Can we predict adolescent cannabis use? A Bayesian semi-parametric approach to project future trends

Despite its decrease in many Western countries, cannabis remains the most used illicit substance among adolescents. This study aims to summarize cannabis consumption during the last two decades and project trends among 15-year-olds in the 2021-22 HBSC survey. A Bayesian semi-parametric hierarchical model was adopted to estimate the trend of cannabis consumption using data of about 287,000 adolescents from the 2001/2002 to the 2017/2018 HBSC wave and the 38 countries that met the inclusion criteria. Data show an overall decline in most countries for both boys and girls. However, in 22 countries of 38 cannabis use is expected to increase again in our projection. The discussion of these findings should take into account cultural, policy, social factors and unpredictable events such as the Covid-19 pandemic, that can significantly impact future trends leading to discrepancies between the projected and observed values. However, these discrepancies can provide insight into understanding the potential impact of preventive strategies and the underlying processes responsible for changes in cannabis use over time.

Yes, I will do it! Factors promoting the intention to volunteer after COVID-19 pandemic in Italy

This cross-sectional study assessed the extent to which the intention to volunteer after the COVID-19 pandemic is associated with resilience, post-traumatic growth, and community service self-efficacy in a representative Italian sample (N = 295; Mage  = 44.77; SD = 14.79; range = 18-83 years; 53.22% men). The model tested through a path analysis revealed a positive association between community service self-efficacy and intention to continue volunteering. Multi-group comparisons revealed that this relationship was maintained in participants who were active volunteers, while in the group of former volunteers, only a positive association between post-traumatic growth and intention to volunteer was found. This study contributed to highlight the importance of community service self-efficacy and post-traumatic growth in the volunteering experience and the intention to continue volunteering in the future.

The global development of community psychology as reflected in the American Journal of Community Psychology

This commentary presents a virtual special issue on the global growth of community psychology (CP), particularly, but not exclusively, as reflected in the American Journal of Community Psychology (AJCP). CP exists in at least 50 countries all over the world, in many of those for over 25 years. Yet, aside from several early Israeli articles, AJCP rarely published work from or about countries outside the US and Canada until the early 2000s, when the number of international articles began to rise sharply. The focus of CP developed differently in different continents. CP in Australia and New Zealand initially followed North America's emphasis on improving social service systems, but has since focused more on environmental and indigenous cultural and decolonial issues that are as salient in those countries as in North America, but have drawn much more attention. CP came later to most of Asia, where it also tended to follow the North American path, but starting in Japan, India, and Hong Kong and now in China and elsewhere, it is establishing its own way. The other two global hotspots for CP for over 40 years have been Europe and Latin America. The level and focus of CP in Europe varies in each country, with some focused on applied developmental psychology and/or community services and others advancing critical and liberation psychology. CP in Latin America evolved from social psychology, but like CP in Sub-Saharan Africa, is also more explicitly political due to a history of political oppression, social activism, and the limitations of individualistic psychology to focus on social change, overcoming poverty, and interventions by (not just for) community members. Despite those differences, CP literature over the past 23 years suggests an increasingly common interest in social justice, multinational collaborations, and decoloniality. There is still a need for more truly (bidirectional) cross-cultural, comparative work for mutual learning, sharing of ideas, methods, and intervention practices, and for CP to develop in countries and communities throughout the globe where it could have the greatest impact.

On the lowest rung of the ladder: How social exclusion, perceived economic inequality and stigma increase homeless people's resignation

Despite the relevance of social exclusion and economic inequality for homelessness, empirical studies investigating how these issues relate to homeless people's psychological well-being are scarce. We aimed to fill this gap by conducting two quasi-experimental studies on homeless and non-homeless groups. The first study (N = 200) showed that homeless (vs. non-homeless) people presented higher levels of resignation, characterized by depression, alienation, helplessness, and unworthiness (Williams, 2009). The second study (N = 183) replicated the findings from Study 1 and showed that perceived economic inequality could increase homeless people's resignation by emphasizing perceptions of social exclusion. Additional analyses found that identification with the stigmatized homeless group could mediate the relationship between perceived inequality and social exclusion, increasing the resignation. Overall, the results showed that chronic social exclusion of homeless people is associated with higher levels of resignation. Moreover, they showed the role of perceived economic inequality and homeless group stigmatized identification as group-specific mechanisms favouring social exclusion and ultimately worsening psychological well-being.

Homeless people's recovery in Housing First and Traditional Services: The role of working alliance in Italian housing services

This study aims to investigate whether a working alliance could represent a potential mechanism that explains the effectiveness of housing services in terms of user recovery, comparing the Housing First (HF) model with Traditional Services (TS). This study included 59 homeless service users in Italy (29 = HF; 30 = TS). Recovery was assessed upon entering the study (T0) and after 10 months (T1). Results indicate that participants inserted in HF services were more likely to report stronger working alliances with social service providers at T0 that, in turn, was directly associated with higher levels of users' recovery at the beginning of the study and indirectly (through recovery at T0) with recovery at T1. Implications of the results are discussed with respect to research and practice on homeless services.

Psychometric properties of the measure of achieved capabilities in homeless services

BACKGROUND

Purposeful participation in personally meaningful life tasks, enjoyment of positive reciprocal relationships, and opportunities to realize one's potential are growth-related aspects of a meaningful life that should be considered important dimensions of recovery from homelessness. The extent to which homeless services support individuals to achieve the capabilities they need to become who they want to be and do what they want to do is, in turn, an important indicator of their effectiveness. In this study, we developed a measure of achieved capabilities (MACHS) for use in homeless services settings, and assessed its construct and concurrent validity.

METHODS

We analysed data collected from homeless services users at two time points in eight European countries to assess the factor structure and psychometric properties of the new measure. Participants were adults engaged with either Housing First (n = 245) or treatment as usual (n = 320).

RESULTS

Exploratory and confirmatory factor analyses yielded a four-factor structure of the capabilities measure: community integration, optimism, safety, and self-determination. We obtained evidence for construct validity through observed correlations between achieved capabilities and recovery, working alliance and satisfaction with services. Moreover, we obtained evidence of the measure's concurrent validity from its positive association between HF and personal recovery, which was fully mediated by achieved capabilities.

CONCLUSIONS

Findings demonstrate that the MACHS is a valid and reliable measure that may be used to assess the extent to which homeless services support their clients to develop capabilities needed for growth-related recovery. Implications for practice and future research directions are discussed.

Using a modified version of photovoice in a European cross-national study on homelessness

This study proposes an innovative use of a modified version of photovoice for cross-national qualitative research that allows participants to express their ideas, experiences, and emotions about a topic through photographic language. We examine factors affecting social service providers' work on people experiencing homelessness in Europe. We highlight five advantages of using photovoice in cross-national research: visual language, methodological flexibility, participatory data analysis, the bottom-up process, and the promotion of social change. Moreover, we identify key stages of the process: writing a detailed protocol for the implementation and fidelity of the projects, using two levels of data analysis, and disseminating the results. This study provides lessons learned for others who may want to use photovoice in cross-national research.

Structural gender inequality and gender differences in adolescent substance use: A multilevel study from 45 countries

-Societal gender inequality relates to gender differences in adolescent substance use.-The gender gap in adolescent substance use is larger in countries with higher levels of gender inequality.-Girls in these countries were less likely to get drunk, use alcohol or smoke cigarettes than boys.

Invasive behaviour of the marine Rhodophyta Sphaerococcus coronopifolius Stackhouse, in a hypereutrophic Mediterranean lagoon

Between 2017 and 2022, sediment labile organic matter, physico-chemical and nutrient content of the water column, biomass and C, N, P, S content of Sphaerococcus coronopifolius, a Rhodophyta that produced vegetative blooms in an area of the Orbetello lagoon (Italy) not far from the effluents of two land-based fish-farms, were examined and compared with an area even further away from that source where the species was not found. In order to understand the reasons for an important mat development in only one specific area, microcosm experiments were also carried out. Results suggest the species developed in dense and extensive mats under high orthophosphate and nitrate nitrogen ion concentrations conditions, behaving as an opportunistic species.

Problematic gaming risk among European adolescents: a cross-national evaluation of individual and socio-economic factors

BACKGROUND AND AIMS

Previous research has identified numerous risk and protective factors of adolescent problematic gaming (PG) at the individual and social levels; however, the influence of socio-economic indicators on PG is less known. This study aimed to measure the contribution of individual and socio-economic factors involved in PG risk among adolescents from 30 European countries.

DESIGN

Multi-level logistic regression analysis of survey data from the 2019 European School Survey Project on Alcohol and Other Drugs (ESPAD) cross-sectional study using self-administered anonymous questionnaires.

SETTING

Thirty European countries.

PARTICIPANTS

A representative cohort of 15-16-year-old students (n = 88 998 students; males = 49.2%).

MEASUREMENTS

The primary outcome measure was adolescents' (low and high) risk of PG. Individual key predictors included self-report assessments of socio-demographic characteristics, time spent gaming and family variables (parental regulation and monitoring, family support). Main country-level predictors comprised Gini coefficient for economic inequalities and benefits for families and children (% gross domestic product), retrieved from international public data sets and national thematic reports. The data analysis plan involved multi-level logistic regression.

FINDINGS

Participants who reported stronger parental regulation [odds ratio (OR) = 0.81, 95% confidence interval (CI) = 0.79-0.83] and higher family support (OR = 0.93, 95% CI = 0.91-0.95) reported lower risk of PG. At the country-level, economic inequalities (OR = 1.05, 95% CI = 1.03-1.07) were positively associated with the risk of PG, while benefits for families and children (OR = 0.78, 95% CI = 0.70-0.89) were negatively correlated with the risk of PG.

CONCLUSIONS

Supportive family environments, lower country-level economic inequalities and higher government expenditures on benefits for families and children appear to be associated with a lower risk of problematic gaming among European adolescents.

Systematic review of response criteria and endpoints in autoimmune hepatitis by the International Autoimmune Hepatitis Group

BACKGROUND & AIMS

Autoimmune hepatitis (AIH) has been well characterised and codified through the development of diagnostic criteria. These criteria have been adapted and simplified and are widely used in clinical practice. However, there is a need to update and precisely define the criteria for both treatment response and treatment.

METHODS

A systematic review was performed and a modified Delphi consensus process was used to identify and redefine the response criteria in autoimmune hepatitis.

RESULTS

The consensus process initiated by the International Autoimmune Hepatitis Group proposes that the term 'complete biochemical response' defined as 'normalization of serum transaminases and IgG below the upper limit of normal' be adopted to include a time point at 6 months after initiation of treatment. An insufficient response by 6 months was a failure to meet the above definition. Non-response was defined as '<50% decrease of serum transaminases within 4 weeks after initiation of treatment'. Remission is defined as liver histology with a Hepatitis Activity Index <4/18. Intolerance to treatment was agreed to stand for 'any adverse event possibly related to treatment leading to potential drug discontinuation'.

CONCLUSIONS

These definitions provide a simple and reproducible framework to define treatment response and non-response, irrespective of the therapeutic intervention. A consensus on endpoints is urgently required to set a global standard for the reporting of study results and to enable inter-study comparisons. Future prospective database studies are needed to validate these endpoints.

LAY SUMMARY

Consensus among international experts on response criteria and endpoints in autoimmune hepatitis is lacking. A consensus on endpoints is urgently required to set a global standard for the reporting of study results and to enable the comparison of results between clinical trials. Therefore, the International Autoimmune Hepatitis Group (IAIHG) herein presents a statement on 5 agreed response criteria and endpoints: complete biochemical response, insufficient response, non-response, remission, and intolerance to treatment, which can be used to guide future reporting.

How Communication Technology Fosters Individual and Social Wellbeing During the Covid-19 Pandemic: Preliminary Support For a Digital Interaction Model

The aim of the present study was to test an explanatory model for individual and social wellbeing which incorporates the advantages of using digital technologies during the COVID-19 pandemic. The study was carried out in Italy, one of the countries that has been most severely affected by the pandemic worldwide. The study was designed to include variables that might be specifically pertinent to the uniqueness of the restrictions imposed by the pandemic. Adults living in Italy (n = 1412) completed an online survey during the lockdown period in March 2020. Results showed two distinct digital interaction processes highlighted by the facilitating use of online emotions ("e-motions") and online social support ("e-support"). In short, e-motions were positively related to posttraumatic growth, which in turn was positively associated with positive mental health and higher engagement in prosocial behaviors. Moreover, individuals who perceived themselves as having greater e-support were characterized by higher levels of positive mental health, which it turn was positively associated with prosocial behaviors. Collectively, these two digital interaction processes suggest that digital technologies appear to be critical resources in helping individuals cope with difficulties raised by the COVID-19 pandemic.

Country-Level Meritocratic Beliefs Moderate the Social Gradient in Adolescent Mental Health: A Multilevel Study in 30 European Countries

PURPOSE

Adolescents with higher socioeconomic status (SES) report better mental health. The strength of the association-the "social gradient in adolescent mental health"-varies across countries, with stronger associations in countries with greater income inequality. Country-level meritocratic beliefs (beliefs that people get what they deserve) may also strengthen the social gradient in adolescent mental health; higher SES may be more strongly linked to adolescent's perceptions of capability and respectful treatment.

METHODS

Using data from 11-15 year olds across 30 European countries participating in the 2013/2014 Health Behaviour in School-aged Children study (n = 131,101), multilevel regression models with cross-level interactions examined whether country-level meritocratic beliefs moderated the association between two individual-level indicators of SES, family affluence and perceived family wealth, and three indicators of adolescent mental health (life satisfaction, psychosomatic complaints, and aggressive behavior).

RESULTS

For family affluence, in some countries, there was a social gradient in adolescent mental health, but in others the social gradient was absent or reversed. For perceived family wealth, there was a social gradient in adolescent life satisfaction and psychosomatic complaints in all countries. Country-level meritocratic beliefs moderated associations between SES and both life satisfaction and psychosomatic complaints: in countries with stronger meritocratic beliefs associations with family affluence strengthened, while associations with perceived family wealth weakened.

CONCLUSIONS

Country-level meritocratic beliefs moderate the associations between SES and adolescent mental health, with contrasting results for two different SES measures. Further understanding of the mechanisms connecting meritocratic beliefs, SES, and adolescent mental health is warranted.

Factors Associated with Providers' Work Engagement and Burnout in Homeless Services: A Cross-national Study

The complexity of homeless service users' characteristics and the contextual challenges faced by services can make the experience of working with people in homelessness stressful and can put providers' well-being at risk. In the current study, we investigated the association between service characteristics (i.e., the availability of training and supervision and the capability-fostering approach) and social service providers' work engagement and burnout. The study involved 497 social service providers working in homeless services in eight different European countries (62% women; mean age = 40.73, SD = 10.45) and was part of the Horizon 2020 European study "Homelessness as Unfairness (HOME_EU)." Using hierarchical linear modeling (HLM), findings showed that the availability of training and supervision were positively associated with providers' work engagement and negatively associated with burnout. However, results varied based on the perceived usefulness of the training and supervision provided within the service and the specific outcome considered. The most consistent finding was the association between the degree to which a service promotes users' capabilities and all the aspects of providers' well-being analyzed. Results are discussed in relation to their implications for how configuration of homeless services can promote social service providers' well-being and high-quality care.

Assessment of the causes of Hg bioaccumulation in the fish of a Mediterranean lagoon subject to environmental management interventions

In a Mediterranean lagoon characterized by high levels of Hg in the sediment, Hg content in commercial fish species was determined, and, in order to establish Hg concentration in the water column, Diffusive Gradient in Thin films technique (DGT) was used. The results allowed to state (1) the disturbance of the surface sediment and its resuspension in the water column did not cause detectable increase in Hg releases, (2) the East basin acted more than the West one in contamination of fish species, (3) the small-sized sea-breams (<400 g) were more contaminated than larger sizes ones (>400 g). We concluded: (1) fish contamination may also depend on direct contact with releases of the contaminant and small, gregarious and less sedentary subjects are more likely to incur releases of Hg; (2) Hg releases can be greater in areas with a relatively low sedimentary organic matter load compared to areas subjected to high density macroalgal mat, regardless of the amount of Hg present in the sediments; (3) wind transport of plant masses in low energy storage areas, may constitute an increase factor of Hg in the sediment. A critical review of the results was made in comparison with the available literature reports and some hypotheses were proposed regarding the possible dynamics and availability of the contaminant.

Sexual behaviour in 15-year-old adolescents: insights into the role of family, peer, teacher, and classmate support

OBJECTIVE

The aim was to investigate the role of different forms of social support in early sexual intercourse and contraceptive use.

MATERIALS AND METHODS

The study sample included 18,918 15-year-olds who took part in the 2018 Italian Health Behaviour in School-aged Children study. Multivariable multilevel logistic regressions were performed taking into account geographical region and socioeconomic status.

RESULTS

21.7% of adolescents reported early sexual intercourse. 71.9% used a condom at last sexual intercourse, 12.2% oral contraceptives 41.2% other contraceptive methods (multiple response question). High support from family and from teachers were associated with a lower likelihood of early sexual intercourse in both genders, while peer support was shown to increase this likelihood among boys. Adolescents with high social support were more likely to use condoms.

CONCLUSIONS

Social support can have a positive influence on adolescents' sexual behaviour. Sexual education programmes should aim to engage peers and those significant adults who can influence adolescents' lives, in and out of school.

Problematic social media use: associations with health complaints among adolescents

OBJECTIVE

Problematic Social Media Use (PSMU) has an addictive potential for young users. The aim of this study was to show the prevalence of PSMU across Italian regions and its association with health complaints.

MATERIALS AND METHODS

Data are gathered from the Italian 2018 Health Behaviour in School-aged Children survey using a representative sample of Italian adolescents aged 11, 13 and 15 years (50.6% males). Participants completed self-administered questionnaires assessing PSMU and health complaints.

RESULTS

PSMU affects 8.9% adolescents in Italy and the prevalence is quite consistent across regions. 13-year-olds girls showed the highest percentage of PSMU (13%). Problematic users of social media are more likely to report multiple somatic (OR = 1.84 [95% CI 1.82-1.85]) and psychological (OR = 2.60 [95% CI 2.58-2.63]) symptoms.

CONCLUSIONS

PSMU represents a widespread problem in Italy. National prevention interventions are needed in order to promote a positive use of social media.

Prevention and treatment of peri-prosthetic joint infection using surgical wound irrigation

Over the past decade, the incidence of revision arthroplasty due to infection has increased substantially, often resulting in multiple surgical interventions with variable success rates and poor clinical outcome. Intraoperative wound irrigation has been proposed to reduce bacterial bioburden and contamination, but currently there is no widely accepted recommendation for the use of topical antiseptics, whether as separate molecules or as a mixed solution. We reviewed studies regarding the use of intraoperative topical antiseptics, their security profile and efficacy in preventing and treating infections of orthopedic implants and introduced a possible combination that may prove valuable in the future.

[Work-related stress of providers in homelessness services: a comparison among workers in traditional services and housing first]

Burnout has recently been identified as a disorder by the World Health Organization. Although helping professions are the most exposed to burnout, there is a lack of research on work-related stress in social service workers, such as frontline workers in homeless services. The aim of this study is to evaluate burnout in a sample of Italian providers working in homelessness services, exploring the differences between traditional services and Housing First. Burnout was measured through the Link Burnout Questionnaire, consisting of four dimensions investigating Psychophysical exhaustion, Depersonalization, Professional inefficacy and Disillusion. A total of 69 participants (40 social providers and 29 educators of both types of service) responded to the survey. The results show similar levels of burnout in providers and educators working in the two types of services.

Homeless Adults' Recovery Experiences in Housing First and Traditional Services Programs in Seven European Countries

Across Europe, as governments turn to housing-led strategies in attempts to reverse rising rates of homelessness, increasing numbers of Housing First (HF) programs are being implemented. As HF programs become more widespread, it is important to understand how service users experience them compared to the more prevalent traditional treatment-first approach to addressing long-term homelessness. Although there is a large body of research on service users' experiences of Housing First compared to treatment-first in North American contexts, comparatively less is known about how these two categories of homeless services are experienced in the European context. In a correlational and cross-sectional study, part of a larger examination of homelessness in Europe, participants (n = 520) engaged with either HF (n = 245) or traditional services (TS; n = 275) programs in seven countries completed measures of their experiences of services (consumer choice, housing quality, and service satisfaction) and recovery (time in independent housing, psychiatric symptoms, and community integration). Across the seven countries, participants engaged with HF programs reported experiencing more consumer choice, better perceived housing quality, and more satisfaction with services than participants engaged in TS programs. Participants in HF programs also reported a greater proportion of time in independent accommodation, fewer psychiatric symptoms, and more community integration. Varying patterns of association between experiences of services and recovery outcomes were observed. Findings indicate HF consistently predicts greater recovery than TS across diverse sociopolitical and economic contexts. Implications of findings for configurations of homeless services and homeless services policy are discussed.

Foot and ankle measurements on cone beam weightbearing computed tomography

Over the last years, an increased number of studies have reported the use of cone beam weightbearing computed tomography (WBCT) in the assessment of foot and ankle pathology. This new technology has enabled to overcome the limits inherently related to two-dimensional radiographs (superimposition bias, operator-related bias, rotation bias) and to obtain images reproducing the bones and joints anatomy during physiological standing with a low radiation dose. We performed a review of the current literature to summarize the evidence about the use of 2D or 3D measurements on WBCT images in various foot and ankle conditions. Our aims were to describe measurements proposed so far and to report data on reliability and validity from primary authors.

Time trends in adolescent sexual behaviour in Italy

Background There has been little research investigating sexual health in Italy. The aim of the present study was to present time trends over 8 years in sexual behaviour among adolescents.

METHODS

This study is part of the Health Behaviour in School-aged Children study (sample: 3983 adolescents aged 15 years; 51.9% girls). Measures included sexual initiation, condom use and age of first sexual intercourse.

RESULTS

No variation was observed in the prevalence of sexual initiation and in condom use. The mean age of first sexual intercourse decreased among surveyed adolescents.

CONCLUSIONS

Considering the tendency of Italian adolescents to begin having intercourse at an earlier age, increased knowledge on sexual behaviours is needed to improve sexual health.

Goals and Principles of Providers Working with People Experiencing Homelessness: A Comparison Between Housing First and Traditional Staircase Services in Eight European Countries

The implementation and adaptation of the Housing First (HF) model represented profound changes the structure and delivery, goals, and principles of homeless services. These features of homeless services directly influence providers, their work performance and the clients’ outcomes. The present research, conducted in eight European countries, investigated how social providers working in HF or TS (Traditional Staircase) describe and conceptualize the goals and the principles of their services. Data were collected through 29 focus group discussions involving 121 providers. The results showed that HF and TS had similar and different goals for their clients in the following areas: support, social integration, satisfaction of needs, housing, and well-being. HF providers emphasized clients’ autonomy and ability to determine their personal goals, with housing being considered a start on the path of recovery, while TS were more focused on individual clients’ basic needs with respect to food, health and finding temporary accommodations. HF providers privileged the person-centered approach and housing as a right, while TS providers were more focused on helping everyone. Implications of the results are discussed as suggestions both for practice and for research.

Protecting youth from gang membership: Individual and school-level emotional competence

The current study examined the association between adolescent emotional competence, operationalized and measured at both the individual and the school levels, and gang membership. The study involved a sample of 12,040 students (51.4% females; mean = 16.9 years) participating in the biennial state department of education coordinated California Healthy Kids Survey, which assesses a range of adolescent health-related behaviors. Hierarchical linear modeling indicated that higher levels of individual emotional competence were associated with a lower likelihood of identifying as a gang member. Moreover, a stronger negative association between emotional competence and identifying as a gang member was found when emotional competence was operationalized at the school level. Implications include the role of schools in promoting emotional regulation, empathy, and behavioral regulation of their entire student body as part of an overall strategy to reduce individual student's attraction to gangs.

Sociopolitical Control for Immigrants: The Role of Receiving Local Contexts

This study examines the individual and contextual factors associated with sociopolitical control expressed by immigrants in southern Spain. We used hierarchical linear modeling to evaluate the relations between individual (community participation, social connectedness, and perceived cultural competence of receiving community services) and municipality characteristics (city community participation, city social connectedness, and city community services' cultural competence) and immigrants' feelings of sociopolitical control. Data were analyzed using a two-level model based on 707 Moroccan immigrants in 25 municipalities. After adjusting for gender, educational level, and psychosocial confounding factors, we observed a positive association between social connectedness and sociopolitical control at the individual level. At the contextual level, we observed a positive association between (a) city community participation, (b) city social connectedness, and (c) city community services' cultural competence, and sociopolitical control. Indeed, living in a municipality where there are community services with high levels of cultural competence and where, on average, many people participate in organizations and neighbors are connected, was associated with higher levels of perceived control in the sociopolitical domain for immigrants. We also discuss implications for community-based research and practice.

Relative deprivation and disordered gambling in youths

BACKGROUND

Previous research has found that area-level income inequality and individual-level relative deprivation both contribute to disordered gambling in adults. However, the socioeconomic factors that contribute to disordered gambling in youths and protective factors in their social environment have not been fully explored. This study examined the association between relative deprivation and youth disordered gambling and the potential moderating role of social support in this association.

METHODS

We used data on family material assets and self-reported symptoms of disordered gambling symptoms in 19 321 participants of the 2013/2014 Italian Health Behaviour in School-aged Children study. Relative deprivation was measured using the Yitzhaki index and classmates as a social reference group. Its association with disordered gambling was tested using multilevel negative binomial regression analyses. We also tested moderated effects of relative deprivation on disordered gambling by four sources of social support: families, peers, teachers and classmates.

RESULTS

Relative deprivation related to a fourfold increase in the rate of disordered gambling symptoms (incidence rate ratio=4.18) after differences in absolute family wealth and other variables were statistically controlled. Symptoms were also more prevalent in males, first-generation immigrants and less supported youth. Peer support moderated the association between relative deprivation and symptoms, suggesting that high deprivation and low peer support have interactive links to disordered gambling.

CONCLUSION

Relative deprivation among classmates relate to youth symptoms of disordered gambling. Youth who live in economically unequal settings and perceive a lack of social support may be at greatest risk.

Trends in adolescent overweight prevalence in Italy according to socioeconomic position

BACKGROUND

The aim of this research is to update the trend in overweight (including obesity) prevalence among Italian adolescents, evaluating possible differences by age and gender, and analyzing their relationships with socioeconomic status, between 2002 and 2014.

METHODS

The present study is based on data from the Italian HBSC study at four time points (2002, 2006, 2010 and 2014), which involved 15 035 adolescents, aged 11-13-15 (7540 boys and 7495 girls).

RESULTS

Gender and age were associated with the occurrence of overweight. In all surveys, boys had a higher prevalence of excess weight compared to girls (p < 0.001), but only among girls there was a significant increasing trend (from 11.2% in 2002 to 13.3% in 2014). From 2002 to 2014, the risk of being overweight was inversely associated with the economic level of the family, for both genders and all age groups.

CONCLUSIONS

Data collected between 2002 and 2014 in Italy showed a low overall increase in prevalence of obesity and overweight and an inverse association between SES and obesity in all age groups and in both genders. These findings suggest that concerted, multi-sectorial, efforts are needed in Italy, in combination with a sound political will, focused on reducing social inequality associate.

School Sense of Community, Teacher Support, and Students' School Safety Perceptions

This study examined the association between two characteristics of school climate (sense of community and teacher support, measured both at the individual and at the school level) and students' feelings of being unsafe at school. The study involved a sample of 49,638 students aged 10-18 years who participated in the 2010-2012 California Healthy Kids Survey. Using hierarchical linear modeling (HLM), our findings revealed that, at the individual level, students perceiving higher levels of sense of community and teacher support at school were less likely to feel unsafe within the school environment. At the school level, sense of community was negatively associated with unsafe feelings, whereas there was no association between school-level teacher support and feelings of being unsafe at school.

Income Inequality and Adolescent Gambling Severity: Findings from a Large-Scale Italian Representative Survey

Background: Studies have shown that problems related to adult gambling have a geographical and social gradient. For instance, adults experiencing gambling-related harms live in areas of greater deprivation; are unemployed, and have lower income. However, little is known about the impact of socioeconomic inequalities on adolescent problem gambling. The main purpose of the present study was to investigate the contextual influences of income inequality on at-risk or problem gambling (ARPG) in a large-scale nationally representative sample of Italian adolescents. A secondary aim was to analyze the association between perceived social support (from family, peers, teachers, and classmates) and ARPG. Methods: Data from the 2013-2014 Health Behavior in School-aged Children Survey (HBSC) Study was used for cross-sectional analyses of ARPG. A total of 20,791 15-year-old students completed self-administered questionnaires. Region-level data on income inequality (GINI index) and overall wealth (GDP per capita) were retrieved from the National Institute of Statistics (Istat). The data were analyzed using the multi-level logistic regression analysis, with students at the first level and regions at the second level. Results: The study demonstrated a North-South gradient for the prevalence of ARPG, with higher prevalence of ARPG in the Southern/Islands/Central Regions (e.g., 11% in Sicily) than in Northern Italy (e.g., 2% in Aosta Valley). Students in regions of high-income inequality were significantly more likely than those in regions of low-income inequality to be at-risk or problem gamblers (following adjustment for sex, family structure, family affluence, perceived social support, and regionale wealth). Additionally, perceived social support from parents and teachers were negatively related to ARPG. Conclusions: Income inequality may have a contextual influence on ARPG. More specifically, living in regions of highest income inequality appeared to be a potential factor that increases the likelihood of becoming an at-risk or problem gambler. Findings of the study suggest that wealth distribution within societies affected by economic policies may indirectly have an influence adolescent gambling behaviors.

Expert clinical management of autoimmune hepatitis in the real world

BACKGROUND

High-quality data on the management of autoimmune hepatitis (AIH) are scarce. Despite published guidelines, management of AIH is still expert based rather than evidence based.

AIM

To survey expert hepatologists, asking each to describe their practices in the management of patients with AIH.

METHODS

A survey questionnaire was distributed to members of the International AIH Group. The questionnaire consisted of four clinical scenarios on different presentations of AIH.

RESULTS

Sixty surveys were sent, out of which 37 were returned. None reported budesonide as a first line induction agent for the acute presentation of AIH. Five (14%) participants reported using thiopurine S-methyltransferase measurements before commencement of thiopurine maintenance therapy. Thirteen (35%) routinely perform liver biopsy at 2 years of biochemical remission. If histological inflammatory activity is absent, four (11%) participants reduced azathioprine, whereas 10 (27%) attempted withdrawal altogether. Regarding the management of difficult-to-treat patients, mycophenolate mofetil is the most widely used second-line agent (n = ~450 in 28 centres), whereas tacrolimus (n = ~115 in 21 centres) and ciclosporin (n = ~112 in 18 centres) are less often reported. One centre reported considerable experience with infliximab, while rescue therapy with rituximab has been tried in seven centres.

CONCLUSIONS

There is a wide variation in the management of patients with autoimmune hepatitis even among the most expert in the field. Although good quality evidence is lacking, there is considerable experience with second-line therapies. Future prospective studies should address these issues, so that we move from an expert- to an evidence- and personalised-based care in autoimmune hepatitis.

Abstract OT3-05-01: Three-monthly dynamic evaluation of CEA and CA15-3 (followed by 18-FDG PET) vs usual practice in the follow-up of early breast cancer (BC) patients (pts): A prospective randomized trial (KRONOS-patient-oriented new surveillance study, Italy)

Background: Current guidelines for BC surveillance in asymptomatic pts recommend annual mammography and periodical physical examination. These recommendations arise from two trials conducted in the 1980's: since then no other randomized controlled trials (RCTs) have been conducted on BC follow-up. However our knowledge on BC biology, diagnosis of metastases and treatment has improved. The aim of this prospective RCT is to verify if the serial measurement of CEA and CA15.3 (followed by 18-FDG PET) can anticipate the diagnosis of breast cancer recurrence compared to control arm. If this intermediate end-point will be met a subsequent extension trial will investigate the impact of the earlier diagnosis of distant metastases on survival. Methods: Pts diagnosed with stage I-III BC, who underwent adequate surgery are eligible. Special histologies and low-risk cases according to St. Gallen criteria are excluded. We will include pts at the beginning of the follow-up after the conclusion of primary treatment (cohort 1), and pts that have concluded without relapse the first 5 years of follow-up (cohort 2). Eligible pts will be randomized in a 1:1 ratio to follow-up according to local practice (control arm) or to three-monthly serial dosing of CEA and CA15.3 and subsequent imaging studies (18-FDG PET) only in case of an increase of CEA and/or CA 15.3 greater than a critical difference (CEA +100% and/or CA15.3 +75%) compared to baseline (experimental arm). The following stratification factors will be used: node negative vs positive, HER2 negative vs positive, ER positive vs negative. Eight-hundred pts will be enrolled over 3 years. For such a calculation, we made the assumption of a 20% 5-year incidence of relapse. The target reduction of 3 months in restricted mean survival time (RMST) between the two arms implies a median time of diagnostic anticipation, conditional on having breast cancer recurrence, of 10 months. The follow-up will continue until 10 years from surgery. The first patient was enrolled on 23rd October 2014, up to now 434 pts have been enrolled. The present trial was approved by the Ethical Commitee of S. Orsola-Malpighi Hospital and is registered on clinicaltrials.gov (NCT02261389).

Citation Format: Zamagni C, Gion M, Mariani L, Stieber P, Quercia S, Rubino D, Bernardi A, Cacciari N, Fini A, Lenzi M, Minichillo S, Pizzirani C, Pagliaro M, Tomasini S, Barbieri E. Three-monthly dynamic evaluation of CEA and CA15-3 (followed by 18-FDG PET) vs usual practice in the follow-up of early breast cancer (BC) patients (pts): A prospective randomized trial (KRONOS-patient-oriented new surveillance study, Italy) [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr OT3-05-01.

Social Capital and Fear of Crime in Adolescence: A Multilevel Study

Hierarchical linear modeling was used to examine the relationships between social capital (at the individual, the neighborhood, and the regional levels) and adolescents' fear of crime, while controlling for the main individual (sociodemographics, television viewing, and bullying victimization), neighborhood (neighborhood size and aggregated victimization), and regional (crime rate and level of urbanization) variables. Data were analyzed using a three-level model based on 22,639 15.7-year-old (SD = 0.67) students nested within 1081 neighborhoods and 19 Italian regions. The findings revealed that individual and contextual measures of social capital, modeled at the individual, neighborhood, and regional levels simultaneously, showed negative associations with adolescents' fear of crime. Males and participants with higher family affluence were less likely to feel fear of crime, whereas victimization, both at the individual and neighborhood levels, had a positive association with fear of crime. Strengths, limitations, and potential applications of the study are discussed.

International trends in electronic media communication among 11- to 15-year-olds in 30 countries from 2002 to 2010: association with ease of communication with friends of the opposite sex

BACKGROUND

Electronic media has become a central part of the lives of adolescents. Therefore, this study examines trends in adolescent electronic media communication (EMC) and its relationship with ease of communication with friends of the opposite sex, from 2002 to 10 in 30 European and North American regions.

METHODS

Data from the HBSC study were collected using self-report questionnaires from 11-, 13- and 15-year-old participants (N = 404 523).

RESULTS

EMC use has grown over the years in most of these regions and increases with age. Even though Internet usage is often blamed for its negative effects on teenagers' social interactions in the physical world, in this study EMC was found to predict ease of communication with friends. Especially, the more they use EMC, the easier they find it to talk with friends of the opposite sex. Although these findings suggest that EMC reinforces communication, the interaction between year (2002-2006-2010) and EMC usage was not significant.

CONCLUSION

This finding contradicts research that suggests that EMC contributes to loneliness and isolation, and supports other studies that present electronic media as a powerful tool for helping to connect people.

Cannabis Liberalization and Adolescent Cannabis Use: A Cross-National Study in 38 Countries

AIMS

To assess the associations between types of cannabis control policies at country level and prevalence of adolescent cannabis use.

SETTING, PARTICIPANTS AND DESIGN

Multilevel logistic regressions were performed on 172,894 adolescents 15 year of age who participated in the 2001/2002, 2005/2006, or 2009/2010 cross-sectional Health Behaviour in School-Aged Children (HBSC) survey in 38 European and North American countries.

MEASURES

Self-reported cannabis use status was classified into ever use in life time, use in past year, and regular use. Country-level cannabis control policies were categorized into a dichotomous measure (whether or not liberalized) as well as 4 detailed types (full prohibition, depenalization, decriminalization, and partial prohibition). Control variables included individual-level sociodemographic characteristics and country-level economic characteristics.

FINDINGS

Considerable intra-class correlations (.15-.19) were found at country level. With respect to the dichotomized cannabis control policy, adolescents were more likely to ever use cannabis (odds ratio (OR) = 1.10, p = .001), use in past year (OR = 1.09, p = .007), and use regularly (OR = 1.26, p = .004). Although boys were substantially more likely to use cannabis, the correlation between cannabis liberalization and cannabis use was smaller in boys than in girls. With respect to detailed types of policies, depenalization was associated with higher odds of past-year use (OR = 1.14, p = .013) and regular use (OR = 1.23, p = .038), and partial prohibition was associated with higher odds of regular use (OR = 2.39, p = .016). The correlation between cannabis liberalization and regular use was only significant after the policy had been introduced for more than 5 years.

CONCLUSIONS

Cannabis liberalization with depenalization and partial prohibition policies was associated with higher levels of regular cannabis use among adolescents. The correlations were heterogeneous between genders and between short- and long-terms.

Adolescent gang involvement: The role of individual, family, peer, and school factors in a multilevel perspective

Youth gang involvement is a serious public health challenge as adolescents involved in gangs are more likely than others to engage in violence and aggression. To better understand gang involvement, we examined the role of protective (empathy and parental support) and risk (peer deviance and lack of safety at school) factors, as well as their interactions, in predicting adolescent gang affiliation. The study involved a sample of 26,232 students (53.4% females; mean age = 14.62, SD = 1.69) participating in the California Healthy Kids Survey (CHKS), a survey investigating a wide range of youth health and risk behaviors administered in all California schools every 2 years. Using hierarchical linear modeling (HLM), findings indicated that high levels of empathy and parental support were associated with a lower likelihood of affiliating with a gang. Associating with deviant peers and perceiving the school as unsafe were positively correlated with gang membership. At the school level, lack of safety and type of school (special education, vocational, or alternative school vs. comprehensive schools) were associated with greater probability of gang membership. Empathy mitigated the association between deviant peers and gang membership.

Time trends in bullying behavior in Italy

BACKGROUND

Given the severity of outcomes associated with involvement in bullying and the resources spent in an effort to reduce its prevalence, it is important to investigate trends in the bullying's occurrence. The main aim of this study was to identify trends from 2002 to 2010 in prevalence of bullying and victimization among Italian adolescents.

METHODS

The survey reported here is part of the larger population-based cross-sectional (2002, 2006, and 2010) "Health Behaviour in School Aged Children" (HBSC) transnational study. The sample was comprised of 13,174 Italian middle and secondary school students (11- to 15-year-olds; 50.3% girls). Data were collected through a self-report questionnaire. Measures included involvement in bullying as either a perpetrator or a victim. Trends were determined using Gamma statistics.

RESULTS

Consistent and robust decreases in the prevalence of bullying between 2002 and 2010 were detected in Italy. During this time frame both frequent and occasional bullying and victimization decreased by half.

CONCLUSIONS

We measured a strong decrease in involvement in bullying behavior in Italy, in particular after 2006, when the Italian government invested more systematically in the prevention effort on bullying. This is encouraging news for policymakers and practitioners working in the field of bullying prevention.

Can Facebook informational use foster adolescent civic engagement?

The findings on the association between Social Networking Sites and civic engagement are mixed. The present study aims to evaluate a theoretical model linking the informational use of Internet-based social media (specifically, Facebook) with civic competencies and intentions for future civic engagement, taking into account the mediating role of civic discussions with family and friends and sharing the news online. Participants were 114 Italian high school students aged 14-17 years (57 % boys). Path analysis was used to evaluate the proposed theoretical model. Results showed that Facebook informational use was associated with higher levels of adolescent perceived competence for civic action, both directly and through the mediation of civic discussion with parents and friends (offline). Higher levels of civic competencies, then, were associated with a stronger intention to participate in the civic domain in the future. Our findings suggest that Facebook may provide adolescents with additional tools through which they can learn civic activities or develop the skills necessary to participate in the future.

Type 1 and type 2 autoimmune hepatitis in adults share the same clinical phenotype

BACKGROUND

Autoimmune hepatitis (AIH) is historically classified into type 1 and type 2 on the basis of the autoantibody profile, anti-nuclear and/or anti-smooth muscle antibodies being the serological markers of type 1 AIH, whereas anti-liver/kidney microsomal antibody type 1 and/or anti-liver cytosol antibody type 1 characterise type 2 AIH.

AIM

To evaluate whether such a distinction is justified on the basis of different expression of the disease in adults.

METHODS

Twenty-six adult patients with type 2 AIH and 52 age- and sex-matched patients with type 1 AIH, representative of the entire cohort of adults with type 1 AIH, were compared at onset and during follow-up.

RESULTS

At diagnosis, median age was 26 years (range 17-53), female sex 86%, acute presentation 43%, severe liver histology 54%, cirrhosis 14%, complete response to treatment 52%, progression of the disease 17%, and median disease duration 72 months (range 12-280). HLA-DRB1*0301 was present in 26%, HLA-DRB1*0401 in 23% and HLA-DRB1*0701 in 25%. Clinical presentation, biochemical parameters, severe liver histology, genetic profile, response rate and progression of the disease were identical between type 1 and type 2 AIH.

CONCLUSION

There is not enough clinical, biochemical, histological or genetic reason to subdivide adults with autoimmune hepatitis into type 1 and type 2 on the basis of the autoantibody profile, and the term 'autoimmune hepatitis' without qualification should be preferred.

Socioeconomic inequalities in adolescent smoking across 35 countries: a multilevel analysis of the role of family, school and peers

BACKGROUND

Tobacco-related heath inequalities are a major public health concern, with smoking being more prevalent among lower socioeconomic groups. The aim of this study is to investigate the mechanisms leading to socioeconomic inequalities in smoking among 15-year-old adolescents by examining the mediating role of psychosocial factors in the peer group, family and school environment.

METHODS

Data were derived from the international WHO-collaborative 'Health Behaviour in School-aged Children (HBSC)' study 2005/2006, including 52 907 15-year-old students from 35 European and North American countries. Socioeconomic position was measured by the Family Affluence Scale. Multilevel logistic regression models were conducted to examine the contribution of family, school and peer factors in explaining the association between family affluence and weekly smoking.

RESULTS

Across countries, adolescents from low affluent families had an increased risk of weekly smoking (OR(boys) 1.14, confidence interval (CI) 1.05-1.23; OR(girls) 1.36, CI 1.26-1.46) compared with adolescents from high affluent families. Family and school factors mediated the association between family affluence and smoking to a high extent up to 100% (boys) and 81% (girls) in joint analyses. The most important single factors were family structure, relationships with parents, academic achievement and school satisfaction. Peer factors did not mediate the association between family affluence and adolescent smoking.

CONCLUSION

The association between socioeconomic status and adolescent weekly smoking can largely be explained by an unequal distribution of family- and school-related factors. Focusing on the parent-adolescent relationship and adolescent school achievement can help to better understand inequalities in adolescent smoking behaviour.

Country- and individual-level determinants of probable problematic gambling in adolescence: a multi-level cross-national comparison

AIMS

To estimate the role of family and socio-economic indicators of welfare state in accounting for probable problem gambling during adolescence in a representative sample of students living in nine European countries.

DESIGN

Data from the 2011 European School Survey Project on Alcohol and Other Drugs (ESPAD) Study were used for cross-sectional analyses of adolescent probable problem gambling.

SETTING

Representative surveys in nine European countries.

PARTICIPANTS

A total of 31 236 16-year-old students.

MEASUREMENTS

Respondents' probable problem gambling, socio-demographic characteristics and parenting (regulation, monitoring and caring) were measured individually. Indicators of wealth (gross domestic product per capita, GDP), expenditure on public health (% GDP) and benefit in kind for families/children (% GDP) were obtained from national public databases.

FINDINGS

Students who perceived more parental caring [odds ratio (OR) = 0.92, 95% confidence interval (CI) = 0.85-0.98] and monitoring (OR = 0.57, 95% CI = 0.53-0.62) reported less involvement in probable problem gambling. Moreover, students who perceived stronger parental regulation (OR = 1.16, 95% CI = 1.09-1.23) were more likely to be possible problematic gamblers. At the country level, expenditure on public health was associated negatively with probable problem gambling (OR = 0.87, 95% CI = 0.78-0.97), whereas GDP per capita (OR = 1, 95% CI = 1.00-1.00) and the benefits in kind for families/children (OR = 1.16, 95% CI = 0.89-1.51) showed no association with probable problem gambling.

CONCLUSIONS

Family characteristics and expenditure on public health may play a key role in explaining probable problem gambling among adolescents in Europe.

How school can teach civic engagement besides civic education: The role of democratic school climate

Civic engagement, defined as involvement in community life, is influenced by reciprocal relationships between individuals and contexts and is a key factor that contributes to positive youth development. The present study evaluates a theoretical model linking perceived democratic school climate with adolescent civic engagement (operationalized as civic responsibility and intentions for future participation), taking into account the mediating role of civic discussions and perceived fairness at school. Participants were 403 adolescents (47.9 % male) ranging in age from 11 to 15 years old (mean age = 13.6). Path analysis results partially validated the proposed theoretical model. Higher levels of democratic school climate were associated with higher levels of adolescent civic responsibility; the association was fully mediated by civic discussions and perceived fairness at school. Adolescents' civic responsibility, then, was positively associated with a stronger intention to participate in the civic domain in the future.

Perceived Teacher Unfairness, Instrumental Goals, and Bullying Behavior in Early Adolescence

The present study examined links between perceived teacher unfairness and bullying behavior in early adolescence, and the potential mediating role of instrumental social goals (specifically, agentic and separate goals). Based on social information processing theory, our model of proactive aggression was evaluated using path analysis in a sample of 662 Italian students aged between 11 and 13 years old (mean age = 12.55, SD = 0.99; 50.6% males). Results showed that perceived teacher unfairness positively relates to bullying, and that this relationship is partially mediated by the endorsement of instrumental goals. Our findings offer promising implications for future research and for intervention programs that aim to prevent school bullying through modifying the classroom context.

Bullying victimization at school and headache: a meta-analysis of observational studies

BACKGROUND AND OBJECTIVES

Being bullied at school is a risk factor for a variety of negative consequences, including somatic problems. The purpose of this meta-analysis is to determine the association between peer victimization and headache in the school-age population.

METHODS

A systematic literature search was conducted in September 2013 to identify observational studies that examined the association between being bullied and headache in children and adolescents. Odds ratios (OR) were pooled by using a random-effects model. Moderator and sensitivity analyses were conducted.

RESULTS

Twenty studies, including a total of 173,775 participants, satisfied the pre-stated inclusion criteria. Fourteen studies reported data on the prevalence of headache, which was on average 32.7% (range: 9.1-71.7%) in the bullied group and 19.1% (range: 5.3-46.1%) in the control group. Two separate meta-analyses of the association between being bullied and headache were performed on 3 longitudinal studies (OR = 2.10, 95% confidence interval = 1.19-3.71) and 17 cross-sectional studies (OR = 2.00, 95% confidence interval = 1.70-2.35), respectively. Results showed that bullied children and adolescents have a significantly higher risk for headache compared with non-bullied peers. In the cross-sectional studies, the magnitude of effect size significantly decreased with the increase of the proportion of female participants in the study sample. No further moderators were statistically significant.

CONCLUSIONS

The positive association between bullying victimization and headache was confirmed. Further research on the environmental factors that may influence this symptom is needed.