Emotional, behavioural problems and cigarette smoking in adolescence: findings of a Greek cross-sectional study

The FRESHAIR4Life study: Global implementation research on non-communicable disease prevention targeting adolescents' exposure to tobacco and air pollution in disadvantaged populations

The FRESHAIR4Life study aims to reduce the non-communicable disease (NCD) burden by implementing preventive interventions targeting adolescents' exposure to tobacco use and air pollution (AP) worldwide. This paper presents the FRESHAIR4Life methodology and initial rapid review results. The rapid review, using various databases and PubMed, aimed to guide decision-making on risk factor focus, target areas, and populations. It showed variable NCD mortality rates related to tobacco use and AP across the participating countries, with tobacco as the main risk factor in the Kyrgyz Republic, Greece, and Romania, and AP prevailing in Pakistan and Uganda. Adolescent exposure levels, sources, and correlates varied. The study will continue with an in-depth situational analysis to guide the selection, adaptation, and integration of evidence-based interventions into the FRESHAIR4Life prevention package. This package will be implemented, evaluated, assessed for cost-effectiveness, and iteratively refined. The research places a strong emphasis on co-creation, capacity building, and comprehensive communication and dissemination.

The science of child and adolescent mental health in Greece: a nationwide systematic review

Evidence-based information is essential for effective mental health care, yet the extent and accessibility of the scientific literature are critical barriers for professionals and policymakers. To map the necessities and make validated resources accessible, we undertook a systematic review of scientific evidence on child and adolescent mental health in Greece encompassing three research topics: prevalence estimates, assessment instruments, and interventions. We searched Pubmed, Web of Science, PsycINFO, Google Scholar, and IATPOTEK from inception to December 16th, 2021. We included studies assessing the prevalence of conditions, reporting data on assessment tools, and experimental interventions. For each area, manuals informed data extraction and the methodological quality were ascertained using validated tools. This review was registered in protocols.io [68583]. We included 104 studies reporting 533 prevalence estimates, 223 studies informing data on 261 assessment instruments, and 34 intervention studies. We report the prevalence of conditions according to regions within the country. A repository of locally validated instruments and their psychometrics was compiled. An overview of interventions provided data on their effectiveness. The outcomes are made available in an interactive resource online [ https://rpubs.com/camhi/sysrev_table ]. Scientific evidence on child and adolescent mental health in Greece has now been cataloged and appraised. This timely and accessible compendium of up-to-date evidence offers valuable resources for clinical practice and policymaking in Greece and may encourage similar assessments in other countries.

Tobacco Usage and Its Association With Mental Health Status of School-Going Adolescents Near Patna, Bihar: A Community-Based Cross-Sectional Study in Eastern India

Background Of all the adolescents in India, 7.3% are suffering from some form of mental disorder. They frequently use tobacco to cope with these problems, but get stuck in a vicious cycle of deteriorating mental health. Our study aimed to determine the effect of tobacco on the mental health status of adolescents studying in the 9th to 12th standards in 10 high schools in urban and rural areas near Patna, Bihar. Methodology An analytical cross-sectional study was conducted among 360 school-going adolescents recruited using stratified random sampling. Selected adolescents were given the Indian Adolescent Health Questionnaire. The mental health status was calculated from the Strengths and Difficulties Questionnaire (SDQ) score. Information on sociodemographic characteristics and tobacco use was also obtained. Independent t-test, analysis of variance, and multiple linear regression analysis were used for predicting the significant factors. Significance was set at p-values <0.05. Results In this study, 40 (11.1%) adolescents had abnormal whereas 55 (15.3%) had borderline overall SDQ scores. The majority of those affected had peer problems (40%) and conduct problems (24.7%). All SDQ components of conduct (F = 2.94, p = 0.013), hyperactivity (F = 2.90, p = 0.014), emotional problems (F = 1.14, p = 0.001), and peer pressure (F = 3.06, p = 0.010), as well as the overall SDQ score (F = 5.74, p < 0.001), were significantly associated with increasing age. The adolescents attending rural schools (13.28 ± 5.22, p = 0.047) had significantly higher SDQ scores than those attending urban schools (12.08 ± 5.60). Hyperactivity scores were significantly higher in those studying in class 10 compared to other classes and in those attending rural rather than urban schools. Emotional problems score was significantly higher in 16-17-year-old students than in 14-15-year-old students, in females than in males, and in class 10 than in class 9 students. Only 24 (6.7%) adolescents had a history of tobacco consumption at least once which was significantly associated with the SDQ score (17.71 ± 5.69; t = 4.95, df = 358, p < 0.001). Around 79.4% of adolescents were exposed to passive smoking from close friends which deteriorated their overall mental health status (14.50 ± 5.99; F = 6.29, df = 2,357, p = 0.002). Those who had smoked for more than 10 days had significantly greater conduct problems and lesser pro-social behavior. Overall, 96.1% agreed that tobacco is harmful to health, and 76.1% had seen anti-smoking messages in the media. Female gender, increasing class and age, and history of smoking or chewing tobacco at least once also led to a significant increase in emotional problems. Age, area of the school, history of tobacco consumption, and exposure to cigarette smoke by either a close friend or male guardian had a significant impact on the conduct, hyperactivity, peer problems, and overall mental health status of school-going adolescents. Conclusions Predicting risk factors such as age, area of the school, and the history of tobacco consumption by self or by close friends is important for decision-making by school administration regarding counseling for mental health and preventing tobacco use.

Substance Abuse Amongst Adolescents: An Issue of Public Health Significance

Adolescence is a crucial time for biological, psychological, and social development. It is also a time when substance addiction and its adverse effects are more likely to occur. Adolescents are particularly susceptible to the negative long-term effects of substance use, including mental health illnesses, sub-par academic performance, substance use disorders, and higher chances of getting addicted to alcohol and marijuana. Over the past few decades, there have been substantial changes in the types of illegal narcotics people consume. The present article deals with the review of substance abuse as a public health problem, its determinants, and implications seen among adolescents. A systematic literature search using databases such as PubMed and Google Scholar was undertaken to search all relevant literature on teenage stimulant use. The findings have been organized into categories to cover essential aspects like epidemiology, neurobiology, prevention, and treatment. The review showed that substance addiction among adolescents between 12 to 19 years is widespread, though national initiatives exist to support young employment and their development. Research on psychological risk factors for teenage substance abuse is vast, wherein conduct disorders, including aggression, impulsivity, and attention deficit hyperactivity disorder, have been mentioned as risk factors for substance use. Parents' attitudes toward drugs, alcohol, academic and peer pressure, stress, and physical outlook are key determinants. Teenage drug usage has a significant negative impact on users, families, and society as a whole. It was found that a lot has been done to provide correct intervention to those in need with the constant development of programs and rehabilitative centers to safeguard the delicate minds of youths and prevent them from using intoxicants. Still, there is much need for stringent policy and program guidelines to curb this societal menace.

Exploration factors on smoking among female adolescents based on the viewpoints of Iranian adolescent girls

Background

In recent years, the prevalence of smoking in women has increased significantly. This study aimed to explain the effective factors in the tendency to smoke in female adolescents, employing a qualitative method of content analysis in Mashhad, Iran.

Methods

The data for this conventional content analysis were obtained by conducting semi‑structured interviews with 20 female adolescent smokers. For open coding, integrating codes, creating main category and subcategories, and extracting quotation associated with codes and subcategories, MAXQDA software version 10 was used.

Results

Based on the results of the study, one main category and six subcategories were identified to influence the decision to smoke. The main category was interconnection of psychological and gender experiences. The subcategories included self-management weakness, ignoring the side effects, gender orientation, negative psychological experiences, the attraction of cigarettes, and positive psychological experiences.

Conclusion

Psychological and gender factors play an important role in initiating people's behavior and tendency to smoke and smoking prevention programs in educational settings need to focus efforts around what is known about young women smokers.

Socio-environmental and psychosocial predictors of smoking susceptibility among adolescents with contrasting socio-cultural characteristics: a comparative analysis

BACKGROUND

Despite a steady decline in adolescent smoking globally, it remains a prevalent risk factor for non-communicable disease. Previous research points to differences in socio-environmental and psychosocial risk factors for smoking and how they vary across different settings with disparate social and cultural characteristics. As a result, smoking rates have remained disproportionately higher in some settings while decreasing in others. This study explored the socio-environmental and psychosocial risk factors for smoking susceptibility in a high-income and upper-middle income setting.

METHODS

Cross-sectional data were obtained from 1,573 male and female adolescents aged 11-15 years who completed self-administered questionnaires in schools in Northern Ireland and Bogotá, Colombia. Using logistic regression analysis, we examined how socio-environmental and psychosocial predictors of smoking susceptibility compared across the two countries.

RESULTS

In Northern Ireland, reduced odds of smoking susceptibility were significantly associated with less family smoking (OR: 0.64, 95% CI: 0.41-1.00); having access to information about smoking in school (OR: 0.75, 95% CI: 0.59-0.96); negative attitudes towards smoking (OR: 0.35, 95% CI: 0.23-0.51); higher levels of openness (OR: 0.59, 95% CI: 0.50-0.69); and higher levels of self-reported wellbeing (OR: 0.57, 95% CI: 0.44-0.74). Increased odds of smoking susceptibility were associated with reporting less smoking of a mother (OR: 1.37, 95% CI: 1.06-1.76); higher levels of extraversion (OR: 1.40, 95% CI: 1.04-1.90); and receiving pocket money (OR: 1.20, 95% CI: 1.06-1.37). In Bogotá, reduced odds of smoking susceptibility were significantly associated with reporting less smoking among friends (OR: 0.86, 95% CI: 0.76-0.98); higher levels of self-efficacy (OR: 0.58, 95% CI: 0.40-0.83); greater perceived behavioural control to quit smoking (OR: 0.71, 95% CI: 0.56-0.90); and lower levels of truancy (OR: 0.69, 95% CI: 0.52-0.92). In Bogotá, no factors were associated with increased odds of smoking susceptibility in the final model.

CONCLUSIONS

The findings illustrate that there were differences in predictors of adolescent smoking susceptibility across the two settings. By using a comparative approach we demonstrate that smoking interventions and policies must be sensitive to the cultural and normative context within which they are implemented.

Emotional symptoms and sensation seeking: Implications for tobacco interventions for youth and young adults

INTRODUCTION

Although emotional symptoms and sensation seeking are recognized as important risk factors for tobacco use among youth and young adults, to date, their joint influence on tobacco use has not been examined.

METHODS

Data used in this study are from the Texas Adolescent Tobacco and Marketing Surveillance study, a population-based cohort. At baseline, in 2014, participants were in the 10th grade. Mixed-effects logistic regression models examined associations between emotional symptoms and sensation seeking in 2014 and odds of past 30-day cigarette and e-cigarette use in 2018. Interactions between emotional symptoms and sensation seeking were examined to assess whether one modifies the effect of the other on cigarette and e-cigarette use.

RESULTS

After adjusting for age, sex, race/ethnicity, school type, and ever use of cigarettes or e-cigarettes at baseline, adolescents with high emotional symptoms (AOR_cig=1.97; 95% CI:1.07–3.60, and AOR_e-cig=1.68; 95% CI: 1.06–2.66) and with high sensation seeking tendencies (AOR_cig=2.05; 95% CI: 1.03–4.10, and AOR_e-cig=1.68; 95% CI: 1.02–2.76) had significantly higher odds of past 30-day cigarette and e-cigarette use four years later compared to adolescents with low emotional symptoms and low sensation seeking tendencies. The interaction was significant (p=0.01) for e-cigarette use only; among low sensation seekers, adolescents who reported high levels of emotional symptoms were at increased risk for past 30-day use (AOR_e-cig=3.43; 95% CI: 1.38–8.51), and among adolescents with low emotional symptoms, high sensation seekers were at increased for risk for past 30-day use (AOR_e-cig=3.50; 95% CI: 1.54–7.91).

CONCLUSIONS

It is important for tobacco use prevention programs to consider both behavioral risk factors – sensation seeking and emotional symptoms – in an integrative way, to target high risk subgroups and thereby increase the efficacy of existing effective intervention strategies in order to curb tobacco use among youth and young adults.

Behavior problems in adolescence and subsequent mental health in early adulthood: results from the World Trade Center Health Registry Cohort

BACKGROUND

The present study examined the association between 9/11-related adolescent behavioral problems on mental health outcomes in early adulthood.

METHODS

Data from enrollees of the World Trade Center Health Registry, who completed at least one adolescent (2006-2007 or 2011-2012) and adult survey (2011-2012 or 2015-2016), were analyzed. Adolescent behavioral difficulties were assessed using the adolescent-reported Strengths and Difficulties Questionnaire (SDQ). Adult mental health outcomes included binge drinking, smoking status history, 9/11-related post-traumatic stress disorder (PTSD), depression, and the self-reported number of physician mental health diagnoses. Multivariable regression was used to estimate associations of SDQ scores with mental health outcomes.

RESULTS

Of the 297 enrollees, 16.8% (n = 50) had abnormal/borderline SDQ scores as an adolescent. Binge drinking was not associated with adolescent SDQ scores. Enrollees with abnormal/borderline SDQ scores as an adolescent were more likely to be a consistent smoker (odds ratio (OR): 5.6, 95% confidence interval (CI): 1.2-25.2), have probable PTSD (OR: 3.5, 95% CI: 1.3-9.8), depression (OR: 6.2, 95% CI: 2.7-13.9), and to have two or more self-reported physician-diagnosed mental health conditions as an adult (OR 5.6, 95% CI: 2.0-12.5).

CONCLUSIONS

The findings of this study underscore the need to intervene early with children exposed to traumatic events so as to avert later adolescent and adult problem behaviors.

Adolescent Risk Behaviors and Use of Electronic Vapor Products and Cigarettes

BACKGROUND

Adolescent use of tobacco in any form is unsafe; yet the use of electronic cigarettes and other electronic vapor products (EVPs) has increased in recent years among this age group. We assessed the prevalence and frequency of cigarette smoking and EVP use among high school students, and associations between health-risk behaviors and both cigarette smoking and EVP use.

METHODS

We used 2015 national Youth Risk Behavior Survey data (N = 15 624) to classify students into 4 mutually exclusive categories of smoking and EVP use based on 30-day use: nonuse, cigarette smoking only, EVP use only, and dual use. Prevalence of cigarette smoking and EVP use were assessed overall and by student demographics and frequency of use. Prevalence ratios were calculated to identify associations with health risk-behaviors.

RESULTS

In 2015, 73.5% of high school students did not smoke cigarettes or use EVPs, 3.2% smoked cigarettes only, 15.8% used EVPs only, and 7.5% were dual users. Frequency of cigarette smoking and EVP use was greater among dual users than cigarette-only smokers and EVP-only users. Cigarette-only smokers, EVP-only users, and dual users were more likely than nonusers to engage in several injury, violence, and substance use behaviors; have ≥4 lifetime sexual partners; be currently sexually active; and drink soda ≥3 times/day. Only dual users were more likely than nonusers not to use a condom at last sexual intercourse.

CONCLUSIONS

EVP use, alone and concurrent with cigarette smoking, is associated with health-risk behaviors among high school students.

Depression in late adolescence: a cross-sectional study in senior high schools in Greece

BACKGROUND

Depression is a common mental health problem in adolescents worldwide. The aim of the present study was to investigate the prevalence, comorbidity and sociodemographic and socioeconomic associations of depression and depressive symptoms, as well as the relevant health services use in a sample of adolescents in Greece.

METHODS

Five thousand six hundred fourteen adolescents aged 16-18 years old and attending 25 senior high schools were screened and a stratified random sample of 2,427 were selected for a detailed interview. Psychiatric morbidity was assessed with a fully structured psychiatric interview, the revised Clinical Interview Schedule (CIS-R). The use of substances, such as alcohol, nicotine and cannabis, and several sociodemographic and socioeconomic variables have been also assessed.

RESULTS

In our sample the prevalence rates were 5.67 % for the depressive episode according to ICD-10 and 17.43 % for a broader definition of depressive symptoms. 49.38 % of the adolescents with depressive episode had at least one comorbid anxiety disorder [OR: 7.76 (5.52-10.92)]. Only 17.08 % of the adolescents with depression have visited a doctor due to a psychological problem during the previous year. Anxiety disorders, substance use, female gender, older age, having one sibling, and divorce or separation of the parents were all associated with depression. In addition, the presence of financial difficulties in the family was significantly associated with an increased prevalence of both depression and depressive symptoms.

CONCLUSIONS

Prevalence and comorbidity rates of depression among Greek adolescents are substantial. Only a small minority of depressed adolescents seek professional help. Significant associations with financial difficulties are reported.

Predictors of sexual risk behaviour among adolescents from welfare institutions in Malaysia: a cross sectional study

BACKGROUND

In welfare institutions, it is essential to address the health-related needs of adolescent populations who often engage in sexual activities. This study examines the association between individual and interpersonal factors concerning sexual risk behaviour (SRB) among adolescents in welfare institutions in Malaysia.

METHODS

Data were derived from a cross-sectional study of 1082 adolescents in 22 welfare institutions located across Peninsular Malaysia in 2009. Using supervised self-administered questionnaires, adolescents were asked to assess their self-esteem and to complete questions on pubertal onset, substance use, family structure, family connectedness, parental monitoring, and peer pressure. SRB was measured through scoring of five items: sexual initiation, age of sexual debut, number of sexual partners, condom use, and sex with high-risk partners. Multivariate logistic regression analysis was used to examine the various predictors of sexual risk behaviour.

RESULTS

The study showed that 55.1% (95%CI = 52.0-58.2) of the total sample was observed to practice sexual risk behaviours. Smoking was the strongest predictor of SRB among male adolescents (OR = 10.3, 95%CI = 1.25-83.9). Among females, high family connectedness (OR = 3.13, 95%CI = 1.64-5.95) seemed to predict the behaviour.

CONCLUSION

There were clear gender differences in predicting SRB. Thus, a gender-specific sexual and reproductive health intervention for institutionalised adolescents is recommended.

Accumulation of lifestyle and psychosocial problems and persistence of adverse lifestyle over two-year follow-up among Finnish adolescents

BACKGROUND

Adolescent'psychosocial problems associate with unhealthy behaviors, but data on co-occurring patterns is sparse. We investigated 1) whether adolescents could be categorized into meaningful subgroups with respect to psychosocial and lifestyle factors, 2) whether the prevalence of physical inactivity, overweight and smoking vary within the subgroups and 3) whether these unhealthy behaviors persist in a two-year follow-up.

METHODS

The study was based on a subgroup of the 1986 Northern Finland Birth Cohort, which consisted of adolescents who replied to a postal questionnaire at 16 years (n = 6792) and a subgroup of this sample at 18 years (n = 1552). Latent class analysis (LCA) was performed to establish clusters at 16 years.

RESULTS

Smoking co-existed with emotional and behavioral problems in both genders. Boys with the most inactive lifestyle slept poorly, whereas multiple problems co-occurred among girls. Those with a high body mass index (BMI) separated as groups of their own. Different combinations of adverse lifestyle and emotional and behavioral problems were relatively common in both sexes as only 51% of boys and 67% of girls belonged to the reference cluster with low probability for these findings. Physical inactivity, high BMI and smoking tended to persist over the two-year follow-up.

CONCLUSIONS

It seems that lifestyle and psychosocial factors divide adolescents into distinct subgroups in which unhealthy lifestyle patterns remain between the ages of 16 and 18. This may indicate problems in other life areas and expose them to an increased risk of future health problems.

Psychological problems and cigarette smoking in tehran university students in 2010

BACKGROUND

The present study aimed at comparing psychological problems between smoker and non-smoker students and also males and females.

MATERIALS AND METHODS

A total of 22 faculty members of public and private universities in Tehran were selected through random sampling and 913 students from the same universities were selected through convenient sampling and enrolled in this study with a 2-step sampling method. Hopkins Symptom Checklist was used for data collection.

RESULTS

Significant differences were detected between smoker and non-smoker students in Hopkins score, depression, anxiety and somatization. In addition, smoker women gained higher Hopkins scores, somatization, anxiety and interpersonal sensitivity scores compared to smoker males.

CONCLUSION

Incidence of signs and symptoms of depression, anxiety and other psychological disorders was higher among smoker individuals. Therefore, smoking control strategies should further focus on this subject.

Why to smoke? Why not to smoke? Major reasons for children's decisions on whether or not to smoke

This study, aimed at the primary prevention of smoking behaviour in children and adolescents, attempts to find the main factors that distinguish smokers and non-smokers in the period of their first experimentation with cigarettes. There are only a few studies dealing with investigations into current motivations of teenagers as to whether or not to smoke. The programme entitled "Normal is not to smoke", using evaluation questionnaires given to children in the 3rd and 5th classes, also contains--among many other things--specifics on reasons children have for making the decision whether to become a smoker or non-smoker. The results are reported in this paper.

METHODOLOGY

Responses concerning potential inclination to smoking that were collected from children on the basis of questionnaires were categorized into the following groups: image, the influence of a role model, the effects of smoking, curiosity. Reasons for non-smoking were categorized into the following groups: health, aesthetic, economic, restrictive, other aspects. Children were also asked to describe smokers by using three pairs of opposite characteristics: education, success, wealth. The frequencies of answers were analysed for the whole set, for boys and girls and for children with different smoking behaviour; the differences were evaluated using the statistical programme EPI INFO, version 6.

RESULTS

A total of 1153 children in the 3rd class and 799 children in the 5th class completed the questionnaire. Motivations for smoking were given by nearly 17% of children in the 3rd class and by nearly 27% of the same cohort in the 5th class. Aspects such as image (41.9% vs. 46.2%) were mentioned most frequently, by boys more frequently than by girls (OR 1.77; 95% CI 0.93-3.36; p = 0.06), by children from smokers' families more frequently than by children from non-smokers' families (OR 1.33; 95% CI 0.69-2.57; p = 0.3) and more frequently by children with repeated attempts to smoke (OR 3.93; 95% CI 2.32-6.65) or children who had only had a single smoking attempt (OR 3.18; 95% CI 1.52-6.75). Also the role of models (parents, relatives, friends) was often mentioned (12.9% in the 3rd class and 10.2% in the 5th class). Potential beneficial effects of smoking were expressed by 13% of children in the 3rd class and by 55% of children in the 5th class (p < 0.0001). About 40% of children considered smoking as effective coping with stress and about 20% of them declared smoking for mood improvement. Beneficial effects of smoking significantly more often described children with repeated smoking attempts (OR 2.91; 95% CI 1.73-4.89; p < 0.001). Children often linked smoking to the less educated and less successful social groups but also to the rich. In both investigations, health aspects were the most common reasons for choosing not to smoke (69.2% vs. 73.3%), being more frequently presented by girls and non-smokers. A significant shift in the negative aesthetic perception of smoking (14.1% in the 3rd class vs. 40.2% in the 5th class) and economic disadvantages of smoking (3.9% vs. 24.8%) was observed in the given period of time. Restrictive reasons were given only rarely by pupils in the 3rd class (0.7%), unlike pupils in the 5th class who feared the reaction of their parents (24.8%).

CONCLUSION

Our study provides an overview of current motivations in children aged 9 and 11 years that are crucial for their future smoking/nonsmoking behaviour. The results of the study are important for developing a strategy for the primary prevention of smoking in school programmes and for introducing a general social approach to address the problem of the decreasing age of smoking initiation.