Chronic illness peer support. Assisting adolescent adjustment to life with a chronic illness

A considerable number of young people face the challenge of living with a chronic illness.  For many, the experience of a chronic illness can be fraught with feelings of frustration, alienation and a sense of isolation.  Recently there has been growing interest in the use of peer support programs as a means of assisting young people's adjustment to life with a chronic illness.  Peer support programs offer therapeutic gain while being financially accessible.  This document describes the development of the Chronic Illness Peer Support (ChIPS) program run through the Centre for Adolescent Health, Melbourne.

Association between dependent smoking and a polymorphism in the tyrosine hydroxylase gene in a prospective population-based study of adolescent health

This study reports pilot data on an association between tobacco dependence and a five-allele tetranucleotide repeat polymorphism in the first intron of the tyrosine hydroxylase (TH) gene. One hundred and twenty-six Australian adolescents who had participated in the Health in Transition Study (1993–1997), and who showed patterns of either dependent or nondependent smoking across four waves of data collection, consented to participation in the pilot study. The smoking status of those recruited was confirmed using a telephone-administered drug use questionnaire during 2000. Tobacco dependence was defined as smoking more than 6 days per week and more than 10 cigarettes per day during wave 5 (year 2000) and at lfeast one prior wave (n = 58). A second, more stringent phenotype included smoking within an hour of waking (n = 37). The control group comprised adolescents who had used tobacco but had remained low-level social smokers across each wave of data (n = 56). DNA was collected using a mouthwash procedure. Using the more strictly defined tobacco dependence phenotype, and after adjusting for sex, a significant protective association was found between the K4 allele and tobacco dependence (OR 0.27, 95% confidence interval [CI] 0.09, 0.82). No association was found using the liberal criteria of tobacco dependence (OR 0.51, 95% confidence interval [CI] 0.23, 1.2). These preliminary results replicate a previous association between tobacco use and the K4 allele of the TH gene (Lerman et al., 1997). The potential significance of including time to first cigarette in definitions of tobacco dependence and the possible role that these TH variants might play in tobacco dependence are discussed.

Adolescent resilience : a concept analysis

There is need for greater clarity around the concept of resilience as it relates to the period of adolescence. Literature on resilience published between 1990 and 2000 and relevant to adolescents aged between 12- and 18-years of age was reviewed with the aim of examining the various uses of the term, and commenting on how specific ways of conceptualizing of resilience may help develop new research agendas in the field. By bringing together ideas on resilience from a variety of research and clinical perspectives, the purpose of the review is to explicate core elements of resilience in more precise ways, in the hope that greater conceptual clarity will lead to a range of tailored interventions that benefit young people.

Adolescent chronic illness : a qualitative study of psychosocial adjustment

Introduction: The purpose of this study was to investigate the psychosocial issues facing young people living with a chronic medical condition.

Materials and Methods: Subjects were young people with a range of medical conditions who were on a waiting list to participate in the Chronic Illness Peer Support programme at the Centre for Adolescent Health, Royal Children's Hospital, Melbourne, Australia. Young people agreed to in-depth interviews which were taped and transcribed. Thematic analysis was undertaken by two researchers working independently.

Results: Thirty-five young people were interviewed. Thematic analysis revealed five broad themes: control (in control, under control, out of control); emotional reactions (happiness, frustration, anger, sadness, anxiety); acceptance (of illness, of others, of self); coping strategies, and; a search for meaning. The importance of social connections was emphasised. While illustrating the difficulties of managing a chronic medical condition during adolescence, a generally positive message emerges about these young people.

Conclusions: Many young people with chronic illness appear relatively resilient in the face of the adjustment challenges presented by their illness. Interventions that allow a young person to explore meaning, build self-esteem, and acceptance through positive social connections are likely to improve adjustment outcomes in this group.

The importance of long-term follow-up in child and adolescent obesity prevention interventions

Pediatric overweight and obesity continues to be a major public health concern. Once established it is diffi cult to treat; therefore well-designed and evaluated prevention interventions are vitally important. There is considerable evidence to suggest that obesity prevention initiatives can change children ’ s behaviours and weight status over the short- or mediumterm; however, there is far less evidence on which to judge the impact over the longer term. In response to the rise in short- and medium-term obesity prevention studies for children and adolescents over recent years, the Prevention Stream of the Australasian Child and Adolescent Obesity Research Network highlight fi ve points as to why the dearth of obesity prevention studies with long-term follow-up should be urgently addressed. Furthermore, recommendations to strengthen the evidence base and outline key implications for research design in this area and the support required for long-term follow-up studies are detailed.

A 32 year longitudinal study of child and adolescent pathways to well-being in adulthood

The purpose of the study was to investigate the relative importance of child and adolescent social and academic pathways to well-being in adulthood (32-years) indicated by a sense of meaning, social engagement, positive coping and prosocial values. Data were drawn from a 15 wave (32-year) longitudinal study of the health and development of around 1000 New Zealanders (Dunedin Multidisciplinary Health and Development Study, New Zealand). Moderate continuity in social connectedness (0.38) and high continuity in academic ability (0.90) was observed across childhood and adolescence. Adolescent social connectedness was a better predictor of adult well-being than academic achievement (0.62 vs. 0.12). There was evidence of an indirect pathway from adolescent academic achievement to adult well-being through social connectedness (0.29). Indicators of well-being in adulthood appear to be better explained by social connection rather than academic competencies pathways. Implications for promoting longer term well-being during the school years are discussed.

Am I able? Is it worth it? Adolescent girls' motivational predispositions to school physical education : Associations with health-enhancing physical activity

The study purpose was to investigate predictive associations between adolescent girls’ motivational predispositions to physical education (PE) and habitual physical activity. Two hundred girls (age 13.1 ± 0.6 years) completed the Physical Education Predisposition Scale and the Physical Activity Questionnaire for Older Children. ANCOVAs revealed that girls with the highest Perceived PE Worth and Perceived PE Ability scores were the most habitually active groups (p < .0001). Significant predictors of physical activity identified by hierarchical regression were Perceived PE Ability and body mass index, which accounted for 17% and 3% of variance, respectively. As Perceived PE Ability was strongly associated with physical activity, the correlates of this construct should be further established to inform future school and PE-based interventions.

Parental influences on adolescent fruit consumption : the role of adolescent self-efficacy

The aims of this study were to examine whether adolescent self-efficacy mediates the associations between parental control, perceptions of the importance of healthy nutrition for child health and barriers to buying fruits and vegetables and adolescent fruit consumption using a theoretically derived explanatory model. Data were drawn from a community-based sample of 1606 adolescents in Years 7 and 9 of secondary school and their parents, from Victoria, Australia. Adolescents completed a web-based survey assessing their fruit consumption and self-efficacy for increasing fruit consumption. Parents completed a survey delivered via mail assessing parental control, perceptions and barriers to buying fruit and vegetables. Adolescent self-efficacy for increasing fruit consumption mediated the positive associations between parental control and perceptions of the importance of healthy nutrition for child health and adolescent fruit consumption. Furthermore, adolescent self-efficacy mediated the negative association between parental barriers to buying fruits and vegetables and adolescent fruit consumption. The importance of explicating the mechanisms through which parental factors influence adolescent fruit consumption not only relates to the advancement of scientific knowledge but also offers potential avenues for intervention. Future research should assess the effectiveness of methods to increase adolescent fruit consumption by focussing on both improving adolescents’ dietary self-efficacy and on targeting parental control, perceptions and barriers.