Adolescent Medicine Practices Research Paper


Adolescent Medicine Practices Research Paper

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Adolescent and Young Adult Medicine Research
The goal of researchers in the Division of Adolescent and Young Adult Medicine at UPMC Children’s Hospital of Pittsburgh is to improve the health and well-being of adolescents and young adults ages 12-21. The focus is to help adolescents and providers to address issues that emerge in the context of illness, treatment, behavior and development.Adolescent Medicine Practices Research Paper

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William J. Mayo, M.D., once wrote, “The research we do today will determine the type of medical and surgical practice we carry on at the clinic tomorrow.” That is no less true today as Mayo investigators focus their efforts on moving treatment innovations and research findings to our medical practice as quickly as possible. Mayo Clinic has provided inpatient and outpatient care for infants, children, and adolescents since 1911. Mayo has a strong commitment to advancing pediatric care through basic, clinical and translational research.

The Department of Pediatric and Adolescent Medicine at Mayo Clinic is dedicated to providing the best care to every patient every day through integrated clinical practice, education, and research. The needs of the patient come first. Among patients, the child’s needs are unique from biologic, developmental, demographic, and psychosocial aspects. We have 17 areas of specialties with renowned experts conducting pediatric research, with an emphasis on translating basic science discoveries into enhanced patient care.Adolescent Medicine Practices Research Paper

Division of Adolescent/Young Adult Medicine
In the Adolescent and Young Adult Medicine practice, our health care team provides medical, gynecological, nutritional, and psychological care and counseling. Our team include physicians, nurse practitioners, nurses, dietitians, and mental health providers — all of whom specialize in the care of teenagers and young adults. The Adolescent Practice also includes subspecialty referral programs including second opinion consultation, the Eating Disorders Program, the Reproductive Endocrinology Program, the Boston HAPPENS HIV program, the STEP weight management program, the Long Acting Reversible Contraception (LARC) program, the Heavy Menstrual Bleeding program, and the Clinic for Interactive Media and Internet Disorders (CIMAID).

Adolescent and Young Adult Medicine
The mission of the Division of Adolescent and Young Adult Medicine at UPMC Children’s Hospital of Pittsburgh is to improve the health and well-being of youth and young adults through:

Accessible health care services for adolescents and young adults in the context of their families, cultures, and communities
Interdisciplinary adolescent health care education for health professional trainees and practitioners, as well as youth, young adults, families, and communities
Research to increase understanding of disparities in adolescent health, promote adolescent health equity, and improve adolescent health outcomes
Engagement with youth and young adults in their communities as adult allies and advocates Adolescent Medicine Practices Research Paper
The Division of Adolescent and Young Adult Medicine is a dynamic, interdisciplinary team of researchers, educators, and practitioners dedicated to the health and well-being of adolescents and young adults. Faculty within the division hold regional and national leadership positions with organizations such as the American Academy of Pediatrics, Academic Pediatric Association, Society for Pediatric Research, Society for Adolescent Health and Medicine, and National Association of Pediatric and Adolescent Gynecology. In addition, they contribute to the editorial leadership of the Journal of Pediatric and Adolescent Gynecology and the journal Violence Against Women.

For more than 50 years, the Section of Adolescent Medicine at Nationwide Children’s Hospital has focused on meeting the health needs of adolescents in a developmentally appropriate, multi-disciplinary manner.

The medical speciality where the adolescent diseases are considered and treated is known as Adolescent medicine. The problems related to puberty are most common in Adolescent medicine and consulted to a general medicine doctor. Sexually transmitted diseases, unintended pregnancy, birth control etc. are other diseases.

Understanding adolescent health and research related to adolescent medicine is very important. Present day younger generation has many issues on their health condition and adolescent medicine importance is increasing day by day. Sexuality, Pregnancy testing, Sexually transmitted infection (STI) testing and treatment, Birth control, Substance use, Mental health and Questions you may have about your body are part of adolescent medicine. In several conditions, the research on adolescent medicine is important to treat adult diseases.Adolescent Medicine Practices Research Paper

The Adolescent Medicine Fellowship was accredited by the Accreditation Council for Graduate Medical Education (ACGME) in November 2009, and our first fellow started in July 2010. The fellowship curriculum follows ACGME guidelines, with a predominantly clinical first year followed by an increased focus on research and academic professional development in subsequent years.

The aim of the Adolescent Medicine Fellowship at Nationwide Children’s Hospital is to develop academic subspecialists prepared to provide skilled clinical care, education and leadership across the spectrum of adolescent health, including primary care and prevention, mental health, reproductive health, eating disorders, and substance abuse. Research training prepares all graduates to interpret and assimilate the medical evidence into these endeavors and provides a solid foundation for those pursuing research careers. The graduate of the program will be prepared for a career that includes any combination of clinical medicine, clinical research, medical education, quality improvement and program-building in adolescent health.

The Adolescent Medicine Fellowship Program prepares pediatric internal medicine, pediatric medicine and family practice physicians for academic careers as leading clinicians, scholars and teachers. The fellowship is a three-year program sponsored by the Craig-Dalsimer Division of Adolescent Medicine at The Children’s Hospital of Philadelphia.

The Adolescent Medicine Fellowship, which began in the mid-1970s, is distinguished by its strong training in a broad variety of clinical settings, both in the hospital and in the community, with a special emphasis on underserved populations and behavioral health. Clinical exposure and rotations include inpatient consultation, eating disorders clinic, consultative adolescent clinic, substance abuse clinic, behavioral health, juvenile justice, homeless youth, sports medicine and gynecology.Adolescent Medicine Practices Research Paper

The major research focuses are public health, behavioral, and epidemiologic research in adolescents. Because our research training strongly emphasizes public health, fellows have the opportunity to obtain a Master of Public Health Degree in health services or epidemiology from the University of Washington School of Public Health. The first year involves clinical training, with years two and three focused on research.

Leadership Education in Adolescent Health (LEAH) Training
In July 2012, the University of Washington was awarded a Leadership Education in Adolescent Health (LEAH) interdisciplinary training grant from the Maternal Child Health Bureau, Health Resources and Services Administration, Public Health Service, Department of Health and Human Services. Through the support of this grant, we will be one of seven programs in the country dedicated to increasing leaders for our region and the nation in five key adolescent health disciplines (Medicine, Nursing, Nutrition, Psychology, and Social Work)

Adolescent Medicine Fellowship
The faculty of the Division of Adolescent and Transition Medicine care deeply about the fellowship program and are committed to fellows’ success.

The specialty of Adolescent Medicine was established at Cincinnati Children’s Hospital by Jerry Rauh, MD, in 1965. The Adolescent Medicine fellowship program at Cincinnati Children’s was established in 1972 and gained accreditation from the Accreditation Council for Graduate Medical Education (ACGME) in 1998.

Graduates from our training program most often take positions in academic medicine that lead to leadership roles in research, program development, medical education, and health care administration. Fellows have also chosen career paths in college health, community programs, and public health.Adolescent Medicine Practices Research Paper

Previous fellows’ scholarly work has included public health, community program evaluation, medical education, and healthcare quality improvement. Recent scholarly work has focused on puberty, obesity, eating disorders, depression, asthma, contraception, HIV, syphilis, and quality improvement in transgender medicine.

Program Aims
The Adolescent Medicine Fellowship program in the Division of Adolescent and Transition Medicine will prepare Adolescent Medicine fellows for careers that will improve the health and well-being of adolescents and young adults in a respectful and engaging learning environment to become experts in the field of adolescent medicine.

This innovative fellowship is designed to prepare academic leaders in adolescent medicine. The program uses the resources of CHOP and the graduate departments at the University of Pennsylvania. Because CHOP and UPenn are located next to each other, there is a strong “one-University” philosophy, and the program provides an ideal setting for a creative, multidisciplinary fellowship experience.

Clinical Care
The division maintains an active Oakland-based practice, supports satellite locations in the provision of adolescent care, and provides consultations at Children’s Hospital in Lawrenceville. Clinical services focus primarily on adolescent medicine consultation, as well as primary care, reproductive health, and behavioral health. Faculty members serve a diverse population of youth and young adults, including medical care and leadership at Carlow University; at the county’s juvenile detention facility, Shuman Juvenile Detention Center; and at Family Links shelters, the Gay Lesbian Community Center, and the Auberle Foundation’s 412 Youth Zone, providing care for youth and young adults who are homeless. Faculty members also work collaboratively with colleagues at Western Psychiatric Institute and Clinic (WPIC) and in the community to treat adolescents with eating disorders. The youth-led CHANGE (Children’s Hospital Advisory Network for Guidance and Empowerment) Transition Program focuses on improving support for youth and families in the successful transition to adulthood, including navigating from pediatric health care to the adult system. The Gender and Sexual Development Program (an interdisciplinary collaboration with Behavioral Health and Endocrinology at Children’s Hospital) provides support and treatment for sexual minority and gender-fluid children and youth. The division is also responsible for the clinical services and community outreach provided through the Children’s Hospital Ronald McDonald House Care Mobile (clinical services provided via a mobile van).Adolescent Medicine Practices Research Paper

Clinical Activities
The Division of Adolescent and Young Adult Medicine provides a diverse program of primary care and consultative adolescent medicine. It provides in-hospital care for adolescents up to age 26 at Children’s Hospital, primarily through an inpatient consultation service which allows the division to work closely with medical and surgical professionals, including those in hematology/oncology, endocrinology, gastroenterology, urology, behavioral health, general surgery, and transplant medicine.

Each year, the division has about 7,500 outpatient visits, including approximately 4,100 visits to the Oakland office. Subspecialty clinics include pediatric and adolescent gynecology-focused sessions attended by a gynecologist, as well as insertion of longer-acting, reversible contraceptives. A nutritionist and several psychologists work collaboratively with the adolescent medicine clinicians and see patients in division offices. Clinical interests and expertise of the faculty include smoking cessation, trauma-informed care, sexual violence prevention, contraception in healthy and medically complex patients, pediatric and adolescent gynecology, eating disorders, transitional care for adolescents with chronic conditions, integrated behavioral health, polycystic ovarian syndrome, menstrual disorders, and gender and sexual development (including care for gender-fluid and transgender youth).

Community-based services include the provision of medical care to youth detained at the county’s juvenile detention center, the Shuman Center. The division provides health care to homeless youth and young adults in Allegheny County at multiple Family Links shelters, as well as the Gay and Lesbian Community Center and the Auberle Foundation’s 412 Youth Zone as part of a community-wide collaboration to increase services for unaccompanied youth. The Children’s Hospital Ronald McDonald House Care Mobile provides clinical services to children, youth, and families in underserved communities in the region. Two suburban hospital satellite locations are the sites of additional adolescent clinics (South Fayette in the south and Pine Center in the north). Ana Radovic provides medical care and leadership of the Carlow University’s Health Service and Loreta Matheo oversees the integration of adolescent and young adult care into the region’s Children’s Community Pediatrics practices.Adolescent Medicine Practices Research Paper

Training for those studying to be health care professionals includes rotations for medical, nurse practitioner, and physician assistant students and opportunities for service and scholarly projects; practicum and internship opportunities for public health, social work, psychology, nursing, nutrition, and pharmacy students; resident rotations for those in pediatrics, psychiatry, obstetrics and gynecology, family medicine, and internal medicine; and the Adolescent Medicine Fellowship Program. Fellows in the Reproductive Endocrinology Fellowship at Magee-Womens Hospital of UPMC also participate in the pediatric and adolescent gynecology sessions.

Adolescent medicine or hebiatrics is a medical subspecialty that focuses on care of patients who are in the adolescent period of development. This period begins at puberty and lasts until growth has stopped.[1] Typically, patients in this age range will be in the last years of elementary school up until high school (some doctors in this subspecialty treat young adults attending college at area clinics, in the subfield of college health). In developed nations, the psychosocial period of adolescence is extended both by an earlier start, as the onset of puberty begins earlier, and a later end, as patients require more years of education or training before they reach economic independence from their parents.[2]

Issues with a high prevalence during adolescence are frequently addressed by providers. These include:

Sexually transmitted disease (working with specialists in pediatric endocrinology, adolescent obstetrics and gynecology, immunology infectious diseases, and urology and reproductive medicine)
Unintended pregnancy (working with specialists in adolescent obstetrics and gynecology, especially in neonatology and maternal-fetal medicine; many – though not all – are medically risky or high-risk cases or to those with psychosocial, environmental, and socioeconomic challenges)
Birth control (access to prescription or non-prescription contraceptive methods)
Sexual activity (such as masturbation, sexual intercourse and sexual abuse)
Substance abuse
Menstrual disorders (such as amenorrhea, dysmenorrhea and dysfunctional uterine bleeding)
Acne (working with specialists in dermatology who treat adolescents)
Eating disorders like anorexia nervosa and bulimia nervosa (working with nutritionists and dieticians, and also specialists in pediatric mental health counseling, clinical psychology, and pediatric psychiatry, who work with adolescents)
Certain mental illnesses (especially personality disorders, anxiety disorders, major depression and suicide, bipolar disorder, and certain types of schizophrenia; in concert with mental health counselors, clinical psychologists, and pediatric psychiatrists specializing in adolescent health care)
Delayed or precocious puberty (often working with specialists in adolescent pediatric endocrinology, urology, and andrology)Adolescent Medicine Practices Research Paper

At the Adolescent and Young Adult Medicine practice at Boston Children’s Hospital (BCH), we provide comprehensive confidential care to our patients per guidelines and policies of the Society for Adolescent Health and Medicine, the American Medical Association, and the American Academy of Pediatrics. We welcome patients from all backgrounds and genders to our practice.


We participate in education, research, and community service and we are the oldest adolescent clinic in the United States, founded in 1951.

Adolescent Specific Care
Our team offers complete care for a wide variety of congenital and acquired disorders and adolescent and teen issues including:

Abdominal Pain



Bone Health Problems

Contraception and Sexual Health Counseling

Chronic Fatigue

Chronic Headaches

Complex Medical/Psychosocial Problems

Eating Disorders

Growth and Development

Hormonal Changes

Menstrual Problems

Heavy Menstrual Bleeding


Polycystic Ovary Syndrome (PCOS)

Reproductive Health Problems

Smoking Cessation

STDs and HIV Infection

Substance Use

Teen Pregnancy

Weight Concerns

Boston Children’s is the primary pediatric teaching hospital of Harvard Medical School (HMS) where our physicians hold faculty appointments. We direct and/or co-direct HMS postgraduate courses in adolescent medicine, pediatric and adolescent gynecology at the Harvard School of Public Health.Adolescent Medicine Practices Research Paper

The Division has one of the seven federal training grants in the United States for adolescent health. The Boston Leadership Education in Adolescent Health (LEAH) Program, funded by the Maternal Child and Health Bureau, trains physicians (from Pediatrics, Internal Medicine and Family Medicine), nurses, psychologists, social workers and nutritionists in adolescent health.

Our efforts focus on pediatric cancer therapy, including novel treatments and tumor immunology; pediatric immunogenetics; child growth and neurodevelopment; genetics of pediatric cardiovascular disease; pediatric infections and sepsis; postural orthostatic tachycardia syndrome, and outcomes evaluations.

Our strategic efforts focus upon the following areas which in turn involve a number of our divisions working together.

Pediatric cancer therapy, including novel treatments and tumor immunology
Division of Pediatric Hematology/Oncology
Division of Pediatric Research Laboratories
Pediatric immunogenetics
Division of Pediatric Research Laboratories
Division of Community Pediatric and Adolescent Medicine
Child growth and neurodevelopment
Division of Developmental Behavioral Pediatrics
Division of Community Pediatric and Adolescent Medicine
Division of Pediatric Research Laboratories
Division of Pediatric Endocrinology and Metabolism
Genetics of pediatric cardiovascular disease
Division of Pediatric Cardiology
Pediatric infections and sepsis
Division of Pediatric Critical Care
Division of Pediatric Infectious Disease
Division of Community Pediatric and Adolescent Medicine
Postural orthostatic tachycardia syndrome
Division of General Pediatric and Adolescent Medicine
Division of Pediatric Cardiology
Division of Pediatric Gastroenterology
Division of Child and Adolescent Neurology
Outcomes evaluations
Division of Pediatric Critical Care
Division of Pediatric Infectious Diseases

Although research and new policies and programmatic initiatives have documented the many problems that adolescents face in an increasingly complex and diversified society, a clear federal policy mandate is lacking that sets forth funding and policy priorities, and that could provide guidance for how to approach the needs of diverse adolescent populations (Brindis et al., 1998). The complexity of those needs, and the ambivalence expressed by society concerning the role of adolescents, have made it difficult to establish a focused agenda for youth-related issues. Progress in the coming decade requires that the field take a step back, map out the areas in which additional research is needed, identify opportunities for research to inform policy and practice, and proceed in a thoughtful and coordinated manner to address these needs.Adolescent Medicine Practices Research Paper

In this chapter we outline a number of issues that will become increasingly important and that the Forum on Adolescence expects to explore. These include the implications of a changing adolescent population; new research methodologies and approaches needed to further advance understanding of adolescent health and development; strategies to strengthen and support relationships between teenagers and their parents; the continued development of indicators of adolescent well-being; approaches to integrating frameworks for preventing risk behaviors and promoting positive developmental outcomes among youth; the delivery of developmentally appropriate health care services to youth; and ensuring adolescents’ safe and productive use of new technologies.

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Suggested Citation:”6 Implications for Research and Linking Research to Policy and Practice.” Institute of Medicine and . 1999. Risks and Opportunities: Synthesis of Studies on Adolescence. Washington, DC: The National Academies Press. doi: 10.17226/9721. ×
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As discussed earlier in this report, the size and composition of the adolescent population is expected to change dramatically during the coming decades—i.e., there will be more adolescents than ever before. Moreover, white teenagers will no longer be the majority group, and Hispanic teenagers will outnumber black teenagers. Now is the time to ask if current systems and policies are prepared to respond to these changes. Are private and public institutions and systems (e.g., education, employment, housing, transportation, and health) prepared to respond to these trends? How will institutions and systems need to be redesigned to respond appropriately? How can a national youth policy agenda be developed to ensure the health and well-being of this segment of the population?

With this increase in diversity, coupled with worldwide patterns of increased mobility and migration, cooperative relations among different racial and ethnic groups are essential to the nation’s future. Yet there is growing evidence to suggest that white youth and youth from ethnic minority groups hold deeply divergent views on how to relate to each other. The harmful results of this racial divide among youth are becoming more apparent as demonstrated by an alarming increase of adolescent hate crimes, organized hate groups, and overt expressions of racial intolerance.Adolescent Medicine Practices Research Paper

Research is needed to characterize how youth derive a sense of belonging and personal meaning from their ethnic and other affiliations, as well as on how youth understand, interpret, and experience such constructs as race, ethnicity, racism, and all other forms of discrimination. While there is growing evidence that strategies can be crafted to create positive intergroup relations, there is little agreement regarding what intervention strategies are essential to promote peaceful, respectful relations or to prevent conflict and violence among youth stemming from ethnic identity. Certainly, ethnicity is not the only defining characteristic of teenagers. They also differ from one another according to their physical, cognitive, and learning abilities; body shape and size; religious and political beliefs and values; sexual orientation; and interests and expressions of creativity. Future efforts are needed to encourage and support enduring changes in the ways that teenagers relate and interact with their peers who are different from themselves. As a society, the goal should be to help young people promote peaceful, respectful relations among all youth.

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Suggested Citation:”6 Implications for Research and Linking Research to Policy and Practice.” Institute of Medicine and . 1999. Risks and Opportunities: Synthesis of Studies on Adolescence. Washington, DC: The National Academies Press. doi: 10.17226/9721. ×
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The study of adolescence is becoming an increasingly sophisticated science. Thanks to powerful new research tools and other scientific and technological advances, today’s theories of adolescent development are more likely to be supported by scientific evidence than in the past. Indeed, there has been sufficient research to allow a reassessment of the nature of adolescent development. At the same time, there is greater recognition that neither puberty nor adolescence can be understood without considering the social, psychological, and cultural contexts in which young people grow and develop, including the familial and societal values, social and economic conditions, and institutions that they experience. In the past, researchers tended to conduct research designed to examine the impact of hormones on adolescent behavior. While this work continues, there is now an appreciation for the complex reciprocal relationship and interaction between biological, psychological, and social environments and the interaction between these environments and adolescent behavior.

The field of adolescence is also increasingly benefiting from the fact that researchers from diverse fields, including the biological, behavioral, and social sciences, have developed new techniques to study adolescent development. Use of more rigorous research methods has improved the reliability and validity of the measurement techniques used, and consequently the ability to document the multifaceted dimensions of growth and maturation during adolescence.Adolescent Medicine Practices Research Paper

For example, the development of radioimmunoassay methodology in the late 1960s, and the considerable refinement of that process over the decades, have made it possible to study the hormones that control reproductive maturation. The development of neuroimaging technology in the 1970s created exciting new opportunities for studying brain development; these techniques include more sensitive, easy-to-use hormone assay technology and new brain-imaging technologies, allowing insight into brain development and function.

Moreover, longitudinal studies are increasingly being designed to characterize the interaction among genetic, biological, familial, environmental, social, and behavioral factors (both risk and protective in nature) among children and adolescents. For example, a valuable new source of data that has the potential to significantly advance the knowledge base of physiological and behavioral development among adolescents is the National Longitudinal Study of Adolescent Health (Add Health). From the collection of

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Suggested Citation:”6 Implications for Research and Linking Research to Policy and Practice.” Institute of Medicine and . 1999. Risks and Opportunities: Synthesis of Studies on Adolescence. Washington, DC: The National Academies Press. doi: 10.17226/9721. ×
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longitudinal data, it will be possible to examine how the timing and tempo of puberty influences social and cognitive development among teenagers. This dataset will also permit analyses to examine how family-, school-, and individual-level risk and protective factors are associated with adolescent health and morbidity (e.g., emotional health, violence, substance use, sexuality).Adolescent Medicine Practices Research Paper

Despite advances in the science and knowledge base, it remains the case that current understanding of adolescent development is rather limited. The research conducted to date has been predominately descriptive in nature, has relied on cross-sectional data and adolescent self-report and has been unidimensional in focus. Indeed, few research studies have successfully considered the multiple factors that collectively influence adolescent development. There is now a growing appreciation, however, that new research is needed, including research that employs longitudinal designs; characterizes developmental changes associated with the onset of puberty well before the age of 8; and seeks to characterize growth and development across the life span—i.e., from infancy to adolescence, young adulthood adulthood, and the senior years.

Studying these developmental stages in isolation from one another provides only a partial and incomplete picture. In addition, while the current literature is rich with respect to research that characterizes adolescents’ involvement in risk and risk-related behaviors, research on risk factors is only correlational or bidirectional in nature, which tells only half the story. It examines the extent to which, in any given sample of adolescents and at any given time, teens exposed to a risk factor are doing worse in some respect compared with children who are not exposed to that same risk factor. It says nothing about the base rates of either the risk factors or the outcomes. Base rates could be rising or falling, while the correlations between risk factors and outcomes could be quite undisturbed. This means, for example, that although it may not matter greatly whether there are increasing or decreasing numbers of adolescents in poverty; it is also true that those in poverty are still at risk.

Finally, previous research has been limited when it has assumed that adolescents, as a segment of the population, are a homogenous group. We now know that while all adolescents experience the biological, cognitive, and social transitions of this period, not all adolescents experience these changes in the same way. For example, puberty makes some adolescents feel adult-like, attractive, and confident; it makes others feel awkward, unattractive, and self-conscious. Being able to think in abstract and hypo-Adolescent Medicine Practices Research Paper

thetical terms offers some teenagers the opportunity to imagine the wide range of possibilities that exist for their future; it prompts others to feel uncertainty and despair. While the fundamental changes associated with adolescence are universal, there is wide variation in the ways in which adolescents experience these changes, and this variation is largely accounted for by the child’s interpretation of these changes, as well as the environment in which these changes occur. As described by Bronfenbrenner (1979), the psychological impact of the biological, cognitive, and social changes of adolescence is shaped by the environment in which these changes take place. These considerations need to be further explored by research.

Adolescence is not just a time of major developmental changes in children; it is also a time of significant transformations and realignment in family relations. Raising adolescents can certainly be stressful and difficult for parents who are likely to feel less adequate and more anxious and stressed than when their children were younger. Raising a teenager can also be rewarding, and families as well as other supportive adults clearly matter with respect to the healthy development of adolescents.

As discussed by Small (1990), there have been a number of recent changes in American society and in the nature of adolescence that have also contributed to the challenge of raising adolescents today:

The length of time during which adolescents rely on their parents for financial, emotional, and material support is increasing, with more and more young adults in their early 20s living at home or financially dependent on their parents, resulting in a protracted period of responsibility for parents and a greater uncertainty regarding how to raise adolescents.

Parents have become confused about how best to prepare adolescents for future adult roles as a result of rapid sociocultural change and the multiple and often competing sources of information and values that are increasingly complex in a diverse society.

Parents are often worried as a result of the greater number of potentially dangerous activities, substances, and influences to which contemporary adolescents are exposed.

Compared with research on families with young children, there has been much less attention to the home and family environments of adoles-Adolescent Medicine Practices Research Paper

cents. Yet it is clear, as this report discusses, that adolescents develop best when they live and develop in a supportive home and family environment. Despite the fact that adolescents are moving out beyond the family and striving for greater autonomy, parents remain an important influence in the lives of their adolescent children. In a paper published by Resnick and colleagues, early analyses from the National Longitudinal Study of Adolescent Health found that teenagers who have strong emotional attachments to their parents and teachers are much less likely to use drugs and alcohol, attempt suicide, engage in violence, or become sexually active at an early age (Resnick et al., 1997). The authors concluded that feeling loved, understood, and paid attention to by parents helps teenagers avoid high-risk activities, regardless of whether they come from a one-or a two-parent household. At school, positive relationships with teachers were found to be more important in protecting teenagers than any other factor, including classroom size or the amount of training a teacher has.

What are the practical implications of research on parenting adolescents, and how can research, policy, and practice be linked? Very little is known about how to educate and support parents of adolescents most effectively and enhance their childrearing abilities. There is an enormous gap between what is known about the effects of parenting on adolescents as it naturally occurs and what can be done to enhance it when parents struggle. This gap is especially striking in light of the recent growth in the development and availability of parenting programs, videos, articles, and books aimed at supporting and guiding parents of adolescents. Research on best practices and the effectiveness of education, training, and support programs and materials is almost nonexistent. Understanding of the types of knowledge, skills, and supports that parents of adolescents need and desire, as well as the strategies and change techniques that are likely to be most helpful and effective, is also very limited. Research is therefore needed to further strengthen relationships between teenagers and their parents and to provide support to parents of adolescents.

The past few years have seen a number of encouraging changes and even reversals in trends in some of the leading causes of mortality and morbidity among adolescents. While these trends are not consistent across all causes of death, problems, or risk behaviors, these data are promising and they do suggest that some combination of events—whether it is new ways

in which social services are addressing the needs of adolescents, new approaches to the design and delivery of prevention and health promotion interventions, or new policies—has had a positive impact on the health, safety, and security of teenagers in the United States. The following pages highlight a few of these trends, including recent rates of adolescent mortality, adolescent pregnancy, school dropout, and use of tobacco, alcohol, and other illicit drugs.Adolescent Medicine Practices Research Paper

Adolescent Mortality
As discussed in this report, adolescents have much higher mortality rates compared with younger children. In 1980, the death rate among adolescents was 98 per 100,000. This rate then decreased to 89 in 1991, and further declined to 84 in 1995 (see Figure 6-1). Injury, which includes homicide, suicide, and unintentional injuries, continues to account for 4 out of 5 or 78 percent of deaths among adolescents. While accidents continue to account for more than twice as many teen deaths as any other source, including homicide, examination of recent trends in causes of death among teenagers reveals some changes. Between 1985 and 1996, the number of teen deaths due to accidents fell from 8,202 in 1985 to 6,756 in 1996, while the number of teen homicides increased from 1,602 to 2,924 during the same period

The division has received funding from local, state and national resources, including the Pennsylvania Department of Health’s Center of Excellence for Tobacco Use and Cessation, the National Institutes of Health (NIH), and Centers for Disease Control and Prevention (CDC). Collaborative projects have been conducted with the Pediatric Divisions of Infectious Diseases and Hematology/Oncology, and with faculty from the University of Pittsburgh departments of Psychiatry, Gynecology and General Internal Medicine, as well as the graduate schools of Social Work and Public Health.

Among our current research is the CDC-funded Coaching Boys into Men (CBIM) study, is a randomized controlled trial to test whether using middle school coaches to talk to their male athletes helps to increase recognition of adolescent relationship abuse and ultimately reduce violence against women and girls. This program has been shown to be successful with high school male athletes. Additional randomized controlled trials in the Division include Engendering Healthy Masculinity (EHM), which talks to adolescent boys about respect, nonviolence, and healthy sexuality, and the College Health Center-based Alcohol and Sexual Violence Intervention, which aims to reduce alcohol-related sexual violence on college campuses.

Supporting Our Valued Adolescents (SOVA) is a research project that aims to study how to help young people with depression and anxiety. SOVA connects depressed teens to one another and parents of depressed teens to one another on secure websites (separate for teens and parents) that are moderated by trained behavioral health specialists. We are also conducting a parent engagement survey to help parents identify adolescent health topics (e.g., safe sex practices, substance use, etc.) which they have difficulty discussing with their teenage children. These surveys help providers to identify resources to offer to parents to help them discuss these health topics with their teen.Adolescent Medicine Practices Research Paper



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