BackgroundThe North American non-surgical standard of care for adolescent idiopathic scoliosis (AIS) includes observation and bracing, but not exercises. Schroth physiotherapeutic scoliosis-specific exercises (PSSE) showed promise in several studies of suboptimal methodology. The Scoliosis Research Society calls for rigorous studies supporting the role of exercises before including it as a treatment recommendation for scoliosis.ObjectivesTo determine the effect of a six-month Schroth PSSE intervention added to standard of care (Experimental group) on the Cobb angle compared to standard of care alone (Control group) in patients with AIS.MethodsFifty patients with AIS aged 10–18 years, with curves of 10°-45° and Risser grade 0–5 were recruited from a single pediatric scoliosis clinic and randomized to the Experimental or Control group. Outcomes included the change in the Cobb angles of the Largest Curve and Sum of Curves from baseline to six months. The intervention consisted of a 30–45 minute daily home program and weekly supervised sessions. Intention-to-treat and per protocol linear mixed effects model analyses are reported.ResultsIn the intention-to-treat analysis, after six months, the Schroth group had significantly smaller Largest Curve than controls (-3.5°, 95% CI -1.1° to -5.9°, p = 0.006). Likewise, the between-group difference in the square root of the Sum of Curves was -0.40°, (95% CI -0.03° to -0.8°, p = 0.046), suggesting that an average patient with 51.2° at baseline, will have a 49.3° Sum of Curves at six months in the Schroth group, and 55.1° in the control group with the difference between groups increasing with severity. Per protocol analyses produced similar, but larger differences: Largest Curve = -4.1° (95% CI -1.7° to -6.5°, p = 0.002) and (95% CI -0.8 to 0.2, p = 0.006).ConclusionSchroth PSSE added to the standard of care were superior compared to standard of care alone for reducing the curve severity in patients with AIS.Trial RegistrationNCT01610908

IMPORTANCE Parents’ beliefs about what they need to do to be a good parent when their children are seriously ill influence their medical decisions, and better understanding of these beliefs may improve decision support. OBJECTIVE To assess parents’ perceptions regarding the relative importance of 12 good-parent attributes. DESIGN, SETTING, AND PARTICIPANTS A cross-sectional, discrete-choice experiment was conducted at a children’s hospital. Participants included 200 parents of children with serious illness. MAIN OUTCOMES AND MEASURES Ratings of 12 good-parent attributes, with subsequent use of latent class analysis to identify groups of parents with similar ratings of attributes, and ascertainment of whether membership in a particular group was associated with demographic or clinical characteristics. RESULTS The highest-ranked good-parent attribute was making sure that my child feels loved, followed by focusing on my child’s health, making informed medical care decisions, and advocating for my child with medical staff. We identified 4 groups of parents with similar patterns of good-parent–attribute ratings, which we labeled as: child feels loved (n = 68), child’s health (n = 56), advocacy and informed (n = 55), and spiritual well-being (n = 21). Compared with the other groups, the child’s health group reported more financial difficulties, was less educated, and had a higher proportion of children with new complex, chronic conditions. CONCLUSIONS AND RELEVANCE Parents endorse a broad range of beliefs that represent what they perceive they should do to be a good parent for their seriously ill child. Common patterns of how parents prioritize these attributes exist, suggesting future research to better understand the origins and development of good-parent beliefs among these parents. More important, engaging parents individually regarding what they perceive to be the core duties they must fulfill to be a good parent may enable more customized and effective decision support.

The effects of parental attitudes, practices, and television mediation on adolescent sexual behaviors were investigated in a study of adolescent sexuality and media (N=887). Confirmatory factor analyses supported an eight-factor parenting model with television mediation factors as constructs distinct from general parenting practices. Logistic regressions indicated that adolescents reporting greater parental disapproval and limits on viewing at Wave 1 were less likely to initiate oral sex between Waves 1 and 2. Adolescents who reported more sexual communication with parents were more likely to initiate oral sex. Results for vaginal intercourse were similar to those for oral sex. Co-viewing was a significant negative predictor of initiation of sexual behavior. Parental attitudes and television mediation can delay potentially risky adolescent sexual behaviors. KeywordsAdolescent sexual/contraceptive behavior; media; parenting Although national statistics indicate that the percentage of adolescents who report having engaged in sexual intercourse has decreased from 54% to 46% over the last decade (CDC, 2006), recent research suggests that youth may be supplanting one form of risky behavior with other potentially risky sexual behaviors such as oral sex (Mosher, Chandra, & Jones, 2005). For example, over half of adolescents aged 15 -19 (55% of males and 54% of females) report having ever had oral sex, with a significantly greater proportion of older youth reporting having engaged in oral sex (71%) relative to younger teens (43%). These data give cause for concern as research shows that oral sex places individuals at risk for sexually transmitted infections (STIs) such as human papillomavirus (HPV) and gonorrhea and may also be a greater factor in HIV transmission than previously thought (Edwards & Carne, 1998;Hawkins, 2001;Robinson & Evans, 1999). Given the prevalence and potential risks associated with both oral sex and vaginal intercourse such as unwanted pregnancy and STIs, it is important to understand the psychosocial factors that are predictive of involvement in these sexual behaviors in order to design effective prevention programs.Several decades of parent-child research have identified an extensive set of familial factors and parenting processes that influence adolescent risky behaviors and development both directly and indirectly (see Maccoby & Martin, 1983;Miller, 2002). These variables include genetic influences, structural features, parenting practices/family management, parenting style and emotional relationships. Studies have routinely found relationships between these parenting factors and adolescent sexual behaviors such as intercourse initiation and contraceptive use (see Kotchick, Shaffer, Forehand, & Miller, 2001;Meshke, Bartholomae, & Zentall., 2002;Huebner & Howell, 2003). Additionally, over 25 studies on parenting and adolescent sexuality/sexual behavior have been presented or published using the National Longitudinal Study of Adolescent Health, a large scale national data set with in-de...

As part of a larger study on television exposure, 1,276 shows from the 2001-2002 television season were coded for sexual content. Compared to previous research, this study sampled more networks targeted to adolescents and examined differences across additional program genres. A unique feature is the assessment of sexual content across network types. Three genres were distinguished by high percentages of shows with sexual behavior and talk and greater explicitness. This pattern characterized premium cable movie channels compared to broadcast and other cable networks. Few genres consistently offer programming that is free of sexual content during peak times for teen viewing.

Coping support interventions can alleviate parents' psychological distress during children's hospitalization. More evidence is needed to determine if such interventions benefit children.

Little research has been conducted to examine the influence of exposure to televised sexual content on adolescent sexuality or how parental intervention may reduce negative effects of viewing such content. This study uses self-report data from 1,012 adolescents to investigate the relations among exposure to sexually suggestive programming, parental mediation strategies, and three types of adolescent sexuality outcomes: participation in oral sex and sexual intercourse, future intentions to engage in these behaviors, and sex expectancies. As predicted, exposure to sexual content was associated with an increased likelihood of engaging in sexual behaviors, increased intentions to do so in the future, and more positive sex expectancies. Often, parental mediation strategies were a significant factor in moderating these potential media influences.

Purpose-The current study examined adolescent conceptualizations of virginity and abstinence and whether differences in adolescent definitions of these terms differed by age, gender, ethnicity, and sexual experience.Methods-A series of logistic regressions were conducted to examine whether gender, age, ethnicity and sexual experience predicted whether adolescents believed that an individual was still a virgin or abstinent after engaging in genital touching, oral sex, vaginal intercourse, or anal sex.Results-Findings indicated that loss of virginity was linked primarily with vaginal and anal intercourse. While greater proportion of adolescents attributed a loss of abstinence to lower genital touching and oral sex behaviors as well, significant variability emerged in how abstinent behavior was defined. Sexual experience was the strongest predictor of how adolescents defined virginity and abstinence.Conclusions-Significant differences exist in youths' definitions of abstinence and virginity. This suggests that additional attention is needed to ensure a common understanding of these terms in order to achieve successful sexual education and prevention programs. KeywordsAdolescence; virginity; abstinence In light of the increased attention given to virginity pledges and abstinence programs aimed at delaying adolescent vaginal intercourse, understanding adolescents' conceptualizations of sexual behavior has become increasingly important. Do adolescents who pledge to remain a virgin believe that behaviors other than vaginal intercourse are acceptable and outside the scope of their pledges? Does abstinence include touching a partner's genitals and/or participating in oral sex? It is unknown whether adolescents may be engaging in non-coital sexual behaviors such as oral sex more frequently than vaginal intercourse because they believe they will remain virgins, or alternatively, because they believe they are engaging in abstinent behavior. The current study is a first step at understanding adolescent sexual behavior by assessing how adolescents define a range of sexual behaviors in terms of virginity and abstinence.Previous studies addressing conceptualizations of virginity and abstinence have been conducted primarily among young adults. 1,2 For example, one study asked college students to indicate whether each of 11 different sexual behaviors would be considered "having sex" if it was the most intimate behavior one engaged in with a partner. The items included deep kissing, oral (mouth) contact with breasts or nipples, and penile-anal intercourse. The results indicate that few college students considered deep kissing as sex (2%) whereas almost all considered penile-vaginal intercourse as having sex (99.5%). Interestingly, 60% did not think that oral-genital contact constitutes having sex whereas 81% believed that penile-anal intercourse does count as having sex. 1 Males were more likely than females to indicate that less risky sexual behaviors (e.g., genital touching) counted as having sex, although there were few...

BackgroundParents of seriously ill children participate in making difficult medical decisions for their child. In some cases, parents face situations where their initial goals, such as curing the condition, may have become exceedingly unlikely. While some parents continue to pursue these goals, others relinquish their initial goals and generate new goals such as maintaining the child’s quality of life. We call this process of transitioning from one set of goals to another regoaling.DiscussionRegoaling involves factors that either promote or inhibit the regoaling process, including disengagement from goals, reengagement in new goals, positive and negative affect, and hopeful thinking. We examine these factors in the context of parental decision making for a seriously ill child, presenting a dynamic conceptual model of regoaling. This model highlights four research questions that will be empirically tested in an ongoing longitudinal study of medical decision making among parents of children with serious illness. Additionally, we consider potential clinical implications of regoaling for the practice of pediatric palliative care.SummaryThe psychosocial model of regoaling by parents of children with a serious illness predicts that parents who experience both positive and negative affect and hopeful patterns of thought will be more likely to relinquish one set of goals and pursue a new set of goals. A greater understanding of how parents undergo this transition may enable clinicians to better support them through this difficult process.