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——一个在情感、社会和职业/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比率增加，并在青年期达到顶峰，可能损害健康的心理社会发展。随着减肥手术成为极端肥胖青少年（BMI为40 kg/m2）的一种可行治疗方法，在这些患者进入青年期时，建立一个全面的需求图是至关重要的。在手术之前，极度肥胖的青少年通常患有一系列与体重相关的医学和社会心理合并症。来自具有全国代表性的学校样本的数据表明，与体重正常的同龄人相比，极度肥胖的青少年从事许多高风险行为的比例相当，同时还从事其他更危险的行为（例如，女性在酒精/毒品的影响下进行性活动，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，说明了这一亚群的脆弱性。最初的文献表明，在减肥手术后，青少年的身体和心理健康得到改善，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正在出现的风险，如药物使用增加、危险性行为（如艾滋病毒风险行为）和自杀行为，这些可能会威胁到术后的这些改善。这些是目前PI和一个多机构研究小组通过青少年减肥手术纵向评估（Teen- labs）联盟（U01 DK066568; PI: Inge）， PI附属的辅助研究TeenView （R01DK080020; PI: Zeller）和NIDA向该联盟提供的补充资金（TeenView2）调查的文献中的关键空白。总之，这些具有里程碑意义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危行为的影响以及该途径在短期内（术后头两年）的潜在调节因子/调节因子提供了基础。我们的初步数据表明，手术前高危行为的发生率非常低，一些高危行为在术后24个月似乎增加到更“规范”的水平。当前最重要的，也是本研究的重点（TeenView3）是长期（36,48个月）观察青少年在向青年成年过渡期间的术后体重和社会心理轨迹，以及更全面地测试影响从减肥手术到参与高危行为途径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，这些信息将定义未来青少年患者的临床决策和管理。

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.