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

描述(由申请人提供)：青春期是一个独特的发展时期--情感、社会和职业/职业领域的快速变化时期。与此同时，物质使用率(酒精/烟草/毒品)、危险性行为和自杀行为在青年时期增加并达到顶峰，有可能损害健康的心理社会发展。随着减肥手术成为青少年极端肥胖(BMI&GT；40公斤/平方米)的一种可行的治疗方法，关键是要全面了解这些患者在成年后的需求。在手术前，极端肥胖的青少年通常患有一系列与体重相关的内科和心理社会并存。来自具有全国代表性的学校样本的数据表明，极端肥胖的青少年从事许多高危行为的比率与体重正常的同龄人相当，同时还以更危险的方式从事其他行为(例如，女性在酒精/药物影响下的性行为，男性在13岁之前吸烟)。这些风险，再加上与极端肥胖相关的共病，说明了这一群体的脆弱性。最初的文献表明，在肥胖之后，青少年在身体和心理社会健康方面都会有所改善，这有可能积极地改变他们的生活轨迹。然而，一些青少年可能会遇到新的或新出现的风险，如药物使用的增加、危险的性行为(例如，艾滋病毒危险行为)和自杀行为，这些可能威胁到术后这些改善。这些都是目前由PI和一个多机构调查小组通过减肥手术青少年纵向评估(Teen-Labs)财团(U01 DK066568；PI：INGE)、PI的附属辅助研究TeenView(R01DK080020；PI：Zeller)和授予该财团的NIDA补充基金(TeenView2)调查的文献中的严重空白。总而言之，这些里程碑式的努力是第一次前瞻性对照观察研究，为了解青少年减肥手术对高危行为的影响以及短期内(手术后前两年)这一途径的潜在调节/调节因素奠定了基础。我们的初步数据显示，高危行为在手术前的参与率非常低，一些高危行为在手术后24个月似乎增加到更“正常”的水平。直接重要的是，这项拟议研究(TeenView3)的重点是对青少年在过渡到青壮年期间的术后体重和心理社会轨迹进行较长期(36，48个月)的观察，以及更全面地测试影响从减肥手术到参与高风险行为的相关风险和保护因素。TeenView3将通过识别心理社会风险和益处来提供关键信息，这将定义未来青少年患者的临床决策和管理。 公共卫生相关性：青少年高危行为(酒精/烟草/毒品使用、性行为和自杀行为)不仅是公共卫生关注的焦点，而且对接受减肥手术的青少年进行研究也是及时确定下一代青少年患者的身心健康需求。这项拟议研究的成功完成将提供证据，证明青春期减肥手术的长期益处，以及与青春期手术减肥相关的独特或新出现的风险因素，这些因素可能会影响青少年的健康。因此，这项拟议研究的结果有可能显著影响临床实践、手术候选和这一特定年龄段的术后护理模式的发展。

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. PUBLIC HEALTH RELEVANCE: Not only are adolescent high-risk behaviors (alcohol/tobacco/drug use, sexual behaviors, and suicidal behaviors) a public health focus, but the study of them in adolescents undergoing bariatric surgery is timely to determine the physical and mental health needs for the next generation of adolescent patients. Successful completion of the proposed study will provide evidence of the longer-term benefits of adolescent bariatric surgery and the unique or emerging risk factors associated with adolescent surgical weight loss that may impact health in the young adulthood. Hence, findings from the proposed study have the potential to markedly influence clinical practice, surgical candidacy and the development of post-operative care models for this specific age group.