Can preschool improve child health outcomes? A systematic review

Early childhood development interventions (ECDIs) have the potential to bring about wide ranging human capital benefits for children through to adulthood. Less is known, however, about the potential for such interventions to improve population health. The aim of this study was to examine the evidence for child health effects of centre-based preschool intervention programs for healthy 4 year olds, beyond the preschool years. Medline, Embase, ERIC, Psych Info, Sociological Abstracts, the Cochrane Library, C2-SPECTR and the Head Start database were searched using terms relating to preschool and health from 1980 to July 2008, limited to English language publications. Reference lists and the journal Child Development were hand searched for eligible articles missed by the electronic search. There were 37 eligible studies identified. The reviewed studies examined a range of interventions from centre-based preschool alone, to interventions also including parenting programs and/or health services. The study populations were mostly sampled from populations at risk of school failure (76%). Only eight of the 37 studies had a strong methodological rating, 15 were evaluated as at moderate potential risk of bias and 14 as at high potential risk of bias. The review found generally null effects of preschool interventions across a range of health outcomes, however there was some evidence for obesity reduction, greater social competence, improved mental health and crime prevention. We conclude that the great potential for early childhood interventions to improve population health across a range of health outcomes, as anticipated by policy makers worldwide, currently rests on a rather flimsy evidence base. Given the potential and the increasingly large public investment in these interventions, it is imperative that population health researchers, practitioners and policy makers worldwide collaborate to advance this research agenda.

School-based prevention of depression: a randomised controlled study of the beyondblue schools research initiative

BACKGROUND

Depressive disorders are experienced by 3-5% of the adolescent population at any point of time. They adversely affect adolescent development in a range of areas and greatly increase risk for suicide. The present study investigated the effectiveness of a universal intervention designed to reduce depressive symptoms among students commencing high school.

METHODS

Twenty-five pairs of secondary schools matched on socio-economic status were randomly assigned to either an intervention or a comparison group (n = 5,634 Year 8 students). The intervention extended over a 3-year period and utilised a comprehensive classroom curriculum programme, enhancements to the school climate, improvements in care pathways, and community forums. A range of measures completed by students, average age at baseline = 13.1 years (SD = .5), and teachers was used to assess changes in depressive symptoms, risk and protective factors relevant to depression, and the quality of the school environment.

RESULTS

Changes in the level of depressive symptoms and in the levels of risk and protective factors experienced by students in the two groups did not differ significantly over the 3 years of the study. Furthermore, statistically significant differences in the ratings of school climate across this time period were found only for staff-rated assessments.

CONCLUSIONS

Despite using an extensive, structured programme, based on best evidence to increase protective factors and reduce risk factors at the individual and school levels, the intervention did not reduce levels of depressive symptoms among participating adolescents. The results draw attention to the difficulties faced when implementing large-scale, school-based, universal preventive interventions. These include the need to develop methods to effectively train teachers across large geographical regions to deliver new interventions with fidelity, the difficulty of engaging young adolescents with prevention programmes, and the long period of time required to implement policy and practice changes at 'whole-school' levels.

Socioeconomic risk factors for mental health problems in 4-5-year-old children: Australian population study

OBJECTIVE

To describe the extent to which parent- and teacher-reported child mental health problems vary by different indicators of socioeconomic status.

METHODS

Participants were 4-5-year-old children in the Longitudinal Study of Australian Children (LSAC). Parents (N = 4968) and teacher (N = 3245) completed the 3-4-year-old version of Strengths and Difficulties Questionnaire (SDQ). Parents also reported the socioeconomic indicators of income, education, employment, and family composition (1- vs 2-parent families). Logistic regression models were used to predict SDQ total difficulties and each of the 4 SDQ subscales problems, as reported by parents and by teacher, and considered all putative socioeconomic status (SES) predictor variables simultaneously.

RESULTS

The proportions of children scoring in the abnormal range varied according to SES indicator and mental health subscale. All of the SES indicators independently predicted parent-reported child mental health problems, although odds ratios were generally small to moderate (1.2 to 2.4), and not all reached statistical significance. Low income and parent education showed larger associations than sole parenthood or unemployment. The pattern for teachers was similar, though less consistent. Behavioral problems showed stronger associations with social disadvantage than emotional problems.

CONCLUSIONS

Research examining pathways to young children's mental health should include diverse measures of SES, particularly of family income and education. The fact that mental health problems were most strongly associated with parent education and income should be of interest to policy makers because education and income reflect investments in the lives of our participants' parents during their own childhood and adolescence.

Life events, coping and depressive symptoms among young adolescents: a one-year prospective study

BACKGROUND

To investigate prospectively over one year, the extent to which greater exposure to negative life events, greater use of more negative coping strategies, and less use of positive coping strategies and an optimistic thinking style, predicts the onset of depressive symptoms among adolescents.

METHODS

A prospective longitudinal study of 5,634 adolescents (Mean Age=13.1, SD=0.5) enrolled in Year 8 at secondary school. Standard questionnaires were used to assess depressive symptoms and the predictor variables.

RESULTS

Over a one-year period, there was an independent and statistically significant relationship between transition to a CES-D score above the recommended cut-off score and i) greater exposure to negative life events and use of negative coping strategies, and ii) less use of positive coping strategies and an optimistic thinking style. Among males who experienced a higher number of negative life events, the impact on depressive symptoms was greater among those who made more use of negative coping strategies.

LIMITATIONS

Self-report questionnaires completed by adolescents were employed to evaluate all the variables in the study. Only two assessment points were available. Ten percent of adolescents did not complete the follow-up assessment.

CONCLUSIONS

Particularly among females, early adolescence is marked by increased susceptibility to depressive symptoms. Helping young adolescents to adopt more positive coping strategies and optimistic thinking styles may reduce their risk for the onset of depressive symptoms. This may be particularly important for young males who experience high levels of adverse life events and utilise negative coping strategies.

Comorbidities of overweight/obesity in Australian preschoolers: a cross-sectional population study

OBJECTIVE

To determine relationships between body mass index (BMI) status and indicators of health and morbidity in a nationally-representative population sample of preschool children.

METHODS

Data from the 4-5-year-old cohort in the first wave (2004) of the Longitudinal Study of Australian Children were studied. Main outcome measures were: measured child BMI, categorised as non-overweight, overweight and obese using International Obesity TaskForce cutpoints; parent-reported child global health, health-related quality of life, mental health problems, asthma, sleep problems, injuries, special health care needs, and level of parental concern about the child's weight. Regression methods were used to assess associations with child's BMI status, adjusted for sociodemographic factors.

RESULTS

BMI was available for 4934 (99%) children; 756 (15.3%) were overweight and 258 (5.2%) obese. Compared to non-overweight children, parents of overweight and obese children reported a higher prevalence of special health care needs (adj OR 1.72, 95% CI 1.20 to 2.46), but other health outcomes were similar. Parental concern about the child's weight was low among the overweight (14.4%) and non-overweight (17.8%) children, but rose to 52.7% in the obese. However, parental concern was unrelated to any of the specific health problems studied.

CONCLUSIONS

Despite a high prevalence of overweight/obesity, parents of overweight and obese children reported relatively few additional health burdens over and above those of the non-overweight preschoolers. These findings may shed light on the disparity between strong public concern and parents' expressed lack of concern about overweight/obesity in their own children around the time of school entry.

Relationships between the home environment and physical activity and dietary patterns of preschool children: a cross-sectional study

OBJECTIVE

To assess relationships between characteristics of the home environment and preschool children's physical activity and dietary patterns.

METHODS

Homes of 280 preschool children were visited and information obtained by direct observation and parent interview regarding physical and nutritional characteristics of the home environment. Children's physical activity, sedentary behaviour and dietary patterns were measured using standardised parent-report questionnaires. Associations were analysed using analysis of variance and correlation.

RESULTS

Parental physical activity (p = 0.03-0.008), size of backyard (p = 0.001) and amount of outdoor play equipment (p = 0.003) were associated with more outdoor play. Fewer rules about television viewing (p < 0.001) and presence of playstation (p = 0.02) were associated with more indoor sedentary time. Higher fruit and vegetable intake was associated with restricting children's access to fruit juice (p = 0.02) and restricting high fat/sugar snacks (p = 0.009). Lower intake of non-core foods was associated with restricting children's access to fruit juice (p = 0.007), cordial/carbonated drinks (p < 0.001) and high fat/sugar snacks (p = 0.003). Lower fruit and vegetable intake was associated with reminding child to 'eat up' (p = 0.007) and offering food rewards to eat main meal (p = 0.04). Higher intake of non-core foods was associated with giving food 'treats' (p = 0.03) and offering food rewards to eat main meal (p = 0.04). The availability of food groups in the home was associated with children's intake of these foods (fruit and vegetables, p < 0.001; fat in dairy, p = <0.001; sweetened beverages, p = 0.004-<0.001; non-core foods, p = 0.01-<0.001).

CONCLUSION

Physical attributes of the home environment and parental behaviours are associated with preschool children's physical activity, sedentary behaviour and dietary patterns. Many of these variables are modifiable and could be targeted in childhood obesity prevention and management.

Socio-economic differentials in the health-related quality of life of Australian children: results of a national study

OBJECTIVE

To examine differences in health-related quality of life (HRQL) of children living in different socio-economic contexts in Australia.

METHODS

Parental reports describing the HRQL and socio-economic status of a random national sample of 3,597 school-age children were obtained using the Child Health Questionnaire (CHQ) and a standardised socio-economic interview. Response rate was 70%.

RESULTS

Children in families of higher income, whose parents had more years of schooling and were employed and children who lived in two-parent, original families had significantly higher HRQL across a range of domains assessed by the CHQ.

CONCLUSION

Children from lower socio-economic backgrounds in Australia have a significantly more negative experience of health and wellness. Such differences may well increase unless deliberate political attention is given to addressing the widening differences in relative wealth in Australia.

The health-related quality of life of children and adolescents in home-based foster care

OBJECTIVE

To compare the health-related quality of life (HRQL) of 326 children and adolescents aged 6-17 years living in home-based foster care in metropolitan Adelaide, South Australia with the HRQL of a random sample of 3,582 children aged 6-17 years living in the community in Australia.

METHOD

In both groups, HRQL was assessed using the 50-item version of the Child Health Questionnaire (CHQ-PF50) completed by caregivers/parents, and the 87-item self-report version of the Child Health Questionnaire (CHQ-CF87) completed by 13-17 year olds.

RESULTS

Young people in home-based foster care had significantly poorer HRQL in a wide range of different domains than those in the general community. Furthermore, among children in home-based foster care, those with mental health problems had significantly poorer HRQL in many domains than those without mental health problems. Demographic and placement characteristics of the children in home-based foster care were not significantly associated with differences in HRQL.

CONCLUSION

The findings highlight the importance of providing services and resources to improve the quality of life of children living in home-based foster care.

The mental health and wellbeing of children and adolescents in home-based foster care

OBJECTIVE

To identify the prevalence of mental health problems, rates of suicidal ideation and behaviour, and use of professional mental health services among children and adolescents residing in home-based foster care, and to compare these rates with those reported for children and adolescents in the general Australian community.

DESIGN

Cross-sectional survey.

PARTICIPANTS AND SETTING

326 children and adolescents (aged 6-17 years) residing in home-based foster care in the Adelaide metropolitan region between August 2004 and January 2006.

MAIN OUTCOME MEASURES

Prevalence of emotional and behavioural problems, suicidal ideation and behaviour, and use of professional services to obtain help for emotional and behavioural problems.

RESULTS

61.0% of children and adolescents living in home-based foster care scored above the recommended cut-off for behaviour problems on the Child Behavior Checklist and 35.2% of adolescents scored above the cut-off on the Youth Self Report. 6.7% of 13-17- year olds in home-based foster care reported a suicide attempt that required medical treatment during the previous year. Caregivers reported that 53.4% of children needed professional help for their mental health problems but only 26.9% had obtained help during the previous 6 months.

CONCLUSION

Children in home-based foster care experience high rates of mental health problems but only a minority receive professional help for their problems.

Early Childhood Externalising Behaviour Problems: Child, Parenting, and Family-related Predictors Over Time

This study examined the dynamic relationships between child, parenting, and family-related predictor variables and early childhood externalising behaviour problems. A community sample of 395 Australian children was followed longitudinally, and assessed at 4 and 6 years with the Child Behavior Checklist, Teacher Report Form, and standard measures of parenting, temperament, and familial adversity. Variables based on the average scores across the two assessments and the change in scores between assessments were utilised as predictors of parent-reported and teacher-reported externalising behaviour problems at age 6. It was hypothesised that both higher average scores and more detrimental changes in scores, would independently predict externalising problems at age 6. Multivariable analyses found that the presence of parent-reported child externalising problems in six-year-olds were predicted by: (i) the presence of parent-reported child externalising problems at age 4, (ii) higher average "teacher-reported child externalising behaviour," "inflexible temperament," "non-persistent temperament," and "over-reactive parenting," and (iii) an increased "inflexible temperament" score between age 4 and age 6. The presence of teacher-reported child externalising problems at age 6 was predicted by higher average "parent-reported child externalising behaviour," and "over-reactive parenting." The results provide further evidence of the adverse impact of continuing high levels of temperament difficulties and over-reactive parenting on externalising behaviour in early childhood. However, contrary to expectations, the contribution of including the dynamic change scores was limited.

Is There a Relationship Between Overweight and Obesity and Mental Health Problems in 4- to 5-Year-Old Australian Children?

OBJECTIVE

To investigate the relationship between overweight and obesity, and mental health problems in Australian 4- to 5-year-old children.

METHODS

The study used data from wave 1 (2004) of the Longitudinal Study of Australian Children (LSAC). The participants were 4983 4- to 5-year-old children (2537 boys and 2446 girls) with a mean age of 56.9 months (standard deviation 2.6 months; range 51-67 months). Children were classified as nonoverweight, overweight, and obese on the basis of International Obesity Task Force definitions. Mental health problems were assessed by the Strengths and Difficulties Questionnaire (SDQ) completed by parents and teachers.

RESULTS

Although obese 4- to 5-year-old boys had more mental health problems than nonoverweight boys, differences between the groups were small and substantially reduced when analyses controlled for children's sociodemographic characteristics. Parents reported that overweight/obese girls had more peer problems, whereas teachers reported they had more conduct problems. Children in all weight groups had mean scores within the normal range of scores on all the SDQ subscales.

CONCLUSIONS

Differences in rates of mental health problems experienced by young children of different weight status appear relatively small. Higher rates of mental health problems experienced by more obese boys may reflect differences in their sociodemographic characteristics rather than their weight status per se. Policies that reduce the number of young children living in poverty or experiencing other adverse social circumstances have the potential to reduce rates of mental health problems experienced by older children with overweight/obesity.

Treatment burden and health-related quality of life of children with diabetes, cystic fibrosis and asthma

AIM

To identify the time required by children with cystic fibrosis (CF), diabetes or asthma to complete daily treatment tasks and the hassle they experienced when completing these tasks. To compare parent and child reports of daily treatment time and hassle. To investigate the relationship between treatment time and hassle, and (i) children's health-related quality of life (HRQL); and (ii) disease severity.

METHODS

160 children aged 10-16 years with CF, type 1 diabetes, or asthma were followed over a 2-year period. Information about children's treatment time and hassle, and their HRQL was obtained from parents and children at baseline, 1-year and 2-year follow-up assessments.

RESULTS

On average, children with CF reported spending 74.6 +/- 57.0 min completing treatment tasks, children with diabetes spent 56.9 +/- 27.8 min and children with asthma spent 6.4 +/- 9.3 min. Parents reported that children spent less time that was reported by their children. Over the two years, parent and child reports describing treatment time for children with CF did not vary significantly (P = 0.3). Treatment time for children with diabetes increased (P = 0.02) whereas that for children with asthma reduced (P = 0.001). The level of hassle experienced by children when completing individual treatment tasks was low for all three conditions. There was no significant relationship between treatment time and children's HRQL.

CONCLUSION

Children with CF or diabetes spent a substantial amount of time each day completing the treatment tasks. Although this was not related to HRQL, it could impact the ability to comply with complex and all home-based-therapies for some children.

Are ADHD gender patterns moderated by sample source?

OBJECTIVE

To examine whether ADHD gender patterns with respect to social-demographic characteristics, comorbidity, and impairment vary as a function of service use for emotional or behavioral problems.

METHOD

Two hundred and seventy-nine males and 119 females meeting ADHD symptom criteria identified in a nationally representative sample of Australian youth ages 6 to 17 are stratified according to whether they had attended a service in the previous 6 months.

RESULTS

ADHD gender patterns vary across service use on only 2 of the 31 comparisons made. The two exceptions were child's age at interview (females were older than males among service attendees but younger among nonattendees) and depressive disorders (females had higher rates than males among service attendees but lower rates among nonattendees).

CONCLUSION

Systematic differences in methods of case identification rather than sample source may be responsible for the discrepant ADHD patterns found between clinic and community-based studies.

New measure of parental asthma management for school-age children

A new parent-completed questionnaire to measure parental asthma management was developed. The new questionnaire takes a parental perspective, with content of items and scoring focusing on all behaviors considered important by parents and not just those considered appropriate by clinicians. Parents of 101 school-age children with a previous hospital admission with asthma completed the questionnaire during home visits. The questionnaire was based on five asthma scenarios. Parents were asked to indicate on a 6-point Likert scale how likely they would be to carry out a series of behaviors if the situations occurred. Two methods of scoring were used: scenario-based scoring, and factor-based scoring. Scenario-based subscale scores suggested that parent's level of activity was consistent across different situations. Factor analysis showed that the questionnaire had three dominant factors. The medical assessment subscale describes parent's level of activity in terms of seeking medical care, the external advice subscale describes parent's level of activity in terms of seeking assistance from knowledgeable others, and the home management subscale describes parents' approaches to monitoring and treating children at home. Alpha coefficients for scenario-based and factor-based subscales indicated good internal reliability (0.65-0.84 and 0.81-0.91, respectively). Test-retest reliability, 4 weeks apart, was also adequate (correlation coefficients of 0.75-0.87). This exploratory study describes the development of a new questionnaire, the Asthma Management Questionnaire (AMQ). The questionnaire has a unique parent focus, consistent with contemporary notions of patient-centered chronic-disease management.

The relationship between health-related quality of life, pain, and coping strategies in juvenile arthritis – A one year prospective study

The aim of this 12-month prospective study was to compare reports describing the health-related quality of life (HRQL) of children with Juvenile idiopathic arthritis (JIA) obtained from parents and children, to investigate the extent to which the children's HRQL changed over a 12-month period, and to describe the relationship between children's HRQL, and their experience of pain and use of pain coping strategies. Fifty-four children aged 8-18 years with JIA and their parents completed standard questionnaires assessing children's HRQL, pain intensity, and pain coping strategies at baseline, 6 months, and 12 months. In general, children reported that their HRQL was better than was reported by parents. Both informants described children's HRQL as being very stable over the 12 months of the study. Consistent with the Biobehavioural Model of Pain, there was a significant negative relationship between children's HRQL and their experience of pain. However, there was little evidence that pain coping strategies mediated the relationship between children's experience of pain and their HRQL.

A two-year prospective study of the health-related quality of life of children with chronic illness--the parents' perspective

The aim of this study was to assess prospectively changes in the health-related quality of life (HRQL) of children and adolescents with diabetes, asthma or cystic fibrosis (CF). One hundred and twenty-two parents of children aged 10-16 years with asthma, diabetes, or CF were recruited from specialist paediatric clinics. Parents described their children's HRQL using the Child Health Questionnaire (PF98) at baseline, 6, 12, 18 and 24 months post-baseline. They reported that the general health of children with CF was significantly worse than that of children with asthma and diabetes at baseline. In other domains there were few differences between the HRQL of children in the three groups. In several domains, the HRQL of children with asthma or diabetes improved over the 2 years of the study. This improvement was less evident for children with CF.

Similarities and differences between aggressive and delinquent children and adolescents in a national sample

OBJECTIVE

To examine differences in the correlates, comorbidity and use of services between aggressive and delinquent children and adolescents.

METHOD

An Australian representative sample (n = 4083) of parents of children and adolescents were administered a psychiatric diagnostic interview, the Child Behaviour Checklist, and other instruments to measure service use. The characteristics of children with high scores (top 5%) in the aggressive and delinquent syndromes or both were then examined.

RESULTS

The proportion of aggressive children decreased with increasing age while that of delinquents increased. The aggressive group was specifically associated with the impulsive-hyperactive subtype of attention deficit hyperactivity disorder (ADHD) (OR = 12.63; 95% CI = 5.97-26.74). Comorbidity between ADHD, aggression and delinquency was less frequent among adolescents than in children, with the exception of the inattentive subtype in which comorbidity was higher. Both aggressive and delinquent groups had a considerable overlap with conduct disorder. Aggressive and delinquent youths used services more often, but parents perceived aggressive children as more in need of help than delinquent ones. Living in a sole parent family was specifically associated with the delinquent group (OR = 3.34; 95% CI = 2.25-4.96).

CONCLUSIONS

The results suggest that these empirically derived syndromes while sharing many features also differ in important ways, highlighting the need for further convergence between categorical and dimensional classifications. Their differential association with the subtypes of ADHD requires further examination and may help to understand the relationship between ADHD and conduct problems. The importance of aggressive behaviour in children should not be underestimated since it is associated with significant psychopathology, parental distress and use of services.

Gender differences among children with DSM-IV ADHD in Australia

OBJECTIVE

To examine gender differences among children meeting symptom criteria for DSM-IV attention-deficit/hyperactivity disorder (ADHD) identified in a nationally representative sample of Australian children.

METHOD

From 2,404 children aged 6 to 13 years, 225 boys and 99 girls with ADHD symptoms were identified using the parent version of the Diagnostic Interview Schedule for Children and compared on parent reports of children's behavioral problems and impairment.

RESULTS

When ADHD types were collapsed into a single group, boys and girls did not differ on core symptoms, comorbidity, and impairment with the exception that girls rated higher on somatic complaints and boys had poorer school functioning. However, gender patterns were found to vary across ADHD type on impairment measures of social problems, schoolwork difficulties, and self-esteem, with boys being generally rated as more impaired in the combined and hyperactive-impulsive groups but equally or less impaired in the inattentive group.

CONCLUSIONS

The findings suggest the possibility of gender-specific risks associated with high levels of inattentive and hyperactive-impulsive symptoms indicating that ADHD subtype membership should be considered when conducting ADHD gender comparisons.

Health-related quality of life of children and adolescents with chronic illness--a two year prospective study

The aim of this study was to compare the self-reported health-related quality of life (HRQL) of children and adolescents with diabetes, asthma or cystic fibrosis (CF) with the HRQL of a large community sample, to assess the extent to which the HRQL of the children and adolescents with chronic illness changes over time, and to examine the consistency of changes in different HRQL domains. One hundred and twenty three young people aged 10-16 years with asthma, diabetes, or CF were recruited from specialist paediatric clinics. Children rated their HRQL using the Child Health Questionnaire (CHQ) and three disease-specific measures at baseline, 6, 12, 18 and 24 months post-baseline. In several areas, the HRQL of children with chronic illness was significantly worse than that of children in the community sample. Over the 2 years of the study, although children with asthma and diabetes did not report significant changes in CHQ scores rating their physical health, they reported significant improvements in scores rating the extent to which health problems interfered with physical and family activities. CHQ scores describing their physical health reported by children with CF declined significantly but there was no significant change in scores rating interference with physical and family activities.

Subfactors of DSM-IV conduct disorder: evidence and connections with syndromes from the Child Behavior Checklist

Is conduct disorder (CD) as defined in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV; American Psychiatric Association, 1994) a unitary entity, or do variants of CD exist? We addressed this question, using data collected from the parents of 1,669 Australian boys, aged 6-17. Parents were interviewed to assess DSM-IV Conduct Disorder (DSM-IV CD) criteria. Results revealed 2 subfactors of DSM-IV CD symptoms, made up of overt behaviors (e.g., initiating physical fights) and covert behaviors (e.g., stealing without confrontation). Ordinary least squares regressions showed the 2 CD subfactors to be significantly and uniquely predicted by Child Behavior Checklist (CBCL; T. M. Achenbach, 1991a, 1991b) syndromes labeled Aggressive Behavior and Delinquent Behavior, respectively. The results are discussed in terms of the utility of differentiating these 2 variants of CD in future editions of the DSM.

The relationship between health-related quality of life, pain and coping strategies in juvenile idiopathic arthritis

OBJECTIVES

To investigate the relationship between health-related quality of life (HRQL), experience of pain and pain coping strategies in children with juvenile idiopathic arthritis (JIA). To compare reports describing these variables obtained from children and their parents.

METHODS

Participants were 59 children aged 8 to 18 yr with JIA and their parents. Parents and children completed the PedsQL generic core scales and arthritis module, the visual analogue scale of the Varni-Thompson Pediatric Pain Questionnaire, and the Waldron/Varni Pediatric Pain Coping Inventory. Parents rated children's functional disability using the Childhood Health Assessment Questionnaire.

RESULTS

Parents reported significantly lower scores (indicating worse HRQL) than children on five of the eight PedsQL scales rating children's HRQL. Parents and children reported a significant negative relationship between pain levels and the PedsQL scores assessing children's physical, emotional and social functioning. They also reported a significant negative relationship between scores on several pain coping scales and scores on the PedsQL scales. However, the pattern of these relationships varied for reports from parents and children.

CONCLUSIONS

Pain intensity and pain coping strategies have a significant and independent relationship with several domains that comprise the HRQL of children with JIA. However, parents and children have differing perceptions of the nature of these relationships. The differences emphasize the importance of clinicians obtaining information about children's HRQL, pain levels and pain coping strategies from both parents and children.

Adolescent substance use: beware of international comparisons

PURPOSE

To compare prevalence estimates of adolescents' cigarette, alcohol and marijuana use from one Australian and two U.S. surveys, and to consider the effect of methodological differences on reported use.

METHODS

Secondary analysis of data from the Australian Child and Adolescent Component of the National Survey of Mental Health and Well-being (NSMHWB, 1998), the U.S. Youth Risk Behavior Survey (YRBS, 1999), and National Household Survey on Drug Abuse (NHSDA, 1998). Prevalence estimates and 95% confidence intervals were derived for three substance use behaviors. Differences between estimates were considered statistically significant if the 95% confidence intervals did not overlap.

RESULTS

When Australian and U.S. adolescents were compared using NSMHWB and YRBS data, the former were generally found to be less likely to report using cigarettes, alcohol and marijuana than the latter. However, when NHSDA was used as the comparator, the prevalence of substance use among Australian adolescents was either no different from, or greater than, that of U.S. adolescents. Likely explanations for the discrepant findings include the population focus (i.e., whether the survey targeted only young people or adults as well), sampling issues (i.e., whether school-based and household-based sampling frames introduced different biases in terms of who was likely to be absent when the survey was administered), response rates, the survey context (i.e., whether school-based and household-based survey administration methods promoted different kinds of response behavior), the wording of questions and the precision of estimates of the different surveys.

CONCLUSIONS

Cross-national data on adolescent substance use should be interpreted cautiously. Cross-national comparisons that are done well (i.e., using standard, uniform approaches) can be invaluable in highlighting worthwhile policy directions; cross-national comparisons that are done poorly may lead to erroneous assumptions.

Receipt of psychological or emotional counseling by suicidal adolescents

OBJECTIVE

This study examined utilization of psychological or emotional counseling by suicidal adolescents to answer questions about the extent to which health services can contribute to the prevention of adolescent suicide.

METHOD

The study used data from Wave 1 of the National Longitudinal Study of Adolescent Health, which involved a household-based interview with a nationally representative sample of 15 483 adolescents from grades 7 to 12. Of these, 2482 adolescents were classified as suicidal, as indicated by an affirmative response to the question "During the past 12 months, did you ever seriously think about committing suicide?" For this group, the study asked the following questions: 1) What proportion receives psychological or emotional counseling? 2) What are the sources of this counseling? 3) What factors are associated with receipt of such counseling?

RESULTS

Less than one third (28%) of suicidal adolescents received psychological or emotional counseling. The most common sources of care were private doctors' offices (37%) and schools (34%). Factors associated with receipt of counseling in the past 12 months included age, race, degree of suicidality, depression status, and having had a physical examination during the same period.

CONCLUSIONS

Only one third of those who report suicidal ideation and behavior receive psychological or emotional counseling. Although not all of these young people may identify a need for counseling, this finding still suggests that many of those at risk of harming themselves do not receive professional help. However, on the positive side, those who do use counseling services tend to do so on the basis of their being in the greatest need, rather than their parents' capacity to pay for services. Counseling services have an important role to play in suicide prevention, and a variety of sources of care need to be available. Although counseling services are vital, a range of other strategies is necessary to reduce the youth suicide rate.