Tracking Adolescents After Bariatric Surgery: Substance, HIV and Suicide Risks

追踪减肥手术后的青少年：物质、艾滋病毒和自杀风险

• 批准号: 8840559
• 负责人: MARGARET H ZELLER
• 金额: $ 40.2万
• 依托单位: CINCINNATI CHILDRENS HOSP MED CTR
• 依托单位国家: 美国
• 财政年份: 2012
• 资助国家: 美国
• 起止时间: 2012-05-15 至 2016-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8840559
• 关键词: Accounting; Adolescence; Adolescent; Affect; Age; Alcohol or Other Drugs use; Alcohols; Ancillary Study; Award; Bariatrics; Behavior; Benefits and Risks; Body Weight decreased; Caring; Comorbidity; Data; Deceleration; Development; Drug usage; Emotional; Ensure; Epidemiologic Studies; Exposure to; Family history of; Feeling suicidal; Female; Foundations; Funding; Future; HIV risk; Health; Impulsivity; Individual; Life; Literature; Mediating; Mediator of activation protein; Medical; Mental Health; Modeling; Morbid Obesity; National Institute of Drug Abuse; Obesity; Observational Study; Operative Surgical Procedures; Pathway interactions; Patients; Personality Traits; Pharmaceutical Preparations; Positioning Attribute; Postoperative Period; Public Health; Publishing; Relative (related person); Research Personnel; Risk; Risk Behaviors; Risk Factors; Sampling; Schools; Sex Behavior; Smoking; Suicide; Teenagers; Testing; Time; Tobacco; Variant; Weight; adolescent patient; age group; bariatric surgery; base; career; clinical decision-making; clinical practice; depressive symptoms; emerging adult; emerging adulthood; experience; healthy weight; high risk; high risk behavior; high risk sexual behavior; improved; male; next generation; peer; physical conditioning; prospective; psychologic; psychosocial; psychosocial adjustment; psychosocial development; social; social skills; suicidal behavior; suicidal risk; young adult

DESCRIPTION (provided by applicant): Adolescence is a unique time in development-a period of rapid change in emotional, social and career/vocational domains. At the same time, rates of substance use (alcohol/tobacco/drug), risky sexual behavior, and suicidal behavior increase and peak in young adulthood, potentially compromising healthy psychosocial development. As bariatric surgery emerges as a viable treatment for adolescents with extreme obesity (BMI>40 kg/m2), it is critical to establish a comprehensive picture of the needs of these patients as they mature into young adulthood. Prior to surgery, adolescents with extreme obesity typically suffer from a range of weight-related medical and psychosocial comorbidities. Data from a nationally representative school-based sample indicated that adolescents with extreme obesity in engaged in many high-risk behaviors at comparable rates to healthy-weight peers, while also engaging in other behaviors in more dangerous ways (e.g., sexual activity in females while under the influence of alcohol/drugs, smoking in males before age 13). These risks, combined with the comorbidities associated with extreme obesity, illustrate the vulnerability of this subpopulation. The initial literature indicates that following bariatric surgry, adolescents experience improvements in physical and psychosocial health which have the potential to positively alter their life trajectory. However, some adolescents may encounter new or emerging risks, such as increases in substance use, risky sexual behavior (e.g., HIV-risk behaviors) and suicidal behavior that may threaten these improvements postoperatively. These are critical gaps in the literature currently being investigated by the PI and a multi- institutionl group of investigators through the Teen Longitudinal Assessment of Bariatric Surgery (Teen-LABS) consortium (U01 DK066568; PI: Inge), the PI's affiliated ancillary study TeenView (R01DK080020; PI: Zeller) and NIDA supplemental funds awarded to the consortium (TeenView2). Together, these landmark efforts represent the first prospective controlled observational studies to provide a foundation for the understanding of the impact of adolescent bariatric surgery on high-risk behaviors as well as the potential mediators/moderators of that pathway in the short term (1st two post-operative years). Our initial data suggest remarkably low rates of engagement in high-risk behaviors prior to surgery, with some high-risk behaviors appearing to increase to more "normative" levels at 24-months post-operatively. Of immediate importance, and the focus of the proposed study (TeenView3), is the longer-term (36, 48-month) observation of postoperative weight and psychosocial trajectories for adolescents during the transition to young adulthood, as well as a more comprehensive testing of relevant risk and protective factors affecting the pathway from bariatric surgery to engagement in high-risk behaviors. TeenView3 will provide critical information by identifying psychosocial risks and benefits which will define clinical decision-making and management for future adolescent patients.

描述（由申请人提供）：青春期是一个独特的发展时期——情感、社交和职业/职业领域快​​速变化的时期。与此同时，物质使用（酒精/烟草/毒品）、危险性行为和自杀行为的发生率会增加，并在成年早期达到顶峰，可能会损害健康的社会心理发展。随着减肥手术成为极度肥胖青少年（BMI>40 kg/m2）的可行治疗方法，全面了解这些患者进入青年期的需求至关重要。在手术之前，极度肥胖的青少年通常会患有一系列与体重相关的医学和心理社会并发症。来自全国代表性学校样本的数据表明，极度肥胖的青少年从事许多高风险行为的比例与健康体重的同龄人相当，同时也以更危险的方式从事其他行为（例如，女性在酒精/毒品影响下进行性活动，男性在 13 岁之前吸烟）。这些风险，加上与极度肥胖相关的合并症，说明了该亚群的脆弱性。最初的文献表明，减肥手术后，青少年的身体和社会心理健康得到改善，这有可能积极改变他们的生活轨迹。然而，一些青少年可能会遇到新的或正在出现的风险，例如物质使用的增加、危险的性行为（例如艾滋病毒风险行为）和自杀行为，这些可能会威胁术后的这些改善。目前，PI 和多机构研究人员小组正在通过青少年减肥手术纵向评估 (Teen-LABS) 联盟（U01 DK066568；PI：Inge）、PI 附属辅助研究 TeenView（R01DK080020；PI：Zeller）和 NIDA 向 联盟（TeenView2）。总之，这些里程碑式的努力代表了第一个前瞻性对照观察性研究，为了解青少年减肥手术对高风险行为的影响以及短期内（术后头两年）该途径的潜在调节因素/调节因素奠定了基础。我们的初步数据表明，手术前高风险行为的参与率非常低，一些高风险行为似乎在术后 24 个月时增加到更“规范”的水平。所提出的研究（TeenView3）的当务之急是对青少年在向成年早期过渡期间的术后体重和心理社会轨迹进行长期（36、48 个月）观察，以及对影响从减肥手术到从事高风险行为的相关风险和保护因素进行更全面的测试。 TeenView3 将通过识别社会心理风险和益处来提供关键信息，从而定义未来青少年患者的临床决策和管理。