Adolescents' health and health behaviour as predictors of injury death. A prospective cohort follow-up of 652,530 person-years

Social restrictions due to COVID-19 and the incidence of intoxicated patients in pediatric emergency department

Background

Social restrictions set due to COVID-19 decreased pediatric emergency department (ED). The aim is to report epidemiology of intoxicated patients in pediatric ED during the first and second waves of COVID-19.

Methods

Data for this retrospective hospital discharge register study was gathered from January 2017 to December 2020. Patients aged <18 and intoxicated were included. Incidences are reported per 10,000 children and compared by incidence rate rations (IRRs) with 95% confidence intervals (CIs).

Results

Incidence of ED visit for intoxicated patient was 65 per 10,000 in 2020 and 54 per 10,000 in 2017–2019 (IRR 1.20 CI 0.87–1.68). Incidence was lower during the lockdown compared to reference years (IRR 0.50 CI 0.17–1.44). Peak monthly incidence (12 per 10000) was recorded after lockdown in July 2020 (IRR 2.45 CI 1.01-5.92).

Discussion

Based on these results, the lockdown and social restrictions did not decrease heavy alcohol or drug consumption among adolescents in Finland.

Who Is at Risk of Dying Young from Suicide and Sudden Violent Death? Common and Specific Risk Factors among Children, Adolescents, and Young Adults

OBJECTIVE

Suicides and other sudden violent deaths are the most common causes of death among young people worldwide. This case-control study compared risk factors for suicide and other sudden violent death among young people.

METHOD

A total of 436 psychological autopsy interviews with next of kin were performed. The samples aged 10-25 years included 63 cases of suicide, 62 cases of other sudden violent death, and 104 matched living controls. Two stepwise multiple logistic regression analyses were performed.

RESULTS

The number of recent stressful life events was the only common risk factor for suicide and other sudden violent death. Specific risk factors for suicide were any form of addiction and being an inpatient in adult psychiatric care. Specific risk factors for other sudden violent death were lower elementary school results, lower educational level, and abuse of psychoactive drugs.

CONCLUSIONS

The suicide group seems to have been more vulnerable and exposed to different kinds of stressors, whereas the sudden violent death group seems to have been more acting out and risk-taking. Both groups must be the subject of prevention and intervention programs.

Adolescent criminality: multiple adverse health outcomes and mortality pattern in Swedish men

BACKGROUND

To investigate the impact of adolescent violent and non-violent criminality and subsequent risk of morbidity and mortality in adulthood in a large Swedish cohort of young men conscripted for military service in 1969/70.

METHODS

The cohort consisted of 49,398 18-year-old Swedish conscripts followed up for morbidity and mortality up to the age of 55 years in Swedish national registers. Information about convictions for crime before conscription was obtained from national crime registers. Data from a survey at conscription were scrutinized to get information on potential confounders.

RESULTS

Hospitalization due to alcohol and drug related diagnoses and attempted suicide were significantly more evident in the violent group compared to non-violent criminals and non-criminals. More than one fifth (21.13%) of the young violent offenders, 12.90% of the non-violent offenders and 4.96% of the non-criminals had died during the follow-up period. In Cox proportional multivariate analyses, young violent offenders had twice the hazard (HR = 4.29) of all-cause mortality than the non-violent offenders (HR = 2.16) during the follow-up period. Alcohol and drug related mortality, suicide and fatal accidents were most evident in both violent and non-violent offenders.

CONCLUSIONS

Men with adolescent criminality received more inpatient care due to alcohol and drug related diagnoses and attempted suicide as adults. Mortality due to unnatural causes, alcohol, and drug related diagnoses, suicide and accidents was most evident in violent offenders, while these causes of death were much lower in non-criminals. Men with adolescent criminality are a high-risk group for multiple adverse health outcomes and for early death. Efforts for detection of substance use and psychiatric disorders in this group is important for the prevention work in both local- and community levels as well as national prevention programs.

Parental education and adolescent health problems due to violence, self-harm and substance use: what is the role of parental health problems?

BACKGROUND

Adolescent health problems are more prevalent in families with low socioeconomic position, but few studies have assessed the role of parental health in this association. This study examines the extent to which parental health problems, particularly those related to high-risk health behaviour, might explain the association between parental education and adolescent health problems due to violence, self-harm and substance use.

METHODS

We used longitudinal register data on a 20% representative sample of all families with children aged 0-14 years in 2000 in Finland with information on parental social background and parental and offspring health problems based on hospital discharge data. We estimated discrete-time survival models with the Karlson-Holm-Breen method on hospital admissions due to violence, self-harm and substance use among adolescents aged 13-19 years in 2001-2011 (n=145 404).

RESULTS

Hospital admissions were 2-3 times more common among offspring of basic educated parents than tertiary educated parents. Similar excess risks were observed among those with parental mental health problems and parental health problems due to violence, self-harm and substance use. The OR for offspring of basic educated parents was attenuated from OR 2.73 (95% CI 2.34 to 3.18) to OR 2.38 (2.04 to2.77) with adjustment for parental health problems, particularly those due to violence, self-harm and substance use. Having both low parental education and parental health problems showed simple cumulative effects.

CONCLUSIONS

The excess risks of hospital admissions due to violence, self-harm and substance use among adolescents with lower educated parents are largely independent of severe parental health problems.

Non-Fatal Injury in Thailand From 2005 to 2013: Incidence Trends and Links to Alcohol Consumption Patterns in the Thai Cohort Study

Background

We analyzed population-based injury trends and the association between injury and alcohol consumption patterns in Thailand, a middle-income country undergoing rapid social change.

Methods

A nationwide cohort of 42 785 Thai adult Open University students, who were aged 15 to 87 years at enrolment, participated in cross-sectional assessments at baseline (2005) and 8 years later (2013). Incident non-fatal traffic and non-traffic injuries were recorded. Alcohol consumption patterns were categorized as follows: non-drinkers, occasional light drinkers, occasional heavy drinkers, regular drinkers, and ex-drinkers. Logistic regression was used to assess associations in 2005 and 2013 between injuries and alcohol consumption. We adjusted odds ratios (ORs) for socio-demographic factors, stress, health behaviors, and risk-taking behaviors.

Results

Incidence estimates in 2013 were standardized to the age structure of 2005: the standardized rates were 10% (95% confidence interval [CI], 9.32–9.89) for participants with at least one non-traffic injury and 5% (95% CI, 4.86–5.29) for those with at least one traffic injury. Both standardized incidences for non-traffic and traffic injuries were significantly lower than corresponding rates in 2005 (20% and 6%, respectively). Alcohol consumption was significantly associated with non-traffic injury in 2005, but the association disappeared in 2013. For example, non-traffic injury was associated with regular drinking (adjusted OR 1.17; 95% CI, 1.01–1.40) in 2005, but not in 2013 (adjusted OR 0.89; 95% CI, 0.73–1.10). In both survey years, traffic injury was not associated with occasional heavy drinking when adjusted for health and risk-taking behavior.

Conclusions

We examined non-fatal injury and the health-risk transition in Thailand in 2005 and 2013. Our data revealed decreases in alcohol consumption and non-fatal injury in the Thai Cohort between 2005 and 2013. Alcohol-related injury in Thailand today could be amenable to preventive intervention.

Presence of minor and major mental health impairment in adolescence and death from suicide and unintentional injuries/accidents in men: a national longitudinal cohort study

OBJECTIVE

To examine the association between minor and major mental health impairment in late adolescence and death from suicide and unintentional injuries/accidents in men.

METHODS

In Norway, all men attend a compulsory military medical and psychological examination. We included 558 949 men aged 17-19 years at the time of military examination in 1980-1999 and followed them up for death from suicide and unintentional injuries/accidents until the end of 2013. We used Cox proportional hazard models to examine the association between the presence of minor and major mental health impairments at examination and death from suicide and unintentional injuries/accidents.

RESULTS

Compared to men with no mental health impairment, those with minor mental health impairment was associated with an increased risk of death from suicide (adjusted HR (HR_adj)=1.63, 95% CI 1.39 to 1.92), transport accidents (HR_adj=1.33, 95% CI 1.09 to 1.63), accidental poisoning (HR_adj=2.27, 95% CI 1.79 to 2.88) and other unintentional injuries/accidents (HR_adj=1.54, 95% CI 1.17 to 2.02). In men with major mental health impairment, the risk of death from suicide and accidental poisoning was elevated two times (HR_adj=2.29, 95% CI 1.85 to 2.85) and three times (HR_adj=3.53, 95% CI 2.61 to 4.79), respectively.

CONCLUSIONS

We found an increased risk of death from suicide and unintentional injuries/accidents in men who had minor and major mental health impairment at age 17-19 years.

Fatal injuries in rural and urban areas in northern Finland: a 5-year retrospective study

Background

Finland has the fourth highest injury mortality rate in the European Union. To better understand the causes of the high injury rate, and prevent these fatal injuries, studies are needed. Therefore, we set out to complete an analysis of the epidemiology of fatal trauma, and any contributory role for alcohol, long suspected to promote fatal injuries. As a study area, we chose the four northernmost counties of Finland; their mix of remote rural areas and urban centres allowed us to correlate mortality rates with ‘rurality’.

Methods

The Causes of Death Register was consulted to identify deaths from external causes over a 5‐year time period. Data were retrieved from death certificates, autopsy reports and medical records. The municipalities studied were classified as either rural or urban.

Results

Of 2915 deaths categorized as occurring from external causes during our study period, 1959 were eligible for inclusion in our study. The annual crude mortality rate was 54 per 100,000 inhabitants; this rate was higher in rural vs. urban municipalities (65 vs. 45 per 100,000 inhabitants/year). Additionally, a greater number of pre‐hospital deaths from accidental high‐energy trauma occurred in rural areas (78 vs. 69%). 42% of all pre‐hospital deaths occurred under the influence of alcohol.

Conclusion

The crude mortality rate for fatal injuries was high overall as compared to other studies, and elevated in rural areas, where pre‐hospital deaths were more common. Almost half of pre‐hospital deaths occurred under the influence of alcohol.

Rationale and methods of a cluster-randomized controlled trial to promote active and healthy lifestyles among Brazilian students: the "Fortaleça sua Saúde" program

Background

Interventions on adolescents’ lifestyle are important, but the main mechanisms that explain the changes (mediating variables) on lifestyle are unclear. This paper presents the rationale and methods of an intervention program focused on promoting active and healthy lifestyles (especially physical activity [PA] practice and reducing screen time) among Brazilian students-the Fortaleça sua Saúde program (Portuguese for “strengthen your health”).

Methods/Design

This is a school-based cluster-randomized controlled trial. Three intervention and three control (no intervention) full-time public schools were randomly selected in Fortaleza, northeastern Brazil. Students (n = 1,272) from classes in Grades 7–9 were eligible, and 1,085 (548 in the intervention and 537 in control schools) completed the baseline and follow-up measures. The program duration was approximately four months and took place in 2014. Intervention strategies focused on teacher training, activities on health in the curriculum, active opportunities in the school environment (the availability of equipment for PA), and health education (health materials for students and parents). Data collection was undertaken before and immediately after the intervention. The primary variables included the practice of PA (weekly PA volume, PA behavior change stage and preference for PA during leisure-time) and screen time (TV and computer/video games). Potential intrapersonal, interpersonal and environmental mediators of PA and screen time were evaluated by a standardized questionnaire. Other lifestyle components (e.g., eating habits, substance use), psychological (e.g., self-rated health, body satisfaction) and biological (general and abdominal obesity) aspects, as well as academic performance were also evaluated in the total sample. Depressive symptoms, eating disorders, sleep quality, objectively-measured PA, and sedentary time were evaluated in obese students.

Discussion

If effective, this program will contribute to the development of public policies for the promotion of active and healthy lifestyles in youth, especially those from low- and middle-income countries. The main intrapersonal, interpersonal and/or environmental mediators of PA and screen time may also be indicated. Finally, we anticipate that the proposed strategies may be adaptable to public schools and may even be extended to the entire school system.

Trial registration

ClinicalTrials.Gov: NCT02439827. Registration date: May 3, 2015.

Electronic supplementary material

The online version of this article (doi:10.1186/s12889-015-2543-2) contains supplementary material, which is available to authorized users.

Young adult's own and parental social characteristics predict injury morbidity: a register-based follow-up of 135,000 men and women

Background

Sociodemographic differences in injury mortality are well-established, but population-level studies on social patterns of injury morbidity remain few in numbers, particularly among young adults. Yet injuries are the leading cause of mortality, morbidity and disability among young people. Studies among children have shown steep social gradients in severe injuries, but less is known on the social patterning of injuries in late adolescence and early adulthood, when young people are in the process of becoming independent adults. This study examines how young adults’ current living arrangements, education, main economic activity, and parental social background are associated with hospital-treated injuries in late adolescence and early adulthood.

Methods

The study uses prospective, individual-level data gathered from several administrative sources. From a representative 11% sample of the total Finnish population, we included young people between ages 17–29 years during the follow-up (N = 134 938). We used incidence rates and Cox proportional hazards models to study hospital-treated injuries and poisonings in 1998–2008.

Results

Higher rates of injury were found among young adults living alone, single mothers, the lower educated and the non-employed, as well as those with lower parental social background, experience of childhood family changes or living with a single parent, and those who had left the parental home at a young age. Injury risks were consistently higher among young adults with lower education, but current living arrangements and main economic activity showed some age-related nuances in the associations: both earlier and later than average transitions in education, employment, and family formation associated with increased injury risks. The social differentials were strongest in poisonings, intentional self-harm, and assaults, but social patterns were also found in falls, traffic-related injuries and other unintentional injuries, underlining the existence of multiple distinct mechanisms and pathways behind the differentials.

Conclusions

The transition to adulthood is a life period of heightened risk of injury, during which both parental social background and the young people’s own social position are important determinants of serious injuries that require inpatient care.

Electronic supplementary material

The online version of this article (doi:10.1186/s12889-015-1763-9) contains supplementary material, which is available to authorized users.

ER visits predict premature death among teenagers

BACKGROUND

The purpose of this study was to investigate if teenagers visiting an emergency room because of injury have an increased risk of premature death ahead and, if so, identify possible risk factors and suggest preventive measures.

METHODS

In January 2010, the personal identity numbers of 12,812 teenagers who had visited the emergency room at the University Hospital in Umeå, Sweden, during 1993 through 2006 because of injury were checked against the National Cause of Death Register in Sweden. Standardised mortality ratio and confidence intervals were calculated. For the unnatural deaths that took place in Sweden, the police report, autopsy protocol, and hospital records, if present, were studied.

RESULTS

Thirty-eight fatalities were included giving a standardised mortality ratio of 1.44 (95% CI: 1.02-1.98). A majority of the decedents were males (n=32, 84%) and the median age at the time of death was 21 years. Twenty-three deaths were caused by unintentional injuries and ten by intentional injuries (all suicides), while five deaths were categorised as undetermined whether intentional or not. Seventy-four percent tested positive for either alcohol or drugs or a combination at the post mortem examination. Nine males and one female committed suicide, five tested positive for alcohol (one also for drugs), while four tested negative at the post mortem examination. One died abroad and in this case we lack information on alcohol and drugs.

CONCLUSION

Teenagers visiting an emergency room due to injury experience an increased risk of premature death by unnatural cause and those at risk are especially males. The use of alcohol and drugs often seems to contribute to their untimely deaths. Identifying those at risk when they visit the emergency room for an injury and to take preventive actions at this stage could be a way to reduce the number of fatalities.

The prevalence and correlates of behavioral risk factors for cardiovascular health among Southern Brazil adolescents: a cross-sectional study

Background

The adoption of health-related behaviors is an important part of adolescence. This study examined the prevalence and correlates of the isolated and simultaneous presence of behavioral risk factors for cardiovascular health (BRFCH) among adolescents in Curitiba, Southern Brazil.

Methods

A cross-sectional study was performed with 1,628 adolescents (aged 11-17.9 years, 52.5% males) that were randomly selected from 44 public schools. Self-report instruments were used to assess the variables. Six BRFCH were analyzed: insufficiently active, excessive TV watching, current alcohol and tobacco use, daily soft drinks consumption and inadequate fruit and vegetable consumption. Sociodemographic and behavioral variables were studied as possible correlates of the presence of BRFCH.

Results

The BRFCH with the highest prevalence were insufficiently active (50.5%, 95% confidence interval [95% CI]: 48.0-52.9) and daily soft drinks consumption (47.6%, 95% CI: 45.1-50.0). Approximately 30% of the adolescents presented three or more BRFCH simultaneously. Girls, adolescents who did not participate in organized physical activity, and who used computer/video games daily were the main high-risk subgroups for insufficiently active. Boys and those who used computer/video games daily were the high-risk subgroups for daily soft drinks consumption. For excessive TV watching, we identified to be at risk those who were from a high economic class, unemployed, and who used computer/video games daily. For current alcohol use, we identified older adolescents, who were from a high economic class and who worked to be at risk. Older adolescents, who worked and who spent little active time during a physical education class were the high-risk subgroups for current tobacco use. For inadequate fruit and vegetable consumption, we identified those who did not participate in organized physical activity to be at risk. Older adolescents, who were from a high economic class, who did not participate in organized physical activity and who used computer/video games daily were the high-risk subgroups for simultaneous BRFCH.

Conclusions

We found a high prevalence of BRFCH among adolescents, both isolated and simultaneously. The correlates of the presence of BRFCH can contribute to healthy policies among Brazilian adolescents, mainly focusing on high-risk subgroups for a health risk behavior.

Living arrangements and external causes of deaths in early adulthood

PURPOSE

The mortality-lowering benefits of living in a union are well-known in the adult population, but the association between living arrangements and mortality among the young remains unclear. This study examines the association between current living arrangements and external causes of death in early adulthood, adjusting for factors such as parental socioeconomic position, current main activity, household income, and level of own education.

METHODS

The study is based on annually updated longitudinal register data that include a representative 11% sample of the whole Finnish population with an over-sample of 80% of all deaths. We used mortality rates and Cox proportional hazards models to study deaths in young adults aged between 17 and 29 years of age, from 1995 to 2004.

RESULTS

Compared with living in parental home with married parents, those living alone in late teens and early 20s had clearly higher risk of external mortality among both sexes. Young adults living in cohabiting- or one-parent families carried likewise a higher risk of death. Living with a partner was associated with lower mortality in early 20s, but especially in late 20s. The observed mortality differentials by living arrangements remained notable for the most part, even after adjustment for socioeconomic factors.

CONCLUSIONS

Strong excess mortalities among those living alone, single parents, children of single and cohabiting parents, the nonemployed, the less educated, and the less earning highlight the importance of late adolescence and early adulthood as a critical period for emerging health inequalities.

Adolescent drinking, academic achievement and leisure time use by secondary education students in a rural area of Crete

This study investigated the alcohol consumption of secondary education students and their relationship to school life and leisure time use with peers. A cross-sectional survey was conducted in March 2007, and the study population consisted of 14- to 19-year-old students living in an agricultural area of Crete. The final sample consisted of 117 individuals (response rate 90.0%). A short previously validated self-completion questionnaire was used collecting information on: personal and family characteristics; school progress; leisure time activities and relations with other adolescents; and alcohol consumption. Alcohol consumption differed significantly between male (75.5%) and female (25.8%) students (P < 0.001). Almost half of the participants (48.3%) reported alcohol consumption during nights out with friends. The mean grade for the previous year for students consuming alcohol was lower compared with those who did not, but the difference was not statistically significant (P = 0.066). Statistical evidence supported the hypothesis that students who consumed alcohol had more absences and this association was stronger for male students. The frequency of alcohol consumption was found to relate to the number of absences for both sexes. Male students who had been suspended from school were more likely to drink alcohol than those who had not been suspended. Statistical evidence also supported the hypotheses that students who spent their free time in cafeterias, bars or billiard halls were more likely to drink alcohol and also consume alcohol at higher frequencies than those that did not spend their free time this way (P = 0.002 and P < 0.001, respectively). More health education programmes and actions are needed at the national and local level to help students, families, schools, communities and the state better understand the real dimensions of the problem.

Adolescent risk factors for poisonings - a prospective cohort study

AIM

This study assessed whether adolescents' socioeconomic background, health and health behaviours are associated with later risk of poisoning hospitalization.

METHODS

A prospective cohort of 54,169 Finns aged 14-18 years was followed for an average of 10.6 years. The end-point of the study was poisoning hospitalization, death or termination of follow-up in 2001. The relationships of socioeconomic background, health and health behaviour characteristics with poisoning hospitalization were studied with adjusted Cox's proportional hazard model.

RESULTS

We identified 443 persons (0.8%) with a diagnosed poisoning leading to hospital admission. The mean age at the time of the poisoning hospitalization was 22.7 years. The strongest risk factors for poisoning hospitalization in males were more than three stress symptoms weekly (HR 1.9), poor school success (HR 1.9) and not living with both of the parents in adolescence (HR 1.8). In females, the strongest risk factors were more than three stress symptoms weekly (HR 2.1), poor school success (HR 2.2) and recurring drunkenness as drinking style (HR 1.7).

CONCLUSION

Poor school performance, health and health-compromising behaviour adopted in adolescence are associated with a poisoning hospitalization risk in adulthood. Daily smoking and recurring drunkenness were strongly associated with a later poisoning hospitalization.

Early predictors of injury mortality among Swedish conscripts: a 35-year cohort study

Injuries represent an important cause of mortality among young adults. We studied the associations between adolescents' family, psychological, behavioural and drug-related risk factors in relation to unintentional injury death. A population-based cohort of 49,411 Swedish conscripts aged 18-20 years was followed for 35 years. The end-point of study was injury death up to 2004. The relationship between two family, four psychological and eight behavioural risk factors and injury death were analysed with Cox proportional hazards analyses and χ(2) tests. Among 485 unintentional injury deaths, 40% occurred in subjects aged 25 years or under. The incidence per 1000 person years was 0.29 (95% CI, 0.26-0.31) and the mean age of death was 33 years. Problem drinking at both adolescent and adulthood was more strongly associated with injury death (HR=5.40) than illicit drug use (HR=2.70) even after adjusted for behavioural risk factors: (HR=3.43) and (HR=1.75), respectively. Adolescent risk factors such as contact with police and juvenile authorities, low emotional control, conduct problems at school and low social maturity were significant predictors of injury death in multivariate analyses. Young adults with social, behavioural and psychological problems and especially alcohol and drug use at both adolescent and adulthood have a high mortality rate due to road traffic injuries and all kind of injuries. Early identification of vulnerable groups of adolescents with psychological and behavioural problems including alcohol and drug use at local levels could make a difference.

Adolescent orofacial injury: association with psychological symptoms

Ethnic minority youth living in urban areas experience disproportionately high rates of violent intentional injuries. This study investigates the association of violent intentional injuries with psychological distress and alcohol use among adolescents treated in trauma centers for facial injuries. Interviews were conducted with 67 adolescents treated at two urban trauma centers (predominantly males [86%], and minority [Latino, 72%; African American, 19%]). Adolescents reported experiencing several different types of accidental and assault-related injuries that required medical attention in the past six months. About half (53%) reported experiencing only unintentional injuries (e.g. car accidents, falls, sports injury); 23% experienced one type of intentional injury resulting from either fighting or being attacked; and 24% experienced two types of intentional injuries resulting from both fighting and being attacked. Measures of alcohol use and psychological distress were examined in relation to these three types of injuries. Overall, 30% of study participants reported they had been drinking alcohol at the time of injury. Compared to adolescents without intentional injuries, those who experienced a physical fight and/or attack had higher levels of alcohol problems, depression, paranoia and somatic symptoms, and were more likely to have family members with alcohol problems. There is a considerable need for adolescents with intentional assault-related injuries to be screened for alcohol and mental health problems, and to be referred for appropriate treatment interventions if they score at problem levels.

Antecedents and covariates of alcohol consumption among Swiss male conscripts

This study aimed to investigate prevalence and correlates of alcohol consumption frequency in a sample of Swiss conscripts (n=25,611) in order to identify factors that predispose for frequent consumption. A self-report of drinking frequencies, as well as socio-demographic and psychosocial variables, was collected at psychiatric baseline screening. Based on univariate analyses, relevant variables were included in a multivariate multinomial logistic regression model. Six percent were abstainers, 15% reported rarely drinking, 53% occasional drinking, 24% regular drinking and 2% daily drinking. Except for substance use, most associations followed a “J”-shaped curve across the categories of alcohol frequency. Abstinence and frequent drinking can be perceived as deviations from the social norm. Both behaviors are associated with more psychosocial stressors and might be therefore special targets for further studies and new prevention programs.

Health risks for older US adolescents in foster care: the significance of important others' health behaviours on youths' health and health behaviours

BACKGROUND

Little research to date has examined older foster care youths' physical health and the associated health behaviours of the youth and important people in their lives (parents, peers and important non-parental adults).

METHODS

Older US foster care youth (n= 188) completed surveys on multiple indicators of self-report physical health, including number of chronic health problems, overall health and sick symptoms, as well as their own health-compromising behaviours and the health-compromising behaviours of important others.

RESULTS

The findings suggested that boys, particularly those placed in non-kin foster homes and group homes, appeared to have poorer health than did boys in these placement settings. Girls, however, engaged in similar levels of health-compromising behaviours as boys. Furthermore, the health-compromising behaviours of peers and important non-parental adults (VIPs), but not parents, were associated with youths' health behaviours, which, in turn, were associated with the physical health status of the foster care youth.

CONCLUSION

Youth report high levels of health-related problems and involvement in health-compromising behaviours. Healthcare practitioners can help to improve the health and well-being of children in foster care by becoming informed about adolescent health behaviours, as well as the health behaviours of their peers and other important non-parental adults.