Browsing by Subject "Adolescents"

The prevalence of single combustible tobacco product use has decreased among adolescents and young adults (AYAs) in recent years, but the introduction of alternative tobacco products has led to increases in dual- or poly-use, especially among AYAs. Understanding susceptibility to multiple tobacco product (MTP) use is crucial, as it predicts initiation and subsequent use. Mental distress, including stress and mental health symptoms, may influence susceptibility and harm perceptions, yet this area remains underexplored in the literature. This dissertation aims to fill this gap by examining the influence of mental distress on susceptibility to MTP use among AYAs and whether it alters harm perceptions. By addressing these questions, this research aims to develop effective prevention techniques to prevent substance use initiation and reduce susceptibility among vulnerable populations, ultimately improving long-term health outcomes.Chapter 1 of this dissertation further introduces the background and context of this critical issue at the intersection of mental health and tobacco uptake among the AYA population in the United States, setting the stage for understanding the multifaceted relationship between mental health, stress, tobacco use, and susceptibility among AYAs, and laying a strong foundation for the subsequent chapters' detailed exploration and analysis. The theoretical framework guiding the dissertation is introduced to provide a structured lens through which to examine the complex interplay of factors influencing tobacco use behaviors among AYAs. This framework incorporates theories from psychology, public health, and dependence studies, offering a comprehensive approach to understanding the pathways and mechanisms that contribute to susceptibility and initiation of tobacco product use in this vulnerable population. Chapter 2 was a systematic scoping review which employed the Joanna Briggs Institute (JBI) method and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) checklist to explore factors associated with multiple tobacco product (MTP) susceptibility, uptake, and use among U.S. adolescents and young adults. A comprehensive search strategy in PsycINFO and PubMed databases yielded 52 eligible articles published from 2013 onwards. Data extraction focused on demographic, individual, familial, social, environmental, and societal factors influencing MTP use. Key findings revealed higher susceptibility to MTP use among older adolescents and males, with Hispanic and Non-Hispanic Black adolescents also exhibiting elevated susceptibility to MTP use. Factors such as intentions to use tobacco, peer and parental tobacco use, and limited exposure to pro-smoking media were associated with susceptibility to MTP use. Additionally, e-cigarette use was linked to subsequent cigarette smoking initiation, while experimentation with MTP was influenced by parental use and tobacco marketing exposure. Progression to MTP use involved concurrent use of multiple products, with sociodemographic characteristics and environmental influences playing significant roles. These findings underscore the complex interplay of factors shaping tobacco use behaviors among adolescents and young adults, highlighting areas for further research and targeted interventions. Chapter 3 employed two pilot studies to examine the relationship between mental health factors (perceived stress, anxiety, and depression) and susceptibility to hookah tobacco smoking among adolescents and young adults; examining differences based on susceptibility status and exploring the predictive role of these factors while considering known risk factors and covariates. Statistical analyses using were conducted across two studies to explore demographic characteristics and predictor variables related to susceptibility and smoking status among young adults. Chi-square tests, t-tests (Study 1), and ANOVAs (Study 2) were utilized for comparisons, alongside bivariate logistic regression and proportional logistic regression for relationship exploration. Findings from Study 1 revealed that perceived stress was a significant predictor, with susceptible young adults reporting higher stress levels, indicating a potential link to susceptibility to hookah tobacco smoking (HTS). Peer acceptability and harm perceptions also emerged as influential factors. Study 2 showed differences in psychological distress levels between non-susceptible individuals and hookah users, highlighting the role of psychological factors in HTS behaviors. A positive linear trend in stress, anxiety, and depression levels from susceptibility status transitions (i.e., from non-susceptible, to susceptible, to use) underscored the need for comprehensive interventions targeting multiple risk factors. The consistent predictive power of perceived stress emphasizes its importance in addressing susceptibility to HTS among young adults. These findings advocate for tailored interventions addressing psychological, social, and demographic factors collectively to reduce susceptibility and prevent HTS initiation effectively. Chapter 4 utilized a national dataset (the Population Assessment on Tobacco and Health) to explore longitudinal links between multiple tobacco product (MTP) susceptibility, mental health symptoms, product harm perceptions and initiation of MTP use among AYAs in the US. We first examined whether increased externalizing and internalizing symptoms predicted changes in susceptibility to MTP use. Longitudinal parallel-process (LPP) modeling was used, involving multilevel modeling (MLM) and structural equations modeling (SEM) considering age group as the major predictor. We also examined whether harm perceptions mediated any relationships between mental distress and susceptibility, adjusting for covariates. We then examined if harm perceptions predicted MTP uptake. Cox-proportional hazard regression analyzed relationships between harm perceptions and MTP uptake. A linear regression model estimated longitudinal relationships between harm perceptions and susceptibility status. Mediation analysis determined if susceptibility status mediated the relationship between harm perceptions and MTP uptake. Lastly, as an exploratory analysis, we examined the interaction between mental distress and susceptibility on MTP uptake. We utilized intercepts and slopes for each variable in analyses to provide insights into how these factors evolve over time. Among a sample of AYAs who reported never smoking cigarettes, e-cigarettes, hookah tobacco, nor cigars (traditional, filtered, and cigarillos) at Wave 1, we found that non-susceptible individuals had higher perceived harm and lower mental health symptoms than susceptible individuals. Susceptibility was highest during the transition from ages 12-14 to 15-17, highlighting a critical period for intervention. Young adults showed higher initiation rates of MTP by Wave 6, emphasizing the need for targeted interventions during the transition to adulthood. Unexpectedly, higher initial levels of mental distress were associated with reduced susceptibility to MTP use, challenging conventional assumptions. Perceptions of harm mediated these relationships variably, indicating complex pathways influencing MTP use initiation. Further investigation using Cox-proportional hazard regression models confirmed that higher initial and increasing perceptions of harm over time were protective against MTP initiation. However, contrary to expectations, higher initial harm perceptions were associated with increased susceptibility initially. Initial susceptibility partially mediated the relationship between perceptions of harm and MTP initiation, highlighting nuanced interactions. The study suggests that while mental distress influences susceptibility and perceptions of harm, its direct moderation effect on MTP initiation was not significant. These findings underscore the importance of developmental stages and social contexts in shaping MTP use behaviors, advocating for tailored interventions during critical transitions to mitigate tobacco use among AYAs. Chapter 5 concludes the dissertation by synthesizing its findings from all chapters, discussing their implications and recommendations for future research.

Utilizing data from The National Longitudinal Study of Adolescent Health (Add Health), the current study examined the relationship between cultural values, coping behavior, and HIV risk behaviors among African-American/Black and Hispanic/Latino adolescents (N = 437). The goal of this research was to provide the first step towards testing the construct validity of a theoretical model in which values and cultural context contribute to coping behaviors and coping, in turn, mediates the association between values and HIV risk profile. African-American participants endorsed higher levels of Africentric and religious values than did Hispanic participants and endorsed higher utilization of religious coping. Cultural values including familismo and religiosity were associated with more adaptive coping behavior and lower sexual and substance use risk behaviors across racial/ethnic groups. Results for other cultural values were inconsistent. Coping behavior predicted substance use risk behaviors but was not associated with sexual risk behaviors. Mediation was not supported except in the case of religious coping and religiosity. Implications for HIV prevention and directions for future research are discussed.

Introduction: Sickle cell disease (SCD) is a genetically inherited recessive blood disorder that affects millions of people worldwide. The management of SCD should and can be considered a collaborative team effort, and requires the comprehensive and coordinated support of several medical professionals. The rising number of adults living with SCD creates a need for long term therapeutic and management strategies as well as a better understanding of the transition from pediatric to adult care. The research goal for this project is to compare the two systems that exist for treatment of adolescents with SCD in Jamaica and the United States by assessing differences and similarities in patients’ readiness for adult treatment and their understanding of SCD and its management. Methods: This study was conducted in the Sickle Cell Unit at the University of West Indies (UWI) hospital in Kingston, Jamaica. Eligibility for this study was defined as patients with SCD, between the ages of 13-19, seeking treatment at the health facility in the University of the West Indies, who have no acute illness at the time of study. After a verbal and written consent process during check-in, each participant completed a demographic survey, disease knowledge questionnaire, the ASH Transition Readiness Assessment Questionnaire, and had the opportunity to participate in in-depth interviews. Following data collection, results subsequently with similar previously completed surveys from patients at the Duke University Sickle Cell Center. Results: Gender and socioeconomic factors were not associated with differences in assessment scores in Jamaica. Total scores for disease knowledge questionnaires increased with age, however mean scores for the 17-19 age group were 62.17% lower than Duke University patients of the same age. Self-evaluation with the ASH Transition Readiness Assessment also showed an increase in scores with age, and significant increases in disease knowledge and appointments sections in both the 13-14 and 17-19 age groups, estimated by a p-value of 0.023 and 0.006, respectively. The results, however, were also generally lower than similar Transition Readiness Assessment measures at Duke. In-depth interviews revealed patient insight into disease knowledge, treatment involvement and experiences with doctors, family, and in the clinic. Answers align with both questionnaires used in this study.

Adolescence is a period marked by tremendous social, emotional and physical changes; however, adolescents and young adults (AYAs) with intellectual disability (ID), who must navigate this period with limitations in intellectual and adaptive functioning, face additional difficulties. Much remains unknown about their health care transition (HCT) experiences and their health and well-being as they transition into adulthood; therefore, this study examined the HCT, health status, and functional outcomes of AYAs with ID.

This study incorporated both an individual and population approach to understand needs of AYAs with ID. First, within Chapter 1, a qualitative descriptive design study with semi-structured individual interviews with 16 parent participants was used. We utilized purposive sampling of parents with variation on race/ethnicity and AYA age, stage in transition, and condition; and we utilized content analysis. In Chapter 2, we developed a new method for identifying individuals with ID within large, population-level studies not targeted on ID. We used a secondary analysis of the de-identified, restricted-use National Longitudinal Study of Adolescent to Adult Health (Add Health) database representing 20,745 adolescents to develop a method for identifying individuals who meet criteria of ID. The Add Health ID Indicator was developed from the variables indicative of intellectual and adaptive functioning limitations available within the Add Health database. Through this method, we identified 441 AYAs with ID. Lastly, in Chapter, a descriptive, correlative study utilized the Add Health database and Add Health Indicator to examine the health status and functional outcomes among 254 AYAs with ID.

Our study illuminates the need for (a) improved infrastructure to provide effective HCT and (b) partnerships to help integrate HCT support within other life course systems. Our results support the rationale for a noncategorical HCT-focused approach as well as a parent-peer, coach-facilitated intervention for bridging the gap between systems and meeting family needs. By examining the Add Health ID sample, we identified a decline in health status from adolescence to adulthood among the AYAs with ID, demonstrating that their transition to adulthood is a period during which prevention of obesity and interventions to improve health status should be targeted. The disability-, adolescent-, and family-related factors associated with health status and functional outcomes among AYAs with ID can inform further research, tailoring of interventions, and policies. Researchers can utilize the data-driven method we developed with commonly available data elements in nationally representative datasets to leverage existing rich data sets in order to identify individuals with ID. These data sets, including Add Health, hold significant potential for answering research questions, guiding policy, and informing interventions to improve the health of the ID population.

Obesity and overweight disproportionately impact Black American adolescent females—placing them at a lifetime of elevated physical health risks. Despite this burden, the literature that explores the contributors to obesity and overweight among Black American adolescent females remains limited and unclear. This dissertation aims to develop knowledge related to obesity and overweight in Black American adolescent females, by appraising the current understanding of factors that contribute to their obesity and overweight, and explicating the everyday social influences on dietary practices. The primary study conducted for this dissertation used a mixed method, multiple case study design to examine the mother, daughter, and other household contributors to Black American adolescent daughters’ everyday practices of food consumption, acquisition, preparation, and planning. Findings reveal the importance of understanding the complex and dynamic ways mothers and other household members contribute to a holistic view of everyday dietary practices among adolescent daughters. By deeply examining the nuanced ways the multiple cases varied, context-dependent knowledge essential to understanding the complicated health challenge of obesity was produced. Subsequently, recommendations are provided for health providers and scholars to more holistically approach and examine obesity—particularly among populations who are disproportionately affected.

Background: Alcohol use accounts for over 3 million deaths each year and causes negative mental and physical health outcomes. Both adolescent use and early use initiation are associated with future dependence and alcohol-related harm. Orphaned and separated children (OSC) in low- and middle-income countries (LMICs) are particularly vulnerable to alcohol use. Methods: A cross-sectional analysis was used to explore predictors of adolescent alcohol use and early alcohol initiation among a sample of OSC in 5 LMICs. Bivariable logistic regression models were used to evaluate associations between age, gender, education, care setting, OSC status (single orphan, double orphan, neither), behavior and emotional health, the experience of potentially traumatic events (PTEs), social support, and participation in chores or work and the outcomes of early initiation and recent alcohol use. Variables with p-value <0.15 were included in a multivariable model for that respective outcome and evaluated through multivariable logistic regressions. Results: In multivariable regressions, age [OR 1.28 (1.11-1.48)], community-based setting [OR 2.74 (1.57-5.02)], non-abuse trauma [OR 5.23 (2.51-12.10)], and physical or sexual abuse [OR 1.27 (0.75-2.11)] were associated with recent use. Non-abuse trauma [OR 12.86 (3.83-80.12)] and work [OR 1.72 (0.91-3.12)] were associated with early use. Conclusions: Interventions targeting alcohol use among OSC may be more effective if they target predictors identified in this study, such as a community care setting.

The Singapore Cohort Study of the Risk Factors for myopia (SCORM) is a longitudinal school-based study that recruited 1979 children, aged 7 to 9 years old between 1999 and 2001, who were re-examined as adolescents in 2006 and 2007. This current study is to determine the prevalence, incidence and progression of myopia among Singapore teenagers and describe any trend in the SCORM study.

At each visit, participants underwent comprehensive eye examinations that included cycloplegic autorefraction and ocular biometry measurements. The prevalence of myopia (SE<-0.5D) and high myopia (SE<-6.0D) among Singapore teenagers aged 11-18 years old was 69.1% [95% confidence interval (CI) 66.5-71.7] and 7.1% (95% CI 5.8-8.7), respectively, with the highest prevalence in people of Chinese ethnicity (p<0.001). The annual incidence was 13.7% (95% CI 9.8-17.6). Males had twice the incidence of females (p=0.043), and adolescents with longer axial lengths (p<0.001) and deeper vitreous chamber (p<0.001) had higher myopia incidence. Annual myopia progression was -0.32 Diopters (D) (SD=0.40), with no difference by age, race or gender. However, adolescents with higher myopia levels at 2006 had significantly faster myopia progression rates (p<0.001).

Myopia prevalence in Singapore teenagers, especially Singapore Chinese teenagers, is one of the highest in the world. In adolescents, there is still a high rate of new onset and rapid progression of myopia. These findings indicate that adolescence may still represent a viable period for intervention programs to mitigate myopia onset and progression.

Background: In 2016, 36.7 million people globally were living with HIV and approximately 70% knew their status. Novel HIV testing methods and strategies are needed to reach the first “90-90-90” target by 2020; that is 90% of people living with HIV know their status. Children and adolescents face additional barriers to HIV testing that stem from gaps in provider-initiated testing and counselling (PITC), parents’ concerns related to stigma and discrimination, and beliefs that children living with HIV cannot survive to adolescence. PITC barriers and the stigma and discrimination parents’ may face when seeking HIV testing and counselling (HTC) for their children could be reduced through a novel HIV testing strategy, which includes oral fluid tests (OFTs) and parents performing oral fluid HIV self-tests (O-HIVST) on their children. Therefore, the study aims of this thesis were: 1) to determine the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of an OFT for HIV in children aged 2-18 using the standard point of care rapid diagnostic test (RDT) as a reference, 2) to explore parents’/guardians’ and older adolescent’s knowledge of, and attitudes about, OFTs and O-HIVST, 3) to explore parents’/guardians’ and older adolescent’s preferences when undergoing O-HIVST. No studies to our knowledge have examined the diagnostic accuracy of OFTs in children or the facilitators of O-HIVST performed by a parent or guardian on their children.

Methods: We conducted the study in two large urban hospitals in Harare, Zimbabwe. The sample included children and adolescents aged 2-18 whose HIV status was unknown. We performed an OFT, followed by a finger-prick RDT to validate the OFT results. In addition, we conducted in-depth interviews (IDIs) with parents/guardians of children aged 2-15 and older adolescents aged 16-18. Quantitative analysis included tabulating descriptive statistics and calculating sensitivity, specificity, PPV, and NPV of the OraQuick ADVANCE® Rapid HIV-1/2 Antibody Test. Thematic qualitative analysis was conducted on the IDIs.

Results: Preliminary sensitivity results of the OFT showed high sensitivity at 100% (95% CI 83.89, 100.00) and high specificity at 99.77% (95% CI 99.17, 99.97) compared to the finger-prick RDT. In addition, PPV was 91.30% (95% CI 71.96, 98.93), and NPV was 100% (95% CI 99.57, 100.00). Qualitative findings showed low knowledge of OFTs and O-HIVST among parents and adolescents. However, participants reported favorable attitudes towards performing O-HIVST on themselves and their children and also reported a preference for a wide range of uptake mechanisms when asked about O-HIVST. Participants expressed concern about O-HIVST but felt that counselling could reduce unfavorable reactions to positive O-HIVST results.

Conclusions: The preliminary analysis confirmed the OFT has high sensitivity, but a larger sample size is needed to obtain a more accurate estimate of OFT sensitivity. If future findings confirm our preliminary results, we recommend OFTs as a method to increase HIV testing and uptake among children. Participants’ low knowledge of OFTs and O-HIVST indicate sensitization is needed before scale up of this new method. We also recommend O-HIVST implementation include a variety of strategies to increase O-HIVST uptake among children and adolescents who may face barriers to traditional HTC.

For several decades, researchers have sought to fully understand the nature of the relationship between depression and weight. To date, the research in this area has yielded highly inconsistent results, with some identifying null (Crumpton, Wine, & Groot, 1966; Moore, Stunkard, & Srole, 1962), positive (R. E. Roberts, Kaplan, Shema, & Strawbridge, 2000), negative (Silverstone, 1968; Simon, 1963) and gender specific relationships (DiPietro, Anda, Williamson, & Stunkard, 1992; Istvan, Savela, & Weidner, 1992; Onyike, Crum, Lee, Lyketsos, & Eaton, 2003). The author suggests that these inconsistencies can be explained by the use of measures of depression used which do not differentiate between various subtypes of depression associated with divergent somatic symptoms; including atypical depression (AD) and melancholic depression (MD). Adolescence may be an important intervention point to avert adult obesity and identification of subtypes may identify those at greatest risk. Yet, the characteristics of depression subtypes among adolescents are unknown. In order to identify subtypes of depression among adolescents that are differentially associated with weight, Latent Class Analysis (LCA) was conducted and resulting classes were tested for associations with weight. Six latent classes were identified. Four were uniquely associated with somatic symptoms including hyper- and hypophagia, suggesting that somatic symptoms play an important role in the distinction between depressive subtypes. Analyses showed an association with BMI for the 2 hyperphagic classes but not for the 2 hypophagic classes. The inclusion of depression class improved the fit of regression models for depression predicting BMI. This suggests that the inclusion of depression subtype in analyses may clarify the association between weight and depression.

Purpose. Suicide is the second leading cause of death globally among young adults 15-29 years old. Addressing adolescent suicidal thoughts and behavior (STB) is especially important in low and middle income countries (LMIC) where 46% of suicides occur before 25 years of age. This burden is highest in Asia, with adolescent rates two times greater than the global average. This study examines the role of gender in influencing the relationship between coping dysfunction, self-validation, and suicidality among adolescents in the context of a school-based mental health promotion program in post-earthquake Nepal.

Methods. In this mixed-methods study, adolescents (N = 102, 50% female) attending secondary school (12 – 18 years old, average age 14.3 years) in a highly earthquake-affected region near Kathmandu, Nepal, completed the Ways of Coping Checklist, Self-Validation/Self-Invalidation Questionnaire, and the Suicide Screener Questionnaire. Participants of semi-structured interviews included 23 students, 2 teachers, and 3 caregivers. Gender-stratified focus group discussions (n = 2) were also conducted among students.

Results. The stressor that students identified most frequently (71.4% of interviewees) in qualitative interviews was academic-related sources. Scores on the Ways of Coping Checklist skills and dysfunction scales did not differ significantly by gender. However, girls scoring high in coping dysfunction (t = -2.511, p = 0.015) and low in self-validation (t = 2.916, p = 0.005) were significantly more likely to endorse suicidal ideations in the past two weeks compared to boys with similar dysfunction (t = -0.237, p = 0.813; and self-validation scores t = 1.087, p = 0.282).

Conclusions. Although gender differences in coping skills and coping dysfunction were not quantitatively observed, qualitative analyses revealed that dysfunctional coping was more frequently reported by girls. Future studies should examine the temporal relationship between coping strategies and suicidality. Suicide risk reduction programs should evaluate enhancing adaptive coping skills usage as a mechanism of action to reduce suicidality among girls. Additional research is needed to identify salient risk factors for boys.