Quality of life and health-risk behaviors among adolescents

Relationship of sexual quality of life and mental well-being in undergraduate women in a Canadian university

As young women transition from adolescence to adulthood, they begin to explore their sexual identities and sexual relationships. The current literature supports the relationship between sexual quality of life (QOL) and mental well-being. However, this relationship has not yet been replicated in undergraduate women. In order to address this gap, the authors assessed the correlation between sexual QOL and mental well-being among a sample of women undergraduate students in Canada. The study design was cross-sectional in nature, and demographic information was collected, along with the completion of validated measures of sexual QOL and mental well-being. A total of 157 individuals participated. After removing those who did not meet inclusion criteria and those with > 90% incomplete responses, 124 valid survey responses remained for analysis. A hierarchical multivariable linear regression was conducted while controlling for age, sexual orientation, exercise, history of nonconsensual sexual contact, household income, and self-perceived health status. Every one-unit increase in sexual QOL was associated with a 0.35 increase in mental well-being (95% CI 0.105–0.428, p = .002). A history of unwanted or nonconsensual sexual activity had a significant negative correlation with mental well-being ( p = .027). The authors’ findings suggest a significant relationship between sexual QOL and mental well-being. There is a strong opportunity for universities to bolster the support services available to students, with a required focus on women with a history of nonconsensual sexual contact.

Players at home: Physical activity and quality of life in 12-17 years-old football (soccer) players during the Covid-19 lockdown

BACKGROUND

Aggressive preventive actions were required to face the Covid-19 outbreak. However, from March 2020 on, many healthy youth football players have seen their sporting activities disrupted by the restrictions on outdoor exercise.This study describes physical activity and quality of life during April 2020 lockdown of young people participating in organized football.

METHODS

1163 young football players aged 12-17 years (185 girls) completed a web-based questionnaire including the Youth Physical Activity and the Youth Quality of Life-Short Form Questionnaires; information on lifestyle and football-specific activity were also collected. Differences according to sex, urban/rural context and élite/non-élite club level were tested using a 2 × 2  ×  2 MANOVA (age considered as a covariate).

RESULTS

We found that: (i) on average, exposure to football accounted for 3.2 hours/week, was higher in élite clubs and changed in nature, being mainly performed individually; 19% of participants practiced football <1 hour/week; (ii) only 56% of the participants reported 7 or more hours/week of moderate-to-vigorous physical activity, which decreased with age and changed according to the geographical context; (iii) perceived quality of life was lower in youth playing for non-elite clubs and in older girls; (iv) coaches, rather that official initiatives, were the primary source of football exercises practiced at home.

CONCLUSION

A status of limited physical activity emerged; this might lead to deconditioning and susceptibility to injuries when football could restart. Governing bodies, football Associations and clubs could exploit these results to take informed decisions and support evidence-based interventions during and after the Covid-19 pandemic.

Effects of Social Attachment on Experimental Drug Use From Childhood to Adolescence: An 11-Year Prospective Cohort Study

Background

Drug use among adolescents are still crucial issues that endanger their lifetime health. Evidence concerning the interpersonal-related factors influencing youngsters' experimental drug use behavior, especially from longitudinal and school-based prospective cohort studies, is insufficient. We aimed to describe the annual incidence rate and mean annual incidence rate of experimental drug use from childhood to adolescence by education stage, clarify the risk in childhood and examine the longitudinal relationship between social attachment factors and experimental drug use.

Materials and Methods

The data were derived from the 1st to 11th wave of the longitudinal study. In total, 1,106 respondents aged 19–20-year-old were followed up for 11 years (from 9 to 10-year-old) in Taiwan. A survival analysis was used to analyze the time-invarying/time-dependent effects of social attachment factors on experimental drug use.

Results

The mean annual incidence rate of experimental drug use from childhood to adolescence was 6.8‰. The incidence increased over time and was the highest in the first year of university (19.3‰). Boys were more likely to use drugs than girls. A low degree of self-perceived likeability in childhood was a risk factor influencing experimental drug use. On average, a low degree of parental supervision and a high degree of family conflict were both influential risk factors. According to the time-dependent models, a high degree of parental supervision, a high degree of family support and a low degree of family conflict in the current year can protect children and adolescents from drug use, whereas a sustained low degree of parental supervision and a high degree of family conflict may promote students' experimental drug use.

Conclusion

Parents should be informed and educated to avoid family conflict during childhood, maintain consistent supervision of their children's behavior, provide adequate family support, and pay attention to their children's interpersonal relationships in school. Teachers should focus on the social attachment status of their students while considering their attachments to their families and peers.

Systematic Review of Conceptual, Age, Measurement and Valuation Considerations for Generic Multidimensional Childhood Patient-Reported Outcome Measures

BACKGROUND AND AIMS

Patient-reported outcome measures (PROMs) for children (aged ≤ 18 years) present methodological challenges. PROMs can be categorised by their diverse underlying conceptual bases, including functional, disability and health (FDH) status; quality of life (QoL); and health-related quality of life (HRQoL). Some PROMs are designed to be accompanied by preference weights. PROMs should account for childhood developmental differences by incorporating age-appropriate health/QoL domains, guidance on respondent type(s) and design. This systematic review aims to identify generic multidimensional childhood PROMs and synthesise their characteristics by conceptual basis, target age, measurement considerations, and the preference-based value sets that accompany them.

METHODS

The study protocol was registered in the Prospective Register of Systematic Reviews (CRD42021230833), and reporting followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We conducted systematic database searches for generic multidimensional childhood PROMs covering the period 2012-2020, which we combined with published PROMs identified by an earlier systematic review that covered the period 1992-2011. A second systematic database search identified preference-based value sets for generic multidimensional PROMs. The PROMs were categorised by conceptual basis (FDH status, QoL and HRQoL) and by target age (namely infants and pre-schoolers aged < 5 years, pre-adolescents aged 5-11, adolescents aged 12-18 and multi-age group coverage). Descriptive statistics assessed how PROM characteristics (domain coverage, respondent type and design) varied by conceptual basis and age categories. Involvement of children in PROM development and testing was assessed to understand content validity. Characteristics of value sets available for the childhood generic multidimensional PROMs were identified and compared.

RESULTS

We identified 89 PROMs, including 110 versions: 52 FDH, 29 QoL, 12 HRQoL, nine QoL-FDH and eight HRQoL-FDH measures; 20 targeted infants and pre-schoolers, 29 pre-adolescents, 24 adolescents and 37 for multiple age groups. Domain coverage demonstrated development trajectories from observable FDH aspects in infancy through to personal independence and relationships during adolescence. PROMs targeting younger children relied more on informant report, were shorter and had fewer ordinal scale points. One-third of PROMs were developed following qualitative research or surveys with children or parents for concept elicitation. There were 21 preference-based value sets developed by 19 studies of ten generic multidimensional childhood PROMs: seven were based on adolescents' stated preferences, seven were from adults from the perspective of or on behalf of the child, and seven were from adults adopting an adult's perspective. Diverse preference elicitation methods were used to elicit values. Practices with respect to anchoring values on the utility scale also varied considerably. The range and distribution of values reflect these differences, resulting in value sets with notably different properties.

CONCLUSION

Identification and categorisation of generic multidimensional childhood PROMs and value sets by this review can aid the development, selection and interpretation of appropriate measures for clinical and population research and cost-effectiveness-based decision-making.

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.

Factors Associated with Drug Use Among HIV-Infected Men Who Have Sex with Men in China

Drug use is globally more prevalent in HIV-positive men who have sex with men (HIVMSM) than their heterosexual counterparts. Yet, few studies have investigated the factors associated with drug use among this population beyond Western societies. A cross-sectional survey was conducted to examine factors associated with drug use among 415 HIVMSM in Chengdu, China. The results show that 10.8% of the participants had used drugs in the past 30 days. Among participants who had anal intercourse in the past 30 days, 11.5% had used drugs during anal intercourse. After adjusting for background variables, logistic regression models show that life satisfaction was associated with past 30-day drug use [Adjusted Odds Ratio (ORa) = 0.90, p < 0.001], and with drug use during anal intercourse in the past 30 days (ORa = 0.89, p < 0.01). Participants with more nonregular partners were more likely to use drugs with or without sex in the past 30 days, whereas those with one regular partner were less likely to use drugs during anal intercourse compared to their counterparts with no regular partners. The findings of this study are informative for designing effective substance-use intervention programs targeting HIVMSM.

Victimization, Poverty, and Resilience Resources: Stress Process Considerations for Adolescent Mental Health

Growing evidence suggests that exposure to early life adversity poses risk to youth development, with impaired mental health a central concern. This population-representative study of adolescent students (n=11,222) investigates the effects of two key forms of early adversity- victimization and poverty-on adolescent mental health in a step-wise fashion, also accounting for mutable and accessible resilience resources. Victimization and poverty prevalence reflected social patterning wherein being female, racial and ethnic minority youth, and those with lower resilience resources all reported significantly higher levels of victimization and family poverty. Greater levels of these adversities were significantly associated with lower levels of resilience resources. Poverty and particularly victimization demonstrated significant cumulative and distinct contributions across three indicators of compromised mental health-depression, suicidality, and broader psychological well-being. Resilience resources of family bondedness, school engagement, and sleep sufficiency all carried significant effects and accompanied lesser explanatory strength of victimization and family poverty. In separate analyses, each of four forms of victimization-adult maltreatment, bullying, dating violence, and feeling unsafe at school-were significant contributors to mental health, with cumulative exposure conveying the strongest unique effects. Implications and opportunities for prevention and remedial strategies are discussed, with particular attention to school-based responding.

A systematic review of wellbeing in children: a comparison of military and civilian families

BACKGROUND

Children in military families have uniquely different childhood experiences compared to their civilian peers, including a parent in employment and a stable familial income, frequent relocations, indirect exposure to and awareness of conflict, and extended separation from parents or siblings due to deployment. However, whether children from military families have poorer wellbeing than non-military connected children is not well understood.

METHOD

We conducted a systematic review to explore the relationship between military family membership (e.g. parent or sibling in the military) and child wellbeing compared to non-military connected controls. Searches for this review were conducted in September 2016 and then updated in February 2018.

RESULTS

Nine studies were identified, eight were cross-sectional. All studies utilised self-report measures administered in US school settings. On the whole, military connected youth were not found to have poorer wellbeing than civilian children, although those with deployed parents and older military connected children were at greater risk of some adjustment difficulties (e.g. substance use, externalising behaviour). Although only assessed in two studies, having a sibling in the military and experiencing sibling deployment was statistically significantly associated with substance use and depressive symptoms.

CONCLUSIONS

This study is unique in its direct comparison of military and non-military connected youth. Our results highlight the need to examine the impact of military service in siblings and other close relatives on child wellbeing. Given the adverse impact of poor mental health on child functioning, additional research is needed ensure appropriate, evidence-based interventions are available for youth in military families.

Illict drug use and academia in North Kosovo: Prevalence, patterns, predictors and health-related quality of life

PURPOSE

The purpose of this study were to estimate the prevalence and patterns of illicit drug use in a sample of University students from North Kosovo, to assess factors associated with illicit drug use and to assess health-related quality of life (HRQoL) among students according to illicit drug use.

METHODS

A cross-sectional study was conducted at the Student Public Health Center, where 514 University students were enrolled from April to June 2015 in North Kosovo. Participants completed the general socio-demographic and behavioral questionnaire, Beck Depression Inventory (BDI) and the SF-36 questionnaire for HRQoL assessment. Data on lifetime illicit drug use were self-reported.

RESULTS

As much as 16.0% of students reported ever illicit drug use. The most frequently used drugs were marijuana (9.3%) and bromazepam (7.6%). Factors associated with ever illicit drug use were: being smoker and alcohol user, having chronic diseases and having higher depressive symptoms score. Ever illicit drug users reported all domains of HRQoL as worse.

CONCLUSION

These results could serve as a tool for implementation of preventive strategies and University policies to promote healthy lifestyles and behaviors. Measurement of HRQoL could also be used as indicator of the effect of interventions designed to reduce and/or prevent illicit drug use at institutions of higher education.

Examining Africentric Cultural Values, Ethnic Identity, and Substance Use Abstinence in Low-Income, Early Adolescent, African American Girls

An examination of cultural protective factors that foster substance use abstinence among low-income, early adolescent, African American girls may be helpful in understanding how to promote resilience and reduce negative health outcomes. This study examined the relations between Africentric cultural values, ethnic identity, and substance use abstinence among 196 low-income African American early adolescent girls (age 11-14 years). Results of logistic regressions revealed that Africentric values were negatively linked to cigarette and alcohol abstinence. Results also showed a significant positive interaction between Africentric cultural values and ethnic identity exploration that contributed to increased cigarette and alcohol abstinence. Implications for research and practice with African American early adolescent girls are discussed.

Validation of QUALAS-T, a health-related quality of life instrument for teenagers with spina bifida

Introduction

We aimed to develop and validate a self-reported QUAlity of Life Assessment in Spina bifida for Teenagers (QUALAS-T).

Material and methods

We drafted a 46-question pilot instrument using a patient-centered comprehensive item generation/refinement process. A group of 13–17 years olds with spina bifida (SB) was recruited online via social media and in person at SB clinics (2013–2015). Healthy controls were recruited during routine pediatrician visits. Final questions were identified based on clinical relevance, factor analysis and domain psychometrics. Teenagers with SB completed the validated generic Kidscreen-27 instrument.

Results

Median age of 159 participants was 15.2 years (42.0% male, 77.4% Caucasian), similar to 58 controls (p ≥ 0.06). There were 102 online and 57 clinic participants (82.8% of eligible). Patients, parents and an expert panel established face and content validity of the 2-domain, 10-question QUALAS-T. Internal consistency and test-retest reliability were high for the Family and Independence and Bladder and Bowel domains (Cronbach's alpha: 0.76–0.78, ICC: 0.72–0.75). The Bladder and Bowel domain is the same for QUALAS-T , QUALAS-A for adults and QUALAS-C for children. Correlations between QUALAS-T domains were low (r = 0.34), indicating QUALAS-T can differentiate between distinct HRQOL components. Correlations between QUALAS-T and Kidscreen-27 were also low (r ≤0.41). QUALAS-T scores were lower in teenagers with SB than without (p <0.0001).

Conclusions

QUALAS-T is a short, valid HRQOL tool for adolescents with SB, applicable in clinical and research settings. Since the Bladder & Bowel domains for all QUALAS versions are the same, Bladder and Bowel HRQOL can be measured on the same scale from age 8 through adulthood.

The Ugandan Youth Quality of Life index: assessing the relevance of incorporating perceived importance into the quality of life measure and factors associated with the quality of life among youth in slum areas of Kampala, Uganda

Background

While quality of life (QoL) has long been an explicit policy goal for international development programmes, no instruments have specifically been developed for measuring health-related QoL in resource-limited settings. The aim of this study was to develop and validate a QoL instrument for use in international aid and development programmes and to assess factors associated with QoL among youth participating in a civic engagement project in Kampala.

Design

Using systematic random sampling, data were collected on 663 participants aged between 13 and 24 years in Kampala. The QoL questionnaire included 36 questions divided into a two-part scale: 18 questions rated for satisfaction (Part 1) and 18 other questions rated on importance (Part 2). The total sample was randomly divided into two split-half samples: one for the exploratory factor analysis (EFA; N=310) and the other for the confirmatorty factor analysis (CFA; N=353). The effect of demographic, socio-economic, and lifestyle factors on QoL was assessed using linear regressions.

Results

The EFA yielded three factors: living conditions and lifestyle (seven items, α=0.84), social relationships (five items, α=0.86), and personal independence (five items, α=0.76). In the CFA, the initial model demonstrated a poor to marginal fit model. Its re-specification by examining modification indices resulted in a good model fit: Comparative Fit Index=0.95, Root Mean Square Error of Approximation=0.06, and p of Close Fit >0.05. The model incorporating perceived importance had lower Akaike Information Criteria and Bayesian Information Criteria values than the unweighted model, thereby providing very strong support to weight satisfaction scores with importance ratings when measuring QoL in Uganda. Poor QoL was associated with poor educational attainment, drug and substance misuse, and family disruption.

Conclusions

The findings suggest that there is a relationship between QoL and lifestyle and structural issues among youth in Uganda. The study provides the first validated QoL measure to allow government and non-government organisations in low- and middle-income countries to track progress of international aid and development programmes.

Health-Related Quality of Life With Regard to Smoking, Consumption of Alcohol, and Sports Participation

BACKGROUND

Health-related quality of life (HRQoL) is an important determinant in a person's life.

OBJECTIVES

In this study aimed at physical education students, alcohol consumption and smoking as risk factors and sports as a healthy factor could affect HRQoL.

PATIENTS AND METHODS

This study was an analytical cross-sectional study. For our purpose, the subjects (n = 519) were asked to answer the SF-36 questionnaire (short form health survey for HRQOL). To analyze the data, two-way multivariate analysis of variance (MANOVA), one-way analysis of variance (ANOVA), the independent-samples t-test, and Pearson correlation coefficient were conducted. In this study, the P < 0.05 was considered a significant difference, and due to a Bonferroni correction, for ANOVAs tests, a P < 0.0125 was considered a significant difference.

RESULTS

The results suggest that statistically significant differences for alcohol consumption were only obtained from the role-emotional (RE) scale, in which drinkers had lower mean scores than nondrinkers. For smoking, significant differences were obtained from the scales of RE, vitality (VT), emotional well-being (EW), social functioning (SF), and general health (GH), in which nonsmokers outdid smokers. The combination of alcohol drinking and smoking led to statistically significant lower scores on the RE scale and strongly destroyed the role-emotional part of HRQOL.

CONCLUSIONS

It can be concluded that smoking and alcohol consumption may be related to poor HRQOL in physical education and sports students despite the fact that they regularly engage in sports programs that could positively affect their HRQOL.

Facing the Adversity: the Role of Internal Assets on Well-Being in Adolescents with Special Needs

Negative life events are one of the major threats to well-being. Some adolescents are more vulnerable, namely adolescents with special needs that face special challenges for growing up healthy and happy. Nevertheless, internal assets can act as protective factors. The aim of this study is to analyze the factors that moderate the impact of negative life events, among adolescents with special needs, on well-being. The sample included 472 adolescents with special needs, mean age 14 years old. Pupils attended 77 public schools in Portugal. Sample was collected within the HBSC (Health Behavior in School aged Children) Portuguese survey. Questions used in this study, covered well-being, internal assets and life events. Results showed that the well-being of adolescents with special needs who had a set of internal assets (personal and social competences) was protected, even when they faced negative life events. However when several negative life events were present, the assets that continued to be protective were problem solving, F(4, 383) = 3.79, p = .005, η2 = .04, and self-efficacy, F(4, 377) = 3.39, p = .010, η2 = .04, suggesting the resilience properties of these factors.

Structural model of factors influencing smoking behavior among Korean-Chinese adolescent boys

AIM

The aim of this study is to develop and test structural equation model to explore factors influencing smoking behavior among Korean-Chinese adolescent boys.

METHODS

Participants were recruited from six middle schools in China (N=768). Self-administered questionnaire included: (1) demographic information, (2) smoking behavior, and (3) individual factor (i.e., life satisfaction, future orientedness, stress), familial factor (i.e., relationship with parents, family life, socioeconomic status), environmental factor (i.e., father's smoking, friends' smoking, anti-smoking environment), and Intention Refusal Self-efficacy. AMOS analyses were used to evaluate the proposed model.

RESULTS

The model was a good fit for the data. Intention Refusal Self-efficacy significantly influenced smoking behavior. The model explained 52% of the variance in smoking behavior.

CONCLUSIONS

Smoking behavior is significantly related with factors of intention to smoke, refusal skill, self-efficacy, friends' and father's smoking, and anti-smoking environment. Targeting these issues might be useful when developing strategies for smoking prevention programs.

The long arm of adolescence: school health behavioral environments, tobacco and alcohol co-use, and the 5HTTLPR gene

Although sociologists, demographers, and others have thoroughly studied contextual and life course influences on tobacco and alcohol use in adolescence and young adulthood, far less attention has been paid to the determinants of tobacco and alcohol co-use. This is important to remedy because co-use has a nonadditive effect on long-term health. In this article, we use nationally representative, longitudinal data from adolescents and young adults to examine patterns of joint tobacco and alcohol use behaviors across the life course. Importantly, we describe how these trajectories are linked to respondents' high school's joint profile of tobacco and alcohol use, measured two ways: as the proportion of tobacco and alcohol co-users, and as the "excess proportion" above that expected based on the marginal probabilities of smoking and drinking in that school. Joint tobacco and alcohol use is associated with both measures, emphasizing the "long arm" of adolescent contexts. Furthermore, we extend previous research to assess whether there is a gene-environment interaction between this school-level measure, 5HTTLPR, and tobacco and alcohol co-use, as suggested by recent work analyzing drinking and smoking separately. We find evidence of such a pattern but conclude that it is likely to be due to population stratification or other forms of confounding.

Explaining educational inequalities in adolescent life satisfaction: do health behaviour and gender matter?

OBJECTIVES

There is little evidence on the explanation of health inequalities based on a gender sensitive perspective. The aim was to investigate to what extent health behaviours mediate the association between educational inequalities and life satisfaction of boys and girls.

METHODS

Data were derived from the German part of the Health Behaviour in School-aged Children (HBSC) study 2010 (n = 5,005). Logistic regression models were conducted to investigate educational inequalities in life satisfaction among 11- to 15-year-old students and the relative impact of health behaviour in explaining these inequalities.

RESULTS

Educational inequalities in life satisfaction were more pronounced in boys than in girls from lower educational tracks (OR 2.82, 95 % CI 1.97-4.05 and OR 2.30, 95 % CI 1.68-3.14). For adolescents belonging to the lowest educational track, behavioural factors contributed to 18 % (boys) and 39 % (girls) in the explanation of educational inequalities in life satisfaction.

CONCLUSIONS

The relationship between educational track and life satisfaction is substantially mediated by health-related behaviours. To tackle inequalities in adolescent health, behavioural factors should be targeted at adolescents from lower educational tracks, with special focus on gender differences.

Health-risk behaviors and quality of life among young men

PURPOSE

To examine the associations between substance use and other health-risk behaviors and quality of life (QOL) among young men.

METHODS

The analytical sample consisted of 5,306 young Swiss men who participated in the Cohort Study on Substance Use Risk Factors. Associations between seven distinct self-reported health-risk behaviors (risky single-occasion drinking; volume drinking; cigarette smoking; cannabis use; use of any other illicit drugs; sexual intercourse without a condom; low physical activity) were assessed via chi-square analysis. Logistic regression analyses were conducted to study the associations between each particular health-risk behavior and either physical or mental QOL (assessed with the SF-12v2) while adjusting for socio-demographic variables and the presence of all other health-risk behaviors.

RESULTS

Most health-risk behaviors co-occurred. However, low physical activity was not or negatively related to other health-risk behaviors. Almost all health-risk behaviors were associated with a greater likelihood of compromised QOL. However, sexual intercourse without a condom (not associated with both physical and mental QOL) and frequent risky single-occasion drinking (not related to mental QOL after adjusting for the presence of other health-risk behaviors; positively associated with physical QOL) differed from this pattern.

CONCLUSIONS

Health-risk behaviors are mostly associated with compromised QOL. However, sexual intercourse without a condom and frequent risky single-occasion drinking differ from this pattern and are therefore possibly particularly difficult to change relative to other health-risk behaviors.

Multilevel socioeconomic effects on quality of life in adolescent and young adult survivors of leukemia and lymphoma

PURPOSE

Cancer registry survival analyses have shown that adolescent and young adult patients with low socioeconomic status (SES) have reduced survival compared to those with higher SES. The objective of this study was to determine whether neighborhood- (nSES) and/or individual-level SES (iSES) also predicted current quality of life in adolescent and young adult survivors.

METHODS

The Socioeconomics and Quality of Life study surveyed adolescent and young adult survivors of leukemia and lymphoma at least one year post-diagnosis using population-based ascertainment. Factor analysis was used to create a multidimensional age-relevant iSES score and compared with a preexisting census-block-group derived nSES score. Four quality of life domains were assessed: physical health, psychological and emotional well-being, social relationships, and life skills. Nested multivariable linear regression models were run to test the associations between both SES measures and quality of life and to compare the explanatory power of nSES and iSES.

RESULTS

Data from 110 individuals aged 16-40 were included in the final analysis. After adjustment for sociodemographic confounders, low nSES was associated only with poorer physical health, whereas low iSES was related to poorer quality of life in all four domains with iSES accounting for an additional 14, 12, 25, and 10 % of the variance, respectively.

CONCLUSIONS

Measures of SES at the individual as compared to the neighborhood level may be stronger indicators of outcomes in adolescents and young adults, which has important implications for SES measurement in the context of cancer surveillance.

Substance use by adolescents of the USA National Longitudinal Lesbian Family Study

Although studies show that adolescents with same-sex parents experience homophobic discrimination, little is known about associations between stigmatization and substance use in this population. The 17-year-old offspring of lesbian parents from the largest, longest-running, longitudinal study of same-sex parented families were surveyed about substance use, experiences of homophobic stigmatization, and overall life satisfaction. Compared to matched adolescents from a national probability sample, adolescents with same-sex parents were more likely to report occasional substance use but not more likely to report heavy use. No associations were found between substance use and homophobic stigmatization or life satisfaction.

Mode of communication, perceived level of understanding, and perceived quality of life in youth who are deaf or hard of hearing

Given the important role of parent-youth communication in adolescent well-being and quality of life, we sought to examine the relationship between specific communication variables and youth perceived quality of life in general and as a deaf or hard-of-hearing (DHH) individual. A convenience sample of 230 youth (mean age = 14.1, standard deviation = 2.2; 24% used sign only, 40% speech only, and 36% sign + speech) was surveyed on communication-related issues, generic and DHH-specific quality of life, and depression symptoms. Higher youth perception of their ability to understand parents' communication was significantly correlated with perceived quality of life as well as lower reported depressive symptoms and lower perceived stigma. Youth who use speech as their single mode of communication were more likely to report greater stigma associated with being DHH than youth who used both speech and sign. These findings demonstrate the importance of youths' perceptions of communication with their parents on generic and DHH-specific youth quality of life.

Weight loss and changes in generic and weight-specific quality of life in obese adolescents

PURPOSE

To investigate how weight loss correlates with changes in generic and weight-specific quality of life (QoL).

METHODS

Youth generic (YQOL-S) and weight-specific instruments (YQOL-W) from 133 youth age 11-19 were analyzed at the beginning and end of 4-week immersion camp sessions known to produce weight loss. Paired samples t tests were used to test mean difference between baseline and final Body Mass Index (BMI) and YQOL-S and YQOL-W scores. YQOL-S and YQOL-W scores were transformed to values between 0 and 100, with higher values indicating better QOL. Cohen's d effect sizes were calculated to assess magnitude of effects. Percent weight loss (as % of baseline weight), change in BMI (baseline kg/m²-follow-up kg/m²), and change in % overweight ((BMI-50th% BMI for age and sex)/50th% BMI for age and sex × 100) were calculated. Multiple regressions were used to model final YQOL scores in the 11-14 and 15-19 age groups as functions of each measure of weight change, sex, age, and baseline YQOL score.

RESULTS

Youth experienced significant reductions in BMI (Mean change = 3.7, SD = 1.4, t = 34.1, P < 0.001) and in the other measures of weight change. YQOL-S and YQOL-W scores improved significantly (P < 0.001), and effect sizes were 0.61 and 0.66, respectively.

CONCLUSION

Changes in generic and weight-specific quality of life scores are associated with weight loss. The weight-specific measure is slightly more sensitive to weight changes; however, when controlling for modifiers, the YQOL-W remained significantly associated with weight loss, while the generic QoL measure did not.

Prevalence and associated factors of smoking among secondary school students in Harare Zimbabwe

Background

There is a growing epidemic of tobacco use among adolescents in the developing world. However, there is no up to date information on smoking among adolescents. Although in the developing world concerted efforts are being made to control tobacco use, Zimbabwe does not have any documented tobacco control programmes. We estimated the prevalence of smoking among school going secondary school students in Harare, Zimbabwe.

Methods

A 3-stage stratified random sampling was employed to select six participating schools and students. A descriptive analysis was conducted to describe the demographic characteristics of the participants. The prevalence of smoking was estimated and the comparison of prevalence was performed according to its associated factors. Logistic regression analysis was used to identify risk factors for smoking.

Results

650 students with a mean age 16 years and 47% of them female participated. Prevalence of ever-smoked was 28.8% (95% CI 25.3 to 32.3). Prevalence of ever-smoked among males (37.8%) was significantly (p < 0.001) much higher than among females (18.5%). In the multivariate analysis, smoking was found to be statistically associated with having friends that smoke (OR 2.8), getting involved in physical fights (OR 2.3), alcohol use (OR 5.7), marijuana use (OR 8.1) and having had sexual intercourse (OR 4.4).

Conclusions

The study provides recent estimates of prevalence of smoking, and indicates that there is still a high prevalence of smoking among urban secondary school students. Exposure to friends who smoke, risky behaviour like substance abuse, premarital sex and physical fights are significantly associated with smoking. Interventions to stop or reduce the habit should be implemented now and future studies should monitor and evaluate the impact of the interventions.

Profiles of protection from substance use among adolescents

The purpose of this study was to explore whether adolescents (N = 10,287) could be classified into homogeneous subgroups based on their protective factors and, if so, whether these constellations of protection differentially relate to adolescents' lifetime and 30-day alcohol and tobacco use. Latent class analysis with eight protective factors--four internal and four external--were used to identify the underlying latent class structure. Five profiles of protection emerged: Adequate Protection (54%), Adequate External Protection (9%), Adequate Protection with Low Adult Communication (16%), Adequate Protection with Risky Friends (9%), and Inadequate Protection (12%). Lifetime alcohol use was associated with only a modest increase in odds of belonging to the Adequate External or Low Adult Communication latent classes, but an enormous increase in odds of having Inadequate Protection or Risky Friends. Similar effects were found for past month alcohol use. Unlike alcohol use, which was related most strongly with membership in the Risky Friends latent class (relative to Adequate Protection), cigarette use was most strongly related to membership in the Inadequate Protection latent class. Findings can be used to inform prevention programs as they illustrate the relationships that exist between adolescents' profiles of protection and substance use.

Overweight, obesity, youth, and health-risk behaviors

BACKGROUND

The prevalence and severity of obesity have increased among children and adolescents. Although the medical and psychosocial consequences of youth obesity have been well documented, comparatively less information exists on the association of overweight/obesity with health-risk behaviors, which are considered to be a primary threat to adolescent health.

PURPOSE

This study aims to examine the association of overweight and obesity with health-risk behaviors among U.S. youth.

METHODS

Self-reported height and weight, substance use, violence, and bullying were assessed in a nationally representative sample of students aged 11-17 years (N=7825) who participated in the 2005-2006 Health Behaviors in School-Aged Children survey. Data were analyzed in 2009.

RESULTS

Significant gender and age differences in the relationship of overweight/obesity with risk behaviors were observed. Overweight and obesity were significantly associated with substance use among girls only: Frequent smoking and drinking were associated with overweight and obesity among younger girls, whereas these behaviors were associated with obesity among older girls. Frequent smoking and cannabis use were associated with overweight among younger girls only. Relationships between violent behavior and overweight/obesity were mainly observed among boys: Younger obese boys were more likely to be victims of bullying, whereas older obese boys were more likely to carry weapons compared to boys of normal weight.

CONCLUSIONS

Overweight and obese young people are at risk of developing health-compromising behaviors that may compound medical and social problems associated with excess weight.

Self-reported physical and mental health status and quality of life in adolescents: a latent variable mediation model

Background

We examined adolescents' differentiation of their self-reported physical and mental health status, the relative importance of these variables and five important life domains (satisfaction with family, friends, living environment, school and self) with respect to adolescents' global quality of life (QOL), and the extent to which the five life domains mediate the relationships between self-reported physical and mental health status and global QOL.

Methods

The data were obtained via a cross-sectional health survey of 8,225 adolescents in 49 schools in British Columbia, Canada. Structural equation modeling was applied to test the implied latent variable mediation model. The Pratt index (d) was used to evaluate variable importance.

Results

Relative to one another, self-reported mental health status was found to be more strongly associated with depressive symptoms, and self-reported physical health status more strongly associated with physical activity. Self-reported physical and mental health status and the five life domains explained 76% of the variance in global QOL. Relatively poorer mental health and physical health were significantly associated with lower satisfaction in each of the life domains. Global QOL was predominantly explained by three of the variables: mental health status (d = 30%), satisfaction with self (d = 42%), and satisfaction with family (d = 20%). Satisfaction with self and family were the predominant mediators of mental health and global QOL (45% total mediation), and of physical health and global QOL (68% total mediation).

Conclusions

This study provides support for the validity and relevance of differentiating self-reported physical and mental health status in adolescent health surveys. Self-reported mental health status and, to a lesser extent, self-reported physical health status were associated with significant differences in the adolescents' satisfaction with their family, friends, living environment, school experiences, self, and their global QOL. Questions about adolescents' self-reported physical and mental health status and their experiences with these life domains require more research attention so as to target appropriate supportive services, particularly for adolescents with mental or physical health challenges.

Sample Heterogeneity and the Measurement Structure of the Multidimensional Students' Life Satisfaction Scale

Several measurement assumptions were examined with the goal of assessing the validity of the Multidimensional Students' Life Satisfaction Scale (MSLSS), a measure of adolescents' satisfaction with their family, friends, living environment, school, self, and general quality of life. The data were obtained via a cross-sectional survey of 8,225 adolescents in British Columbia, Canada. Confirmatory factor and factor mixture analyses of ordinal data were used to examine the measurement assumptions. The adolescents did not respond to all the MSLSS items in a psychometrically equivalent manner. A correlated five-factor model for an abridged version of the MSLSS resulted in good fit when all negatively worded items and several positively worded items (the least invariant) were excluded. The abridged 18-item version of the MSLSS provides a promising alternative for the measurement of five life domains that are pertinent to adolescents' quality of life.

Effects of malocclusion and its treatment on the quality of life of adolescents

INTRODUCTION

The relationship between malocclusion and quality of life (QoL) is complex and not well understood. The objective of this study was to determine whether malocclusion and its treatment influence an adolescent's general and oral health-related QoL.

METHODS

An observational, cross-sectional design with a longitudinal component was used. Clinical and self-reported data were collected from 293 participants aged 11 to 14. The children were recruited from orthodontic and pediatric dental clinics at the University of Washington and a community health clinic in Seattle. The participants were classified into precomprehensive orthodontic (n = 93), postinterceptive orthodontic (n = 44), and nonorthodontic comparison (n = 156) groups. Assessments of dental esthetics and occlusion were evaluated with the Index of Complexity, Outcome, and Need. Three QoL questionnaires were completed: Youth Quality of Life to assess general QoL, Children's Oral Health-Related Quality of Life to assess oral health QoL, and Treatment Expectations and Experiences to evaluate participants' expectations for changes in specific aspects of their lives. Nonparametric tests were used for all analyses.

RESULTS

In general, overall and oral health QoL were high in this population. The instruments were correlated so that when oral health QoL improved, so did general QoL. No differences were found in these measurements between the university and community health clinics. Nor were there differences between the 3 study groups on general QoL and oral health QoL. There was little effect of malocclusion complexity on any QoL measure. Both preorthodontic and postorthodontic participants expected improvements in their health, oral function, appearance, and social well-being after orthodontic treatment; the postinterceptive sample's posttreatment experiences were consistent with their pretreatment expectations in all domains.

CONCLUSIONS

Malocclusion and orthodontic treatment do not appear to affect general or oral health QoL to a measurable degree, despite subjective and objective evidence for improved appearance, oral function, health, and social well-being.

Risk-taking behaviour in adolescence: a literature review

This article gives a review of the literature outlining risk-taking behaviour in the adolescent population, linking this to developmental tasks. The review includes reference to health, peers, parenting, self-esteem and quality of life issues. A theoretical overview of the research area in general is presented and links to social and society issues. The possible causes of risk-taking, including alcohol, drugs and violence, are considered and factors reviewed.

A review of similarities between domain-specific determinants of four health behaviors among adolescents

Schools are overloaded with health promotion programs that, altogether, focus on a broad array of behavioral domains, including substance abuse, sexuality and nutrition. Although the specific content of programs varies according to the domain focus, programs usually address similar concepts: knowledge, attitudinal beliefs, social influences and skills. This apparent conceptual overlap between behaviors and programs provides opportunities for a transfer-oriented approach which will stimulate students to apply the knowledge and skills they have learned in one domain (e.g. skills for resisting tobacco use) to other domains (e.g. alcohol, sex). A requirement for such an approach is that behaviors share at least some determinants. This review addresses this issue by examining similarities between domain-specific determinants of smoking, drinking, safe sex and healthy nutrition among adolescents. Recent empirical studies and reviews were examined. The results show that the following determinants are relevant to all four behaviors: beliefs about immediate gratification and social advantages, peer norms, peer and parental modeling and refusal self-efficacy. Several other determinants have been found to relate to at least two behaviors, e.g. health risk beliefs and parental norms. These results can be used for the development of a transfer-oriented school health promotion curriculum.

Self-reported health status and quality of life in youth with cerebral palsy and typically developing youth

OBJECTIVE

To describe self-reported health status and quality of life (QOL) of ambulatory youths with cerebral palsy (CP) compared with sex- and age-matched typically developing youth (TDY).

DESIGN

Prospective cross-sectional cohort comparison.

SETTING

Community-based.

PARTICIPANTS

A convenience sample of 81 youth with CP (age range, 10-13 y) with Gross Motor Function Classification System (GMFCS) levels I through III and 30 TDY participated. They were recruited from 2 regional children's hospitals and 1 regional military medical center.

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

Participants completed the Child Health Questionnaire-Child Form (CHQ-CF87) for health status and the Youth Quality of Life for QOL.

RESULTS

Youth with CP reported significantly lower health status than age- and sex-matched TDY in the following CHQ-CF87 subscales: role/social behavioral physical, bodily pain, physical function, and general health (CP mean rank, 46.8-55.2; TDY mean rank, 62.2-80.9). There were significant differences across GMFCS levels. There were no significant differences in self-reported QOL.

CONCLUSIONS

Self-reported health status, but not QOL, appears sensitive to the functional health issues experienced by ambulatory youth with CP. Pain management and psychosocial support may be indicated for them.

Stigma experiences in youth with facial differences: a multi-site study of adolescents and their mothers

OBJECTIVES

To describe stigma experiences of adolescents with congenital and acquired facial differences.

DESIGN

Used baseline cross-sectional stigma-related responses from a four site (Seattle WA, Galveston TX, Chicago IL and Chapel Hill NC) US study enrolling 185 English speaking, US participants ages 1118 years old with facial differences (60% male; 80% congenital conditions). Closed-ended, self-administered questions drawn from the Youth Quality of Life Instrument Facial Differences Module (YQOL-FD) determined perceptions of stigmatization. Mothers (n=153) were independently asked seven matching questions.

RESULTS

Frequencies report combined responses of 'sometimes,' 'fairly often,' and 'very often.' Mother's responses are in parentheses. *35% (47%) noticed people staring at their face in the past week. * 28% (43%) talked with others about how their face looks in the past month. * 29% (31%) heard others say something about their face in the past month. * 32% (32%) told peers about their facial difference in the past month. * 12% (12%) felt left out of doing things with peers because of how their face looks in the past month. * 11% (8%) got into a fight because of how their face looks in the past month. * 20% (18%) were teased about how their face looks in the past month.

CONCLUSIONS

Stigma experiences were frequently reported by youth with facial differences and were correlated with independent parental report. This level of stigma suggests that media and public health interventions may be warranted to reduce discrimination, prejudice and negative adolescent social experiences related to facial difference.

Satisfaction with life, psychosocial health and materialism among Hungarian youth

Previous research suggests that youth's life satisfaction may be influenced by health and certain socioeconomic/sociocultural factors, which may be important in a post-socialist country like Hungary. We investigated the relationship between youth's life satisfaction, materialism and their psychosocial health in a sample of secondary school students (N = 1114) in Hungary. Findings show that youth's psychosocial health may play an important role in their levels of life satisfaction, particularly depressive and psychosomatic symptoms and health behaviors (e.g. diet control and smoking). SES self-assessment and materialistic success were positively, while materialistic happiness was negatively related to youth's life satisfaction.

Career goals in the high risk adolescent

Possessing a career goal might serve as a protective factor for an adolescent's healthy development. This could be especially important in adolescents who engage in high risk behaviors. The relationship between high risk adolescents' future career goals and selected predictor variables were examined. Almost half (49%) the students indicated a career goal. Students who reported a job were 5.1-fold more likely to have listed a future career goal. Females, those aged 18 years, and those whose mothers were employed were twice as likely to have a career goal. Considerations for fostering career goals for high risk students are warranted.

Clustering of Health-Related Behaviors and Their Determinants: Possible Consequences for School Health Interventions

Characterizing school health promotion is its category-by-category approach, in which each separate health-related behavior is addressed independently. Such an approach creates a risk that extra-curricular activities become overloaded, and that teaching staff are distracted by continuous innovations. Within the health promotion sector there are thus increasing calls for an integrative approach to health-related behaviors. However, a meaningful integrative approach to different lifestyles will be possible only if there is some clustering of individual health-related behaviors and if health-related behaviors have a minimum number of determinants in common. This systematic review aims to identify to what extent the four health-related behaviors smoking, alcohol abuse, safe sex and healthy nutrition cluster; and how their determinants are associated. Potentially modifiable determinants that offer clues for an integrative approach of school health-promotion programs are identified. Besides, the direction in which health educators should look for a more efficient instructional design is indicated.