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Health Status of Well vs Ill Adolescents

Health Status of Well vs Ill Adolescents Abstract Background: Accountability of health services in meeting needs and assessing outcomes is hampered by the absence of tools to assess health, especially in children and youth. Because it is no longer adequate to assess health by a narrow focus on biological and physiological measurers, instruments that assess functional status, person-focused general health status, and overall well-being in a more comprehensive way are needed. Objective: To examine whether a health status instrument we have developed discriminates between teenagers in schools and teenagers attending clinics for acute or chronic conditions. Methods: Teenagers (aged 11-17 years) in schools and in general medical and specialty clinics completed a questionnaire The Child Health and Illness Profile-Adolescent Edition (CHIP-AE), comprehensively covering aspects of health in 6 domains: discomfort, satisfaction with health, disorders, achievement of social expectations, risks, and resilience. Results: Acutely ill teenagers reported more physical discomfort, minor illnesses, and lower physical fitness; chronically ill teenagers reported more limitations of activity, long-term medical disorders, dissatisfaction with their health, and less physical fitness than teenagers in the school samples. Age, sex, and social class did not explain the differences. Teenagers within the acutely and chronically ill clinic populations differed substantially in their health status. Implications: Availability of a comprehensive instrument (CHIP-AE) to assess adolescent health provides a means of documenting health needs and outcomes in populations of teenagers with acute or chronic illness. The heterogeneity within these groups provides support for a person-focused (rather than a disease-focused) approach to assessing both needs for care and the influence of care on promoting health.Arch Pediatr Adolesc Med. 1996;150:1249-1256 References 1. Roper WL. Perspectives on physician-payment reform: the resource-based relative-value scale in contex . N Engl J Med . 1988;319:865-867.Crossref 2. Starfield B, Vivier P. Population and selective (high risk) approaches to prevention in well child care . In: Solloway MR, Budetti PP, eds. Child Health Supervision: Analytical Studies in the Financing, Delivery, and Cost-Effectiveness of Preventive and Health Promotion Services for Infants, Children, and Adolescents . Arlington, Va: National Center for Education in Maternal and Child Health 1995:274-306. 3. Wilson I, Cleary P. Linking clinical variables with health-related quality of life: a conceptual model of patient outcomes . JAMA . 1995;273:59-65.Crossref 4. Ingersoll GM, Marrero DG. A modified quality-of-life measure for youths: psychometric properties . Diabetes Educ . 1991;17:114-118.Crossref 5. Cousens P, Waters B, Said J, Stevens M. Cognitive effects of cranial irradiation in leukemia: a survey and meta-analysis . J Child Psychol Psychiatry . 1988; 29:839-852.Crossref 6. Mulhern RK, Wasserman AL, Friedman AG, Fairclough D. Social competence and behavioral adjustment of children who are long-term survivors of cancer . Pediatrics . 1989;83:18-25. 7. Croog SH, Levine S, Testa MA, et al. The effects of antihypertensive therapy on the quality of life . N Engl J Med . 1986;314:1657-1664.Crossref 8. Starfield B, Bergner M, Ensminger M, et al. Adolescent health status measurement: development of CHIP . Pediatrics . 1993;91:430-435. 9. Offord D, Boyle M, Szatmari P, et al. Ontario Child Health Study, II: six-month prevalence of disorder and rates of service utilization . Arch Gen Psychiatry . 1987;44:832-836.Crossref 10. Wallander JL, Varni IW, Babani L, Banis HT, Wilcox KT. Children with chronic physical disorders: maternal reports of their psychological adjustment . J Pediatr Psychol . 1988;13:197-212.Crossref 11. Bussing R, Halfon N, Benjamin B, Wells KB. Prevalence of behavior problems in US children with asthma . Arch Pediatr Adolesc Med . 1995;149:565-572.Crossref 12. Olson AL, Boyle WE, Evans WM, Zug LA. Overall function in rural childhood cancer surviviors: the role of social competence and emotional health . Clin Pediatr . 1993;32:334-342.Crossref 13. Long N, Starfield B, Kelleher K. Childhood co-morbidity of psychiatric disorders in pediatric primary care . In: Miranda J, Hohmann A, Attkisson C, Larson D, eds. Mental Disorders in Primary Care . San Francisco, Calif: Jossey-Bass; 1994:109-135. 14. Cadman D, Boyle MH. Szatmari P, Offord DR. Chronic illness, disability, and mental and social well-being: findings of the Ontario Child Health Study . Pediatrics . 1987;79:805-813. 15. Stein R & Jessop D. A noncategorical approach to chronic childhood illness . Public Health Rep . 1982;97:354-362. 16. Starfield B, Riley AW, Green BF, et al. The adolescent CHIP: a population-based measure of health . Med Care . 1995;33:553-556.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Pediatrics & Adolescent Medicine American Medical Association

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Publisher
American Medical Association
Copyright
Copyright © 1996 American Medical Association. All Rights Reserved.
ISSN
1072-4710
eISSN
1538-3628
DOI
10.1001/archpedi.1996.02170370027003
Publisher site
See Article on Publisher Site

Abstract

Abstract Background: Accountability of health services in meeting needs and assessing outcomes is hampered by the absence of tools to assess health, especially in children and youth. Because it is no longer adequate to assess health by a narrow focus on biological and physiological measurers, instruments that assess functional status, person-focused general health status, and overall well-being in a more comprehensive way are needed. Objective: To examine whether a health status instrument we have developed discriminates between teenagers in schools and teenagers attending clinics for acute or chronic conditions. Methods: Teenagers (aged 11-17 years) in schools and in general medical and specialty clinics completed a questionnaire The Child Health and Illness Profile-Adolescent Edition (CHIP-AE), comprehensively covering aspects of health in 6 domains: discomfort, satisfaction with health, disorders, achievement of social expectations, risks, and resilience. Results: Acutely ill teenagers reported more physical discomfort, minor illnesses, and lower physical fitness; chronically ill teenagers reported more limitations of activity, long-term medical disorders, dissatisfaction with their health, and less physical fitness than teenagers in the school samples. Age, sex, and social class did not explain the differences. Teenagers within the acutely and chronically ill clinic populations differed substantially in their health status. Implications: Availability of a comprehensive instrument (CHIP-AE) to assess adolescent health provides a means of documenting health needs and outcomes in populations of teenagers with acute or chronic illness. The heterogeneity within these groups provides support for a person-focused (rather than a disease-focused) approach to assessing both needs for care and the influence of care on promoting health.Arch Pediatr Adolesc Med. 1996;150:1249-1256 References 1. Roper WL. Perspectives on physician-payment reform: the resource-based relative-value scale in contex . N Engl J Med . 1988;319:865-867.Crossref 2. Starfield B, Vivier P. Population and selective (high risk) approaches to prevention in well child care . In: Solloway MR, Budetti PP, eds. Child Health Supervision: Analytical Studies in the Financing, Delivery, and Cost-Effectiveness of Preventive and Health Promotion Services for Infants, Children, and Adolescents . Arlington, Va: National Center for Education in Maternal and Child Health 1995:274-306. 3. Wilson I, Cleary P. Linking clinical variables with health-related quality of life: a conceptual model of patient outcomes . JAMA . 1995;273:59-65.Crossref 4. Ingersoll GM, Marrero DG. A modified quality-of-life measure for youths: psychometric properties . Diabetes Educ . 1991;17:114-118.Crossref 5. Cousens P, Waters B, Said J, Stevens M. Cognitive effects of cranial irradiation in leukemia: a survey and meta-analysis . J Child Psychol Psychiatry . 1988; 29:839-852.Crossref 6. Mulhern RK, Wasserman AL, Friedman AG, Fairclough D. Social competence and behavioral adjustment of children who are long-term survivors of cancer . Pediatrics . 1989;83:18-25. 7. Croog SH, Levine S, Testa MA, et al. The effects of antihypertensive therapy on the quality of life . N Engl J Med . 1986;314:1657-1664.Crossref 8. Starfield B, Bergner M, Ensminger M, et al. Adolescent health status measurement: development of CHIP . Pediatrics . 1993;91:430-435. 9. Offord D, Boyle M, Szatmari P, et al. Ontario Child Health Study, II: six-month prevalence of disorder and rates of service utilization . Arch Gen Psychiatry . 1987;44:832-836.Crossref 10. Wallander JL, Varni IW, Babani L, Banis HT, Wilcox KT. Children with chronic physical disorders: maternal reports of their psychological adjustment . J Pediatr Psychol . 1988;13:197-212.Crossref 11. Bussing R, Halfon N, Benjamin B, Wells KB. Prevalence of behavior problems in US children with asthma . Arch Pediatr Adolesc Med . 1995;149:565-572.Crossref 12. Olson AL, Boyle WE, Evans WM, Zug LA. Overall function in rural childhood cancer surviviors: the role of social competence and emotional health . Clin Pediatr . 1993;32:334-342.Crossref 13. Long N, Starfield B, Kelleher K. Childhood co-morbidity of psychiatric disorders in pediatric primary care . In: Miranda J, Hohmann A, Attkisson C, Larson D, eds. Mental Disorders in Primary Care . San Francisco, Calif: Jossey-Bass; 1994:109-135. 14. Cadman D, Boyle MH. Szatmari P, Offord DR. Chronic illness, disability, and mental and social well-being: findings of the Ontario Child Health Study . Pediatrics . 1987;79:805-813. 15. Stein R & Jessop D. A noncategorical approach to chronic childhood illness . Public Health Rep . 1982;97:354-362. 16. Starfield B, Riley AW, Green BF, et al. The adolescent CHIP: a population-based measure of health . Med Care . 1995;33:553-556.Crossref

Journal

Archives of Pediatrics & Adolescent MedicineAmerican Medical Association

Published: Dec 1, 1996

References