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，在情感，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），危险的性行为和自杀行为增加，并在年轻时达到高峰，可能会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>40 kg/m2）的可行治疗方法，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心理社会共病。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率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/药物影响下的性活动，男性在13岁之前吸烟）。这些风险，再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，肥胖治疗后，青少年的身体和心理健康得到改善，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，如药物使用的增加，危险的性行为（例如，HIV危险行为）和自杀行为，可能会威胁到术后的这些改善。这些是目前由PI和多机构研究者小组通过青少年减肥手术纵向评估（Teen-LABS）联盟（U 01 DK 066568; PI：Inge）、PI的附属辅助研究TeenView（R 01 DK 080020; PI：Zeller）和授予联盟的NIDA补充资金（TeenView 2）研究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短期内（术后前两年）该途径的潜在中介者/调节者提供了基础。我们的初步数据表明，手术前参与高风险行为的比率非常低，一些高风险行为似乎在术后24个月增加到更“规范”的水平。最直接的重要性和拟议研究（TeenView 3）的重点是长期（36，48个月）观察青少年在向年轻成年过渡期间的术后体重和心理社会轨迹，以及更全面地测试影响从减肥手术到参与高风险行为途径的相关风险和保护因素。TeenView 3将通过识别心理社会风险和获益提供关键信息，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.