Parenting Practices Are Associated With Out-of-School Physical Activity in US Adolescents in 2014

INTRODUCTION

Lack of physical activity (PA) is associated with obesity, diabetes, hypertension, cardiovascular diseases, and cancer. Parenting practices influence PA in young children. However, there is little evidence available for adolescents. We examined whether parenting practices were associated with out-of-school PA (OSPA) in US adolescents.

METHODS

This cross-sectional 2019 study analyzed data from the 2014 FLASHE study, a web-based, quota-sampled survey of parent-adolescent dyads. Inclusion required survey completion and parents to live with their teen (ages 12-17 y old). Physically limited adolescents were excluded. Dyads were stratified by teen age. Exposures included parental modeling, monitoring, facilitation, restriction, guided choice, and pressure. The outcomes of interest were OSPA Youth Activity Profile scores. Odds ratios (ORs) with 95% confidence intervals (CI) were calculated using adjusted logistic regressions.

RESULTS

A total of 1109 dyads were included. Guided choice increased odds of OSPA for 15- to 17-year-olds (OR = 2.12; 95% CI, 1.17-3.84). Facilitation increased odds of OSPA for 12- to 14-year-olds (OR = 2.21; 95% CI, 1.13-4.33). Monitoring decreased odds of OSPA for 15- to 17-year-olds (OR = 0.34; 95% CI, 0.20-0.57) and 12- to 14-year-olds (OR = 0.45; 95% CI, 0.27-0.74). Friend support increased odds of OSPA in 15- to 17-year-olds (OR = 4.03; 95% CI, 2.29-7.08) and 12- to 14-year-olds (OR = 3.05; 95% CI 1.69-5.51).

CONCLUSION

Future interventions should prioritize (1) shared decision making for older teens, (2) access to PA opportunities for younger adolescents, and (3) promoting peer PA and friend support for everyone.

Nomophobia and Alcohol, Tobacco, and Cannabis Consumption in Adolescents in Galicia

This study aimed at exploring the association of nomophobia with alcohol, tobacco, and/or cannabis consumption among high school students. We carried out a cross-sectional study among high school and vocational training students in Galicia, Northwest Spain (N = 3,100). Collected data included nomophobia, sociodemographic variables, and alcohol, tobacco, and cannabis consumption. Nomophobia was measured using the validated Nomophobia Questionnaire. Adjusted odds ratios (ORs) and their 95 percent confidence intervals (CIs) were estimated using generalized linear mixed models. More than a quarter of the adolescents (27.7 percent) had nomophobia. We found an association between nomophobia and a high level of tobacco smoking in the last month in boys (OR = 2.16; 95 percent CI: 1.55-3.03). Nomophobia was also associated with higher odds of binge drinking in both genders (girls: OR = 1.86; 95 percent CI: 1.61-3.52; boys: OR = 2.29; 95 percent CI: 1.68-3.13) and with cannabis consumption in boys (OR = 1.74; 95 percent CI: 1.07-2.81). Our findings highlight the importance of a comprehensive investigation of the factors underlying alcohol, tobacco, and cannabis consumption in the adolescent population.

Examining changes of adolescent physical habitus-a retrospective study of physical capital networks

Introduction

In recent years, massive studies have examined sport from the standpoint of cultural capital. However, these studies have not examined cultural capital in relation to habitus within specific fields.

Methods

This article utilized a multivariate latent growth curve model to analyze changes of participants' physical habitus. Hypotheses concerning the form of growth in physical habitus, individual perceived capital influence differences in the common trajectory over time, and covariates influencing the growth of PH were tested.

Results

Significant linear increases existed for perceived influence from family and school, while significant linear decreases existed for perceived influence from community. The second-order alternative format of the latent growth curve model indicated that associations among individual perceived influence differences could be adequately explained by a higher order physical habitus construct. Gender, personal health condition, family socio-economic status, and weekly time spent on physical activities significantly predicted initial levels of physical habitus, whereas family social economic status significantly predicted the rate of change in physical habitus simultaneously.

Discussion

These findings not only support the participation in sport is constructed socially but also that individual efforts and contextual influences contribute to physical habitus. Furthermore, three types of perceived influences intertwined so much in simultaneity, instead of contributing to physical habitus across time.

Independent and combined effects of lifestyle behaviors on adolescent health-related quality of life

OBJECTIVE

To investigate the independent and combined effects of lifestyle behaviors, including physical activity, sedentary behavior, sleep duration and food intake, in the health-related quality of life (HRQoL) of Brazilian adolescents.

METHODS

Cross-sectional school-based study, with the participation of 306 adolescents aged 14 to 18 years. A questionnaire was applied with structured questions to collect lifestyle behaviors data. Perception of the HRQoL was identified using the Kidscreen-27. The study used covariance analysis and linear regression models for statistical analysis.

RESULTS

Adolescents who reported ≤ 2 hours/day of screen-based sedentary behavior and sleep duration equivalent to 8-10 hours/night presented significantly higher HRQoL. Adolescents who reported joint adherence ≥ 3 healthy lifestyle behaviors demonstrated approximately two [OR=2.12] to three times [OR=3.04] more chance of presenting higher perceptions of HRQoL.

CONCLUSION

Although healthy lifestyle behaviors had a positive independent effect on HRQoL, joint adherence to healthy behaviors enhances the cumulative effect.

A tri-directional examination of adolescent personality, perceived parenting, and economic and parental adversity contexts in influencing adolescent behavioral outcomes

INTRODUCTION

Adolescent personality is consistently linked to behavioral strengths and difficulties. However, most of this work is limited in that it does not consider personality beyond the Big Five or economic or parental adversity contexts. The Tri-Directional Framework of Parent and Offspring Traits and Outcomes highlights the collective influence of personality, parenting, and context on offspring behavioral outcomes.

METHODS

Parent and adolescent cross-sectional data were collected from 2019 to 2021 as part of the Parents and Children Together project in the United Kingdom. Adolescents (N = 310, 48.7% female) self-reported on Dark Triad traits, parenting, and behavior. Parents (N = 288, 46.9% mothers) self-reported on socioeconomic status and adverse childhood experiences. In two path analysis models, we examined: (1) adolescent Dark Triad, context, and their interactions as predictors of perceived maternal and paternal warmth, hostility, and control; and (2) adolescent Dark Triad, perceived parenting, context, and personality-parenting interactions as predictors of adolescent behavioral strengths and difficulties.

RESULTS

Adolescent narcissistic traits were the strongest predictors of perceived maternal parenting, whereas adolescent psychopathy and Machiavellianism were the strongest predictors of perceived paternal parenting. Adolescent personality interacted with contextual factors in predicting parenting, but not with perceived parenting in predicting behavior.

CONCLUSION

Adolescent Dark Triad traits, especially narcissism, and contextual factors are important for the parent-offspring relationship and developmental outcomes. We recommend that research move beyond assessing direct trait-outcome associations to examining how these associations operate in different environments.

Daring and Distress: Insights on Adolescent Risk Taking and Difficulties in Emotion Regulation from a Network Analysis Perspective

We explored the interrelationships between risk-taking and self-harm in typically developing adolescents by examining various contributing factors, such as personality traits, difficulties in emotion regulation, attachment styles, and maladaptive psychological functioning. A sample of 234 Italian adolescents completed the Risk-Taking and Self-Harm Inventory for Adolescents (RTSHIA), the Risk-Taking Questionnaire (RT-18), the Difficulties in Emotion Regulation Strategies (DERS), the State Adult Attachment Measure (SAAM), and the Youth Self-Report (YSR). Network analysis was used to visualize and describe the interdependencies among the variables. Risk-taking behaviors were strongly linked to rule-breaking, aggression, and risk propensity, while self-harm behaviors were connected to limited access to emotion regulation strategies and thought problems. Centrality indices indicated that variables such as anxiety/depression, limited access to emotion regulation strategies, and rule-breaking had a high influence within the network. This study provided a comprehensive understanding of the nomological network of risk-taking and self-harm behaviors among adolescents. It highlighted the relative importance of factors such as emotion regulation difficulties and maladaptive psychological functioning in influencing these behaviors. The findings could inform psychological interventions and prevention strategies targeting adolescents at risk for engaging in risk-taking or self-harm behaviors.

Association of health predictors with quality of life in children and adolescents

OBJECTIVES

To evaluate the association of health-related quality of life (HRQOL) with physical activity, food consumption, sleep duration and screen time in children and adolescents.

METHODS

Cross-sectional study with 268 students aged 10-17 years from a public school in Brazil. The outcome variable was HRQOL score, evaluated by the Pediatric Quality of Life Inventory™ (PedsQL™). Exposure variables were habitual physical activity, food consumption, sleep duration, and screen time. A general linear model was used to estimate age-adjusted means and 95 % confidence interval (95 % CI) of HRQOL scores, and a multivariable analysis of variance to identify factors associated with lower/higher HRQOL scores. The study was approved by the Human Research Ethics Committee of the Pontifical Catholic University of Campinas.

RESULTS

Overall HRQOL score was 70.3 (95 % CI: 68.0-72.6). Multivariable analyses showed lower HRQOL scores for those adolescents who: 1-were physically inactive (67.3; p=0.014); 2-sleep less than 6 h per night (66.8; p=0.003); 3-eat fruits and vegetables less than five days/week (68.9; p=0.027); and 4-eat fast food twice/week or more (68.6; p=0.036) when compared to their opposite groups. Screen time was not statistically significantly associated with total HRQOL.

CONCLUSIONS

The joint association found in our study suggests that at least three habits must change to improve the HRQOL of children and adolescents (physical activity, food consumption, and sleep duration). Therefore, interventions in schools to promote a healthy lifestyle to achieve a better HRQOL should include a multidisciplinary team to properly guide children and adolescents about these habits simultaneously.

Risk-Taking Behavior of Adolescents and Young Adults Born Preterm

OBJECTIVES

To study sexually transmitted Chlamydia trachomatis infections (STCTs), teenage pregnancies, and payment defaults in individuals born preterm as proxies for engaging in risk-taking behavior.

STUDY DESIGN

Our population-based register-linkage study included all 191 705 children alive at 10 years (8492 preterm [4.4%]) born without malformations in Finland between January 1987 and September 1990 as each mother's first child within the cohort. They were followed until young adulthood. We used Cox regression to assess the hazards of STCTs, teenage pregnancies, payment defaults, criminal offending, and substance abuse by gestational age. Gestational age was considered both as a continuous and categorical (extremely, very, moderately, late preterm, early term, post term, and full term as reference) exposure.

RESULTS

A linear dose-response relationship existed between gestational age and STCT and teenage pregnancy; adjusted hazard for STCT decreased by 1.6% (95% CI, 0.7%-2.6%), and for teenage pregnancy by 3.3% (95% CI, 1.9%-4.8%) per each week decrease in gestational age. Those born extremely preterm (23-27 completed weeks) had a 51% (95% CI, 31%-83%) lower risk for criminal offending than their full-term born counterparts, and those born very preterm (range, 28-31 weeks) had a 28% (95% CI, 7%-53%) higher hazard for payment defaults than those born at full term. Gestational age was not associated with substance abuse.

CONCLUSIONS

The lower risk-taking that characterizes people born preterm seems to generalize to sexual and to some extent criminal behavior. Those born very preterm are, however, more likely to experience payment defaults.

Typicality and trajectories of problematic and positive behaviors over adolescence in eight countries

In this study, we examine the predictions of a storm and stress characterization of adolescence concerning typicality and trajectories of internalizing, externalizing, and wellbeing from late childhood through late adolescence. Using data from the Parenting Across Cultures study, levels and trajectories of these characteristics were analyzed for 1,211 adolescents from 11 cultural groups across eight countries. Data were longitudinal, collected at seven timepoints from 8 to 17 years of age. Results provide more support for a storm and stress characterization with respect to the developmental trajectories of behavior and characteristics from childhood to adolescence or across the adolescent years than with respect to typicality of behavior. Overall, adolescents' behavior was more positive than negative in all cultural groups across childhood and adolescence. There was cultural variability in both prevalence and trajectories of behavior. The data provide support for arguments that a more positive and nuanced characterization of adolescence is appropriate and important.

Prevalence of sexual initiation and associated factors in school adolescents in Piauí, Brazil, 2015

OBJECTIVE

to analyze prevalence of sexual initiation and associated factors in adolescents in Piauí.

METHODS

this was a cross-sectional study, with secondary data from the 2015 National Adolescent School-based Health Survey. Hierarchical analysis was performed using robust Poisson regression.

RESULTS

a total of 3.872 adolescents were interviewed. Prevalence of sexual initiation was 24.2%; risk factors for sexual initiation were being male [prevalence ratio (PR) = 2.18; 95% confidence interval (95%CI) 1.90;2.47], being 15 years old or over (PR = 2.49; 95%CI 2.18;2.76), living with mother (PR = 0.68; 95%CI 0.54;0.82), working (PR = 1.82; 95%CI 1.55;2.10), attending a public school (PR = 1.39; 95%CI 1.09;1.75), practicing bullying (PR = 1.50; 95%CI 1.31;1.72), using alcohol (PR = 2.35; 95%CI 2.09;2.64), using cigarettes (PR = 1.46; 95%CI 1.22;1.70) and using illicit drugs (PR = 1.40; 95%CI 1.15;1.66).

CONCLUSION

prevalence of sexual initiation was high and associated with sociodemographic characteristics and vulnerable health behaviors, indicating the need for health promotion strategies.

Latent profile analyses of disordered eating behaviors and nonsuicidal self-injury among Vietnamese adolescents

OBJECTIVE

Comorbidity of disordered eating (DE) behaviors and nonsuicidal self-injury (NSSI) is linked to increased functional impairment. The present study identified subtypes of DE and NSSI comorbidity in a non-Western, low- and middle-income country where there has been particularly little research in this area.

METHOD

Latent profile analyses (LPA) were conducted to identify patterns of subgroup comorbidity in self-reported DE behaviors and NSSI behaviors, in a sample of Vietnamese high-school students (N = 1451, 51% female). Parallel-process LPA was used to predict NSSI subgroup membership from DE subgroup membership.

RESULTS

A seven-class LPA model was identified for DE: (1) Low frequencies of all DE behaviors; (2) Frequent levels of all DE behaviors; (3) Frequent fasting and purging behaviors; (4) Frequent binge eating only; (5) Moderate binge eating; (6) Moderate fasting and purging behaviors; (7) Exercise and fasting. A two-class (high versus low) model was identified for NSSI. Odds of membership in the high-NSSI class were significantly increased for all DE classes except the class characterized by moderate binge eating. Odds of belonging to the high-NSSI class were highest for those in DE classes involving purging behaviors. Males predominated in classes characterized by high behavior dysregulation.

DISCUSSION

DE and NSSI represent important clinical concerns among Vietnamese youth in urban contexts, and males may show particular vulnerability for certain risk behaviors. The association of classes of DE behaviors to NSSI was particularly strong for classes that involved purging, highlighting the importance of this specific behavior for understanding comorbidity of DE and NSSI.

PUBLIC SIGNIFICANCE

Disordered eating and nonsuicidal self-injury (NSSI; hurting oneself without intending to die) commonly co-occur. There has been less research on disordered eating and NSSI among individuals from non-Western or low/middle-income countries. We examined patterns of these behaviors in a school-based sample of Vietnamese adolescents. We found that patterns of disordered eating distinguished by purging showed particular links to NSSI, which could have implications for screening and treatment.

Retrospective Self-Reports of How Adolescent Substance Use Changed with the COVID-19 Pandemic

The final year of high school is a challenging phase of adolescents' lives and substance use can play an important role. We examined changes in the frequency and quantity of alcohol and cannabis use, and demographic correlates among Grade 12 students of 2020. Students (N = 844) from nine schools retrospectively self-reported changes in substance use after the easing of COVID-19 lockdowns (back to school), compared to before the pandemic. Changes in use were examined with age, gender, Aboriginal or Torres Islander, parental and family characteristics, and truancy. Thirty-one percent of students reported that they used alcohol less frequently, and 24% reported that they used it more frequently compared to pre-COVID-19. Most students (46%) reported that they used cannabis less, while a subset reported using more frequently (22%). A history of truancy was associated with an increased frequency (OR = 2.13 [1.18-3.83]) of cannabis use. A substantial minority of adolescents used more alcohol and cannabis after the initial COVID-19 lockdown period. Students in their final year who reported increased use may benefit from increased support to manage their substance use.

Construction and validation of podcast for teen sexual and reproductive health education

OBJECTIVE

to construe and validate a podcast for teen sexual and reproductive health education.

METHOD

a methodological study was conducted based on Freire's perspective. The podcast was construed based on the Knowledge about Sexuality Questionnaire applied to 60 adolescents and an integrative literature review. Eleven experts conducted the validation process. Internal consistency was evaluated using Item-level Content Validity Index ≥0.78 and Cronbach's alpha ≥0.700.

RESULTS

four podcast episodes were produced with the adolescents' participation using the radio play format, addressing sex and sexuality, contraceptive methods, human immunodeficiency virus (HIV) and Acquired Immunodeficiency Syndrome (AIDS) and other sexually transmitted infections. The podcast episodes last between 8 and 11 minutes and was validated with Item-level Content Validity Index = 0.87 and Cronbach's alpha = 0.951.

CONCLUSION

the podcast was validated for teen sexual and reproductive health education and constitutes a tool for health professional practices, particularly nurses, as well as autonomous use by adolescents.

(1) Adolescents helped construct the technology. (2) Podcast is an easy-to-access, low-cost educational resource. (3) The radio play format emulates the target audience’s style and language. (4) The podcast format is little used by nursing, especially in health education. (5) The unpublished and judge-validated podcast is available for free.

Rates of Tobacco Use Disorder, Pharmacologic Treatment, and Associated Mental Health Disorders in a Medicaid Claim Review Among Youth in Indiana, USA

Purpose

This study delineates a number of Medicaid youth with tobacco use disorder (TUD), prescribing habits for treatment, and associated externalizing disorders.

Methods

Youth Medicaid claims from 2007-2017 processed in a large Midwestern city were analyzed for a diagnosis of TUD, related pharmacotherapy, and externalizing mental health and substance use disorders.

Results

Claims connected 6541 patients with 42 890 visits. Mean age was 16.4 with 40% female. 1232 of the 6541 charts contained a TUD diagnosis equating to 1848 visits. A comorbid diagnosis of ADHD, cannabis use, and conduct disorder were more common in males (3.9% vs 1.3% in females; 3.4% vs .8%; and 2.8% vs .8%; P < .05). 808 scripts were provided to 152 of the 1232 youths, with 4.7% of those scripts a nicotine replacement product.

Conclusions

Pharmacotherapy is underutilized in this Medicaid claims data set. Certain externalizing factors were associated with males with TUD more than females.

Designing illustrative social media stories to promote adolescent peer support and healthy sexual behaviors

Objective

Adolescent females in the United States continue to have unmet sexual and reproductive healthcare needs. Research shows that interventions incorporating peer support can augment perceived self-efficacy and reinforce healthy behaviors. Yet, few user-centered digital sexual health interventions incorporate peer support, and aim to change perceptions of peer norms and model social skills. The objective of this study was to design and demonstrate the receptivity of adolescent females to illustrated digital social media stories that promote healthy sexual behaviors and peer social support.

Methods

We conducted a three-phase study approved by our Institutional Review Board. In Phase 1, we presented sexually active adolescent female emergency department patients aged 14-19 with eight sexual health scenarios via a survey study. Participants wrote three text messages addressed to the protagonist of each scenario which motivated and encouraged her to consider the use of contraceptives. Messages were scored based on the construct of peer support (emotional, tangible, informational, and belonging). In Phase 2, we worked with a professional artist and screenwriter to design digital sexual health comics using the gathered messages. In Phase 3, we gathered feedback on the comics from adolescent female emergency department patients.

Results

Females (n  =  22) provided 352 messages. Using top rated messages, we designed five digital visualizations in a running story called Mari tells it like it is. Each story incorporated 5-12 peer-authored quotes. We inserted the final images into Instagram®. Additional females (n  =  39) found the images "relatable," "super-realistic," and "educational."

Conclusion

Collecting peer-authored texts from our local adolescent community led to the creation of well-received sexual health visualizations. This novel method of design incorporated adolescent voices to promote peer support and healthy behaviors.

Impact of sports participation on components of metabolic syndrome in adolescents: ABCD growth study

OBJECTIVES

This study aimed to analyze the impact of sports participation (12 months of practice) on the components of metabolic syndrome (MetS) in both sexes.

METHODS

This is an observational longitudinal study, a part of which is entitled "Analysis of Behaviors of Children During Growth" (ABCD Growth Study), Presidente Prudente, São Paulo, Brazil. The sample was composed of 171 adolescents (112 boys and 59 girls), divided into non-sports and sports groups. High-density lipoprotein-cholesterol (HDL-c), triglycerides, and glucose were analyzed by the colorimetric method of dry chemistry and processed biochemically. Systolic blood pressure and diastolic blood pressure were measured using an automatic device. Body fat was estimated using a densitometry scanner.

RESULTS

Adolescents who practiced sports were younger (p-value=0.001) and had a lower peak height velocity (p-value=0.001) than the non-sports group. The differences (Δ) after 12 months were of greater magnitude for the sports group when compared to the non-sports group (p-value=0.013), glucose (moderate magnitude in favor of the sports group; p-value=0.001), HDL-c (small magnitude in favor of the sports group; p-value=0.0015), and MetS (moderate magnitude in favor of the sports group; p-value=0.001).

CONCLUSIONS

The practice of sports in adolescents had a protective effect on the metabolic components of MetS.

A multi-media digital intervention to improve the sexual and reproductive health of female adolescent emergency department patients

BACKGROUND

Adolescent females presenting to emergency departments (EDs) inconsistently use contraceptives. We aimed to assess implementation outcomes and potential efficacy of a user-informed, theory-based digital health intervention developed to improve sexual and reproductive health for adolescent females in the ED.

METHODS

We conducted a pilot-randomized controlled trial of sexually active female ED patients age 14-19 years. Participants were randomized to the intervention Dr. Erica (Emergency Room Interventions to improve the Care of Adolescents) or usual care. Dr. Erica consists of an ED-based digital intervention along with 3 months of personalized and interactive multimedia messaging. We assessed the feasibility, adoption, and fidelity of Dr. Erica among adolescent female users. Initiation of highly effective contraception was the primary efficacy outcome.

RESULTS

We enrolled 146 patients; mean (±SD) age was 17.7 (±1.27) years and 87% were Hispanic. Dr. Erica demonstrated feasibility, with high rates of consent (84.4%) and follow-up (82.9%). Intervention participants found Dr. Erica acceptable, liking (98.0%, on Likert scale) and recommending (83.7%) the program. A total of 87.5% adopted the program, responding to at least one text; a total of 289 weblinks were clicked. Dr. Erica demonstrated fidelity; few participants opted out (6.9%) and failed to receive texts (1.4%). Contraception was initiated by 24.6% (14/57) in the intervention and 21.9% (14/64) in the control arms (absolute risk difference [ARD] = 2.7%, 95% confidence interval [CI] = -12.4% to 17.8%). Participants receiving Dr. Erica were more likely to choose a method to start in the future (65.9% [27/41]) than controls (30.0% [15/50]); ARD = 35.9%, 95% CI = 16.6% to 55.1%).

CONCLUSIONS

A personalized, interactive digital intervention was feasible to implement, acceptable to female ED patients and demonstrated high fidelity and adoption. This ED-based intervention shows potential to improve contraception decision making.

Is Binge Drinking Associated with Suicidal Behaviors among Brazilian Adolescents?

OBJECTIVE

To evaluate the association between suicidal behaviors and binge drinking among Brazilian adolescents.

METHODS

A cross-sectional study was conducted with 2,476 students 14 to 19 years of age from 26 public high schools in the city of Olinda, Brazil. Data collection occurred between March and June 2018 through the self-administered Youth Risk Behavior Survey. Descriptive analysis and Poisson regression (p < 0.05, 95%CI) were performed.

RESULTS

The prevalence of suicidal ideation, planning and attempt in the previous 12 months was 23.7%, 17.4% and 13.5%, respectively. Suicidal ideation was associated with binge drinking one to two days (PR:1.053, 95%CI:1.011-1.096) and ≥ three days in the previous 30 days (PR:1.069, 95%CI:1.016-1.125), sadness/hopelessness in the previous 12 months (PR:1.313, 95%CI:1.267-1.360), a report of family physical aggression in the previous 12 months (PR:1.111, 95%CI:1.068-1.155), the female sex (PR:1.082, 95%CI:1.049-1.115) and a non-nuclear family (PR:1.037, 95%CI:1.004-1.071). Suicidal planning was associated with sadness/hopelessness in the previous 12 months (PR:1.257, 95%CI:1.214-1.302), report of family physical aggression in the previous 12 months (PR:1.110, 95%CI:1.065-1.156) and the female sex (PR:1.072, 95%CI:1.041-1.104). Suicide attempt was associated with binge drinking ≥ three days in the previous 30 days (PR:1.062, 95%CI:1.008-1.119), sadness/hopelessness in the previous 12 months (PR:1.202, 95%CI:1.161-1.244), report of family physical aggression in the previous 12 months (PR:1.105, 95%CI:1.060-1.153) and the female sex (PR:1.064, 95%CI:1.034-1.095). The Catholic (PR:0.938, 95%CI:0.899-0.979; PR:0.925, 95%CI:0.888-0.9865; PR:0.937, 95%CI:0.899-0.977) and Evangelical (PR:0.956, 95%CI:0.922-0.992; PR:0.954, 95%CI:0.919-0.991) religions acted as a possible protective factor against suicidal behaviors.

CONCLUSIONS

Suicidal ideation and attempt were associated with binge drinking.

Self-Perception and Self-Acceptance Are Related to Unhealthy Weight Control Behaviors in Catalan Adolescents: A Cross-Sectional Study

Adolescence is associated with a higher vulnerability that may result in a high dissatisfaction, the practice of unhealthy weight-control behaviors (UWCB) and, eventually, the onset of body image-related mental disorders. These factors are strongly associated with the social context, so it is important to characterize them in local or regional studies. To assess the relationship between body image and UWCB presence, a cross-sectional study was performed among 2496 schooled adolescents from Lleida (Spain) between 2017 and 2019. Their perceived and desired images were evaluated and compared with the real image in order to obtain the body distortion and the body dissatisfaction and relate them with UWCB. The studied individuals perceived themselves thinner than they actually were, with no differences between males and females. However, differences were found regarding body dissatisfaction, showing that females desired to be thinner, while males desired a more corpulent body image. Furthermore, one out of ten individuals reported UWCB, with higher prevalence among females. UWCB was associated with a desire to be thinner and with distorted body images. It is essential to work on self-perception and self-acceptance in early adolescence from an interdisciplinary perspective at educational, social and health levels to promote health in adolescence.

Perspectives on and preferences for on-demand and long-acting PrEP among sexual and gender minority adolescents assigned male at birth

INTRODUCTION

Sexual and gender minority (SGM) adolescents assigned male at birth who have sex with male partners are at increased risk for HIV. Daily oral pre-exposure prophylaxis (PrEP) is available for minor adolescents in the United States, who may have difficulty with adherence. Adolescents' perspectives toward emerging PrEP delivery methods that would not require daily pill-taking have not been well-explored.

METHODS

We conducted online surveys and focus groups in November 2018-February 2019 with 59 SGM adolescents assigned male at birth who reported sex with or attraction to male partners. Questions assessed their perspectives on and preferences for biomedical (on-demand, injection, implant) and non-biomedical HIV prevention options (condoms). Data were analyzed thematically.

RESULTS

Of all prevention options, the implant and condoms were rated highest, and participants preferred the implant over other biomedical options. Convenience, duration, and ease of access played important roles in adolescents' preferences. Parents were viewed as a barrier to taking PrEP regardless of delivery method due to their role in adolescents' ability to access healthcare.

CONCLUSIONS

SGM adolescents are interested in long-acting PrEP, yet also perceive substantial obstacles to using biomedical prevention that reflect adolescents' developmental contexts.

POLICY IMPLICATIONS

State laws expanding adolescents' access to HIV preventive services, sex education inclusive of PrEP information, and parent- and provider-initiated PrEP conversations can reduce barriers regardless of PrEP delivery method. Research to accelerate the availability of long-acting implants for adolescents is needed.

Chaos in Schools and Its Relationship to Adolescent Risk Behaviors

OBJECTIVE

Chaos in the home is associated with worse childhood behaviors. We hypothesize chaos in the school environment might also be associated with teen risk behaviors.

METHODS

We analyzed data from the Reducing Inequities through Social and Educational change Follow-Up study, a natural experiment designed to examine the impact of high-performing schools on adolescent outcomes. Students reported the amount of noise, order, and control in their school environment and whether they engaged in substance use, fighting, school absenteeism, and delinquent behaviors. We conducted cross-lagged panel structural equation modeling to examine the relationship between school chaos at 10th grade with risk behaviors at 11th grade while simultaneously examining the relationship between behaviors at 10th grade with chaos at 11th grade.

RESULTS

Among a sample of 1114 teens, 90% were Latinx and 40% were native English speakers. Students reporting more school chaos in 10th grade were more likely in 11th grade to report recent alcohol and cannabis use, physical fighting, school absenteeism, and delinquent behaviors in the last year. Cross-lagged structural equation model analyses indicate school chaos at 10th grade is linked to alcohol use and absenteeism at 11th grade, while fighting, absenteeism, and any delinquent behaviors at 10th grade are associated with more chaos at 11th grade. School engagement was not a mediating factor.

CONCLUSIONS

Although causal relationships cannot be assumed, school chaos may be an important predictor of adolescent risk behaviors. Future studies should examine whether reducing school chaos leads to lower rates of adolescent risk behaviors.

Birth by cesarean section and mood disorders among adolescents of a birth cohort study in northern Brazil

The increasing number of cesarean sections worldwide has encouraged research on the long-term effects of this birth type on the offspring's mental health. The objective of this study was to investigate whether there is an association between birth by cesarean section and the development of mood disorders (depression and bipolar disorders) in adolescents. A cohort study was carried out with 1603 adolescents from 18 to 19 years old who participated in the third phase of a birth cohort study in São Luís, MA, in 2016. Information on birth type and weight, prematurity, mother's age and schooling, parity, marital status, and smoking behavior during pregnancy, were collected at birth. The study outcomes were depression, bipolar disorder, and "mood disorder" construct. A Directed Acyclic Graph (DAG) was developed to select the variables for minimal adjustment for confounding and collision bias. Associations were estimated through propensity score weighting using a two-step estimation model, and confounders for cesarean birth were used in the predictive model. There was no significant association in the relationship between birth type and depression (95%CI: -0.037 to 0.017; P=0.47), bipolar disorder (95%CI: -0.019 to 0.045; P=0.43), and mood disorder (95%CI: -0.033 to 0.042; P=0.80) in adolescents of both sexes. Birth by cesarean section was not associated with the development of mood disorders in adolescents.

Effects of participation level and physical activity on eating behavior and disordered eating symptoms in the Brazilian version of the New Moves intervention: data from a cluster randomized controlled trial

BACKGROUND

Childhood and adolescent obesity is a worldwide public health concern. The New Moves program aims to change eating behavior (EB) and physical activity (PA).

OBJECTIVE

To evaluate the effectiveness of an intervention and predictors of better outcomes relating to EB and PA levels.

DESIGN AND SETTING

Secondary data from a cluster randomized controlled trial in 10 public schools in São Paulo, Brazil.

METHODS

270 female adolescents, aged 12 to 14 years, were analyzed. Participation levels were categorized as presence in 1 to 9 sessions or 10 to 17 sessions, or control. Effectiveness was evaluated through improvement in disordered EB (DEB) and EB. Predictors of better outcomes relating to PA levels were evaluated through clustering of individual characteristics that affected changes in PA scores.

RESULTS

Participation level was not significantly associated with changes in DEB or EB. Girls with higher body mass index percentile (BMI-P) percentile tended to have increases in sedentary lifestyles through the program. Girls with less body image dissatisfaction presented higher increases in daily PA. Girls with higher BMI-P percentile and higher self-esteem showed reductions in sedentary lifestyles. The program seemed to have more effect on daily PA among older girls than among younger girls.

CONCLUSIONS

This program could be used as a structured action plan in schools, with the aims of improving eating behaviors and physical activity, in addition to promoting self-acceptance. The results indicate the importance of evaluating determinants of adherence, as these metrics might influence the effectiveness and future design of lifestyle programs.

Reducing Alcohol and Opioid Use Among Youth in Rural Counties: An Innovative Training Protocol for Primary Health Care Providers and School Personnel

Background

Given that youth alcohol use is more common in rural communities, such communities can play a key role in preventing alcohol use among adolescents. Guidelines recommend primary care providers incorporate screening, brief intervention, and referral to treatment (SBIRT) into routine care.

Objective

The aim is to train primary care providers and school nurses within a rural 10-county catchment area in Pennsylvania to use SBIRT and facilitate collaboration with community organizations to better coordinate substance use prevention efforts.

Methods

To build capacity to address underage drinking and opioid use among youth aged 9-20 years, this project uses telehealth, specifically Project ECHO (Extension for Community Healthcare Outcomes), to train primary care providers and school nurses to address substance use with SBIRT. Our project will provide 120 primary care providers and allied health professionals as well as 20 school nurses with SBIRT training. Community-based providers will participate in weekly virtual ECHO sessions with a multidisciplinary team from Penn State College of Medicine that will provide SBIRT training and facilitate case discussions among participants.

Results

To date, we have launched one SBIRT ECHO project with school personnel, enrolling 34 participants. ECHO participants are from both rural (n=17) and urban (n=17) counties and include school nurses (n=15), school counselors (n=8), teachers (n=5), administrators (n=3), and social workers (n=3). Before the study began, only 2/13 (15.5%) of schools were screening for alcohol use.

Conclusions

This project teaches primary care clinics and schools to use SBIRT to prevent the onset and reduce the progression of substance use disorders, reduce problems associated with substance use disorders, and strengthen communities’ prevention capacity. Ours is an innovative model to improve rural adolescent health by reducing alcohol and opioid use.

International Registered Report Identifier (IRRID)

DERR1-10.2196/21015

Adolescent Tobacco Exposure in 31 Latin American Cities before and after the Framework Convention for Tobacco Control

Our objective was to describe the prevalence and changes in tobacco use and tobacco control policies in Latin American countries and cities before and after ratification of the 2003 Framework Convention on Tobacco Control (FCTC). Country-level tobacco policy data came from reports on the global tobacco epidemic (World Health Organization, 2007-2014). Global Youth Tobacco Survey data, 2000-2011, came from six countries (Argentina, Brazil, Chile, Colombia, Mexico, Peru), 31 cities and 132,065 students. Pre- and post-FCTC prevalence and relative changes were estimated. All countries showed improvements in tobacco control policies but Mexico and Peru showed the smallest improvements. In general, adolescents reduced their tobacco use, reported less exposure to smoking at home, more tobacco education, and more retailer refusals to sell them cigarettes. Adolescents reported smaller reductions in secondhand smoke exposure outside the home and no change in exposure to tobacco media/promotions. Pre-FCTC prevalence and relative changes during the post-FCTC period were more heterogeneous across cities than across countries. Despite overall improvements in tobacco policies and the decline in exposure to tobacco, policies related to media/promotions and secondhand smoke need strengthening. There was wide variation in adolescent exposure to tobacco between cities (within countries), which suggested major heterogeneity of policy implementation at the local level.

Geosocial Networking Application Use, Characteristics of App-Met Sexual Partners, and Sexual Behavior Among Sexual and Gender Minority Adolescents Assigned Male at Birth

Although many sexual and gender minorities (SGM) assigned male at birth (AMAB) use sexual networking applications intended for adult sexual minority men, little is known about adolescents' use of these technologies and characteristics of their online-met partners. We conducted an online survey of 219 sexually experienced SGM AMAB adolescents in the USA aged 15-17 (39.3% racial/ethnic minority; 74.9% gay; 94.1% cisgender male). Questions assessed app use patterns, partner-seeking behaviors on sexual minority male-specific apps vs. social media/other dating apps, app-met partner characteristics, and sexual behavior with app-met partners. Most (70.3%) used apps for sexual minority men, 14.6% used social media/other apps to meet partners, and 15.1% used neither. Nearly 60% of adolescents who used any type of app reported having met people from the apps in person, and nearly 90% of these reported at least one online-met sexual partner. Most partners were reportedly older than participants, and participants were more likely to report condomless receptive anal sex with older (vs. younger) online-met partners. Although partnerships were primarily sexual in nature, a minority reported friendships or serious partnerships. Meeting same-sex/gender partners via applications for adults may be common among SGM AMAB adolescents, which has implications for their sexual health and well-being.

Bystanders' behaviours and associated factors in cyberbullying

Background

Cyberbullying is presently an alarming problem worldwide due to its impact on the emotions, behaviour and psychological well-being of not only the victims, but the bullies themselves and also bystanders.

Aim

This study aims to investigate bystanders' behaviours in cyberbullying and associated factors.

Methods

This research is a cross-sectional study of 578 secondary school students in Bangkok, Thailand. Simple random sampling was used to select four secondary schools. Data were collected through online questionnaires which included four sections: (1) demographic data, (2) bystanders' behaviour in cyberbullying (cyberbullying experience and attitude towards cyberbullying were included in this section), (3) parental attachment (Inventory of Parent Attachment-Revised), and (4) self-esteem (Rosenberg Self-Esteem Scale-Revised).

Results

It was found that most occurrences of bystanders' behaviour were: (a) willing to intervene or help victims (34.6%), (b) ignoring the cyberbullying (28%) or (c) partaking in cyberbullying (26.3%). Participants who either were victims of cyberbullying or knew of cyberbullying happening to friends or relatives and had high parental attachment would intervene more than those who never had such experiences. Participants who knew of cyberbullying happening to the general public had tendencies towards ignoring the cyberbullying. Participants who indicated they were bullies and had positive attitude towards joining in tended to partake in the cyberbullying more than those who were not.

Conclusion

Factors relating to the behaviours of bystanders in cyberbullying should be further explored to provide support in the discouragement of ignoring and averting participation in cyberbullying. Secure parental attachment is one important factor that should be instilled during childhood years.

Prevalence of suicidal behaviors and associated factors among Peruvian adolescent students: an analysis of a 2010 survey

Introduction

Adolescence is one of the stages in life most affected by suicide. In Peru, 22% of suicides occur in people 10 to 19 years old. However, mental health overall and factors associated with suicidal behaviors have not been well studied.

Objective

To determine the prevalence of suicidal behaviors (ideation and ideation plus suicidal planning) and associated factors in Peruvian adolescent students.

Methods

A cross-sectional study analyzing data from the Global School-based Student Health Survey for Peru in 2010 was conducted to measure the prevalence of suicidal behaviors (ideation and ideation plus suicidal planning) and associated factors in Peruvian adolescent students.

Results

Of the 2521 students evaluated, 19.9% (95% CI: 17.8 to 22.2) presented suicidal ideation and 12.7% (95% CI: 11.1 to 14.5) presented suicidal planning in the last 12 months. Females had a higher prevalence of both ideation (27.5%, 95% CI: 24.9 to 30.4) and ideation plus suicidal planning (18.5%, 95% CI: 16.4 to 20.7). Multivariate analysis found that being female, having little parental support, having felt loneliness, having suffered from physical aggression, having been bullied, and alcohol consumption, were associated with ideation and ideation plus suicidal planning in adolescent students.

Conclusion

Ideation and ideation plus suicidal planning is a problem in the Peruvian adolescent population and is associated with several factors. Strategies are needed to identify and register suicide in adolescents in Peru and to develop prevention programs.

Psychiatric Disorders and Gun Carrying among Adolescents in the United States

OBJECTIVES

To estimate associations between psychiatric disorders and gun carrying among adolescents and to estimate the total number of adolescents in the US who have psychiatric disorders and report carrying guns.

STUDY DESIGN

We used cross-sectional data from the National Comorbidity Survey - Adolescent Supplement, a nationally representative sample of adolescents age 13-18 years (N = 10 123; response rate = 75.6%). Psychiatric disorders were assessed using the Composite International Diagnostic Interview. Gun carrying in the 30 days prior to the interview was assessed by self-report. We used multivariable Poisson regression to test for associations.

RESULTS

The analytic sample included 10 112 adolescents, 2.4% of whom reported carrying a gun in the prior 30 days. The prevalence of gun carrying was greater among adolescents with conduct disorder (adjusted prevalence ratio [APR] = 1.88, 95% CI 1.38, 2.57), drug use disorders (APR = 1.91, 95% CI 1.05, 3.45), and specific phobias (APR = 1.54, 95% CI 1.07, 2.22) compared with adolescents without these disorders. We estimated that 1.1% (95% CI 0.77, 1.48) of adolescents with a disorder associated with self- or other-directed violence also carry guns. Nationally, that is approximately 272 000 adolescents with both risk factors.

CONCLUSIONS

Specific psychiatric disorders are associated with an increased risk of gun carrying among adolescents, but the vast majority of adolescents with psychiatric disorders did not report gun carrying. Targeted efforts to assess access to and use of firearms in mental healthcare and other clinical settings are important, as are efforts to identify population approaches to prevention.

Obscenity of Cigarette and Hookah Smoking in Iranian Adolescents: A Longitudinal School-based Study

Background:

There is a very limited information on the obscenity of cigarette and hookah smoking among adolescents. Using a large and representative longitudinal sample of adolescents (n = 4820) aged 14–19 years from Tabriz (a metropolitan city in northwestern Iran), this study aimed at comparing the obscenity of cigarette and hookah smoking and assessing factors associated with obscenity of smoking. Moreover, we examined how the obscenity of cigarette and hookah smoking affected by the progress in the stages of cigarette and hookah smoking.

Methods:

In this longitudinal study, a random sample of high-school students was selected in Tabriz in 2010. Using a valid and reliable self-administered questionnaire, the data from the sampled students were collected twice at two points in time, 12 months apart. Multivariate backward logistic regression was used to determine the effect of the transition in cigarette (or hookah) smoking stages on the obscenity of cigarette (or hookah) smoking.

Results:

While 3,079 (63.9%) students expressed that obscenity of cigarette smoking is higher than obscenity of hookah smoking, 1,741 (36.1%) students expressed that obscenity of hookah smoking is higher than obscenity of cigarette smoking. The results of multivariate backward logistic regression indicated that the transition in cigarette (hookah) smoking stages was not related to the obscenity of cigarette (hookah) smoking.

Conclusions:

The results showed that obscenity of hookah smoking was less than obscenity of cigarette smoking, especially among females. Further study is required to understand the effect of obscenity on smoking and transition to different stages of cigarette and hookah smoking.

Exploring the Role of Sex and Sexual Experience in Predicting American Indian Adolescent Condom Use Intention Using Protection Motivation Theory

Introduction: American Indian (AI) youth experience poor sexual health outcomes. Research indicates the Protection Motivation Theory (PMT) is a robust model for understanding how sexual risk and protective behaviors are associated with condom use intention (CUI). Studies indicate the constructs of the PMT which influence CUI vary by sex and sexual experience. This analysis explores associations between PMT constructs and CUI by sex and sexual experience among AI youth who participated in the Respecting the Circle of Life (RCL) trial, a sexual and reproductive health intervention. Methods: We analyzed baseline data from the sample of 267 AIs, ages 13-19, who participated in the evaluation. We examined CUI and PMT construct scores by sex and sexual experience utilizing generalized estimated equations and multiple regression models to test which PMT constructs were associated with CUI across sex and sexual experience. Results: Twenty-two percentage of participants were sexually experienced; 56.8% reported CUI at baseline. We found several differences in scores in PMT constructs by sex and sexual experience including self-efficacy, response efficacy, vulnerability, severity, and extrinsic rewards. We also found constructs varied that were associated with CUI varied across sex and sexual experience. No PMT constructs were associated with CUI among sexually experienced youth. Conclusion: Results provide support for developing, selecting and delivering sexual health programs by sex and sexual experience in American Indian communities. Girls programs should focus on internal satisfaction and self-worth while boys should focus on negative impacts of not using condoms. Programs for youth who are not sexually active should focus on negative impacts of not using condoms. Programs for sexually inactive youth should work to change peer norms around condom use and improve knowledge about the efficacy of condom use.

Gender Differences in Dental Anxiety and Medical Fear in Croatian Adolescents

OBJECTIVES

The aim of this study was to differentiate anxious from nonanxious adolescents and evaluate gender differences in anxiety with respect to previous negative dental and medical experiences. The purpose was also to evaluate a causative relationship between child medical fear and dental anxiety.

STUDY DESIGN

This study sampled 113 Croatian adolescents from 15 to18 years of age. Children's Fear Survey Schedule - Dental Subscale (CFSS-DS) was used for the assessment of child dental anxiety regarding visits to the dentist and receiving dental treatment. A modified version of Child Medical Fear Questionnaire (CMFQ-M) was used for evaluation of child medical fear related to medical treatment and doctors in general.

RESULTS AND CONCLUSION

The results showed significantly higher dental anxiety (CFSS-DS) and medical fear (CMFQ-M) in adolscent girls (p<0,001) as compared to adolescent boys. A significantly strong correlation between medical fear and dental anxiety in adolescent girls was proved by Pearson's correlation coefficient (p < 0,01). In this study, CMFQ-M and CFSS-DS questionnaires were standardized in the Croatian adolescent population and proved reliable in the estimation of anxious behaviour with respect to specific medical and dental situations.

Perspectives on Underlying Factors for Unhealthy Diet and Sedentary Lifestyle of Adolescents at a Kenyan Coastal Setting

Unhealthy diet and physical inactivity are among the key modifiable risk factors for non-communicable diseases, such as diabetes and cardiovascular disease. Although such diseases often only appear in adulthood, these behaviors are typically initiated or reinforced already during adolescence. However, knowledge on underlying factors for adolescents' unhealthy dieting and physical inactivity in sub-Saharan Africa (SSA) is poor. We conducted in-depth interviews and focus group discussions to explore the perceptions of a diverse group of 78 young people of 10-19 years of age, which also included some adolescents living with HIV, as this is an emerging group in the HIV/AIDS epidemic in many parts of SSA. In addition, 10 stakeholders, such as teachers, clinicians, and staff from organizations at the Kenyan coast and seven young adult community representatives informed us on: (a) adolescents' unhealthy food choices and their forms of sedentary behavior; (b) predisposing factors; and (c) protective factors against unhealthy food choices and sedentary behavior of adolescents living in Kilifi County. The findings reveal that adolescents occasionally access nutritious foods, such as fruits, vegetables, and animal protein. However, there is a growing tendency to consume unbalanced diets with high intake of carbohydrates, oily foods, and consumption of sugar dense processed foods and drinks. Sports and domestic chores were found to be major sources of physical activity. Sedentary lifestyles characterized by a long-time sitting and chatting, watching sports games and movies were described. Adolescents living with HIV did not indicate any divergent perceptions from those of other adolescents relating to diet and physical activity, but mentioned health-related conditions, such as medication, asthma, and low body weight, as a risk factors for sedentary lifestyle. Using a Socio-Ecological model, our findings suggest that risk factors are numerous and interrelated, especially at intrapersonal, interpersonal, and community level. The negative influences at an intrapersonal level were as follows: body image concerns, attitudes and misconceptions, substance use behavior, and taste for unhealthy foods. In the interpersonal domain, household poverty and parenting practices that condone unhealthy habits were identified risk factors. Availability of affordable unhealthy foods, high prices for nutritious food, farming practices, gambling, and influx of transportation alternatives in the community were interrelated but also had relationships with intrapersonal and interpersonal risk factors. Modernization and poor implementation of policies were discussed as enabling factors especially by stakeholders from a societal perspective. Seasonality and farming practices, school attendance, community-based services, and regulations mitigating adolescents' engagement in gambling were identified as potential protective factors. Our findings provide a unique qualitative insight of the factors underlying adolescents' dietary and sedentary lifestyle and highlight the need for ecological intervention approaches to address these forms of health risk behavior in a rural African setting.

Sexual Health and the Internet: Cross-Sectional Study of Online Preferences Among Adolescents

BACKGROUND

The Internet is widely used by adolescents for sexual health information and bears the potential to increase knowledge and positively affect behavior.

OBJECTIVE

The objective of this study is to assess students' preferences when looking for sexual health information online.

METHODS

We conducted a cross-sectional survey among ninth grade students in a convenience sample of 13 secondary schools in Berlin, Germany. During a regular school period, participants were requested to rate the importance they attribute to nine aspects of sexual health websites in a paper-based questionnaire. Bivariate and multivariable analyses were used to assess awareness and preferences by gender, age, migrant background, and school type.

RESULTS

Of 1190 eligible students, 1177 (98.91%) students with a mean age of 14.6 (SD 0.7) years participated, 52.52% (605/1152) were male, and 52.94% (612/1156) had at least one parent born abroad. Participant numbers were spread equally across three types of secondary schools in Berlin. Website aspects most frequently cited as important were easily comprehensible wording (88.33%, 961/1088), clear information layout (80.57%, 871/1081), and reliability of the website's publisher (79.28%, 857/1081), whereas the visual style of a website was deemed important by the lowest number of students (35.13%, 378/1076). There was a marked gender difference in the importance students attached to website publisher reliability. Although 437/515 (84.9%) of female participants regarded this as important, only 420/566 (74.2%) of male participants did likewise (P<.001). In multivariable analyses, demographic differences were also particularly visible in the importance of publisher reliability: male participants were significantly less likely to find this aspect important (OR 0.50, 95% CI 0.37-0.69). The odds ratio for students with migrant background was 0.64 (95% CI 0.50-0.81, reference=no migrant background) and OR 2.04 (95% CI 1.03-4.03) for students in the most academic school type (reference=least academic).

CONCLUSIONS

Students prefer easily understandable online resources. Setting up sexual health websites according to the explicit preferences of the target audience might encourage usage, especially by those subpopulations less likely to critically assess information validity: male adolescents, children of immigrants, and the academically disadvantaged.

Health and Well-Being Among Young People From Canadian Farms: Associations With a Culture of Risk-Taking

PURPOSE

To determine whether patterns of adolescent risk behavior in rural populations, and especially farm populations, are associated with negative indicators of adolescent health and well-being, beyond an established association between risk-taking and injury.

METHODS

The study base was Cycle 7 (2014) of the Canadian Health Behaviour in School-Aged Children study. Children aged 11-16 years (n = 2,565; 2,533 weighted) who reported living or working on farms were matched within schools in a 1:1 ratio with other rural children. We related a scale describing engagement in multiple risk behavior to a series of indicators of adolescent health and well-being.

FINDINGS

Farm children, particularly male farm children, showed the highest levels of risk behavior. Multiple risk behavior was strongly and consistently associated with negative indicators of general health, mental health (life satisfaction, psychosomatic symptoms), and academic performance in all subpopulations.

CONCLUSIONS

Adolescent risk behavior in rural populations, and especially farm populations, is common and associated with a variety of negative indicators of adolescent health and well-being. We speculate that the origins of this risk-taking lifestyle surround cultural definitions of self and identity, which have both protective and negative effects.

Binge drinking and illicit drug use among adolescent students

OBJECTIVE

To estimate the prevalence of illicit drug use and its association with binge drinking and sociodemographic factors among adolescent students.

METHODS

This is a cross-sectional study with probabilistic conglomerate sampling, involving 1,154 students, aged 13 to 19 years old, from the public school system, in the city of Olinda, State of Pernambuco, Brazil, carried out in 2014. We used the Youth Risk Behavior Survey questionnaire, validated for use with Brazilian adolescents. The Chi-square test (≤ 0.05) and Poisson regression analysis were used to estimate the prevalence ratios, with 95% confidence intervals.

RESULTS

Use in life of illicit drugs was four times more prevalent among students who reported binge drinking (95%CI 3.19-5.45). Being in the age group of 16 to 19 years, being male, and having no religion were also significantly associated with illicit drug use.

CONCLUSIONS

The prevalence of use in life of illicit drugs was higher in this study than in other studies carried out in Brazil and it was strongly associated with binge drinking. This factor was associated with gender, age, and religion.

OBJETIVO

Estimar a prevalência do uso de drogas ilícitas e sua associação com binge drinking e fatores sociodemográficos entre estudantes adolescentes.

MÉTODOS

Estudo transversal com amostra probabilística por conglomerado, envolvendo 1.154 estudantes, de 13 a 19 anos de idade, da rede pública de ensino, no município de Olinda, PE, 2014. Foi utilizado o questionário Youth Risk Behavior Survey, validado para uso com adolescentes brasileiros. Para análise dos dados foi utilizado o teste do Qui-quadrado (≤ 0,05) e análise de regressão de Poisson, para estimar razões de prevalência, com intervalos com 95% de confiança.

RESULTADOS

O uso na vida de drogas ilícitas foi quatro vezes mais prevalente entre os estudantes que relataram o binge drinking (IC95% 3,19-5,45). Estar na faixa etária de 16 a 19 anos, ser do sexo masculino e não ter religião também foram significativamente associados ao uso de drogas ilícitas.

CONCLUSÕES

A prevalência do uso de drogas ilícitas na vida foi superior a outros estudos realizados no Brasil e esteve fortemente associado ao binge drinking. Esse fator mostrou associação com gênero, idade e religião.

Body Piercing: Motivations and Implications for Health

Body piercing has evolved from a behavior once considered extreme to an accepted choice among the general population. Earlobe piercing is so common that it is now considered a normative behavior. The motivations for choosing body piercing have changed and are associated with piercing site and number of piercings chosen by the individual. Meanings ascribed to body piercing were traditionally related to enhanced sexual desirability and experience, but now range from the innocuous, such as a fashion statement, to the risk laden, such as nonsuicidal self-injury. Professional piercers are the primary providers of piercing services, and people will first turn to their professional piercer for advice when complications of the site arise, thus delaying entry into needed health care. Health care providers are often perceived as uninformed, dismissive, and biased against individuals, who are pierced particularly those with multiple piercings and piercings in intimate areas of the body. Common complications of piercing include infection, bleeding, and problems relating to tissue trauma and scarring, and are reported by nearly 50% of individuals who are pierced. Metal allergies can develop as a result of piercing, making the type of jewelry used for body adornment an important consideration. Additionally, management of the piercing site becomes critical under certain conditions, such as during pregnancy and birth, lactation, or surgery. This article provides information supporting midwives and other health care providers to offer anticipatory guidance and health care services in a nonjudgmental and supportive manner to individuals choosing body piercing.

Parental Deployment, Adolescent Academic and Social-Behavioral Maladjustment, and Parental Psychological Well-being in Military Families

OBJECTIVE

Increases in the frequency and length of military deployments have raised concerns about the well-being of military families. We examined the relationship between a military parent's deployment and (1) adolescent academic and social-behavioral maladjustment and (2) parental psychological well-being.

METHODS

We collected data from April 2013 through January 2014 from 1021 families of enlisted US Army personnel with children aged 12 or 13 during the Military Teenagers' Environments, Exercise, and Nutrition Study. Through online parent surveys, we collected data on deployment, adolescent academic and social-behavioral maladjustment, and parental psychological well-being. We estimated adjusted logistic and linear regression models for adolescents (all, boys, girls), military parents (all, fathers, mothers), and civilian parents.

RESULTS

Compared with no or short deployments, long deployments (>180 days in the past 3 years) were associated with significantly higher odds of decreases in adolescent academic performance (adjusted odds ratio [AOR] = 1.54), independence (AOR = 2.04), and being responsible (AOR = 1.95). These associations were also significant for boys but not for girls. Among parents, long deployments were associated with significantly higher odds of being depressed (AOR = 2.58), even when controlling for adolescent maladjustment (AOR = 2.54). These associations did not differ significantly between military and civilian parents and were significant for military fathers but not military mothers. Recent deployment (in the past 12 months) was not associated with either adolescent or parent outcomes.

CONCLUSION

Long deployments are associated with adolescents' academic and social-behavioral maladjustments and diminished parental well-being, especially among boys and military fathers.

Caffeine Consumption and General Health in Secondary School Children: A Cross-sectional and Longitudinal Analysis

Although caffeine is sometimes associated with beneficial effects in adults, the substance may be dangerous if intake is too high. This concern is particularly relevant in regards to children and adolescents, as consumption of energy drinks may be particularly high in such populations. For this reason, the current study examined data from the Cornish Academies Project to determine whether caffeine intake in secondary school children was related to responses to a single-item measure of general health. Two cross-sections of data were available: questionnaires were completed by 2030 at baseline, by 2307 at 6-month follow-up, and by 1660 at both time-points. Relationships were, therefore, explored both cross-sectionally and longitudinally. High caffeine consumption (i.e., 1000 mg/week) was associated with low general health in both cross-sections of data, and analyses of individual caffeine sources suggested that the effects related specifically to cola and energy drinks. However, after controlling for additional aspects of diet, demography, and lifestyle, total weekly intake only remained significantly associated with general health at the latter time-point. Further to this, null findings from cross-lag and change-score analyses suggest that caffeine and general health were unlikely to be causally linked in this sample. However, due to methodological limitations, such as the two cross-sections of data being collected only 6 months apart, it is suggested that further longitudinal and intervention studies are required in order for firm conclusions to be drawn.

The Profile of Academic Offenders: Features of Students Who Admit to Academic Dishonesty

Dishonesty in academic settings is a reckless behavior that is unique to students and is associated with cheat    ing and plagiarism of academic tasks. Incidents involving dishonesty in higher education have increased considerably in the past decade, with regard to the extent of these practices, the types of dishonesty employed, and their prevalence. The current study examines the profile of "academic offenders". Which types are more prone to commit academic offenses? To what degree are they "normative" and do they represent the average student with regard to personal traits, personal perceptions, features of their academic studies, risk behaviors, and health risks. The study is based on a structured anonymous questionnaire. The sample consisted of 1,432 students, of whom 899 were female (63%) and 533 male (37%). The research findings indicate a common tendency among more than one quarter of the sample reported cheating on homework and 12.5% reported cheating on tests. Strong associations were found between academic dishonesty and various personal perceptions, the academic study experience, and involvement in other risky and deviant behaviors. Significant predictors of academic dishonesty were found, i.e., self-image, ethics, grades, time devoted to homework, and deviant and daring behaviors. The research findings might help indicate policies for optimally dealing with dishonesty, maybe even before the offense is committed, by means of cooperation between academic forces.

Parental Post-Traumatic Stress Symptoms as Predictors of Psychosocial Problems in Children Treated for Cancer

The purpose of this study was to explore the association between psychosocial functioning of children treated for cancer and that of their parents. Factors associated with psychosocial functioning were also examined. The present study was a cross-sectional survey of 33 mothers and one father (mean age: 37.9), each of whom had a child that had been treated for cancer. The participants answered a package of questionnaires consisting of the Impact of Event Scale-Revised (IES-R), the Parent Experience of Child Illness (PECI), and the Child Behavior Checklist (CBCL). Information about the children's illnesses was collected from medical records. The CBCL total problems T score was correlated with the parental IES-R total scores. Intensity of treatment independently predicted the variance of parental long-term uncertainty. In conclusion, psychosocial problems of children with cancer were associated with parental post-traumatic stress symptoms (PTSS). Provision of early, adequate support to parents who are vulnerable to PTSS will help not only the parents, but also their children with cancer.

Factors associated with the implementation of programs for drug abuse prevention in schools

OBJECTIVE

To analyze if characteristics of managers, schools, and curriculum are associated with the implementation of programs for drug abuse prevention in elementary and high schools.

METHODS

Cross-sectional study, with random sample of 263 school managers. Data were collected between 2012 and 2013 by a program that sends forms via internet. A closed self-filling questionnaire was applied online. Statistical analysis included Chi-square tests and logistic regression models. The outcome variable was the presence of program for drug abuse prevention inserted in the daily life and educational program of the school. The explanatory variables were divided into: demographic data of the manager; characteristics of the school and of the curriculum; health education; and drug use in the school.

RESULTS

We found that 42.5% (95%CI 36.1-49.1) of the evaluated schools had programs for drug abuse prevention. With the multiple logistic regression model, we observed that the more time the manager has worked with education, the chance of the school having a program increased at about 4.0%. Experimenting with innovative teaching techniques also increased at about six times the chance of the school developing a program for drug abuse prevention. The difficulties in the implementation of the programs were more present in state and municipal schools, when compared with private schools, due to, for instance: lack of teaching materials, lack of money, and competing demands for teaching other subjects.

CONCLUSIONS

The implementation of programs for drug abuse prevention in the city of Sao Paulo is associated with the experience of the manager in education and with the teaching strategies of the school.

OBJETIVO

Analisar se características dos dirigentes, das escolas e do currículo escolar estão associadas à implantação de programas de prevenção ao uso de drogas nas escolas do ciclo fundamental II e médio.

MÉTODOS

Estudo transversal, com amostra aleatória sistemática de 263 dirigentes escolares. Os dados foram coletados nos anos de 2012 e 2013 por meio de um programa de envio de formulários pela internet. Aplicou-se questionário fechado, de autopreenchimento on-line. A análise estatística incluiu testes Qui-quadrado e modelos de regressão logística. A variável desfecho foi a presença de programa de prevenção ao uso de drogas inserido no cotidiano e no programa pedagógico da escola. As variáveis explicativas foram divididas em: dados demográficos do dirigente; características da escola e do currículo; educação em saúde; e consumo de drogas na escola.

RESULTADOS

Constatou-se que 42,5% (IC95% 36,1-49,1) das escolas avaliadas possuíam programa de prevenção ao uso de drogas. Com o modelo de regressão logística múltipla, observou-se que, a cada ano de atuação do dirigente na educação, a chance de a escola ter um programa aumentava em aproximadamente 4,0%. O fato de experimentar técnicas de ensino inovadoras também aumentou em cerca de seis vezes a chance de a escola desenvolver um programa de prevenção ao uso de drogas. As dificuldades na implantação dos programas foram mais presentes nas redes estadual e municipal, quando comparadas à rede privada, destacando-se: a falta de material didático, a falta de dinheiro e as demandas concorrentes para ensino de outras disciplinas.

CONCLUSÕES

A implantação de programas de prevenção ao uso de drogas no município de São Paulo está associada à experiência do dirigente escolar na educação e nas estratégias de ensino da escola.

Family-Based Interventions in Preventing Children and Adolescents from Using Tobacco: A Systematic Review and Meta-Analysis

BACKGROUND

Tobacco is the main preventable cause of death and disease worldwide. Adolescent smoking is increasing in many countries with poorer countries following the earlier experiences of affluent countries. Preventing adolescents from starting smoking is crucial to decreasing tobacco-related illness.

OBJECTIVE

To assess effectiveness of family-based interventions alone and combined with school-based interventions to prevent children and adolescents from initiating tobacco use.

DATA SOURCES

Fourteen bibliographic databases and the Internet, journals hand-searched, and experts consulted.

STUDY ELIGIBILITY CRITERIA, PARTICIPANTS, AND INTERVENTIONS

Randomized controlled trials (RCTs) with children or adolescents and families, interventions to prevent starting tobacco use, and follow-up ≥6 months.

STUDY APPRAISAL/SYNTHESIS METHODS

Abstracts/titles independently assessed and data independently entered by 2 authors. Risk of bias was assessed with the Cochrane Risk-of-Bias tool.

RESULTS

Twenty-seven RCTs were included. Nine trials of never-smokers compared with a control provided data for meta-analysis. Family intervention trials had significantly fewer students who started smoking. Meta-analysis of 2 RCTs of combined family and school interventions compared with school only, showed additional significant benefit. The common feature of effective high-intensity interventions was encouraging authoritative parenting.

LIMITATIONS

Only 14 RCTs provided data for meta-analysis (approximately a third of participants). Of the 13 RCTs that did not provide data for meta-analysis 8 compared a family intervention with no intervention and 1 reported significant effects, and 5 compared a family combined with school intervention with a school intervention only and none reported additional significant effects.

CONCLUSIONS AND IMPLICATIONS OF KEY FINDINGS

There is moderate-quality evidence that family-based interventions prevent children and adolescents from starting to smoke.

Are normal-weight adolescents satisfied with their weight?

CONTEXT AND OBJECTIVE

The high prevalence of obesity has led to public policies for combating it. People with normal weight may gain greater awareness of this issue and change their perceptions of their weight. The aim of this study was to evaluate the prevalence of body weight dissatisfaction among normal-weight adolescents, according to demographic and socioeconomic variables, health-related behavior and morbidities.

DESIGN AND SETTING

Population-based cross-sectional study that used data from a health survey conducted in the city of Campinas, São Paulo, in 2008-2009.

METHODS

The prevalence and prevalence ratios of weight dissatisfaction were estimated according to independent variables, by means of simple and multiple Poisson regression.

RESULTS

573 normal-weight adolescents aged 10 to 19 years (mean age 14.7 years) were analyzed. The prevalence of weight dissatisfaction was 43.7% (95% confidence interval, CI: 37.8-49.8). Higher prevalences of weight dissatisfaction were observed among females, individuals aged 15 to 19 years, those whose households had eight or more domestic appliances, former smokers, individuals who reported alcohol intake and those who had one or more chronic diseases. Lower prevalence of dissatisfaction was observed among adolescents living in substandard housing. Among the normal-weight adolescents, 26.1% wished to lose weight and 17.6% wished to gain weight.

CONCLUSION

The results from this study indicate that even when weight is seen to be within the normal range, a high proportion of adolescents express dissatisfaction with their weight, especially females, older adolescents and those of higher socioeconomic level.

Identifying Psychosocial Variables That Predict Safer Sex Intentions in Adolescents and Young Adults

Young people are especially vulnerable to sexually transmitted infections (STIs). The triad of deliberate and effective safer sex behavior encompasses condom use, combined with additional information about a partner’s sexual health, and the kind of sex acts usually performed. To identify psychosocial predictors of young people’s intentions to have safer sex, as related to this triad, we conducted an online study with 211 sexually active participants aged between 18 and 24 years. Predictors [i.e., perceived behavioral control (PBC), subjective norms, and intention] taken from Fishbein and Ajzen’s Reasoned Action Approach (RAA), were combined with more distal variables (e.g., behavioral inhibition, sensation seeking, parental monitoring, and knowledge about STIs). Beyond the highly predictive power of RAA variables, additional variance was explained by the number of instances of unprotected sexual intercourse (SI) during the last 12 months and reasons for using barrier protection during first SI. In particular, past condom non-use behavior moderated PBC related to intended condom use. Further, various distal variables showed significant univariate associations with intentions related to the three behaviors of interest. It may, therefore, be helpful to include measures of past behavior as well as certain additional distal variables in future safer sex programs designed to promote health-sustaining sexual behavior.

Breakfast and Energy Drink Consumption in Secondary School Children: Breakfast Omission, in Isolation or in Combination with Frequent Energy Drink Use, is Associated with Stress, Anxiety, and Depression Cross-Sectionally, but not at 6-Month Follow-Up

A considerable amount of research suggests that breakfast omission and the frequent use of caffeinated energy drinks may be associated with undesirable effects, and particularly so in children and adolescents. The current paper presents cross-sectional and longitudinal data from the Cornish Academies Project to investigate the effects of consuming energy drinks and missing breakfast on stress, anxiety, and depression in a cohort of secondary school children from the South West of England. Questionnaires were administered at two time-points (spaced 6 months apart) to collect information relating to diet and lifestyle over the previous 6 months. Demographic and school data were acquired through the School Information Management System, and single-item measures of stress, anxiety, and depression were administered at the second time-point only. Associations between breakfast and energy drink consumption and stress, anxiety, and depression were investigated, and a multivariate approach was taken so that additional variance from diet, demography, and lifestyle could be controlled for statistically. Cross-sectional analyses showed that breakfast omission was consistently associated with negative outcomes, and that this was largely observed for both those who frequently consumed energy drinks and those who did not. However, cross-lag analyses showed that neither breakfast omission or energy drink consumption, alone or in combination, was predictive of stress, anxiety, or depression at 6-month follow-up. This suggests that associations between breakfast and mental health may be bi-directional rather than breakfast being the causal factor.

Brief school-based interventions and behavioural outcomes for substance-using adolescents

BACKGROUND

Adolescent substance use is a major problem in and of itself, and because it acts as a risk factor for other problem behaviours. As substance use during adolescence can lead to adverse and often long-term health and social consequences, it is important to intervene early in order to prevent progression to more severe problems. Brief interventions have been shown to reduce problematic substance use among adolescents and are especially useful for individuals who have moderately risky patterns of substance use. Such interventions can be conducted in school settings. This review set out to evaluate the effectiveness of brief school-based interventions for adolescent substance use.

OBJECTIVES

To evaluate the effectiveness of brief school-based interventions in reducing substance use and other behavioural outcomes among adolescents compared to another intervention or assessment-only conditions.

SEARCH METHODS

We conducted the original literature search in March 2013 and performed the search update to February 2015. For both review stages (original and update), we searched 10 electronic databases and six websites on evidence-based interventions, and the reference lists of included studies and reviews, from 1966 to February 2015. We also contacted authors and organisations to identify any additional studies.

SELECTION CRITERIA

We included randomised controlled trials that evaluated the effects of brief school-based interventions for substance-using adolescents.The primary outcomes were reduction or cessation of substance use. The secondary outcomes were engagement in criminal activity and engagement in delinquent or problem behaviours related to substance use.

DATA COLLECTION AND ANALYSIS

We used the standard methodological procedures outlined by The Cochrane Collaboration, including the GRADE approach for evaluating the quality of evidence.

MAIN RESULTS

We included six trials with 1176 adolescents that measured outcomes at different follow-up periods in this review. Three studies with 732 adolescents compared brief interventions (Bls) with information provision only, and three studies with 444 adolescents compared Bls with assessment only. Reasons for downgrading the quality of evidence included risk of bias of the included studies, imprecision, and inconsistency. For outcomes that concern substance abuse, the retrieved studies only assessed alcohol and cannabis. We generally found moderate-quality evidence that, compared to information provision only, BIs did not have a significant effect on any of the substance use outcomes at short-, medium-, or long-term follow-up. They also did not have a significant effect on delinquent-type behaviour outcomes among adolescents. When compared to assessment-only controls, we found low- or very low-quality evidence that BIs reduced cannabis frequency at short-term follow-up in one study (standardised mean difference (SMD) -0.83; 95% confidence interval (CI) -1.14 to -0.53, n = 269). BIs also significantly reduced frequency of alcohol use (SMD -0.91; 95% CI -1.21 to -0.61, n = 242), alcohol abuse (SMD -0.38; 95% CI -0.7 to -0.07, n = 190) and dependence (SMD -0.58; 95% CI -0.9 to -0.26, n = 190), and cannabis abuse (SMD -0.34; 95% CI -0.65 to -0.02, n = 190) at medium-term follow-up in one study. At long-term follow-up, BIs also reduced alcohol abuse (SMD -0.72; 95% CI -1.05 to -0.40, n = 181), cannabis frequency (SMD -0.56; 95% CI -0.75 to -0.36, n = 181), abuse (SMD -0.62; 95% CI -0.95 to -0.29, n = 181), and dependence (SMD -0.96; 95% CI -1.30 to -0.63, n = 181) in one study. However, the evidence from studies that compared brief interventions to assessment-only conditions was generally of low quality. Brief interventions also had mixed effects on adolescents' delinquent or problem behaviours, although the effect at long-term follow-up on these outcomes in the assessment-only comparison was significant (SMD -0.78; 95% CI -1.11 to -0.45).

AUTHORS' CONCLUSIONS

We found low- or very low-quality evidence that brief school-based interventions may be more effective in reducing alcohol and cannabis use than the assessment-only condition and that these reductions were sustained at long-term follow-up. We found moderate-quality evidence that, when compared to information provision, brief interventions probably did not have a significant effect on substance use outcomes. It is premature to make definitive statements about the effectiveness of brief school-based interventions for reducing adolescent substance use. Further high-quality studies examining the relative effectiveness of BIs for substance use and other problem behaviours need to be conducted, particularly in low- and middle-income countries.

Socioeconomic inequalities and changes in oral health behaviors among Brazilian adolescents from 2009 to 2012

OBJECTIVE To analyze oral health behaviors changes over time in Brazilian adolescents concerning maternal educational inequalities. METHODS Data from the Pesquisa Nacional de Saúde do Escolar (Brazilian National School Health Survey) were analyzed. The sample was composed of 60,973 and 61,145 students from 26 Brazilian state capitals and the Federal District in 2009 and 2012, respectively. The analyzed factors were oral health behaviors (toothbrushing frequency, sweets consumption, soft drink consumption, and cigarette experimentation) and sociodemographics (age, sex, race, type of school and maternal schooling). Oral health behaviors and sociodemographic factors in the two years were compared (Rao-Scott test) and relative and absolute measures of socioeconomic inequalities in health were estimated (slope index of inequality and relative concentration index), using maternal education as a socioeconomic indicator, expressed in number of years of study (> 11; 9-11; ≤ 8). RESULTS Results from 2012, when compared with those from 2009, for all maternal education categories, showed that the proportion of people with low toothbrushing frequency increased, and that consumption of sweets and soft drinks and cigarette experimentation decreased. In private schools, positive slope index of inequality and relative concentration index indicated higher soft drink consumption in 2012 and higher cigarette experimentation in both years among students who reported greater maternal schooling, with no significant change in inequalities. In public schools, negative slope index of inequality and relative concentration index indicated higher soft drink consumption among students who reported lower maternal schooling in both years, with no significant change overtime. The positive relative concentration index indicated inequality in 2009 for cigarette experimentation, with a higher prevalence among students who reported greater maternal schooling. There were no inequalities for toothbrushing frequency or sweets consumption. CONCLUSIONS There were changes in the prevalences of oral health behaviors during the analyzed period; however, these changes were not related to maternal education inequalities.