The health and well-being of adolescents: a school-based population study of the self-report Child Health Questionnaire

doi:10.1016/S1054-139X(01)00211-7

Journal of Adolescent Health

Volume 29, Issue 2, August 2001, Pages 140-149

https://doi.org/10.1016/S1054-139X(01)00211-7 Get rights and content

Abstract

Purpose: To evaluate a new generic measure of adolescent health status, the self-report version of the Child Health Questionnaire (CHQ), and provide population-based data. Furthermore, we aimed to examine the impact of common adolescent illness and health concerns on their health and well-being.

Methods: A stratified, two-stage, random cluster sampling design was used to obtain a cross-sectional sample of subjects through schools. A written questionnaire included the 80-item 12-scale self-report CHQ and items measuring health concerns, illnesses/health conditions, and sociodemographics.

Results: A total of 2361 adolescents participated (response rate of 70%). Reliability was high: Tests of internal consistency and discriminant validity reported 90% of item-scale correlations >.4; all scales had Cronbach alpha coefficients >.7. Adolescents with illnesses/conditions or health concerns reported lower scores and larger differences for content-related scales, supporting content and construct validity. Statistically significant age and gender trends were observed for Mental Health, Self-Esteem, General Health, and Family Cohesion scales. Health status worsened as health concerns increased (X² linear trend, p = .00) with deterioration in health of 5–20% on all scales for emotional health concerns (40% of sample).

Conclusions: The self-report CHQ is a reliable and seemingly valid measure of health and well-being for adolescent health research, although additional measures may be required where scales have high ceiling values. The significantly lower scores reported by adolescents with illness and/or health concerns lend support to the use of standardized health measures and longitudinal research to further examine the impact of adolescent comorbidities and their causal determinants.

Section snippets

Methodology

The data were collected within the Health of Young Victorians Study (HOYVS), a school-based epidemiologic study of children and adolescents conducted between July and November 1997 in Victoria, Australia. Questionnaires were provided to adolescents and their parents; this study reports the adolescent self-reported data.

Results

A total of 2361 adolescents completed the CHQ self-report form (CHQ CF80), representing a response rate of 70% (53% male). Mean age of the sample was 15.13 years (SD 1.75). Eighty-eight percent of adolescents were born in Australia, with higher proportions of the remaining adolescents being born in the United Kingdom and Ireland, Vietnam, Hong Kong, the Philippines, and China; 0.01% of the sample was of Aboriginal or Torres Strait Islander descent.

Discussion

This study evaluated a new generic self-report measure of adolescent health status (CHQ CF80) and provides comprehensive evidence from a large population-based cross-sectional sample of its reliability and validity. In doing so, the CHQ enabled us to describe the impact common illnesses and frequently reported health concerns have on the health and well-being of adolescents. Population-based normative data of the CHQ mean scale scores, attained from this large representative sample of

Acknowledgements

This project was funded by the Public Health Branch, Victorian Government Department of Human Services.

References (44)

D Raphael et al.
The Quality of Life Profile–Adolescent VersionBackground, description and initial validation
J Adolesc Health
(1996)
D.A Bukstein et al.
Evaluation of a short form for measuring health-related quality of life among pediatric asthma patients
J Allergy Clin Immunol
(2000)
The Health of Young Victorians
(1998)
R Wilkinson et al.
Social Determinants of HealthThe Solid Facts
(1999)
B Starfield et al.
The adolescent child health and illness profileA population-based measure of health
Med Care
(1995)
R Levi et al.
Critical issues and needs in health-related quality of life assessment of children and adolescents with chronic health conditions
Official Records of the World Health Organization No. 2
(1948)
M Apajasalo et al.
Quality of life in pre-adolescenceA 17-dimensional health-related measure (17D)
Qual Life Res
(1996)
M Apajasalo et al.
Quality of life in early adolescenceA sixteen-dimensional health-related measure (16D)
Qual Life Res
(1996)
P Graham et al.
A new measure of health-related quality of life for childrenPreliminary findings
Psychol Health
(1997)

U Ravens-Sieberer et al.

Assessing health-related quality of life in chronically ill children with the German KINDLFirst psychometric and content analytical results

Qual Life Res

(1998)

J.W Varni et al.

The PedsQLMeasurement model for the pediatric quality of life inventory

Med Care

(1999)

J.H Wasson et al.

A short survey for assessing health and social problems of adolescents

J Fam Pract

(1994)

J.M Landgraf et al.

The CHQ User’s Manual

(1996)

R.K Stein et al.

Functional status II(R)A measure of child health-status

Med Care

(1990)

T Vogels et al.

Measuring health-related quality of life in childrenThe development of the TACQOL parent form

Qual Life Res

(1998)

J Collier et al.

Developing a generic child quality of life measure

Health Psychol Update

(1997)

N.M Theunissen et al.

The proxy problemChild report versus parent report in health-related quality of life research

Qual Life Res

(1998)

D.R Dossetor et al.

Measuring health outcome in paediatricsDevelopment of the RAHC measure of function

J Paediatr Child Health

(1996)

G Singh et al.

Measurement of health-status in children with juvenile rheumatoid-arthritis

Arthritis Rheum

(1994)

B Lindstrom et al.

Quality of life among children in the Nordic countries

Qual Life Res

(1993)

H.M Koopman et al.

The DUCATQOLA global measure of quality of life of school-aged children [abstract]

Qual of Life Res

(1997)

Cited by (88)

Outcome of initially nonoperative treatment for acute simple appendicitis in children
2018, Journal of Pediatric Surgery
Citation Excerpt :
Unfortunately, owing to a low response rate in the immediate appendectomy group formal statistical testing was considered useless. Low response rates were also noted in other studies investigating HRQOL in the paediatric population [9,11,20,28,29]. Explanations for these low response rates include, but are not limited to the time it takes to fill out the questionnaires, with general questions not related to any specific disease, and the time interval between initial appendicitis episode and the current study.
To compare the outcome of initially nonoperative treatment with immediate appendectomy for simple appendicitis in children.
Between September 2012 and June 2014 children aged 7–17 years with a radiologically confirmed simple appendicitis were invited to participate in a multicentre prospective cohort study in which they were treated with an initially nonoperative treatment strategy; nonparticipants underwent immediate appendectomy. In October 2015, their rates of complications and subsequent appendectomies, and health-related quality of life (HRQOL) were assessed.
In this period, 25 children were treated with an initially nonoperative treatment strategy and 19 with immediate appendectomy; median (range) follow-up was 25 (16–36) and 26 (17–34) months, respectively. The percentage [95%CI] of patients experiencing complications in the initially nonoperative group and the immediate appendectomy group was 12 [4–30]% and 11 [3–31]%, respectively. In total 6/25 children (24%) underwent an appendectomy; none of the 6 patients operated subsequently experienced any postappendectomy complications. Overall, HRQOL in the nonoperative treatment group was similar to that of healthy peers.
Outcome of initially nonoperative treatment for acute simple appendicitis in children is similar to the outcome in those who undergo immediate appendectomy. Initially nonoperative management seems to be able to avoid appendectomy in 3 out of 4 children.
2 (prospective comparative study). This research did not receive any specific grant from funding agencies in the public, commercial or not-for-profit sectors.
A systematic review of generic multidimensional patient-reported outcome measures for children, part II: Evaluation of psychometric performance of english-language versions in a general population
2015, Value in Health
The objectives of this systematic review were 1) to identify studies that assess the psychometric performance of the English-language version of 35 generic multidimensional patient-reported outcome measures (PROMs) for children and young people in general populations and evaluate their quality and 2) to summarize the psychometric properties of each PROM.
MEDLINE, EMBASE, and PsycINFO were searched. The methodological quality of the articles was assessed using the COnsensus-based Standards for selection of health Measurement INstruments checklist. For each PROM, extracted evidence of content validity, construct validity, internal consistency, test-retest reliability, proxy reliability, responsiveness, and precision was judged against standardized reference criteria.
We found no evidence for 14 PROMs. For the remaining 21 PROMs, 90 studies were identified. The methodological quality of most studies was fair. Quality was generally rated higher in more recent studies. Not reporting how missing data were handled was the most common reason for downgrading the quality. None of the 21 PROMs has had all psychometric properties evaluated; data on construct validity and internal consistency were most frequently reported.
Overall, consistent positive findings for at least five psychometric properties were found for Child Health and Illness Profile, Healthy Pathways, KIDSCREEN, and Multi-dimensional Student Life Satisfaction Scale. None of the PROMs had been evaluated for responsiveness to detect change in general populations. Further well-designed studies with transparent reporting of methods and results are required.
Health status recovery at one year in children injured in a road accident: A cohort study
2014, Accident Analysis and Prevention
Citation Excerpt :
Aitken et al. (2002) showed differences in summary physical health scores between the injured children and controls on the Children Health Questionnaire (CHQ) which persisted 6 months after trauma. However, the majority of studies targeted children with traumatic brain injuries (TBI) and evaluated consequences for the child and family (Max et al., 1998; Waters et al., 2001; Anderson et al., 2005b; Aitken et al., 2009). Other types of injury due to road traffic accidents could also affect children's health-related quality of life (QoL), especially lower-limb injuries, which were compared to TBI in some studies and may also have an impact on children's physical condition (Stancin et al., 2002).
Despite the frequency of traumatic injuries due to road accidents and potential importance of identifying children at risk of impaired recovery one year after a road accident, there is a lack of data on long-term recovery of health status, except in children with severe traumatic brain injury. The aim of the present study was to evaluate predictive factors of recovery in children one year after road traffic injuries. The prospective cohort study was composed of children aged <16 years, admitted to public or private sector hospitals in the Rhône administrative area of France following a road accident. Recovery of health status one year after the accident and information concerning quality of life and the consequences of the accident for the child or family 1 year after the accident were collected by questionnaire, usually completed by the parents. Victims were in majority male (64.6%) and had mild or moderate injuries (81.9% with Maximum Abbreviated Injury Scale (M-AIS) <3). One year after the accident, 75.0% of the mild-to-moderate and 34.8% of the severe cases estimated health status as fully recovered. After adjustment, severity score (M-AIS ≥ 3) and lower limb injury (AIS > 1) were associated with incomplete recovery of health status: weighted odds ratio (OR_w), 4.3 [95% confidence interval (95% CI), 1.3–14.6] and OR_w, 6.5 [95% CI, 1.9–21.7], respectively. Recovery status correlated significantly with quality of life physical scores (r = 0.46), especially body pain (r = 0.48) and role/social–physical (r = 0.50) and, to a lesser extent, quality of life psychosocial scores (r = 0.21). In a cohort of children injured in a road accident, those with high injury severity score and those with lower limb injuries are less likely to recover full health status by 1 year. Impaired health status was associated with a lower physical quality of life score at 1 year.
Long-term functional health status and exercise test variables for patients with pulmonary atresia with intact ventricular septum: A Congenital Heart Surgeons Society study
2013, Journal of Thoracic and Cardiovascular Surgery
Citation Excerpt :
Improved instrument performance may be due to the comprehensive nature of the CHQ (87 questions) relative to the PedsQL (23 questions), or the CHAT (45 questions), or to enhanced discrimination within domains related to physical functioning. Although the major focus of our investigation was to determine the relationship of initial morphologic factors and end states on late FHS, we anticipated based on previous data5,8,23-35 and an unpublished report by Kulik and colleagues that noncardiac factors might contribute to these outcomes. McCrindle and colleagues5,8 found in a cross-sectional evaluation of Fontan patients that noncardiac medical conditions and psychosocial factors were likely to be more important factors associated with FHS than objective measurements of cardiopulmonary function.
A bias favoring biventricular (BV) repair exists regarding choice of repair pathway for patients with pulmonary atresia with intact ventricular septum (PAIVS). We sought to determine the implications of moving borderline candidates down a BV route in terms of late functional health status (FHS) and exercise capacity (EC).
Between 1987 and 1997, 448 neonates with PAIVS were enrolled in a multi-institutional study. Late EC and FHS were assessed following repair (mean 14 years) using standardized exercise testing and 3 validated FHS instruments. Relationships between FHS, EC, morphology, and 3 end states (ie, BV, univentricular [UV], or 1.5-ventricle repair [1.5V]) were evaluated.
One hundred two of 271 end state survivors participated (63 BV, 25 UV, and 14 1.5V). Participants had lower FHS scores in domains of physical functioning (P < .001) compared with age- and sex-matched normal controls, but scored significantly higher in nearly all psychosocial domains. EC was higher in 1.5V-repair patients (P = .02), whereas discrete FHS measures were higher in BV-repair patients. Peak oxygen consumption was low across all groups, and was positively correlated with larger initial tricuspid valve z-score (P < .001), with an enhanced effect within the BV-repair group.
Late patient-perceived physical FHS and measured EC are reduced, regardless of PAIVS repair pathway, with an important dichotomy whereby patients with PAIVS believe they are doing well despite important physical impediments. For those with smaller initial tricuspid valve z-score, achievement of survival with BV repair may be at a cost of late deficits in exercise capacity, emphasizing that better outcomes may be achieved for borderline patients with a 1.5V- or UV-repair strategy.
Effects of a hospital based wellness and exercise program on quality of life of children with severe burns
2013, Burns
To examine the effect of a 12-week Wellness and Exercise (W&E) program on the quality of life of pediatric burn survivors with burns of ≥40% total body surface area. We hypothesized this comprehensive regimen would improve physical and psychosocial outcomes.
Children were recruited for participation upon their discharge from the ICU. They were not taking anabolic/cardiovascular agents. Seventeen children participated in the W&E group and 14 children in the Standard of Care (SOC) group. Quality of life was assessed with the Child Health Questionnaire (CHQ) at discharge and 3 months. Children completed the CHQ-CF 87 and caregivers completed the CHQ-PF 28.
The mean age of children in the W&E group was 14.07 ± 3.5 years and mean TBSA was 58 ± 11.8%. The mean age of children in the SOC group was 13.9 ± 3.1 years and mean TBSA was 49 ± 7.8%. ANOVA did not reveal statistically significant differences between the groups. Matched paired t-tests revealed that parents with children in the W&E group reported significant improvements with their children's physical functioning, role/social physical functioning, mental health, overall physical and psychosocial functioning after exercise.
These results are clinically relevant in that a comprehensive W&E program may be beneficial in promoting physical and psychosocial outcomes.
Quality of life and exercise performance in unoperated children with anomalous aortic origin of a coronary artery from the opposite sinus of valsalva
2017, Cardiology in the Young

View all citing articles on Scopus

View full text

International articleThe health and well-being of adolescents: a school-based population study of the self-report Child Health Questionnaire

Abstract

Section snippets

Methodology

Results

Discussion

Acknowledgements

J Adolesc Health

J Allergy Clin Immunol

The Health of Young Victorians

Social Determinants of HealthThe Solid Facts

The adolescent child health and illness profileA population-based measure of health

Med Care

Critical issues and needs in health-related quality of life assessment of children and adolescents with chronic health conditions

Official Records of the World Health Organization No. 2

Quality of life in pre-adolescenceA 17-dimensional health-related measure (17D)

Qual Life Res

Quality of life in early adolescenceA sixteen-dimensional health-related measure (16D)

Qual Life Res

A new measure of health-related quality of life for childrenPreliminary findings

Psychol Health

Assessing health-related quality of life in chronically ill children with the German KINDLFirst psychometric and content analytical results

Qual Life Res

The PedsQLMeasurement model for the pediatric quality of life inventory

Med Care

A short survey for assessing health and social problems of adolescents

J Fam Pract

The CHQ User’s Manual

Functional status II(R)A measure of child health-status

Med Care

Measuring health-related quality of life in childrenThe development of the TACQOL parent form

Qual Life Res

Developing a generic child quality of life measure

Health Psychol Update

The proxy problemChild report versus parent report in health-related quality of life research

Qual Life Res

Measuring health outcome in paediatricsDevelopment of the RAHC measure of function

J Paediatr Child Health

Measurement of health-status in children with juvenile rheumatoid-arthritis

Arthritis Rheum

Quality of life among children in the Nordic countries

Qual Life Res

The DUCATQOLA global measure of quality of life of school-aged children [abstract]

Qual of Life Res

International article
The health and well-being of adolescents: a school-based population study of the self-report Child Health Questionnaire