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Item 153. AYA Subspecialty Patient and Parent Views on COVID-19 Vaccination(Elsevier, 2022) Hardman, Sara; Jacob, Seethal A.; Coven, Scott L.; Rahim, Mahvish Q.; Miller, Meagan E.; Zimet, Gregory D.; Meagher, Carolyn G.; Ott, Mary A.; Pediatrics, School of MedicinePurpose: Adolescents/young adults (AYA) with hematologic and oncologic (heme-onc) conditions are important targets for vaccine outreach because they are at increased risk for complications from COVID-19. AYA patients may also need additional support, as they are transitioning from parent to independent vaccine decision-making. AYA with sickle cell disease (SCD) are of particular concern because a high proportion are African American and experience structural racism in addition to their illness. Our objective was to examine AYA and parent attitudes regarding the COVID-19 vaccine among heme-onc populations. Methods: As part of a larger IRB-approved study, we recruited vaccine decision-makers in pediatric SCD and oncology survivor clinics, including parents of adolescents under 18 years (n=35), AYA patients 18-21 years old (n=21), and parents of AYA patients 18-21 years old (n=14). After informed consent, participants completed a demographic survey and a semi-structured interview regarding their vaccine decision-making process. Example questions included “What do you see as the benefits of the COVID-19 vaccine?” and “What are your concerns about the COVID-19 vaccine?”. Saturation was reached. Interviews were audio recorded, transcribed, and analyzed using thematic analysis. Codes were developed from the literature and early interviews. Examples included “attitudes against vaccine,” “medical mistrust,” “hesitancy,” “vaccine side effects,” and “vaccine interactions with disease process.” Fisher exact statistical tests were performed to analyze quantitative data. Results: In SCD clinic, we recruited 31 index patients (mean age: 15.1±3.5 years; 30 African American and 1 Other or Mixed), yielding 11 AYA and 26 parent interviews. In survivor clinic, we recruited 26 index patients (mean age: 16.0±3.4 years; 20 White, 2 Hispanic or Latinx; 2 Other or Mixed, 1 African American, and 1 Asian), yielding 10 AYA and 23 parent interviews. Out of the total index patients, 8 had already received the vaccine, 13 were planning to receive it, 27 were considering it, and 9 had declined it. There was no clear relationship between patients’ diagnosis (SCD or cancer) and their vaccine decisions nor between the index patient’s age (under or over 18) and their vaccine decisions. A high proportion of participants saw benefits to vaccination, such as lowering personal risk, community benefits of preventing the spread of COVID-19, and a possible return to “normal.” However, many AYA and parent participants also had concerns toward the vaccine, including concerns about short-term side effects and the potential for unknown, long-term effects. Concerns were also voiced about how rapidly the vaccine was developed and misconceptions about the vaccine were common, namely the vaccine causing infertility or increasing one’s susceptibility to contracting COVID-19. Medical mistrust toward either the vaccine or providers was explicitly stated by several participants, the majority of whom were from minoritized groups. Conclusions: COVID-19 vaccines have the potential to protect medically and socially vulnerable AYA, however patient and parent concerns, misconceptions, and mistrust are still prevalent. These data provide insights into the design and implementation of vaccine counseling interviews for AYA subspecialty patients and families.Item 80. Disparities in Perceived Vulnerability to COVID-19 Consequences Among U.S. Adolescents and Young Adults: Findings from a Nationally Representative Survey(Elsevier, 2021-02) Hensel, Devon J.; Rosenberg, Molly; Luetke, Maya; Herbenick, Debby; Pediatrics, School of MedicinePurpose: Global research has documented the adverse impact of COVID-19 on the health and well-being of adolescents and young adults (AYA). Pandemic conditions can increase AYA vulnerability to COVID-19-related health (e.g. getting sick or missing medical appointments), social (e.g. not having enough to eat) and economic (e.g. job loss) consequences. Structural inequalities may further exacerbate exposure to these outcomes. We used nationally representative data to examine AYA perceived vulnerability to health/social outcomes early in the COVID-19 pandemic. Methods: Data were the 2020 National Survey of Sexual and Reproductive Health during COVID-19 (Ipsos Research: Menlo Park, CA, USA), an online, nationally representative survey of COVID-19 experiences and knowledge among noninstitutionalized adults in the United States (all 50 states and District of Columbia). Of all individuals recruited (N=1632; 18-94 years), 1010 (62%) completed the survey. We retained a subsample of participants 18-25 years of age (N=106; 10.1% of the larger study) for our current analytic sample. Participants rated the next 12-week occurrence likelihood of eight COVID consequences (all dichotomized for analsis: no chance + low chance – 25% vs. medium chance – 25% to 75% + high chance - >75%). Illness consequences were: being exposed to COVID-19, getting an infection from COVID-19, being hospitalized from COVID-19, knowing someone with COVID-19, knowing someone who has died from COVID-19. Social/economic consequences were: losing job, partner/spouse losing job, not having enough to eat, parent(s) losing their job, missing important healthcare appointments/treatments. Structural variables were: gender (male/female), age (18-21/22-25), sexual identity (heterosexual/sexual minority [SM]) and race/ethnicity (White/BIPOC). We evaluated the prevalence heterogeneity across structural variables using nonparametric McNemar tests. All estimates were adjusted using Ipsos provided weights to account for sampling differences and/or nonresponse. Results: The majority of AYA in the United States (85%) believed they were vulnerable to 2+ health or social/economic consequences. Significantly more SM (36.4%-57.5%) than heterosexual (23.2%-37.0%; p<.001 both) AYA perceived vulnerability to being exposed to and/or getting an infection from COVID-19. A significantly greater number of BIPOC (16.2%-38.7%) than White (11.4%-18.8%; p<.001 both) believed they were vulnerable to COVID19-associated hospitalization or job loss. More SM (26.4%) than heterosexual (22.4%; p<.001) AYA estimated a medium-to high likelihood they would know someone who died of COVID-19. Significantly more BIPOC than White AYA felt high vulnerability to personal job loss (38.7% vs. 18.8%; p=.015), parent job loss (19.0% vs. 16.3%; p<.001) and not having enough to eat (16.3% vs. 10.0%; p<.001). Conclusions: Nationally, many AYA – particularly sexual minority and BIOPC youth – believe they are highly vulnerability to COVID-19 associated consequences. Professionals who work with youth may consider including screening for COVID-19 worries during clinical/educational interactions as a means of both understanding and normalizing AYA’s experiences, as well as helping them devise support or coping mechanisms, during this unprecedented time. These “check-ins” may be particularly where long-term worry about COVID-19 could exacerbate existing disparities in mental and physical health among marginalized AYA.Item Adolescent Women with Congenital Heart Disease: Self-Reported Reproductive Health Discussions with Health Care Providers(Elsevier, 2022) Katz, Amy J.; Lyon, Shannon; Farrell, Anne G.; Srivastava, Nayan; Wilkinson, Tracey A.; Shew, Marcia L.; Pediatrics, School of MedicineStudy objective: This study evaluated self-reported discussions with health care providers (HCPs) among adolescent and young adult (AYA) women with congenital heart disease (CHD). Design: Data were collected through a one-time survey of AYA women. Setting: Participants were recruited from pediatric cardiology clinics. Participants: AYA women with CHD, ages 14-21 (N = 107) INTERVENTIONS: None MAIN OUTCOME MEASURES: Questionnaires assessed adolescent characteristics and specific HCP discussions regarding transmissibility of a cardiac condition to the infant, risk of pregnancy, and hormonal contraception. Outcome measures were self-reported discussions with HCPs about these reproductive health topics. Results: Mean age was 16.8 years (SD = 2.1). Self-reported reproductive health discussions were infrequent, including discussions on transmissibility of a heart condition to their offspring (37%), risk of pregnancy to their offspring (34%), risks of pregnancy to their health (46%), and risks of hormonal contraception given their heart condition (21%). Reported discussions were most commonly with a cardiologist. Conclusions: AYA women with CHD reported limited discussions about reproductive health topics important to those with CHD. Lack of appropriate and timely counseling could lead to poor maternal and child health outcomes. Targeted interventions that improve reproductive health discussions between HCPs and AYA women with CHD are needed to close critical information and service gaps.Item Art Therapy Treatment Model for Rural LGBTQ+ Emerging Adults(2020) Kimbrough, Libby; Leigh, HeatherLGBTQ+ individuals living in rural areas who are aging into adulthood face specific challenges, such as isolation, discrimination, bullying, and hate crimes, leading to mental health issues that often go untreated due to lack of services, stigma, fear of being outed, as well as distrust of mental health clinicians. Art therapy is an emerging treatment modality that may help to address these barriers to treatment. An integrative literature-based review was conducted to study the treatment needs of LGBTQ+ rural emerging adults in order to design a model for an art therapy program for queer emerging adults in rural communities. Created from an antioppressive perspective, the model focuses on using art therapy with clients to assist them in building and exploring their identity, empowering them in the face of discrimination, and decreasing isolation through a therapeutic group experience. The model may also serve to train and educate clinicians to treat this population ethically.Item Banking the Future: Adolescent Capacity to Consent to Biobank Research(Wiley, 2019) McGregor, Kyle A.; Ott, Mary A.; Pediatrics, School of MedicineAdolescents are an important population to represent in biobanks. Inclusion of biospecimens from adolescents advances our understanding of the long-term consequences of pediatric disease and allows the discovery of methods to prevent adult diseases during childhood. Consent for biobanking is complex, especially when considering adolescent participation, as it brings up issues that are not present with general clinical research. The development and successful implementation of an adolescent capacity assessment tool applied specifically to biobanking can potentially provide researchers and clinicians with contextualized information on participants' understanding, appreciation, reasoning, and voluntary choice for biobanks. This tool would enhance current studies looking at the role of shared decision-making in biobanking, as well as provide a formal measurement when considering decisions around pediatric and adolescent biobanking participation. This study adapted the MacCAT-CR for use with a hypothetical adolescent biobank study and examines predictors of MacCAT-CR scores on healthy and chronically ill adolescents.Item Characterizing chronic pain in late adolescence and early adulthood: prescription opioids, marijuana use, obesity, and predictors for greater pain interference(Wolters Kluwer, 2018-11-22) Anastas, Tracy; Colpitts, Kelsey; Ziadni, Maisa; Darnall, Beth D.; Wilson, Anna C.; Psychology, School of ScienceIntroduction: Chronic pain in late adolescence and young adults is understudied and poorly characterized. Objectives: We sought to characterize key variables that may impact pain interference in late adolescents and young adults with chronic pain, including prescription opioid use, marijuana use, psychological symptoms, and obesity. Methods: Retrospective, cross-sectional medical chart review for patients aged 17 to 23 years (N = 283; 61% Females) seeking care at a tertiary care pain clinic. Data on pain characteristics, health behaviors, and mental health distress were examined, in addition to self-reported pain intensity and interference. Results: Overlapping pain conditions were common in this young adult sample (mean ≥ 2 pain conditions). Back pain was the most commonly cited pain condition, and the majority of pain was of unknown etiology. Results revealed high rates for current opioid prescription, overweight or obese status, and mental health problems. Those using prescription opioids were more likely to endorse tobacco use and had greater pain interference. Importantly, the presence of mental health distress and opioid use were predictive of higher levels of pain-related interference. Conclusion: Treatment-seeking adolescents and young adults with chronic pain evidence complex care needs that include pain and mental comorbidities, as well as risky health behaviors. Pain and mental health distress were associated with poorer physical health, opioid prescription and marijuana use, and pain-related interference. Findings underscore the need for additional research on pain, treatment patterns, and health behaviors and their impact on developmental trajectories, as well as the need to develop and apply effective early interventions in this at-risk population.Item CYP2A6 metabolism in the development of smoking behaviors in young adults(Wiley, 2018-01) Olfson, Emily; Bloom, Joseph; Bertelsen, Sarah; Budde, John P.; Breslau, Naomi; Brooks, Andrew; Culverhouse, Robert; Chan, Grace; Chen, Li-Shiun; Chorlian, David; Dick, Danielle M.; Edenberg, Howard J.; Hartz, Sarah; Hatsukami, Dorothy; Hesselbrock, Victor M.; Johnson, Eric O.; Kramer, John R.; Kuperman, Samuel; Meyers, Jacquelyn L.; Nurnberger, John; Porjesz, Bernice; Saccone, Nancy L.; Schuckit, Marc A.; Stitzel, Jerry; Tischfield, Jay A.; Rice, John P.; Goate, Alison; Bierut, Laura J.; Biochemistry and Molecular Biology, School of MedicineCytochrome P450 2A6 (CYP2A6) encodes the enzyme responsible for the majority of nicotine metabolism. Previous studies support that slow metabolizers smoke fewer cigarettes once nicotine dependent but provide conflicting results on the role of CYP2A6 in the development of dependence. By focusing on the critical period of young adulthood, this study examines the relationship of CYP2A6 variation and smoking milestones. A total of 1209 European American young adults enrolled in the Collaborative Study on the Genetics of Alcoholism were genotyped for CYP2A6 variants to calculate a previously well-validated metric that estimates nicotine metabolism. This metric was not associated with the transition from never smoking to smoking initiation nor with the transition from initiation to daily smoking (P > 0.4). But among young adults who had become daily smokers (n = 506), decreased metabolism was associated with increased risk of nicotine dependence (P = 0.03) (defined as Fagerström Test for Nicotine Dependence score ≥4). This finding was replicated in the Collaborative Genetic Study of Nicotine Dependence with 335 young adult daily smokers (P = 0.02). Secondary meta-analysis indicated that slow metabolizers had a 53 percent increased odds (OR = 1.53, 95 percent CI 1.11-2.11, P = 0.009) of developing nicotine dependence compared with normal metabolizers. Furthermore, secondary analyses examining four-level response of time to first cigarette after waking (>60, 31-60, 6-30, ≤5 minutes) demonstrated a robust effect of the metabolism metric in Collaborative Study on the Genetics of Alcoholism (P = 0.03) and Collaborative Genetic Study of Nicotine Dependence (P = 0.004), illustrating the important role of this measure of dependence. These findings highlight the complex role of CYP2A6 variation across different developmental stages of smoking behaviors.Item Effectiveness of Occupational Therapy Interventions to Promote Social Participation in Children and Young Adults with Autism Spectrum Disorder(2023-05) Chelmella, Payton; Jackman, Ellie; Negash, Shushan; Richardson, Nicole; Vaccaro, Hannah; Chase, Tony; Sego, Daniel; Department of Occupational Therapy, School of Health and Human SciencesA systematic review of the literature related to effective occupational therapy interventions on socialization for children and adolescents with Autism Spectrum Disorder (ASD). This review provides a comprehensive overview and discussion of 25 studies that addressed the variety of interventions that can be used when targeting social skills including sensory integration, animal-assisted interventions, technology, play, school-based, and caregiver-assisted interventions. The findings reveal that the use of these interventions is clinically significant yet there is limited evidence to support generalizability to the population. This review supports the premise that children and adolescents with ASD who experience socialization challenges as compared to typically developing peers can improve their social skills through these interventions.Item Examining an Altruism-Eliciting Video Intervention to Increase COVID-19 Vaccine Intentions in Younger Adults: A Qualitative Assessment Using the Realistic Evaluation Framework(MDPI, 2023-03-11) Zhu, Patricia; Tatar, Ovidiu; Haward, Ben; Steck, Veronica; Griffin-Mathieu, Gabrielle; Perez, Samara; Dubé, Ève; Zimet, Gregory; Rosberger, Zeev; Pediatrics, School of MedicineCOVID-19 vaccine-induced immunity wanes over time, and with the emergence of new variants, additional "booster" doses have been recommended in Canada. However, booster vaccination uptake has remained low, particularly amongst younger adults aged 18-39. A previous study by our research team found that an altruism-eliciting video increased COVID-19 vaccination intentions. Using qualitative methods, the present study aims to: (1) identify the factors that influence vaccine decision-making in Canadian younger adults; (2) understand younger adults' perceptions of an altruism-eliciting video designed to increase COVID-19 vaccine intentions; and (3) explore how the video can be improved and adapted to the current pandemic context. We conducted three focus groups online with participants who: (1) received at least one booster vaccine, (2) received the primary series without any boosters, or (3) were unvaccinated. We used deductive and inductive approaches to analyze data. Deductively, informed by the realist evaluation framework, we synthesized data around three main themes: context, mechanism, and intervention-specific suggestions. Within each main theme, we deductively created subthemes based on the health belief model (HBM). For quotes that could not be captured by these subthemes, additional themes were created inductively. We found multiple factors that could be important considerations in future messaging to increase vaccine acceptance, such as feeling empowered, fostering confidence in government and institutions, providing diverse (such as both altruism and individualism) messaging, and including concrete data (such as the prevalence of vulnerable individuals). These findings suggest targeted messaging tailored to these themes would be helpful to increase COVID-19 booster vaccination amongst younger adults.Item The Impact of Gain- and Loss-Framed Messages on Young Adults' Sexual Decision Making: An Experimental Study(Springer, 2017-02) Macapagal, Kathryn; Janssen, Erick; Matson, Margaret; Finn, Peter R.; Heiman, Julia R.; Richard M. Fairbanks School of Public HealthMessages that frame a target behavior in terms of its benefits (gain frame) or costs (loss frame) have been widely and successfully used for health promotion and risk reduction. However, the impact of framed messages on decisions to have sex and sexual risk, as well as moderators of these effects, has remained largely unexplored. We used a computerized laboratory task to test the effects of framed messages about condom use on young adults' sexual decision making. Participants (N = 127) listened to both gain- and loss-framed messages and rated their intentions to have sex with partners who posed a high and low risk for sexually transmitted infections (STIs). The effects of message frame, partner risk, participant gender, ability to adopt the messages, and message presentation order on intentions to have sex were examined. Intentions to have sex with high-risk partners significantly decreased after the loss-framed message, but not after the gain-framed message, and intentions to have sex increased for participants who received the gain-framed message first. Yet, participants found it easier to adopt the gain-framed message. Results suggest that loss-framed messages may be particularly effective in reducing intentions to have sex with partners who might pose a higher risk for STIs, and that message presentation order may alter the relative effectiveness of gain- and loss-framed messages on sexual decision making. Future studies should examine the precise conditions under which gain- and loss-framed messages can promote healthy sexual behaviors and reduce sexual risk behaviors.
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