Marjorie J. Allan

Reliability in adolescent reporting of clinician counseling, health care use, and health behaviors.

Background: Accurate measures of health-care use by adolescents would be useful in managed care quality assurance, public health surveillance, and health-care research. Objective: To assess test-retest reliability and factors associated with reliability of adolescent reports of clinician counseling, preventive health services, and health behaviors. Research Design: A convenience sample of high school students (N = 253) completed identical paper-and-pencil surveys in school and 2 weeks apart. Multiple linear regression was used to evaluate the influence on response reliability of individual factors and question item characteristics. Reliability was assessed using Cohen &kgr;. Results: &kgr; values for specific questions varied widely (0.94–0.33). Median &kgr; values for behavioral, counseling, and health-service questions were 0.74, 0.63, 0.56, respectively. Lower sentence complexity, certain time frames (ever, age at first occurrence, last time), and behavioral question type were associated with greater reliability in adolescent reporting (final model R2 = 0.54). Adolescents’ age and ethnicity were not predictive of reliability, though girls were slightly more reliable reporters than boys. Overall, the prevalence of responses at times 1 and 2 were similar; 95% of responses at time 2 were within 5 percentage points of time-1 estimates (SD = 2.4). Conclusions: The reliability of adolescent reporting was strongly influenced by question characteristics such as sentence complexity and time frame; these should be carefully considered in the construction of questionnaires for adolescents. Adolescents can be an accurate source of health-care service data.

A Potential Pitfall in Provider Assessments of the Quality of Asthma Control

BACKGROUND Pediatricians elicit information about asthma control from parents to help formulate management plans. If parents of children with significant asthma symptoms inappropriately indicate good control, physician recommendations may not be optimal. We examined whether a single general question about asthma control might lead to inaccurate assessment of severity. DESIGN/METHODS Children 3-7 years of age who met the National Heart, Lung, and Blood Institute (NHLBI) criteria for mild persistent to severe asthma were identified from 40 urban schools. A phone survey of their parents provided demographic information, symptom frequency, medication use, and general interpretation of their childs asthma control. Chi-square analyses compared the parents general interpretation of control with demographic characteristics and measures of asthma severity. RESULTS One hundred sixty of 224 eligible children participated in this study. Seventy-eight percent were described as in good asthma control. General assessment of asthma control did not vary by demographic characteristics. Parents were as likely to describe children with daily asthma symptoms in good control as they were to describe children with less frequent symptoms in good control. Parents were less likely to report good control in children using daily rescue medications when compared with children with less frequent medication use (65% vs 82%, P =.03), but the majority of children in both groups was described as having good control. CONCLUSIONS Most parents underestimated the severity of their childs asthma and reported good control with their global assessment. Parents frequently reported good control even when the children had daily asthma symptoms. Pediatricians should ask about specific asthma symptoms during patient encounters because a global question about asthma control likely will result in underestimations of asthma severity.

School-based child care for children of teen parents: evaluation of an urban program designed to keep young mothers in school

Abstract This study examined the effects of the school-based Early Childhood Centers for Children of Teen Parents Program. Designed to keep young mothers in school, the program provides needed support to urban young mothers including free on-site child care for their infants and toddlers, parenting classes, and referral to other service agencies. Archived school record information was collected on teen mothers who participated in the program (n=81) and on a group of teen mothers who had applied for the program but did not receive services (n=89). Controlling for pre-service differences, participant mothers were found to have better school attendance and deemed to be at lower overall risk than were the non-participant young mothers. Significant differences were also evident in the graduation rates of these young mothers—70% of the participant mothers graduated, 28% of the non-participant young mothers graduated. Logistic regression correctly classified graduation/drop-out status in 76% of the cases. School attendance, mothers age at birth of the child, and participation/non-participation in the program were significant predictors. Percent core courses passed and average risk scores did not significantly add to prediction. Implications and future areas of study are discussed.

ADOLESCENTS' PERCEIVED ACCESS TO HEALTH CARE. † 20

OBJECTIVE: Adolescents face financial and non-financial barriers to use of health care. This study assesses whether adolescents: 1) are able to use their own health insurance, and 2) perceive availability of or use confidential care. DESIGN: We approached adolescents in 6 shopping malls in upstate NY while recruiting 18 and 19 year olds for a study of health services use. Ability to use insurance was measured by whether or not an adolescents had their own health insurance card. RESULTS: More than half (53%) of 486 11 to 21 year old adolescents reported having their own health insurance card. The proportion of adolescents with their own insurance card did not vary by age, gender, ethnicity, or site of recruitment. Of 110 eligible 18 and 19 year olds, 80 (72%) enrolled in the survey and 57 (71%) completed telephone interviews. Nearly half (44%) were female, 26% were non-white, and 93% reported good or excellent health status. Most (91%) adolescents reported having a regular source of health care, and 84% reported having health insurance; however, only 40% of insured youth reported being able to independently use their insurance. Nearly two thirds (65%) reported being able to use their primary care source confidentially. Only 17% of adolescents had used a confidential care source other than their primary care provider. However, 32% were unable to identify any source of confidential care. Those with and without their own insurance cards were equally likely to identify an available source of confidential care. Females were much more likely than males to have used a confidential care source. More then half (56%) of all adolescents were sexually active; of these, 67% reported having ever discussed sexually transmitted diseases or their relationships with their provider(s). Many (41%) sexually active youth and only 6% of non-sexually active youth had used confidential care sources (p=0.02). CONCLUSIONS: Although half of all adolescents have their own insurance cards, many older adolescents remain unable to use their own insurance, obtain confidential primary care, or identify other available sources of confidential health care. Knowledge of available services and ability to use their health insurance remain substantial non-financial barriers to access for many adolescents.

Examining the Factorial Structure of the T-CRS 2.1

The factor structure of the Teacher–Child Rating Scale (T-CRS 2.1) was examined using confirmatory factor analysis (CFA). A cross-sectional study was carried out on 68,497 children in prekindergarten through Grade 10. Item reduction was carried out based on modification indices, standardized residual covariance, and standardized factor loadings. A higher order model with a general super-ordinate factor fit the data well, and is consistent with the notion of a unidimensional non-cognitive set of learning-related skills. Model-based reliability estimates are provided.

GROWTH AND STABILITY OF ADOLESCENT HEALTH PROGRAMS. † 18

OBJECTIVE: To assess the growth and stability of adolescent health services delivery programs in the United States between 1990 and 1995.