is considerable within this population, and ADHD and ADHD-like symptoms often present as comorbid conditions. To further the understanding of this problem, a review is provided of youth tobacco and substance use and their biobehavioral influences in the context of ADHD. Using primary care as an example, opportunities for tobacco and substance use prevention and treatment within this high-risk population are examined.

Health attitudes, beliefs, and risk behaviors among adolescents and young adults with type 1 diabetes

Decision making about engaging in health-promoting and health-compromising behaviors among adolescents and young adults with type 1 diabetes is an important but understudied topic. The purpose of this study was to describe the health attitudes, beliefs, risk behaviors, and general psychological functioning of adolescents and young adults with diabetes and to compare these psychosocial aspects of health to those of adolescents and young adults without diabetes. Fifty-three adolescents and young adults with type 1 diabetes and 53 demographically matched controls were recruited from 2 pediatric teaching hospitals and administered a confidential self-report questionnaire consisting of individual survey items and standardized scales. Compared to healthy adolescents and young adults, adolescents and young adults with diabetes had more frequent thoughts about health and sickness, rated their health as poorer, viewed smoking as less addictive, reported greater symptoms of depression, and reported greater exposure to smoking in their households, but less smoking experimentation. Poorer metabolic control was associated with decreased physical activity. Additional research on the design and implementation of diabetes-specific cardiovascular disorder and tobacco control programs for adolescents and young adults is warranted.