Research Promotion

SAM POSITION PAPERS

• Guidelines for Adolescent Health Research
  
• Code of Research Ethics

THE ROLE OF SAM IN THE PROMOTION OF RESEARCH
IN ADOLESCENT HEALTH

• Annual Meeting
  
• Special Interest Groups Regarding Research
  
• Research Awards
  
• Journal
  
• Research Guidelines
  
• References

(The following article by Barbara A. Cromer, MD and John Santelli, MD, MPH was printed in the Journal of Adolescent Health, December 1998 Supplement.)

From its beginnings, the Society for Adolescent Medicine (SAM) has maintained, among its several basic goals, an emphasis on research in all aspects of adolescent health. Before the official organization of SAM, the national newsletter in 1965 noted that "Research activities [had] increased in clinical investigation as well as basic research" (1). In 1967, a meeting was held among a progenitor group of SAM members, which focused on experimental design in adolescent health research (2). Following the incorporation of SAM in 1969, primarily to focus on issues related to clinical practice and professional education, a parallel movement evolved emphasizing research as a priority of the new society. For example, in the first set of articles of the SAM constitution, a stated purpose was to "offer opportunities for those interested in adolescent medicine in ... research. . . ."(3).

Annual Meeting

The first program of research papers was presented in Chicago, 1973, largely through the efforts of Michael Cohen and Stanford Friedman (2). In 1979, during a retreat of the Executive Council of SAM in Washington, DC, a focus statement was developed: "The major focus of the Society for Adolescent Medicine is to promote the development, synthesis, and dissemination of scientific and scholarly knowledge unique to the development and health care needs of adolescents"(4).  Of the five SAM goals listed in the current constitution, the second goal is "to promote excellence in research related to the health of adolescents and to disseminate the results of such research"(4).

Along with all aspects of the annual meeting, the general trend of the program committee of SAM has been to expand the research portion of the program. After the initial program of 13 podium (0 poster) presentations in 1974, the numbers of papers and posters increased over the following 23 years (Fig. 1). Whereas paper presentations doubled to 26 the next year and have remained within the range of 18-28 each year, the number of posters increased over the decades to 68 in 1997 (72% of total presentations).

The evaluation of abstracts submitted to each annual meeting has been under the able leadership of the following SAM members in chronological order: Joseph Rauh, Lonnie Zeltzer, Samuel LeBaron, Sheridan Phillips, Jean Emans, Lawrence Neinstein, and currently, Elizabeth Woods (4). A recent addition has been that of poster discussion groups in 1996, organized around themes related to that year's poster presentations (5). This approach, which includes a moderator for each group, has facilitated communication among investigators of similar interests and was continued for the 1997 and 1998 annual meetings.

From 1976 to the present, annual meetings have included at least one workshop on research design. The first, led by Felix Heald and Michael Plaut, reviewed "Research Directions and Program Design in Adolescent Medicine." Subsequent sessions have addressed research design, abstract preparation, paper presentation, clinical research, funding for research, and electronic data management. "Meet the Professor" luncheons were introduced so that attendees could discuss their works in progress with established investigators.

Special Interest Groups

Another forum for the discussion and presentation of research within SAM has been fostered within the special interest groups (SIGs), each of which meets during the annual SAM meeting and communicates, to a greater or lesser extent, during the rest of the year. SIGs initially formed around professional responsibilities, or roles in an academic or practice setting: for example, training directors, fellows in training, and private practitioners. Nonphysician members of SAM met in 1979 to share their concerns, including those related to research within their own disciplines and as members of multidisciplinary faculty. In 1980, nurses and psychologists each met separately during the annual meeting.

The Nutrition Research SIG, initially formed as an ad hoc committee called the Nutrition Research Forum in 1985, is an example of the role of SIGs in promoting research. Meetings of this SIG since 1987 have allowed investigators to discuss their research with an interdisciplinary panel and participants. Many invited speakers have been Young/New Investigators of the Year from previous meetings. Non-SAM colleagues with related interests, living in the vicinity where an annual meeting is held, often have been invited to these sessions.

Members of the Nutrition Research SIG have participated in the National Nutrition in Adolescent Pregnancy Study Group; the Maternal Child Interagency Nutrition Group, established by the Maternal and Child Health Bureau (MCHB) to identify and prioritize research issues of adolescent nutritional health of adolescents (6); the Fifth Congress of the International Association for Adolescent Health in Montreux in 1991; as well as at meetings in Portugal, Brazil, Canada, Spain, Italy, and around the United States. The scientific base for information to be acted upon in the newly initiated Partners in Program Planning for Adolescent Health (PIPPAH), another MCHB project, will have been summarized and articulated in the Position Statement developed by the group (7). Thus, SAM has provided opportunities and stimulation for an interdisciplinary network of investigators who have contributed and disseminated significant research in the area of adolescent nutritional health.

Other SIGs have also incorporated research into their activities., For example, the Lesbian, Gay and Bisexual (LGB) Adolescents SIG first discussed research at the 1996 SAM conference in Washington, DC, when the membership was polled for current research interests and activities. The following year at the conference in San Francisco, a small group within the SIG met to initiate a collaborative research project, consisting of a provider survey regarding practices related to LGB adolescents. Members of the LGB Adolescent SIG at the 1998 meeting in Atlanta presented research projects to solicit input from other SIG members.

The Eating Disorders SIG also has research projects in the early stages of development. Investigators are discussing the selection of a collaborative topic such as evaluation of medical indications for admission, approaches to refeed malnourished patients, and treatment of osteopenia associated with eating disorders.

Since 1995, a SIG of researchers and clinicians who use qualitative research techniques have met at annual SAM meetings to present research, share ideas, and network with others exploring this new, vital, and rapidly growing field. This is in recognition of the potential role of qualitative research as a creative approach to increasing our understanding of the lives, attitudes, and health of adolescents. A multidisciplinary audience has discussed projects ranging from narratives about teen sexuality across African cultures to content analyses of popular media to visual anthropology using video to investigate the patient's understanding of illness. At the 1998 SAM meeting, the Qualitative Research SIG was augmented by the addition of a workshop entitled "Qualitative Research Methods-Deep Inquiry Into the Lives of Adolescents," which provided a hands-on overview of these techniques for those who have been interested, but unsure where to begin, in qualitative research.

The Society for Adolescent Medicine has also acknowledged its collegial relationship with the Society for Research on Adolescence, an academic society which shares with SAM a focus on adolescent behavioral issues. In 1990 and 1992, the two societies met concurrently in Atlanta and Washington, DC, respectively, to facilitate an exchange of research ideas, designs, and potential resources (4).

Research Awards

Another manifestation of SAM's support for research can be found in its award process. Over the past 8 years, SAM, with the support of Mead Johnson Nutritionals and Organon, Inc., has elected to allocate monies to recognizing individuals within the Society for achievement in research. The New Investigator Award (changed from the Young Investigator Award in 1996) was begun in 1989, with Barbara Moscicki as the initial recipient (Table 1). At a more senior level, a Research Visiting Professor Award was initiated in 1995 and Susan Millstein was the first recipient (Table 2). An additional aim of this award each year is, as stated by Robert DuRant, "to help a training program that is currently engaging in adolescent health research enhance its research program so that it will become better equipped to compete for resources and fund a research program" (8).

Journal

The Journal of Adolescent Health is a prominent forum within which research, some of which is initially presented at the SAM meetings, is peer reviewed and published. First issued as the Journal of Adolescent Health Care in 1980, the Journal has published each year's program content, which includes abstracts of papers and posters presented at the meeting. Also included in the Journal have been many review articles which critically assess the scientific literature on research topics salient to adolescent health and to the Society. The history of the Journal is described in more detail by Verdain Bames, Richard Brookman, and Iris Litt: (pp 148-151of December 1998 Supplement of JAH).

Research Guidelines

Recent advances have been made in the establishment of official guidelines regarding research in adolescent health within the bounds of the organization. In the early 1990s, there was increasing recognition within SAM of the ethical and legal complexities regarding adolescents' participation in research. In response, a process was begun in SAM to develop a set of guidelines for use by individual researchers and institutional review boards (IRBs) in the design of studies and informed consent considerations unique to adolescents.

The plan to create guidelines grew out of numerous conversations (often at SAM meetings) among adolescent health researchers who expressed difficulties in obtaining IRB approval for research involving adolescents as research subjects. Federal research regulations provided little specific guidance to IRB members who review adolescent health research proposals. Surveys of IRB members had suggested that IRBs are uncertain about research involving adolescents and would welcome guidance to clarify the federal regulations for adolescent research involvement (9).

These Guidelines for Adolescent Health Research (10) were the product of a multiyear consensus process among national organizations. The key sponsor of this process was SAM; considerable advice was received from the American Medical Association's (AMA's) National Coalition on Adolescent Health. In September 1991, a committee to study this issue was established by SAM President Robert Blum. Funding to support the process was obtained from the Robert Wood Johnson Foundation in March 1993.

The Committee to develop Guidelines for Adolescent Research of SAM included John Santelli and Walter Rosenfeld (co-chairs), and Robert DuRant, Nancy Dubler, Madlyn Morreale, Abigail English, and Audrey Rogers. The goals of this project were fourfold:

1. To develop national guidelines which clarify the unique legal, ethical, and developmental questions associated with the conduct of health research involving adolescents;
2. To protect individual adolescents from risks associated with research;
3. To enhance adolescent health through the facilitation of important research; and
4. To assist those concerned about adolescent health and well being with the interpretation of the current federal regulations.

The first phase of this national consensus process involved information gathering, preparation of draft guidelines, and the commissioning of background papers. The second phase consisted of a conference held on May 19-20, 1994 in Alexandria, Virginia. This assembled a diverse group of ethicists, lawyers, policy makers, and health researchers to frame the context of their work: Robert Levine, Abigail English, Anne Petersen, Nancy Leffert, Janet Gans, Claire Brindis, Renee Jenkins, and Delores Parron. These individuals provided background papers reflecting their individual areas of expertise; Kathleen Mammel and David Kaplan later provided additional pertinent papers.

At the conference, the group struggled with reasonable interpretations of the language in the federal regulations, the complexities of developing adolescent capacity to provide informed consents, and the special vulnerabilities of adolescent research subjects. After much hard work, the group was able to craft consensus guidelines for the ethical conduct of adolescent health research. A position paper on the Guidelines was written by the committee to capture the essential points gleaned from the background papers and the discussion in Alexandria (10). The final phase of the consensus process involved the dissemination of these guidelines to adolescent health researchers, members of IRBs, professional organizations and federal, state, and local agencies. The consensus guidelines and the papers from the meeting were published in the Journal of Adolescent Health in November 1995 (11).

The authors thank Felix Heald, Edie Moore, Larry Neinstein, Seth Ammerman, Neal Hoffinan, Jane Rees, and Michael Rich for their input, as well as Harold Regan for his help in researching and preparing the manuscript, tables, and graphics.

Table 1: Research Awards Presented at the Annual Meeting of SAM:  New Investigator Award Recipients*

Table 2: Research Visiting Professors and Sites Visited*

* - Supported by Organon, Inc.

Figure 1.  Paper and Poster Presentations at annual SAM meetings. 

*The number of papers presented in 1975 is unknown due to lack of records.
+There was no annual meeting in 1984.

References

1. Adolescent Medicine, a Semi-annual Newsletter 1965;1:2.
2. Heald FP. History of adolescent medicine. In: McAnarney E, Kreipe RE, Orr DP, Comerci GD, eds. Textbook of Adolescent Medicine 1992;4. Philadelphia, W.B. Saunders.
3. Society for Adolescent Medicine Constitution, 1979:1.
4. Personal communication. SAM Office, Blue Springs, MO.
5. Neinstein LS. A review of Society for Adolescent Medicine abstracts and Journal of Adolescent Health Care articles. J Adolesc Health Care 1987;8:198.
6. Sharbaugh CO, ed. Call to Action: Better Nutrition for Mothers, Children, and Families. Washington, DC: National Center for Education in Maternal and Child Health, 1991. Recomniendations revised 1995.
7. Jacobson MS, Rees JM, Golden NH, Irwin CE, eds. Adolescent nutritional disorders: Prevention and treatment. Ann NY Acad Sci 1997;817.
8. DuRant RH. Adolescent health research as we proceed into the twenty-first century. J Adolesc Health 1995;17.
9. Mammel KA, Kaplan DW. Research consent by adolescent minors and institutional review boards. J Adolesc Health 1995;17:323.
10. Santelli JS, Rosenfeld W, DuRant R, et al. Guidelines for adolescent health research (a position paper of the Society for Adolescent Medicine). j Adolesc Health 1995;17:270.
11. Society for Adolescent Medicine. Guidelines for adolescent health research: Conference proceedings.  J Adolesc Health 1995;17:264.

site map | return to home page | contact us