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1.  School Placement and Perceived Quality of Life in Youth Who Are Deaf or Hard of Hearing 
In the education of students who are deaf and hard of hearing (DHH), there is much debate about how placement affects educational outcomes and quality of life. This study examined the relationship between quality of life and educational placement that include and do not include other DHH youth. Participants included 221 DHH youth, ages 11–18 with bilateral hearing loss. Results showed that there were few differences in quality of life related to school placement (with age, gender, depression symptoms, and hearing level as covariates). For both participation and perceived stigma, there was an interaction between school placement and parent hearing status, with no single school placement showing the best results. DHH youth with hearing parents in schools specifically for DHH students scored lower than DHH with deaf parents in some domains (Participation and Perceived Stigma). When the DHH youth were compared with the general population, those in schools that included DHH students scored lower in some aspects of quality of life, particularly Self and Relationships. This study demonstrates that DHH students may not differ much in terms of quality of life across schools placements, but that there may be differences in subsets of DHH youth.
doi:10.1093/deafed/ens039
PMCID: PMC3521777  PMID: 23184867
2.  Validation of a Quality-of-Life Measure for Deaf or Hard of Hearing Youth 
Objective
Quailty-of-life (QOL) measures targeting youth with hearing loss are useful in population needs assessment, educational placement, and program design and evaluation. This study assesses the cross-sectional validity of the Youth Quality of Life Instrument–Deaf and Hard of Hearing Module (YQOL-DHH).
Study Design
Instrument development and cross-sectional survey.
Setting
Recruitment through schools, professional organizations, clinics, and programs for youth who are deaf or hard of hearing.
Subjects and Methods
Thirty-five candidate items were administered to 230 adolescents aged 11 to 18 years: 49% female, 61% white, 11% mild hearing loss, 20% moderate/moderate-severe, 41% severe/profound, and 28% with cochlear implants. Participants completed individual or group-administered questionnaires by paper and pencil (58%), Web-based English (29%), American Sign Language (ASL) or Pidgin Signed English (PSE) (9%) on DVD, or interviewer-supervised ASL or PSE DVD (4%). The Children's Depression Inventory (CDI-S) was also completed. Factor structure, reliability, construct validity, and respondent burden were assessed.
Results
Thirty-two Items were retained in the final instrument covering 3 domains: seif-acceptance/advocacy (14 items, Cronbach α = 0.84), perceived stigma (8 items, Cronbach α = 0.85), and participation (10 items, Cronbach α = 0.86). QOL was not significantly associated with hearing level. One-week test-retest coefficients were acceptable: self-acceptance/advocacy (0.70), perceived stigma (0.78), and participation (0.92). As predicted, the total CDI-S score was associated in the appropriate direction (P < .0001) with all YQOL-DHH domains. Time to complete the paper-and-pencil version was 12 minutes.
Conclusion
The YQOL-DHH shows good reliability and validity for assessing hearing-specific QOL in adolescents.
doi:10.1177/0194599810397604
PMCID: PMC4199826  PMID: 21493349
hearing-impaired persons; deaf persons; quality of life; adolescent; childhood hearing loss
3.  Peer Victimization Experienced by Children and Adolescents Who Are Deaf or Hard of Hearing 
PLoS ONE  2012;7(12):e52174.
Victimization is a relatively common, yet serious problem, with potentially severe consequences for children's psychosocial and academic functioning. Children who are Deaf or Hard of Hearing (DHH) may be at a higher risk for victimization than hearing children. The aims of the present study were to compare DHH and hearing children on i) self-reported experiences of victimization and ii) associations between victimization, parental- and child variables. In total 188 children (mean age 11;11 years) from the Netherlands and Dutch-speaking part of Belgium participated in the study. No difference between DHH and hearing children were found on general experiences of victimization. However, differences between the groups were found on specific forms of experienced victimization and on the associations between victimization and parental variables. For DHH children, parental sensitivity and parents who challenge their DHH children to become competent in the practical, emotional, cognitive and social domain is associated with them being less victimized. For hearing children at this age these relations were reversed, absent or more complex. Finally, DHH children in special schools were more victimized than DHH children in regular schools. It can be concluded that parents can play an important role in reducing social problems experienced by DHH children and young adolescents.
doi:10.1371/journal.pone.0052174
PMCID: PMC3526587  PMID: 23284923
4.  Foundations for Literacy: An Early Literacy Intervention for Deaf and Hard-of-Hearing Children 
The present study evaluated the efficacy of a new preschool early literacy intervention created specifically for deaf and hard-of-hearing (DHH) children with functional hearing. Teachers implemented Foundations for Literacy with 25 DHH children in 2 schools (intervention group). One school used only spoken language, and the other used sign with and without spoken language. A “business as usual” comparison group included 33 DHH children who were matched on key characteristics with the intervention children but attended schools that did not implement Foundations for Literacy. Children’s hearing losses ranged from moderate to profound. Approximately half of the children had cochlear implants. All children had sufficient speech perception skills to identify referents of spoken words from closed sets of items. Teachers taught small groups of intervention children an hour a day, 4 days a week for the school year. From fall to spring, intervention children made significantly greater gains on tests of phonological awareness, letter–sound knowledge, and expressive vocabulary than did comparison children. In addition, intervention children showed significant increases in standard scores (based on hearing norms) on phonological awareness and vocabulary tests. This quasi-experimental study suggests that the intervention shows promise for improving early literacy skills of DHH children with functional hearing.
doi:10.1093/deafed/enu022
PMCID: PMC4146385  PMID: 25125456
5.  Effects Through 24 Months of an HIV/AIDS Prevention Intervention Program Based on Protection Motivation Theory Among Preadolescents in the Bahamas 
Pediatrics  2009;123(5):e917-e928.
OBJECTIVES
The purpose of this work was to report the intervention effects of Focus on Youth in the Caribbean (youth HIV intervention), an HIV prevention intervention based on protection motivation theory, through 24 months of follow-up on sexual risk and protection knowledge, perceptions, intentions, and behavior among Bahamian sixth-grade youth.
METHODS
We randomly assigned 1360 sixth-grade youth (and their parents) attending 15 government elementary schools in the Bahamas to 1 of 3 conditions: (1) youth HIV intervention plus a parental monitoring/communication/HIV education intervention; (2) youth HIV intervention plus a parental goal-setting intervention; or (3) an environmental protection intervention plus the parental goal-setting intervention. Baseline and 4 follow-up surveys at 6-month intervals were conducted. Intervention effects were assessed using the mixed model for continuous outcome variables and the generalized linear mixed model for dichotomous outcome variables.
RESULTS
Through 24 months of follow-up, youth HIV intervention, in combination with the parent interventions, significantly increased youths’ HIV/AIDS knowledge, perceptions of their ability to use condoms, perception of the effectiveness of condoms and abstinence, and condom use intention and significantly lowered perceived costs to remaining abstinent. There was a trend for higher condom use among youth in the Focus on Youth in the Caribbean groups at each follow-up interval.
CONCLUSIONS
Focus on Youth in the Caribbean, in combination with 1 of 2 parent interventions administered to preadolescents and their parents in the Bahamas, resulted in and sustained protective changes on HIV/AIDS knowledge, sexual perceptions, and condom use intention. Although rates of sexual experience remained low, the consistent trend at all of the follow-up periods for higher condom use among youth who received youth intervention reached marginal significance at 24 months. Additional follow-up is necessary to determine whether the apparent protective effect is statistically significant as more youth initiate sex and whether it endures over time.
doi:10.1542/peds.2008-2363
PMCID: PMC3008808  PMID: 19380429
protection motivation theory; preadolescent; intervention; HIV/AIDS; condom use; sexual behavior
6.  Vocabulary Knowledge of Deaf and Hearing Postsecondary Students 
Deaf children generally are found to have smaller English vocabularies than hearing peers, although studies involving children with cochlear implants have suggested that the gap may decrease or disappear with age. Less is known about the vocabularies of deaf and hard-of-hearing (DHH) postsecondary students or how their vocabulary knowledge relates to other aspects of academic achievement. This study used the Peabody Picture Vocabulary Test to examine the vocabulary knowledge of DHH and hearing postsecondary students as well as their awareness (predictions) of that knowledge. Relationships between vocabulary knowledge and print exposure, communication backgrounds, and reading and verbal abilities also were examined. Consistent with studies of children, hearing college students demonstrated significantly larger vocabularies than DHH students both with and without cochlear implants. DHH students were more likely to overestimate their vocabulary knowledge. Vocabulary scores were positively related to reading and verbal abilities but negatively related to sign language abilities. Among DHH students they also were positively related to measures of spoken language ability. Results are discussed in terms of related cognitive abilities, language fluency, and academic achievement of DHH students and implications for postsecondary education.
PMCID: PMC4280560  PMID: 25558473
Hearing loss; achievement; vocabulary; language; metacognition
7.  Health-related quality of life in overweight German children and adolescents: do treatment-seeking youth have lower quality of life levels? Comparison of a clinical sample with the general population using a multilevel model approach 
BMC Public Health  2013;13:561.
Background
Health-related quality of life (HRQoL) is reduced in obese children and adolescents, especially in clinical samples. However, little is known regarding the HRQoL of moderately overweight youth. Moreover, several studies have indicated perceived overweight as a critical factor associated with lower HRQoL. Our main objective was to compare HRQoL between treatment-seeking overweight youth and the general adolescent population, whilst separating the effects of treatment-seeking status and perceived weight from those of objective weight status.
Methods
We compared the HRQoL of a clinical sample of overweight youth (N=137 patients, mean age±s.e.=11.24±0.15 years) with that of a representative population sample (N=6354, mean age=12.75±0.03 years). The population sample was subdivided into groups based on measured and perceived weight status. We used hierarchical linear models to compare HRQoL subscale scores (self- and parent-reported) between patients and population groups, adjusted for sociodemographic characteristics and taking into account clustering of the population sample.
Results
The parent-reported HRQoL of the treatment sample was significantly lower than that of other overweight youth perceived as ‘too fat’ on two subscales: ‘self-esteem’ and ‘friends’ (effect sizes: d=0.31 and 0.34, respectively). On other subscales, patients scored lower than adolescents perceived as having a ‘proper weight’ by their parents. The patterns for self-reported HRQoL in adolescents were different: patients reported higher self-esteem than other overweight youth feeling ‘too fat’ (d=-0.39). Female patients also reported higher physical well-being (d=-0.48), whereas males scored lowest among all compared groups (d=0.42-0.95). Patients did not differ from other overweight youth who felt ‘too fat’ with respect to other HRQoL dimensions. In general, lower HRQoL was primarily associated with a perceived, rather than actual, overweight status.
Conclusions
The treatment-seeking status of overweight youth was notably associated with low social well-being, which may therefore be the main motive for seeking treatment. Other HRQoL domains were not consistently reduced in treatment-seekers. Our results further indicate that perceived overweight rather than actual overweight impacts HRQoL in youth with a modest excess weight. These results have implications for interventions in overweight youth and in individuals who are dissatisfied with their weight.
Trial registration
‘Obeldicks light’ is registered at clinicaltrials.gov (NCT00422916).
doi:10.1186/1471-2458-13-561
PMCID: PMC3683337  PMID: 23759033
Health-related quality of life; Overweight; Obesity; Weight perception; Body image; Children and adolescents; Treatment-seeking status
8.  Youth’s narratives about family members smoking: parenting the parent- it’s not fair! 
BMC Public Health  2012;12:965.
Background
Successful cancer prevention policies and programming for youth must be based on a solid understanding of youth’s conceptualization of cancer and cancer prevention. Accordingly, a qualitative study examining youth’s perspectives of cancer and its prevention was undertaken. Not surprisingly, smoking (i.e., tobacco cigarette smoking) was one of the dominant lines of discourse in the youth’s narratives. This paper reports findings of how youth conceptualize smoking with attention to their perspectives on parental and family-related smoking issues and experiences.
Methods
Seventy-five Canadian youth ranging in age from 11–19 years participated in the study. Six of the 75 youth had a history of smoking and 29 had parents with a history of smoking. Youth were involved in traditional ethnographic methods of interviewing and photovoice. Data analysis involved multiple levels of analysis congruent with ethnography.
Results
Youth’s perspectives of parents and other family members’ cigarette smoking around them was salient as represented by the theme: It’s not fair. Youth struggled to make sense of why parents would smoke around their children and perceived their smoking as an unjust act. The theme was supported by four subthemes: 1) parenting the parent about the dangers of smoking; 2) the good/bad parent; 3) distancing family relationships; and 4) the prisoner. Instead of being talked to about smoking it was more common for youth to share stories of talking to their parents about the dangers of smoking. Parents who did not smoke were seen by youth as the good parent, as opposed to the bad parent who smoked. Smoking was an agent that altered relationships with parents and other family members. Youth who lived in homes where they were exposed to cigarette smoke felt like a trapped prisoner.
Conclusions
Further research is needed to investigate youth’s perceptions about parental cigarette smoking as well as possible linkages between youth exposed to second hand smoke in their home environment and emotional and lifestyle-related health difficulties. Results emphasize the relational impact of smoking when developing anti-tobacco and cancer prevention campaigns. Recognizing the potential toll that second-hand smoke can have on youth’s emotional well-being, health care professionals are encouraged to give youth positive messages in coping with their parents’ smoking behaviour.
doi:10.1186/1471-2458-12-965
PMCID: PMC3503740  PMID: 23140551
Youth; Cigarette smoking; Second-hand smoke; Parents; Cancer prevention; Qualitative research
9.  Discrepancies Between Youth and Mothers’ Perceptions of Their Mother–Child Relationship Quality and Self-Disclosure: Implications for Youth- and Mother-Reported Youth Adjustment 
Journal of youth and adolescence  2012;41(9):1151-1167.
Recently, researchers have devoted greater attention to understanding how disagreement between mothers and their children regarding parent–child relationship quality and functioning impacts youth adjustment. While some view discrepancies as indices of developmentally appropriate individuation, discrepancies regarding family functioning also have been found to predict problematic youth functioning. This study examined the effects of mother–child discrepancies for mother–child relationship qualities and youth self-disclosure on youth-and mother-reported youth internalizing and externalizing adjustment. 232 fifth, eighth, and 11th grade youth (55 % female) and their mothers completed measures of mother–child relationship quality, youth self-disclosure, and youth internalizing and externalizing adjustment. For internalizing adjustment, few effects of discrepancy on adjustment were evident. Instead, informant-specific perceptions of mother–child relationship functioning were most relevant for informant-specific reports of youth adjustment. For youth externalizing adjustment, the magnitude of mother–child discrepancies for negative relationship quality and for youth self-disclosure predicted lower levels of problematic externalizing behavior from both the children’s and the mothers’ perspectives, which could indicate a lack of parent–child communication. Future research is needed to fully understand how discrepancies in negative or mal-adaptive aspects of mother–child relationships are formed (e.g., low disclosure), are understood by the members of and contribute to the onset, maintenance, and treatment of problematic behavioral outcomes.
doi:10.1007/s10964-012-9773-8
PMCID: PMC3484376  PMID: 22573279
Informant discrepancies; Mother child relations; Self-disclosure; Internalizing and externalizing adjustment; Assessment
10.  Parental Support and Mental Health Among Transgender Adolescents 
Purpose
Family support is protective against health risks in sexual minority individuals. However, few studies have focused specifically on transgender youth, who often experience rejection, marginalization, and victimization that place them at risk for poor mental health. This study investigated the relationships among parental support, quality of life, and depression in transgender adolescents.
Methods
Sixty-six transgender youth presenting for care at Children’s Hospital Los Angeles completed a survey assessing parental support (defined as help, advice and confidante support), quality of life, and depression. Regression analyses assessed the associations between parental support and mental health outcomes.
Results
Parental support was significantly associated with higher life satisfaction, lower perceived burden of being transgender, and fewer depressive symptoms.
Conclusions
Parental support is associated with higher quality of life and is protective against depression in transgender adolescents. Interventions that promote parental support may significantly impact the mental health of transgender youth.
doi:10.1016/j.jadohealth.2013.07.019
PMCID: PMC3838484  PMID: 24012067
transgender; adolescents; parental support; depression; quality of life
11.  Posttraumatic stress disorder symptom trajectories in Hurricane Katrina affected youth 
Journal of affective disorders  2012;147(0):198-204.
Objective
This study examined trajectories of posttraumatic stress disorder symptoms in Hurricane Katrina affected youth.
Method
A total of 426 youth (51% female; 8–16 years old; mean age=11 years; 75% minorities) completed assessments at 4 time points post-disaster. Measures included Hurricane impact variables (initial loss/disruption and perceived life threat); history of family and community violence exposure, parent and peer social support, and post-disaster posttraumatic stress symptoms.
Results
Latent class growth analysis demonstrated that there were three distinct trajectories of posttraumatic stress disorder symptoms identified for this sample of youth (resilient, recovering, and chronic, respectively). Youth trajectories were associated with Hurricane-related initial loss/disruption, community violence, and peer social support.
Conclusions
The results suggest that youth exposed to Hurricane Katrina have variable posttraumatic stress disorder symptom trajectories. Significant risk and protective factors were identified. Specifically, youth Hurricane and community violence exposure increased risk for a more problematic posttraumatic stress disorder symptom trajectory, while peer social support served as a protective factor for these youth. Identification of these factors suggests directions for future research as well as potential target areas for screening and intervention with disaster exposed youth.
Limitations
The convenience sample limits the external validity of the findings to other disaster exposed youth, and the self-report data is susceptible to response bias.
doi:10.1016/j.jad.2012.11.002
PMCID: PMC4231137  PMID: 23206321
Posttraumatic stress symptoms; Children; Disasters; Growth mixture modeling
12.  Health-related quality of life of Canadian children and youth prenatally exposed to alcohol 
Background
In Canada, the incidence of Fetal Alcohol Spectrum Disorder (FASD) has been estimated to be 1 in 100 live births. Caused by prenatal exposure to alcohol, FASD is the leading cause of neuro-developmental disabilities among Canadian children, and youth. Objective: To measure the health-related quality of life (HRQL) of Canadian children and youth diagnosed with FASD.
Methods
A prospective cross-sectional study design was used. One-hundred and twenty-six (126) children and youth diagnosed with FASD, aged 8 to 21 years, living in urban and rural communities throughout Canada participated in the study. Participants completed the Health Utilities Index Mark 3 (HUI3). HUI3 measures eight health attributes: vision, hearing, speech, ambulation, dexterity, emotion, cognition, and pain. Utilities were used to measure a single cardinal value between 0 and 1.0 (0 = all-worst health state; 1 = perfect health) to reflect the global HRQL for that child. Mean HRQL scores and range of scores of children and youth with FASD were calculated. A one-sample t-test was used to compare mean HRQL scores of children and youth with FASD to those from the Canadian population.
Results
Mean HRQL score of children and youth with FASD was 0.47 (95% CI: 0.42 to 0.52) as compared to a mean score of 0.93 (95% CI: 0.92 to 0.94) in those from the general Canadian population (p < 0.001). Children demonstrated moderate to severe dysfunction on the single-attributes of cognition and emotion.
Conclusion
Children and youth with FASD have significantly lower HRQL than children and youth from the general Canadian population. This finding has significant implications for practice, policy development, and research.
doi:10.1186/1477-7525-4-81
PMCID: PMC1617087  PMID: 17040571
13.  What goes up must come down: The burden of bipolar depression in youth 
Journal of affective disorders  2013;150(3):1048-1054.
Background
In the pediatric bipolar disorder literature, mania has eclipsed depression as the mood state of most interest. Though depressive episodes tend to be more prevalent and persisting than manic episodes, research about the associated consequences is limited. The goal of the present study was to compare the influences of depressive and manic symptoms on domains of functioning in which youth with bipolar disorder often demonstrate deficits.
Method
Youth meeting DSM-IV-TR criteria for bipolar spectrum disorders (I, II, and NOS) between the ages of seven and 13 were recruited from a clinic in a large Midwestern city (N=54). Both parent and clinician report of manic and depressive symptoms were used in regression analyses to determine how each set of symptoms was related to child functioning.
Results
Parent-rated child depression symptoms were associated with problem behaviors (p<.05), and lower quality of life (p<.001). Clinician-rated child depression was associated with greater psychiatric illness (p<.05), lower child self-concept (p<.001), lower quality of life (p<.05), hopelessness (p<.05, and suicidal ideation (p<.05). Parent-rated mania was associated with better self-esteem (p<.05) and physical wellbeing (p<.05). Clinician-rated mania was associated with greater psychiatric illness (p<.05) and physical wellbeing (p<.05).
Limitations
The specific outcomes predicted by parent and clinician-rated symptoms vary. Though the overall story told – that bipolar depression is associated with significant impairment in youth – is consistent, further research is necessary to more fully understand the impact of each mood state.
Conclusion
Mania is undoubtedly destructive, but this study provides evidence to suggest that depression may be more deleterious to youths’ psychosocial functioning and quality of life; more attention to understanding and ameliorating the effects of bipolar depression on youth is warranted.
doi:10.1016/j.jad.2013.05.039
PMCID: PMC3759628  PMID: 23768529
Pediatric bipolar disorder; depression; mania; quality of life; impairment
14.  Health-related Quality of Life of Youth with Inflammatory Bowel Disease: A Comparison with Published Data Using the PedsQL 4.0 Generic Core Scales 
Inflammatory bowel diseases  2010;16(6):939-946.
Background
This study compared youth and parent-proxy reports of health-related quality of life (HRQoL) among youth with inflammatory bowel disease (IBD) to published comparison group data and examined concordance between youth and parent-proxy reports of HRQoL.
Method
One hundred thirty-six youth and parent-proxy reports on the PedsQL 4.0 Generic Core Scales were compared to published data from chronically ill, acutely ill, and healthy comparison groups using independent samples t-tests. Reporter agreement was examined using paired samples t-tests and intraclass correlations (ICCs).
Results
Youth with IBD reported lower psychosocial functioning than the healthy comparison group, higher physical and social functioning than the chronically ill group, and lower school functioning than all published comparison groups. Parent-proxy reports of youth HRQoL were higher than the chronically ill group, but lower than the healthy group on all scales except psychosocial functioning. Youth with active IBD reported lower physical health domain scores than youth with inactive disease. Concordance between youth and parent-proxy reports was moderate, with lowest agreement in school and social functioning.
Conclusions
Youth with IBD and their parents rate HRQoL as lower than healthy youth but do not perceive the impact of IBD to be as limiting as in other chronic conditions. Youth report suggests that IBD may be particularly detrimental to HRQoL in the school functioning domain. Moderate agreement between parent and youth reports substantiates continued use of multiple informants in studies of pediatric HRQoL.
doi:10.1002/ibd.21128
PMCID: PMC2873051  PMID: 19998462
Inflammatory bowel disease; pediatrics; health-related quality of life; PedsQL 4.0
15.  Cultural and community determinants of subjective social status among Cherokee and White youth 
Ethnicity & health  2008;13(4):289-303.
Background
Subjective social status (SSS) is associated with physical and mental health in diverse samples. However, community, cultural, and ethnic influences on SSS are poorly understood, especially among rural and American Indian populations.
Objective
We aimed to examine similarities and differences in how community poverty, family context, and life course attainment predict SSS among Cherokee and White youth in Appalachia.
Design
We assessed culturally and developmentally appropriate aspects of life course attainment among 344 Cherokee and White youth (age 19–24) using the Life Trajectory Interview for Youth (Brown et al. 2006. International Journal of Methods in Psychiatric Research, 15, 192–206). Combined with information regarding community context and family history, these data were used to examine common patterns and ethnic differences in community, family, and cultural influences on SSS.
Results
Overall, both Cherokee and White youth rank their families lower in SSS than previously studied US youth. Family poverty during childhood and low parental education negatively influence family SSS, Cherokee youth rank higher on subjective socioeconomic status (SES) than Whites, as do participants in high poverty areas. However, White youth rank higher on peer SSS. Ethnographically generated items perform better than standard demographic markers in predicting SSS. Educational attainment is associated with peer SSS among Cherokee (but not White) youths.
Conclusions
Cultural identity, community context, and local reference groups are crucial determinants of SSS. Both White and Cherokee youth in Appalachia exhibit SSS rankings consistent with socioeconomic and cultural marginalization. On a local scale, however, living in high poverty areas or minority communities may buffer individuals from some negative social comparisons regarding subjectively perceived SES. Meanwhile, social monitoring in small minority communities may constrain optimistic bias in assessments of peer popularity and status. Social ecology, family context, and individual attainment appear to exert distinctive influences on SSS across different cultural and ethnic groups.
doi:10.1080/13557850701837302
PMCID: PMC4075651  PMID: 18701990
Native American; Appalachia; culture; socioeconomic status; social hierarchy; poverty
16.  Assessing the Psychometric Properties of Both a Global and a Domain-Specific Perceived Quality of Life Measure When Used with Youth Who Have Chronic Conditions 
Social Indicators Research  2012;114(3):1243-1257.
The purpose of this paper was to assess the psychometric properties of the Students’ Life Satisfaction Scale (SLSS) and the Brief Multidimensional Students’ Life Satisfaction Scale (BMSLSS) when used with youth who have chronic conditions. Baseline data from a longitudinal study examining predictors of changes in perceived quality of life (PQOL) for youth with chronic conditions were used. SLSS and BMSLSS data were collected on over 400 youth aged 11–17 using youth self-report and parent proxy-report versions. Internal consistency, convergent validity, and factor structure were examined for both versions. Extent of agreement and magnitude of differences between youth and parent report were evaluated. Finally, gender, age, and condition group differences in youth report scores were examined for the SLSS and BMSLSS. Strong internal consistency was demonstrated for the youth and parent reports of both measures. As with normative samples, a single factor structure was found for youth and parent reports of the BMSLSS. However, both youth and parent reports of the SLSS had a two-factor structure: one consisting of five positively worded items, and the other, two negatively worded items. Youth reported their PQOL to be significantly higher than did their parents. Significant differences in PQOL scores for the youth report were not found by age, gender, or conditions. Findings show that, from a psychometric standpoint, the BMSLSS (both youth and parent report) is a promising measure of PQOL for use in population-based research with youth who have chronic conditions. The SLSS may need to be revised to exclude negative items when used with this population of youth.
doi:10.1007/s11205-012-0200-z
PMCID: PMC4254371  PMID: 25484486
Quality of life; Life satisfaction; Adolescence; Chronic conditions; Measurement
17.  Complementary and Alternative Medicine Use and Quality of Life in Pediatric Diabetes 
Abstract
Objectives
The objectives of this study were to explore the association between complementary and alternative medicine (CAM) use as reported by youth, and parents' and children's reported quality of life in youth with diabetes.
Design
The study design was a cross-sectional survey.
Setting
Youth in Washington State participated in the SEARCH for Diabetes in Youth study, a national, multisite epidemiological study designed to assess the prevalence and incidence of diabetes in U.S. youth. Surveys assessing CAM utilization were mailed in January and April 2006.
Participants
One thousand four hundred and thirty-nine (1439) youth were mailed a CAM survey. The final sample consisted of 467 youth with both CAM survey results and quality-of-life data.
Outcome measures
Difference in mean scores on Pediatric Quality of Life Inventory (PedsQL) between CAM users and nonusers overall, and specific CAM therapies were the outcome measures.
Results
Of the 1439 participants approached, 587 (40.8%) returned the CAM survey. In adjusted analyses, children reported any CAM use as associated with more barriers to treatment (difference in mean scores −3.48, 95% confidence interval [CI] −6.65, −0.31). Children following a CAM diet reported higher quality of life (PedsQL Core Total difference 4.01, 95% CI [0.10–7.91]; Core Psychosocial difference was 6.45, 95% CI [1.95 to 10.95]), but those using stress-reduction activities reported poorer quality of life (Diabetes Total difference −4.19, 95% CI [−8.35 to −0.04]). Parent-reported quality of life was lower for children who used “other supplements” (Core Total difference −6.26, 95% CI [−11.29 to −1.24]; Core Psychosocial difference was −5.92, 95% CI [−11.65 to −0.19]).
Conclusions
CAM diets were associated with increased quality of life in youth with diabetes, whereas supplement use and stress-reduction activities were associated with decreased quality of life. The temporal sequence between CAM use and quality of life requires further study.
doi:10.1089/acm.2008.0566
PMCID: PMC3110095  PMID: 20180689
18.  Effects of unilateral input and mode of hearing in the better ear: Self-reported performance using the Speech, Spatial and Qualities of Hearing Scale 
Ear and hearing  2014;35(1):10.1097/AUD.0b013e3182a3648b.
Objective
To evaluate effects of hearing mode (normal hearing, cochlear implant or hearing aid) on everyday communication among adult unilateral listeners using the Speech, Spatial and Qualities of Hearing scale (SSQ). Individuals with one good, naturally hearing ear were expected to have higher overall ratings than unilateral listeners dependent on a cochlear implant or hearing aid. We anticipated that listening environments reliant on binaural processing for successful communication would be rated most disabling by all unilateral listeners. Regardless of hearing mode, all hearing-impaired participants were expected to have lower ratings than individuals with normal hearing bilaterally. A secondary objective was to compare post-treatment SSQ results of participants who subsequently obtained a cochlear implant for the poorer hearing ear to those of participants with a single normal hearing ear.
Design
Participants were 87 adults recruited as part of ongoing research investigating asymmetric hearing effects. Sixty-six participants were unilateral listeners who had one unaided/non-implanted severe to profound hearing loss ear and were grouped based on hearing mode of the better ear: 30 had one normal hearing ear (i.e., unilateral hearing loss participants); 20 had a unilateral cochlear implant; and 16 had a unilateral hearing aid. Data were also collected from 21 normal-hearing individuals, as well as a subset of participants who subsequently received a cochlear implant in the poorer ear and thus became bilateral listeners. Data analysis was completed at the domain and subscale levels.
Results
A significant mode-of-hearing group effect for the hearing-impaired participants (i.e. with unilateral hearing loss, unilateral cochlear implant or unilateral hearing aid) was identified for two domains (Speech and Qualities) and six subscales (Speech in Quiet, Speech in Noise, Speech in Speech Contexts, Multiple Speech Stream Processing and Switching, Identification of Sound and Objects, and Sound Quality and Naturalness). There was no significant mode-of-hearing group effect for the Spatial domain or the other four subscales (Localization, Distance and Movement, Segregation of Sounds, and Listening Effort). Follow-up analysis indicated the unilateral normal hearing ear group had significantly higher ratings than the unilateral cochlear implant and/or hearing aid groups for the Speech domain and four of the ten subscales; neither the cochlear implant nor hearing aid group had subscale ratings significantly higher than each other or the unilateral hearing loss group. Audibility and sound quality imparted by hearing mode were identified as factors related to subjective listening experience. After cochlear implantation to restore bilateral hearing, SSQ ratings for bilateral cochlear implant and/or cochlear implant plus hearing aid participants were significantly higher than those of the unilateral hearing loss group for Speech in Quiet, Speech in Noise, Localization, Distance and Movement, Listening Effort, and the Spatial domain. Hearing-impaired individuals had significantly poorer ratings in all areas compared to those with bilateral normal hearing.
Conclusions
Adults reliant on a single ear, irrespective of better ear hearing mode, including those with one normal hearing ear, are at a disadvantage in all aspects of everyday listening and communication. Audibility and hearing mode were shown to differentially contribute to listening experience.
doi:10.1097/AUD.0b013e3182a3648b
PMCID: PMC3872501  PMID: 24084062
Unilateral hearing loss; Hearing disability; Cochlear implant; Hearing aid
19.  Identification of Minimal Clinically Important Difference Scores of the PedsQL in Children, Adolescents, and Young Adults With Type 1 and Type 2 Diabetes 
Diabetes Care  2013;36(7):1891-1897.
OBJECTIVE
To establish minimal clinically important difference (MCID) scores representing the smallest detectable change in quality of life (QOL), using the Pediatric Quality of Life Inventory (PedsQL) Generic Core and Diabetes Module among youth with diabetes and their parents, and to identify demographic and clinical correlates of QOL change over 1 year.
RESEARCH DESIGN AND METHODS
Participants in the SEARCH for Diabetes in Youth Study aged >5 years and parents of youth aged <18 years completed PedsQL surveys at their initial and 12-month study visits. MCIDs for each PedsQL module were calculated using one standard error of measurement. Demographic and clinical characteristics associated with QOL change were identified through multiple linear and logistic regression analyses.
RESULTS
The sample comprised 5,004 youth (mean age, 12.5 ± 4.7 years; mean diabetes duration, 3.4 ± 3.7 years). Of 100 possible points, PedsQL total score MCIDs for youth with type 1 and type 2 diabetes, respectively, were Generic Core, 4.88, 6.27 (parent) and 4.72, 5.41 (youth); Diabetes Module, 4.54, 6.06 (parent) and 5.27, 5.96 (youth). Among 1,402 youth with a follow-up visit, lower baseline QOL, male sex, private insurance, having type 1 diabetes, longer diabetes duration, and better glycemic control predicted improvements in youth- and parent-reported PedsQL total scores over 1 year. Clinically meaningful (≥1 MCID) improvements in total score for at least one PedsQL module were predicted by private insurance, lower BMI, and lower A1C at baseline.
CONCLUSIONS
These diabetes-specific reference points to interpret clinically meaningful change in PedsQL scores can be used in clinical care and research for youth with type 1 and type 2 diabetes.
doi:10.2337/dc12-1708
PMCID: PMC3687260  PMID: 23340884
20.  Preoperative evaluation, surgical procedure, follow up and results of 150 cochlear implantations 
Hippokratia  2007;11(2):77-82.
Background: The cochlear implantation is among the most important achievements of medicine and biotechnology in the last 20 years, because it allows individuals who had never heard or had lost their hearing to perceive sound and improve their quality of life. Selection criteria for candidates are strict and are evaluated in each individual by a scientific committee specially trained for implantations which includes Ear Nose and Throat (ENT) surgeon, audiologist, psychiatrist and speech therapist.
Patients and methods: In our department, the first cochlear implantation was performed in 1995. During the last ten years more than 250 individuals have been evaluated due to profound hearing loss and 170 of them were found to be suitable candidates for cochlear implantation. One hundred and fifty (150) have already been operated and most of them are children with congenital hearing loss. No major or permanent complications were recorded in any of our 150 patients. Activation and fitting/mapping of the cochlear implant is initiated three weeks post-operatively. Regular follow- up and mapping of the implant are held, more frequently in children, along with specialized speech therapy. Each new mapping is evaluated according to the record of the patient with regard to the acoustic perception of sounds and speech and the discrimination of individual elements of phonation based on a protocol that we have created for the needs of Greek language.
Results: Speech discrimination (AHEPA Hospital protocol), before the Implantation, at the activation of the cochlear implant and till 4 years of the follow-up showed that in our patients, we obtained better and faster results in post-speech acquisition adults with recent or chronic deafness and in children with congenital deafness operated before the 5th year of age, who underwent special preoperative speech therapy programme, fact which is in agreement with current literature. Patient satisfaction evaluated by "Sanders" psychometrics tests, was achieved in accordance to pre-operative expectations.
Conclusions: In our patients, we observed better and faster results in children with congenital deafness operated before the third year of age, in post-speech acquisition adults with recent deafness and in post-speech acquisition adults with chronic deafness but with auditory memory reserve.
PMCID: PMC2464273  PMID: 19582182
cochlear implant; cochlear implantation; surgical procedure of cochlear implantation; follow up of cochlear implantation; results of cochlear implantation
21.  Perceived social approval and condom use with casual partners among youth in urban Cameroon 
BMC Public Health  2011;11:632.
Background
HIV prevention programs targeting youth often emphasize the role of peers, and assume that youths will model their behavior after their peers'. We challenge this view; we argue that adopting a given behavior requires social approval, and that youths do not necessarily turn to peers for such approval. This study analyzes survey data on youths in urban Cameroon to 1) identify which type of persons youths look to for social approval, and 2) establish how important social approval by these persons is for condom use among youths.
Methods
We analyzed data from three survey waves (2000, 2002, and 2003) of a reproductive health survey conducted among urban Cameroonian youth (aged 15-24). Only respondents who reported having at least one casual partner in the past year were retained for the analysis. Bivariate analyses and structural equation modeling were used to examine relationships among perceived social approval, attitudes towards condoms and condom use.
Results
The data show that only 3% of youths named their friends as people whose opinion they valued, while 93% mentioned family members. The perceived approval of condom use by these persons had a significant positive effect on the frequency of condom use among youths. The frequency of condom use was also affected by the respondents' attitudes toward condom use, the range of persons with whom they discussed reproductive health matters, whether they were enrolled in school, socioeconomic status, their self-efficacy, perceived severity of AIDS, risk perception and sexual risk behavior. The perceived social approval of condom use and the respondents' own condom attitudes were correlated.
Conclusions
Our analysis demonstrates that perceived social approval facilitates the adoption of condom use among urban Cameroonian youth. However, youths tend to value the opinions of family members much more than the opinions of their peers. These results suggest that interventions targeting youths should not focus exclusively on peers but should also include other groups, such as parents and community leaders.
doi:10.1186/1471-2458-11-632
PMCID: PMC3170619  PMID: 21819611
22.  A Meta-analytic Review of the Psychosocial Adjustment of Youth with Inflammatory Bowel Disease 
Journal of Pediatric Psychology  2010;35(8):857-869.
Objective To conduct a meta-analytic review of psychosocial adjustment of youth with inflammatory bowel disease (IBD). Methods Nineteen studies with a total of 1167 youth with IBD (M age = 14.33, 50% female) were included. Effect size (ES) estimates were calculated for anxiety symptoms & disorders, depressive symptoms & disorders, internalizing symptoms & disorders, externalizing symptoms, quality of life (QOL), social functioning, and self-esteem. Separate ESs were calculated for comparisons between IBD and youth with chronic illnesses versus healthy youth. Results Youth with IBD had higher rates of depressive disorders and internalizing disorders than youth with other chronic conditions. Youth with IBD had higher parent-reported internalizing symptoms, lower parent- and youth-reported QOL, and lower youth-reported social functioning compared to healthy youth. Conclusions Clinical attention to depressive disorders, QOL, and social functioning may be particularly salient in the context of pediatric IBD.
doi:10.1093/jpepsy/jsp120
PMCID: PMC3107587  PMID: 20123705
inflammatory bowel disease; meta-analysis; psychosocial functioning; quality of life
23.  Sex Differences in Youth-Reported Depressive Symptomatology and Unwanted Internet Sexual Solicitation 
Background
As the number of youths using the Internet regularly increase, so too does the number of youths potentially vulnerable to negative experiences online. Clinicians, policy makers, and parents need to better understand the Internet and factors related to positive and negative experiences online.
Objective
Primarily to investigate the association between youth-reported depressive symptomatology and unwanted Internet sexual solicitation and secondarily to identify sex differences in related characteristics of affected youth.
Methods
Data from the Youth Internet Safety Survey were analyzed to investigate the association between reported depressive symptomatology and unwanted Internet sexual solicitation. The Youth Internet Safety Survey was a nationally-representative, cross-sectional telephone survey. Youth participants (N = 1501) were English speakers between the ages of 10 and 17 years who had accessed the Internet at least 6 times in the previous 6 months and had resided in the household for at least 2 weeks in the previous year. Eighty-two percent of contacted households agreed to participate.
Each participant was asked to indicate whether any of the 9 symptoms of major depression defined by the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) had been present within the previous month. Logistic regression was used to estimate the odds of reporting an unwanted sexual solicitation online for youths with mild or major depressive symptomatology versus no symptomatology. A parsimonious, multivariate model of significant youth characteristics was identified separately for males and females.
Results
Youths who report major depressive-like symptoms were 3.5 times more likely (odds ratio, 3.54; 95% confidence interval, 2.19-5.71) to also report an unwanted sexual solicitation online compared to youths with mild/no symptomatology. After adjusting for significant Internet and psychosocial characteristics, male Internet users who report major depressive-like symptomatology were 2.5 times more likely to also indicate an unwanted Internet solicitation (adjusted odds ratio, 2.72; 95% CI, 1.15-6.40); significant differences were not observed among otherwise-similar females. Further, among youths reporting an Internet solicitation (N = 283), youths with major depressive-like symptomatology were twice as likely to report feeling emotionally distressed by the incident compared to youths with mild/no symptomatology (odds ratio, 2.27; 95% CI, 1.03-5.02).
Conclusions
While the majority of youths report positive experiences online, some youths may be more vulnerable to negative experiences. Cross-sectional results indicate that the report of depressive symptomatology is significantly related to the concurrent report of an unwanted Internet sexual solicitation, especially for young males. Future research should focus on parsing out the temporality of events and identifying additional populations of vulnerable youths online.
doi:10.2196/jmir.6.1.e5
PMCID: PMC1550591  PMID: 15111271
Youth; Internet; depression; sexual solicitation; mental health
24.  Parsing dimensional versus diagnostic category-related patterns of reward circuitry function in behaviorally and emotionally dysregulated youth in the Longitudinal Assessment of Manic Symptoms (LAMS) study 
JAMA psychiatry  2014;71(1):71-80.
Context
Pediatric disorders characterized by behavioral and emotional dysregulation pose diagnostic and treatment challenges because of high comorbidity, suggesting that they may be better conceptualized dimensionally rather than categorically. Identifying neuroimaging measures associated with behavioral and emotional dysregulation in youth may inform understanding of underlying dimensional vs. disorder-specific pathophysiology.
Objective
Identify, in a large cohort of behaviorally and emotionally dysregulated youth, neuroimaging measures that: 1) are associated with behavioral and emotional dysregulation pathological dimensions (behavioral and emotional dysregulation measured with the Parent General Behavior Inventory 10 Item Mania Scale [PGBI-10M], mania, depression, anxiety); or 2) differentiate diagnostic categories(BPSD, ADHD, anxiety, disruptive behavior disorders (DBD)).
Design
Multi-site neuroimaging study(February 2011–April 2012).
Setting
Academic medical centers: Case Western Reserve University, Cincinnati Children’s Hospital, University of Pittsburgh.
Patients
Referred sample of behaviorally and emotionally dysregulated youth(n=85) from the Longitudinal Assessment of Manic Symptoms study and healthy youth (n=20).
Main Outcome Measures
Region-of-interest analyses examined relationships among prefrontal-ventral striatal reward circuitry during a reward paradigm (Win, Loss, control conditions), symptom dimensions, and diagnostic categories.
Results
Regardless of diagnosis, higher PGBI-10M scores were associated with greater left middle prefrontal cortical (mPFC; r=0.28), and greater levels of anxiety with greater right dorsal anterior cingulate cortical (dACC; r=0.27), activity to Win. The 20 highest (t=2.75) and 20 lowest (t=2.42) PGBI-10M scoring youth showed significantly greater left mPFC activity to Win than 20 healthy youth. DBD were associated with lower left ventrolateral prefrontal cortex(VLPFC) activity to Win (t=2.68) (all ps<0.05, corrected).
Conclusions
Greater PGBI-10M-related left mPFC activity, and greater anxiety-related right dACC activity, to Win may reflect heightened reward sensitivity and greater attention to reward in behaviorally and emotionally dysregulated youth, regardless of diagnosis. Reduced left VLPFC activity to Win may reflect reward insensitivity in youth with DBD. Despite a distinct reward-related neurophysiology in DBD, findings generally support a dimensional approach to studying neural mechanisms in behaviorally and emotionally dysregulated youth.
doi:10.1001/jamapsychiatry.2013.2870
PMCID: PMC4238412  PMID: 24285346
25.  Music Perception with Cochlear Implants: A Review 
Trends in Amplification  2004;8(2):49-82.
The acceptance of cochlear implantation as an effective and safe treatment for deafness has increased steadily over the past quarter century. The earliest devices were the first implanted prostheses found to be successful in compensating partially for lost sensory function by direct electrical stimulation of nerves. Initially, the main intention was to provide limited auditory sensations to people with profound or total sensorineural hearing impairment in both ears. Although the first cochlear implants aimed to provide patients with little more than awareness of environmental sounds and some cues to assist visual speech-reading, the technology has advanced rapidly. Currently, most people with modern cochlear implant systems can understand speech using the device alone, at least in favorable listening conditions. In recent years, an increasing research effort has been directed towards implant users’ perception of nonspeech sounds, especially music. This paper reviews that research, discusses the published experimental results in terms of both psychophysical observations and device function, and concludes with some practical suggestions about how perception of music might be enhanced for implant recipients in the future. The most significant findings of past research are: (1) On average, implant users perceive rhythm about as well as listeners with normal hearing; (2) Even with technically sophisticated multiple-channel sound processors, recognition of melodies, especially without rhythmic or verbal cues, is poor, with performance at little better than chance levels for many implant users; (3) Perception of timbre, which is usually evaluated by experimental procedures that require subjects to identify musical instrument sounds, is generally unsatisfactory; (4) Implant users tend to rate the quality of musical sounds as less pleasant than listeners with normal hearing; (5) Auditory training programs that have been devised specifically to provide implant users with structured musical listening experience may improve the subjective acceptability of music that is heard through a prosthesis; (6) Pitch perception might be improved by designing innovative sound processors that use both temporal and spatial patterns of electric stimulation more effectively and precisely to overcome the inherent limitations of signal coding in existing implant systems; (7) For the growing population of implant recipients who have usable acoustic hearing, at least for low-frequency sounds, perception of music is likely to be much better with combined acoustic and electric stimulation than is typical for deaf people who rely solely on the hearing provided by their prostheses.
doi:10.1177/108471380400800203
PMCID: PMC4111359  PMID: 15497033

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