virus infection or unintended pregnancy; tobacco use; dietary behaviors that contribute to adult morbidity and mortality; and physical inactivity.
Adolescents are more prone to athletic injuries and suicide than children at other developmental periods. In a study (Baumert, Henderson, & Thompson, 1998) surveying high school students in grades 9 through 12, athletes and nonathletes were found to differ in specific health risk behaviors. Adolescent athletes appear less likely to smoke cigarettes or marijuana, more likely to engage in healthy dietary behaviors, and less likely to feel bored or hopeless.
Peterson and Brown (1994) reviewed the literature on unintentional injuries in children. They pointed out the similarities between factors predicting both unintentional injuries and child neglect. It was not until the 1980s that the focus shifted from the physical environment to sociocultural and personal factors, including the immediate environment and the skills and abilities of the parents. A deficit in problem solving and a failure to provide appropriate supervision appear to be difficult constructs to measure as both involve a lack of response. In coming up with a working model to encompass all of the etiological factors for child injury, they provide both caregiver- based and child-based variables. Several studies showed that stress contributes to risk of child injury. Thus, families who exist in poverty, chaos, crowding, and residence change have a higher chance of having a vulnerable child. Social isolation may increase caregiver stress, particularly in young single mothers. Maternal depression may be a particularly critical injury risk factor (Garbarino et al., 1991).
A recent study (Kramer, Warner, Olfson, Ebanks, Chaput, & Weissman, 1998) of the offspring of depressed parents found that there is an increased susceptibility to specific medical conditions and hospitalization relative to the depression status of both the parent and the offspring. The study revealed that the offspring depression status was associated with a history of general medical problems and hospital visits only among those offspring who also had a depressed parent. The association was demonstrated for genitourinary disorders, headaches, respiratory disorders, and hospitalizations. Parental depression without considering offspring depression was limited to a report of unconsciousness in the offspring and may be related to an increased prevalence of accidents resulting from inadequate parental monitoring among depressed parents. These findings were consistent with a longitudinal study of children of depressed parents (Billings & Moos, 1985). They found that the offspring of depressed parents had more general medical problems, more health risk factors (i.e., smoking, drinking, and drug use), and poorer functioning than children of nondepressed controls. It was further found that having a parent with a lifetime measurement of depression even if it had remitted, still presents a risk for medical problems. In the two-generation study, it was found that a history of depression in both the offspring and the parents was necessary to exhibit a significant association between depression and medical problems. However, these results may be due to either genetic or environmental influences or both. There is some association between allergies and depression, which may mean that both dysfunction in the adrenergic and cholinergic systems may predispose people to both atopic disorders (e.g., allergy and asthma) and some forms of depression. This may be passed on genetically, thus producing the medical comorbidity only among those with two generations of depression.
Thus, within each of the areas of research reviewed, it is important to consider the parents' state of stability, ongoing stressors in the home, and the childrens' developmental age in the assessment and treatment programming of the health care team. The first task of a functional analysis would be to view the problem within the framework of what developmental tasks need to be accomplished during the next 5 years of the child's life. Differences between independence struggles and age capacities will indicate how involved the parent should be in the implementing of the medical program. Often compliance can be improved by educational discussions and nonthreatening guidance of parents in more appropriate problem solving. In the case of adolescents, they may be encouraged to modify the program to fit in more with their life style and identification needs. Especially in the area of suspected child neglect when too many visits to the emergency room with accidents or asthmatic attacks occur, the parent needs to feel believed and not evaluated or blamed for the injury or failure of medical compliance. A team approach by the hospital staff and health consultants would allow better supervision and more constructive individualization of programs as multiple input will pinpoint strengths and weaknesses in each individual involved in the care of children. When parental depression is lifelong, it may be necessary to encourage an independent evaluation of the suffering parent so that medication and social support from the other spouse may be improved. In impoverished environments due to dysfunctional families, low access to health care, poverty, crowdedness, or environmental hazards, the school could serve as an entry point for mobilizing community resources.
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