Parental report of receipt of adolescent preventive health counseling services from pediatric providers

OBJECTIVE

Little is known about prevention-focused counseling health providers deliver to parents of adolescents. This study compared parental report of discussions with their adolescents' providers about a range of adolescent prevention topics.

METHODS

Between June and November 2009, a questionnaire was provided to parents accompanying adolescents aged 11-18 on outpatient clinic visits. Parents indicated, anonymously, which of 22 prevention topics they remembered discussing with their adolescent's provider. Hierarchical logistic regression models were used to identify correlates of parental recall.

RESULTS

Among the 358 participants, 83% reported discussing at least one prevention topic. More parents reported discussing general prevention topics than mental health or high-risk topics (e.g. sex). Adolescent gender, visit type, having a usual source of care, and parental beliefs about their adolescents' risk behaviors correlated with parental report of discussions about high-risk and mental health topics.

CONCLUSION

Most parents recalled discussing one or more topics with their adolescent's health provider. However, parental report of discussions about topics linked to significant adolescent morbidity was low.

PRACTICE IMPLICATIONS

Strategies to improve the frequency, timeliness and appropriateness of counseling services delivered to parents about adolescent preventive health are needed. Strategies that utilize decision support tools or patient education tools may be warranted.

Adolescent bariatric surgery program characteristics: the Teen Longitudinal Assessment of Bariatric Surgery (Teen-LABS) study experience

The number of adolescents undergoing weight loss surgery (WLS) has increased in response to the increasing prevalence of severe childhood obesity. Adolescents undergoing WLS require unique support, which may differ from adult programs. The aim of this study was to describe institutional and programmatic characteristics of centers participating in Teen Longitudinal Assessment of Bariatric Surgery (Teen-LABS), a prospective study investigating safety and efficacy of adolescent WLS. Data were obtained from the Teen-LABS database, and site survey completed by Teen-LABS investigators. The survey queried (1) institutional characteristics, (2) multidisciplinary team composition, (3) clinical program characteristics, and (4) clinical research infrastructure. All centers had extensive multidisciplinary involvement in the assessment, pre-operative education, and post-operative management of adolescents undergoing WLS. Eligibility criteria and pre-operative clinical and diagnostic evaluations were similar between programs. All programs have well-developed clinical research infrastructure, use adolescent-specific educational resources, and maintain specialty equipment, including high weight capacity diagnostic imaging equipment. The composition of clinical team and institutional resources is consistent with current clinical practice guidelines. These characteristics, coupled with dedicated research staff, have facilitated enrollment of 242 participants into Teen-LABS.

Psychotropic medication use among adolescents: United States, 2005-2010

Approximately 6.0% of U.S. adolescents aged 12-19 reported psychotropic drug use in the past month. The use of antidepressants (3.2%) and attention deficit hyperactive disorder (ADHD) drugs (3.2%) was highest, followed by antipsychotics (1.0%); anxiolytics, sedatives, and hypnotics (0.5%); and antimanics (0.2%). Males (4.2%) were more likely than females (2.2%) to use ADHD drugs. Females (4.5%) were more likely than males (2.0%) to use antidepressants. Psychotropic drug use was higher among non-Hispanic white (8.2%) adolescents than non-Hispanic black (3.1%) and Mexican-American (2.9%) adolescents. About one-half of U.S. adolescents using psychotropic drugs in the past month had seen a mental health professional in the past year (53.3%). Prior studies have shown an increase in psychotropic medication use among adolescents. However, most studies were based on clinical samples or high-risk populations. This report provides the estimate of any psychotropic medication use in the past month among U.S. noninstitutionalized adolescents aged 12-19 during 2005-2010, using National Health and Nutrition Examination Survey (NHANES) data. Psychotropic medication is a type of drug used to treat clinical psychiatric symptoms or mental disorders. Specific psychotropic drug types addressed are antidepressants; medications for attention deficit hyperactive disorder (ADHD); anxiolytics, sedatives, and hypnotics (ASH); antimanics; and antipsychotics. Adolescents using psychotropic drugs are further examined by sex, race and Hispanic origin, and mental health professional consultation.

[Adolescents in the walk-in clinic]

Jugendliche sind eine medizinisch unterversorgte Altersgruppe. Sind befinden sich in der Transition vom Kinderarzt weg zum Hausarzt. Sie sind häufig vom Ersten nicht ganz gelöst, geschweige bei Letzterem angekommen. In diesem Artikel wird eine sehr kurze Zusammenfassung alterstypischer Probleme und Fragestellungen mit den praktischen Erfahrungen, speziell der den Jugendlichen entgegenkommenden «Walk-in Praxis» ergänzt.

Family physician preferences and knowledge gaps regarding the care of adolescent and young adult survivors of childhood cancer

PURPOSE

Childhood cancer survivors are at risk for long-term morbidity and early mortality. Since most adult and some adolescent survivors of childhood cancer will receive their long-term care from a primary care physician, we sought to determine family physicians' comfort with caring for this population.

METHODS

A survey was mailed to 2,520 United States (US) and Canadian family physicians to assess their attitudes and knowledge regarding the care of adolescent and young adult survivors of childhood cancer.

RESULTS

One thousand one hundred twenty-four family physicians responded (704 US, 420 Canadian). Median age was 53 years; 63 % were men; 81 % had cared for ≤2 childhood cancer survivors in the past 5 years. Of those who had cared for a survivor, 48 % had never or almost never received a treatment summary from the referring cancer center; 85 % preferred to care for survivors in consultation with a cancer center-based physician or long-term follow-up program. Only 33, 27, and 23 % of respondents were very comfortable caring for survivors of childhood Hodgkin lymphoma, acute lymphoblastic leukemia or osteosarcoma, respectively. Only 16, 10, and 74 % of respondents correctly identified the guideline recommended surveillance for secondary breast cancer, cardiac dysfunction and hypothyroidism in response to a vignette describing a Hodgkin lymphoma survivor. Respondents rated access to clinical care guidelines and receipt of a patient-specific letter from specialists with surveillance recommendations as the modalities most likely to assist them in caring for survivors.

CONCLUSIONS

Most family physicians are willing to care for childhood cancer survivors in consultation with a cancer center, and with specific tools to facilitate this care.

IMPLICATIONS FOR CANCER SURVIVORS

Adult and adolescent survivors of childhood cancer who receive their follow-up care from a family physician must be empowered to choose a physician who is comfortable with caring for survivors. Further, the survivor must ensure that their physician has access to a treatment summary as well as to patient-specific recommendations for surveillance for late effects of cancer therapy.

Impact of social network characteristics on shelter use among street youth in San Francisco

PURPOSE

We examined the cross-sectional and longitudinal association between social network characteristics and street youths' shelter use, a determinant of health outcomes for homeless youth.

METHODS

We analyzed interview data from 138 street youth recruited through venue-based sampling in San Francisco, to assess the cross-sectional relationship between shelter use in youths' social networks and youths' reported shelter use. We also assessed the relationship between baseline network shelter use and shelter use at 6-month follow-up.

RESULTS

Low proportions of street youth reported shelter use at baseline (38%) and follow-up (29.6%). Twenty-nine (26.9%) youth were in networks with shelter users at baseline, compared with 17 youth (15.7%) at follow-up. In cross-sectional analysis, youth in networks with shelter users had 5-fold increased odds of reporting shelter use (OR: 5.86, p = .006). A 1-person increase in the number of network shelter users was associated with 2-fold increased odds of youths' shelter use (OR: 2.16, p = .02). In longitudinal analysis, youth in networks with shelter users at baseline had nearly 5-fold increased odds of shelter use at follow-up (OR: 4.95, p = .01). A 1-person increase in the number of network shelter users at baseline was associated with 3-fold increased odds of shelter use at follow-up (OR: 3.15, p = .004).

CONCLUSION

Shelter users seem to cluster together. Shelter use by extended network members was associated with increased odds of youths' own shelter use. Understanding how network behaviors influence street youths' health-related behaviors, such as shelter use, could inform network-based interventions encouraging service uptake among marginalized and hard-to-reach street youth populations.

Healthcare utilization and expenditure analysis between individuals with intellectual disabilities and the general population in Taiwan: a population-based nationwide child and adolescent study

This study examines differences in outpatient-visit frequency and medical expenditures between (1) children and adolescents in Taiwan with intellectual disabilities and (2) children and adolescents in Taiwan's general population. A cross-sectional study was conducted to analyze data from 2007 provided by Taiwan's National Health Insurance program. A total of 236,045 beneficiaries younger than 19 years made use of outpatient services; among them, 35,802 had a principal diagnosis of mental retardation (intellectual disability). The average number of ambulatory visits was 14.9 ± 12.4, which is much higher than in the United States and other developed countries. The mean number of annual visits of the individuals with intellectual disabilities was significantly higher than that of the general population in Taiwan (20.1 ± 20.0 vs. 14.0 ± 12.2); age, gender, urbanization level of residential area, and copayment status affected outpatient visit frequency. The mean annual outpatient costs were NTD6371.3 ± NTD11989.1 for the general population and NTD19724.9 ± NTD40469.9 for those with intellectual disabilities (US $1 equals approximately NTD30). Age, gender, urbanization level of residential area, and copayment status were the determinants that accounted for this difference in cost. Children and adolescents with intellectual disabilities had higher use rates of rehabilitative and psychiatric services than the general population. We conclude that individuals with intellectual disabilities had higher demands than the general population for healthcare services, especially for rehabilitative and psychiatric services.

Child- and state-level characteristics associated with preventive dental care access among U.S. children 5-17 years of age

The objectives of this study is to identify factors associated with lack of preventive dental care among U.S. children and state-level factors that explain variation in preventive dental care access across states. We performed bivariate analyses and multilevel regression analyses among 68,350 children aged 5-17 years using the 2007 National Survey of Children's Health data and relevant state-level data. Odds ratios (ORs) for child- and state-level variables were calculated to estimate associations with preventive dental care. We calculated interval odds ratios (IOR), median odds ratios (MOR), and intraclass correlation coefficients (ICC) to quantify variation in preventive dental care across states. Lack of preventive dental care was associated with various child-level factors. For state-level factors, a higher odds of lack of preventive dental care was associated with a higher percentage of Medicaid-enrolled children not receiving dental services (OR = 1.30, 95 % confidence interval (CI): 1.15-1.47); higher percentage of children uninsured (OR = 1.48, 95 % CI: 1.29-1.69); lower dentist-to-population ratio (OR = 1.36, 95 % CI: 1.03-1.80); and lower percentage of dentists submitting Medicaid/State Children's Health Insurance Program claims (OR = 1.04, 95 % CI: 1.01-1.06). IORs for the first three state-level factors did not contain one, indicating that these state-level characteristics were important in understanding variation across states. Lack of preventive dental care varied by state (MOR = 1.40). The state-level variation (ICC = 3.66 %) accounted for a small percentage of child- and state-level variation combined. Child- and state-level characteristics were associated with preventive dental care access among U.S. children aged 5-17 years. State-level factors contribute to variation in dental care access across states and need to be considered in state-level planning.

Intervening with practitioners to improve the quality of prevention: one-year findings from a randomized trial of assets-getting to outcomes

There continues to be a gap in prevention outcomes achieved in research trials versus those achieved in "real-world" practice. This article reports interim findings from a randomized controlled trial evaluating Assets-Getting To Outcomes (AGTO), a two-year intervention designed to build prevention practitioners' capacity to implement positive youth development-oriented practices in 12 community coalitions in Maine. A survey of coalition members was used to assess change on individual practitioners' prevention capacity between baseline and one year later. Structured interviews with 32 program directors (16 in the intervention group and 16 in the control group) were used to assess changes in programs' prevention practices during the same time period. Change in prevention capacity over time did not differ significantly between the intervention and control groups. However, in secondary analyses of only those assigned to the AGTO intervention, users showed greater improvement in their self-efficacy to conduct Assets-based programming and increases in the frequency with which they engaged in AGTO behaviors, whereas among non-users, self-efficacy to conduct Assets-based programming declined. Interview ratings showed improvement in several key areas of performance among intervention programs. Improvement was associated with the number of technical assistance hours received. These results suggest that, after one year, AGTO is beginning to improve the capacity of community practitioners who make use of it.

Pacific secondary school students' access to primary health care in New Zealand

AIM

Previous research states Pacific peoples' experience barriers to primary care. A better understanding of young Pacific peoples' experiences and perspectives on health services can improve responsiveness to young Pacific New Zealanders' health needs. This study identifies primary health (including dental care) barriers in access, utilisation and unmet need for Pacific youth ages 13-17 years.

METHODS

Data were collected as part of Youth'07, a nationally representative survey of the health and wellbeing of New Zealand (NZ) adolescents. 1178 Pacific students who identified any of their ethnicities as Samoan, Cook Islands, Tongan, Niue, Tokelauan, Fijian, or Other Pacific Peoples were included.

RESULTS

Compared to their NZ European peers, Pacific youth accessed primary health care services, including dental care less often in the previous year; Pacific students were twice more likely to forego accessing health care and dental care when needed; were more likely to find it difficult to get healthcare for specific health issues like injuries/accident; to stop smoking, alcohol/drugs use and for chronic conditions. Not knowing how to access healthcare and rating unfair treatment by health professionals due to their ethnicity were significant factors impacting access.

CONCLUSION

Good access and utilisation of primary care services is an important resource of preventable health for Pacific New Zealanders. This study finds that Pacific youth are an underserved group experiencing inequitable access within the current primary healthcare sector. Innovative approaches to specialist youth-oriented healthcare services, professional training and increasing the Pacific health workforce are recommended interventions.

Forgone health care among secondary school students in New Zealand

INTRODUCTION

Perceived lack of confidential health care is an important barrier for young people accessing health care services in New Zealand (NZ).

AIM

To determine the prevalence of forgone health care among a nationally representative sample of NZ secondary school students and to describe the health concerns and specific health issues for which young people had difficulty accessing health care.

METHODS

Random sample of 9107 NZ secondary school students participated in a 2007 health survey using internet tablets. Questions about access to health care included whether there had been a time when they had not accessed health care when needed, reasons for difficulty in accessing health care, current health concerns and health risk behaviours.

RESULTS

One in six students (17%) had not seen a doctor or nurse when needed in the last 12 months. Female Maori and Pacific students and those living in neighbourhoods with high levels of deprivation were more likely to report forgone health care. Students with chronic health problems, those engaging in health risk behaviours or experiencing symptoms of depression were more likely to report being unable to access health care when needed. Students reporting privacy concerns were more likely to report difficulty accessing health care for sensitive health issues, such as sexual health, emotional problems, pregnancy-related issues, stopping cigarette smoking, or alcohol or drug use.

DISCUSSION

NZ secondary school students who forgo health care are at increased risk of physical and mental health problems and in need of accessible and confidential health services.

Burden of psychiatric disorders in the pediatric population

In order to estimate the burden of mental disorders in a representative Italian pediatric population, an epidemiological study was performed using three administrative databases: a drug prescription, a hospital discharge form, and an outpatient ambulatory visit database. The population target was 1,616,268 children and adolescents under 18 years living in the Lombardy Region, Italy. A youth was defined as a case if during 2008 he/she received at least one psychotropic drug prescription or was hospitalized for a psychiatric disorder (International Classification of Disease codes 290-319), or attended a child neuropsychiatric outpatient unit for a visit and/or a psychological intervention or rehabilitation at least once. Epileptic children were excluded. In all, 63,550 youths (39.3 per 1000; 95%CI 39.1-39.7‰) were identified as users of health care resources for a putative mental disorder. The prevalence was higher in boys than in girls (47.0‰ versus 31.3‰) and the highest value was recorded in children 8 years old (60.2‰). A total of 59,987 youths (37.1‰) attended a child and adolescent neuropsychiatry service at least once, 3605 (2.2‰) were admitted to hospital, and 2761 (1.7‰) received at least one psychotropic drug prescription, 57% of which did not attend a child neuropsychiatry service. In all, 14,741 youths (23.1% of users) had a disorder that required a high intensity of care (e.g. recurrent prescriptions for drugs and/or ambulatory care). The proportion of youths who received care for mental disorders in the Lombardy Region seems lower than in other countries. However, the fact that many children were prescribed psychotropic drugs without the supervision of a child psychiatrist is a reason for concern.

A randomized trial of the effect of centralized reminder/recall on immunizations and preventive care visits for adolescents

OBJECTIVE

To assess the impact of a managed care-based patient reminder/recall system on immunization rates and preventive care visits among low-income adolescents.

METHODS

We conducted a randomized controlled trial between December 2009 and December 2010 that assigned adolescents aged 11-17 years to one of three groups: mailed letter, telephone reminders, or control. Publicly insured youths (n = 4115) were identified in 37 participating primary care practices. The main outcome measures were immunization rates for routine vaccines (meningococcus, pertussis, HPV) and preventive visit rates at study end.

RESULTS

Intervention and control groups were similar at baseline for demographics, immunization rates, and preventive visits. Among adolescents who were behind at the start, immunization rates at study end increased by 21% for mailed (P < .01 vs control), 17% for telephone (P < .05), and 13% for control groups. The proportion of adolescents with a preventive visit (within 12 months) was: mailed (65%; P < .01), telephone (63%; P < .05), and controls (59%). The number needed to treat for an additional fully vaccinated adolescent was 14 for mailed and 25 for telephone reminders; for an additional preventive visit, it was 17 and 29. The intervention cost $18.78 (mailed) or $16.68 (phone) per adolescent per year to deliver. The cost per additional adolescent fully vaccinated was $463.99 for mailed and $714.98 for telephone; the cost per additional adolescent receiving a preventive visit was $324.75 and $487.03.

CONCLUSIONS

Managed care-based mail or telephone reminder/recall improved adolescent immunizations and preventive visits, with modest costs and modest impact.

Unmet health and mental health need among adolescents: the roles of sexual minority status and child-parent connectedness

Using a representative national sample from the National Longitudinal Study of Adolescent Health (Add Health) survey (N = 18,924), this article explores sexual minority status (SMS) and child-parent connectedness in relation to the unmet needs for health or mental health care among adolescents. Through the use of logistic regression models, data were analyzed to determine whether SMS and child-parent connectedness predict unmet health and mental health need. In addition, models tested whether child-parent connectedness, sex or gender, and race or ethnicity interact with SMS to predict unmet need. Results show that both SMS and child-parent connectedness predict unmet health and mental health need. Being a sexual minority youth (SMY) significantly increases the odds of having an unmet need for health or mental health care; female SMY have the highest odds of an unmet mental health need. Child-parent connectedness is a predictor of unmet need regardless of SMS. Youth with lower levels of child-parent connectedness have significantly higher odds of an unmet health or mental health need. Findings call for service providers to address the unmet needs of SMY both in terms of outreach to youth and parents and to communicate the importance of the parental role in helping teens access care.

Does grade level relate to school-based youth health center utilization among male youth? Quantitative findings from a mixed-methods study in Nova Scotia, Canada

BACKGROUND

Male adolescents underutilize youth health centers' (YHC) services despite facing a variety of significant health issues. The purpose of our study was to explore adolescent males' perceptions of health service needs, utilization of YHC services, and barriers and facilitators for such utilization as a function of school grade among a sample of males from rural Nova Scotia in Canada.

METHODS

A 76-item self-completion survey was developed to obtain quantitative data on male students' use and perceptions of YHCs. The survey was pilot tested in June of 2009 and subsequently revised for readability and layout purposes. In October 2009, the revised survey was administrated to male youth in grades 10-12 at 4 high schools in Cape Breton, Nova Scotia.

RESULTS

Although more than 50% of the participants reported that they would be comfortable using the YHC in their school, only 16.5% had ever accessed the center, and only 5% indicated frequent use. Differences according to grade were noted, especially regarding knowledge of YHCs and intention to use a variety of YHC services.

CONCLUSIONS

School-based YHCs are becoming more common as a means of responding to adolescent health needs. Despite experiencing numerous health challenges, male youth continue to underutilize these services. Multisectoral health promotion strategies are needed, especially in higher grades, to help create an environment that encourages utilization of YHCs.

[Being a migrant and an adolescent: which strategies for health promotion?]

Young recently arrived migrants represent a vulnerable population. The influence of socioeconomic and environmental factors on health is now well known. The accumulation of protective factors can counterbalance the negative effect of risk factors, based on the concept of health assets. The migration process may threaten this balance. Some studies have observed better health in migrants than in the host population, but this is not a permanent effect as health deteriorates with time. Pre-migration experiences as well as post-migration conditions in the host country largely influence migrants' health outcomes. Family and social support and integration into the host society are primordial factors that need to be strengthened.

Outreach with street-involved youth: a quantitative and qualitative review of the literature

Outreach workers meet with street-involved youth in their environment, and attempt to engage them in services vital to their well-being. The goal of this study is to conduct a systematic review of both the quantitative and qualitative research that explores outreach with street-involved youth. Using 16 outreach programs with quantitative information, our meta-analysis found that 63% of youth who are contacted through outreach later participate in the offered service. Our meta-synthesis of 31 qualitative articles on outreach uncovered 13 themes across 4 conceptual domains of interest. Themes pertaining to the therapeutic relationship, flexibility, and youth-centric programming had a large presence among the majority of the articles. Outreach with street-involved youth, when characterized through a strong bond between worker and youth, is an effective strategy for involving youth in agency services.

Use and perceptions of sexual and reproductive health services among northern Thai adolescents

This study sheds light on obstacles to safe sexual health for young Thais and their need for appropriate sexual and reproductive health services. The study population was 1,745 unmarried adolescents aged 17-20 who resided or worked in Chiang Mai, the major city in northern Thailand. The study used quantitative and qualitative methods to explore the vulnerability of sexually active adolescents as well as the lack of support and care for them from parents and health providers. We found that young Thais still prefer pharmacies for self-medication and use government health care facilities as a last resort. Current health services are not suitable for adolescents in northern Thailand because they lack privacy and impose judgemental attitudes, especially towards sexually active adolescent females. Current programs for adolescent sexual and reproductive health focus on education and counselling and do not provide appropriate privacy or clinical care. There is a pressing need for advocacy, and policy support for the development of youth-friendly sexual and reproductive health services in Thailand.

Educational outcomes in a system of care for children with emotional disturbance

In North Carolina, only 69% of high school students graduate in 4 years; however, recent data suggest that only 42% of students with mental and emotional disabilities graduate. MeckCARES, a system of care (SOC) in Mecklenburg County, North Carolina, is designed to serve youth with severe emotional disturbances and their families. The SOC philosophy is a prominent family-focused approach intended to provide comprehensive, coordinated networks of services, tailored to the needs of the child and family, while emphasizing the strengthening of natural community supports. In addition to other mental health objectives, a particular goal of MeckCARES is to address specific school-based needs of system-identified youth to improve educational outcomes and reduce the risk of dropping out. This study sought to assess empirically the impact that enrollment in MeckCARES has on graduation precursors; namely, grades, suspensions, and absences. This study found that, on average, enrollment in MeckCARES is not associated with positive changes in educational variables. Implications of these findings are discussed, as are future directions. For example, additional research is needed with more sensitive measurement and data collection procedures (i.e., access to graduation rates and Medicaid information) to adequately assess the impact of enrollment in MeckCARES on educational outcomes.

Using latent growth curve modeling to examine changes in mental health outcomes for children enrolled in a system of care

MeckCARES, a system of care (SOC) in Mecklenburg County, North Carolina, is designed to serve youth with severe emotional disturbances and their families. This study employed latent growth curve (LGC) modeling to examine (a) the degree to which youth improved on indicators of adjustment over the course of the first year of enrollment in MeckCARES, and (b) the services or demographic variables associated with individual differences in the rate of change over time. Participant caregivers (N = 121) reported on 3 major indicators of youth adjustment at baseline, 6-month follow-up, and 12-month follow-up. Primary analyses indicated that there was a modest yet significant improvement in all 3 outcome measures over the first year of enrollment in MeckCARES. Additional analyses revealed that caregiver reports of receiving case management at any point in the first year were associated with improvement in behavioral and emotional strengths as well as a reduction in psychological and behavioral symptoms. No significant differences in rate of change were observed based on caregiver-reported receipt of individual or family therapy nor any demographic variables. These findings suggest that MeckCARES may be particularly effective when youth are receiving case management services. Additional implications for practice are discussed.

[Visits to the doctor because of illness or injury of the students of vocational schools who consume or do not consume psychoactive substances (comparative aspects)]

AIM

To elucidate what impact has the use of different narcotic drugs, alcohol and tobacco on the health of students and the risk of injuries.

MATERIAL AND METHODS

We carried out a questionnaire survey of the first year students from all six vocational schools of Klaipeda (Lithuania) in 2004, 2006 and 2008. A total of 912 students (507 boys and 405 girls, mean age 17.5 years) were surveyed with an anonymous questionnaire. The findings were analysed with computer soft SPSS (SPSS 16.0 for Windows).

RESULTS

The results showed that the use of any psychoactive substances is damaging to health, especially injection and club narcotic drugs. Adolescents addicted to any psychoactive substances more often than non-addicts visited doctor due to illness or injury during the last 12 months.

CONCLUSION

Adolescents on illegal drugs, especially boys on injectable narcotic drugs and girls on club drugs were at twice higher risk for disease or injury (odds ratio--OR--3.39, 95% confidence interval--CI--1.25 to 9.19, p = 0.016 and OR--2.38, CI--1.35 to 4.20, p = 0.003, respectively). Tobacco and alcohol consumption did not significantly increase this risk with the exception of tobacco smoking girls. We think it happened because these two addictions are widely spread among large part of the boys from the vocational schools.

Sexuality education: Finnish and Chilean experiences

All children and young people have the right to age-appropriate sexuality education regardless of gender, sexual orientation, ability or faith. Sexuality education provides knowledge, skills and positive values to determine and enjoy their sexuality, have safe, fulfilling relationships if one so wishes and decides, and to take responsibility for their own and for a possible partner's sexual health and well-being. Several international programs have been developed and recently published by the Population Council, IPPF and other coworkers, by UNICEF, and by WHO Europe. This chapter will briefly describe recent global development in sexuality education, and then, as examples, experience from two countries, Finland and Chile. The experiences from these school based programs suggest an important role of sexuality education.