Loneliness and health risk behaviours among Russian and U.S. adolescents: a cross-sectional study

Loneliness around the world: Age, gender, and cultural differences in loneliness

The BBC Loneliness Experiment provided a unique opportunity to examine differences in the experience of lonelines across cultures, age, and gender, and the interaction between these factors. Using those data, we analysed the frequency of loneliness reported by 46,054 participants aged 16-99 years, living across 237 countries, islands, and territories, representing the full range of individualism-collectivism cultures, as defined by Hofstede (1997). Findings showed that loneliness increased with individualism, decreased with age, and was greater in men than in women. We also found that age, gender, and culture interacted to predict loneliness, although those interactions did not qualify the main effects, and simply accentuated them. We found the most vulnerable to loneliness were younger men living in individualistic cultures.

Longitudinal Trajectories, Social and Individual Antecedents, and Outcomes of Problematic Internet Use Among Late Adolescents

Given the detrimental effects associated with problematic internet use (PIU) and the need to better understand its nature and evolution, the present study examined the development of PIU in a sample of 1,750 adolescents (aged 16-19) from Finland over a 3-year period. We documented the social (loneliness, perceived maternal and paternal behaviors) and individual (sex) antecedents, as well as the outcome implications (depressive symptoms, substance use, academic achievement) of PIU trajectories. Outcomes also predicted PIU trajectories. Latent curve modeling revealed an initially moderate, and subsequently decreasing trajectory of PIU. PIU was predicted by loneliness, paternal neglect, maternal care, depressive symptoms, and being male. In turn, PIU trajectories predicted increases in depressive symptoms and substance use, but decreases in academic achievement.

Individual differences in social play behaviour predict alcohol intake and control over alcohol seeking in rats

RATIONALE

Social play behaviour is a rewarding social activity displayed by young mammals, thought to be important for the development of brain and behaviour. Indeed, disruptions of social play behaviour in rodents have been associated with cognitive deficits and augmented sensitivity to self-administration of substances of abuse, including alcohol, later in life. However, the relation between social development and loss of control over substance use, a key characteristic of substance use disorders including alcohol use disorder (AUD), has not been investigated. Moreover, it remains unknown how inherent differences in playfulness relate to differences in the sensitivity to substance use and AUD.

OBJECTIVE

The objective of this study is to determine how individual differences in juvenile social play behaviour predict alcohol intake and loss of control over alcohol seeking.

METHODS

Juvenile male Lister hooded rats were characterized for their tendency to engage in social play behaviour. Subsequently, alcohol consumption and conditioned suppression of alcohol seeking were assessed in the tertiles of rats that showed the most and least social play.

RESULTS

The rats that engaged most in social play behaviour consumed more alcohol than their less playful counterparts. However, whereas the most playful rats showed intact conditioned suppression of alcohol seeking, the least playful rats showed no such suppression.

CONCLUSION

Individual levels of playfulness predict the sensitivity to alcohol-directed behaviour. Highly playful rats are more prone to alcohol intake, yet show greater control over alcohol seeking. These findings increase our understanding of the relationship between social development and vulnerability to AUD.

Shifts in Drug Use Behavior Among Electronic Dance Music Partygoers in New York During COVID-19 Social Distancing

Background: Little is known about how COVID-19-related social distancing has affected illegal drug use. We surveyed electronic dance music (EDM) partygoers-a population known for high levels of drug use-to determine whether their drug use patterns had changed during state-mandated social distancing in New York. Methods: Individuals were recruited online and screened for eligibility throughout April and May 2020. We surveyed 128 eligible adults and queried, retrospectively, whether their drug use behavior had changed during COVID-19-related social distancing. Results: Most participants reporting past-three-month use reported decreased frequency of use during COVID-19-related social distancing. Specifically, 78.6% reduced frequency of use of cocaine, 71.1% reduced frequency of use of ecstasy/MDMA/Molly, and 68.0% reduced frequency of use of LSD. Although some participants reported increased frequency of use of cocaine (7.1%), ecstasy (7.9%), or LSD (12.0%), 35.0% reported increased frequency of cannabis use. Most (66.7%) of those reporting cocaine use reduced the amount used. The majority of those reporting use of cannabis, ecstasy, cocaine, and/or LSD reported that drug cost (80.0-84.0%) and drug quality (84.2-92.0%) did not change during social distancing. Having a college degree was associated with higher odds for decreasing frequency of cannabis use. Older participants (ages ≥23) were at lower odds for decreasing frequency of cocaine use, as were those earning >$500 per week, and participants who attended EDM events biweekly or more often were at higher odds for decreasing frequency of LSD use. Conclusions: Participants in this sample tended to reduce party drug use during COVID-19-related social distancing.

Evaluation of Internet Gaming Disorder, Social Media Addiction, and Levels of Loneliness in Adolescents and Youth with Substance Use

Substance use and addictive disorders are among the most significant public health concerns, particularly during adolescence. The current study aims to investigate internet gaming disorder, social media addiction, and loneliness levels in adolescents and youths with substance use. Methods: The study group consisted of 93 adolescents and youths aged 15-24 who presented to the Alcohol and Substance Addiction Research and Application Center or the Child and Adolescent Mental Health and Diseases outpatient clinic for substance use. Ninety-one healthy volunteers who did not use substances during any period of their lives participated as a control group. The participants fulfilled the Social Media Addiction Scale (SMAS), Internet Gaming Disorder Scale - Short-Form (IGDS9-SF), UCLA Loneliness Scale (UCLA-LS), and Drug Use Disorders Identification Test - Extended (DUDIT-E). Results: The symptoms of internet gaming disorder were significantly lower in the patient group compared with the control group. Although it was not significant, social media addiction was higher in the patient group than in the control group. The experience of loneliness was significantly higher in the patient group than in the control group. A significant negative correlation was found between treatment motivation and loneliness. Conclusions: School guidance teachers should monitor children who do not have friends or are lonely and be aware of the potential for substance use because it can emerge as a method of coping with the feeling of loneliness among adolescents. In future studies, investigating comprehensive factors contributing to different addictive behaviors may help to clarify the co-occurrence.

Relationship between Emotional Intelligence, Cybervictimization, and Academic Performance in Secondary School Students

The benefits attributed to emotional intelligence (EI) in a school environment can be observed in areas such as interpersonal relationships, psychological well-being, academic performance, and avoidance of disruptive behaviors. The objective of this study was to analyze a sample of 3451 adolescents from a secondary school to test whether EI is a protector against cybervictimization and the repercussions of cybervictimization, and whether EI has an influence on academic performance. The instruments used in the study included a questionnaire of risk factors for cybervictimization-the Trait Meta Mood Scale 24 (Spanish version)-and the global marks or academic performance of the students. The relationships between the variables were analyzed and a structural equation model was developed. The correlations revealed that there was a positive relationship between EI and student academic performance, but there was also a negative relationship regarding cybervictimization. In other words, students with lower EI were more likely to suffer from cybervictimization and could experience negative repercussions on school success. Through EI training and addressing disruptive behaviors by focusing on school climate, classroom management, and discipline, we can create emotional regulation guidelines among students to eradicate disruptive behaviors.

Prevalence and Associated Factors of Loneliness Among National Samples of In-School Adolescents in Four Caribbean Countries

BACKGROUND

The goal of the study was to estimate the prevalence and correlates of loneliness among adolescent school children in four Caribbean countries.

METHODS

Nationally representative cross-sectional data were analysed from 9,143 adolescents (15 years=median age) that took part in the "2016 Dominican Republic, 2016 Suriname, 2017 Jamaica and 2017 Trinidad and Tobago "Global School-Based Student Health Survey (GSHS)."

RESULTS

The prevalence of loneliness was 15.3% in four Caribbean countries, ranging from 12.1% in Dominican Republic to 18.6% in Jamaica. In adjusted logistic regression analysis, female sex, having no close friends, older age, anxiety induced sleep disturbance, frequent bullying victimization (≥3 days/month), having been physically attacked, parental emotional neglect, having sustained multiple serious injuries (past year) and not eating fruit and vegetables were associated with loneliness. In addition, in sex stratified adjusted logistic regression analysis, among boys, daily exposure to passive smoking, and being from Suriname, and among girls, frequent experience of hunger, low peer support, trouble from drinking alcohol and high leisure-time sedentary behaviour (≥8 hrs/day) were associated with loneliness. Moreover, in addition to above results, in unadjusted analysis, involvement in physical fight, parents never check on homework, parental disrespect of privacy, frequent school truancy (≥3 days/month), current tobacco use, having no physical education and drinking frequently soft drinks (≥3/day) were associated with loneliness.

CONCLUSION

Almost one in six students reported loneliness and several associated factors were identified which can aid intervention strategies.

Association between Personal Social Capital and Loneliness among Widowed Older People

To explore the association between the personal social capital and loneliness among the widowed older adults in China. Data from 1497 widowed older adults were extracted from China’s Health-Related Quality of Life Survey for Older Adults 2018. The Chinese version of the Personal Social Capital Scale (PSCS-16) was used to evaluate the participants’ status of bonding and bridging social capital (BOC and BRC). Loneliness was assessed by the short-form UCLA Loneliness Scale (ULS-8). Multiple linear regression models were established to examine the relationship between social capital and loneliness. The BOC and BRC of rural widowed older people were significantly lower than those of widowed older people in urban areas, while loneliness of rural widowed older people was higher than that of widowed older people in urban areas. The result of the final model showed that loneliness of rural participants was significantly associated with both BOC (B = 0.141, p = 0.001) and BRC (B = −0.116, p = 0.003). The loneliness of the urban widowed sample had no association with both BOC and BRC (p > 0.05). These findings suggested that more social support and compassionate care should be provided to enrich the personal social capital and thus to reduce loneliness of widowed older adults, especially those in rural areas.

Reducing loneliness among people with substance use disorders: Feasibility of 'Groups for Belonging'

INTRODUCTION AND AIMS

Although loneliness is common among people with substance use disorders, few interventions to reduce loneliness have been developed for this population. This study aimed to determine the feasibility of delivering a six-session group-based intervention, 'Groups for Belonging', that builds social group connectedness.

DESIGN AND METHODS

Participants were 41 individuals accessing residential substance use treatment services. The primary aims of the present study were to determine indicators of feasibility of Groups for Belonging; namely, demand (recruitment, attendance and retention) for and acceptability (program adherence and participant satisfaction) of the Groups for Belonging program in residential substance use treatment settings.

RESULTS

Over half of the people attending the services were interested in participating in Groups for Belonging. Of 41 participants who commenced the program, 20 participants completed the program per protocol. In terms of acceptability, the average number of sessions attended was 3.7 (SD = 1.76, range 1-6). Program adherence was 99.3% and overall satisfaction with the program was high, with 95% of participants reporting they enjoyed Groups for Belonging.

DISCUSSION AND CONCLUSIONS

The Groups for Belonging program may be feasible for delivery in residential substance use treatment services. Findings from this study suggest that an adequately powered replication study is warranted.

Loneliness and Telomere Length: Immune and Parasympathetic Function in Associations With Accelerated Aging

BACKGROUND

Lonely people's heightened risks for chronic health conditions and early mortality may emerge in part through cellular aging. Lonelier people have more severe sympathetic responses to acute stress, increasing their risk for herpesvirus reactivation, a possible path to shorter telomeres. Parasympathetic function may modulate this risk.

PURPOSE

The current study aimed to examine the associations among loneliness, herpesvirus reactivation, and telomere length, with parasympathetic activity as a moderator, in healthy middle-aged and older adults.

METHODS

A sample of 113 healthy men and women of ages 40-85 provided blood samples that were assayed for telomere length, as well as the latent herpesviruses cytomegalovirus (CMV) and Epstein-Barr virus (EBV). They also provided heart rate variability (HRV), a measure of parasympathetic activity, and reported on their feelings of loneliness.

RESULTS

Lonelier people with lower HRV (i.e., lower parasympathetic activity) had greater CMV reactivation and shorter telomeres compared with their less lonely counterparts, above and beyond demographics, health behaviors, resting heart rate, and social network size. However, loneliness was not associated with viral reactivation or telomere length among those with higher HRV. In turn, greater CMV and EBV reactivation was associated with shorter telomeres.

CONCLUSIONS

Taken together, these data implicate parasympathetic function in novel links between loneliness and accelerated cellular aging.

Trends in social inequality in loneliness among adolescents 1991-2014

BACKGROUND

Loneliness and social inequality in health are important public health concerns. We examined (i) trends in loneliness among adolescents from 1991 to 2014 in Denmark and (ii) trends in social inequality in loneliness.

METHODS

Study population: 11-15-year olds in random samples of schools in 1991, 1994, 1998, 2006 and 2014, n = 19 096. Loneliness was measured by a single item and social background by parents' occupational social class (OSC). We calculated absolute (%) differences in loneliness between high and low OSC and relative differences by odds ratio for loneliness.

RESULTS

Across all surveys, 6.3% reported feeling lonely. The prevalence increased from 4.4% in 1991 to 7.2% in 2014. The prevalence of loneliness in high, middle and low OSC was 5.8, 5.9 and 8.0%. The increase in loneliness was more pronounced in higher than lower OSC, resulting in a decreasing absolute social inequality in loneliness. The statistical interaction between OSC and survey year was significant, P = 0.0176, i.e. the relative social inequality in loneliness also decreased from 1991 to 2014.

CONCLUSION

The prevalence of loneliness increased from 1991 to 2014. The social inequality in loneliness decreased in both absolute and relative terms because of a rising prevalence of loneliness among children from high OSC.

The association between smoking and loneliness among Chinese university freshmen

Background

In Chinese culture, smoking can promote social connectedness and integration. We therefore hypothesized that smoking would be negatively associated with loneliness in China. Given that loneliness is common and associated with adverse academic and health outcomes in university freshmen, examining correlates of loneliness in this population may deepen our understanding on the etiology of loneliness. This study investigated the association between smoking and loneliness in Chinese university fresh students.

Methods

In this cross-sectional study, by using a two-stage cluster sampling approach, we recruited a total of 1,452 fresh students from a comprehensive university in Wuhan, China. These students completed a self-administered questionnaire containing the Chinese six-item De Jong Gierveld Loneliness Scale (DJGLS) and standardized questions on socio-demographics, internet use, and substance use, including smoking and use of alcohol and illicit drugs. Multiple linear regression was used to test the independent association of loneliness with smoking.

Results

In Chinese university freshmen, current smokers had significantly higher DJGLS scores than non-smokers (11.9±4.60 vs. 8.53±3.72, t=7.351, P<0.001). After controlling for socio-demographic variables, current drinking, lifetime illicit drug use, and daily hours of internet use, the positive association between current smoking and DJGLS score remained statistically significant (unstandardized coefficient: 3.053, P<0.001).

Conclusions

Smoking is independently and positively associated with loneliness in Chinese university freshmen. Smoking cessation might be helpful for preventing and reducing loneliness among Chinese university fresh students.

Perceived social support and the risk of cardiovascular disease and all-cause mortality in the Women's Health Initiative Observational Study

OBJECTIVE

Previous studies have shown social support to be inversely associated with cardiovascular disease (CVD) in men, whereas fewer studies have assessed the relationship in women. The purpose of this study was to evaluate the relationship between perceived social support and cardiovascular outcomes among postmenopausal women enrolled in the Women's Health Initiative Observational Study.

METHODS

We examined the relationships between perceived social support and (1) incident coronary heart disease (CHD), (2) total CVD, and (3) all-cause mortality. Participants were Women's Health Initiative Observational Study women, ages 50 to 79 years, enrolled between 1993 and 1998 and followed for up to 10.8 years. Social support was ascertained at baseline via nine questions measuring the following functional support components: emotional/informational, tangible, positive social interaction, and affectionate support.

RESULTS

Among women with prior CVD (n = 17,351) and no prior CVD (n = 73,421), unadjusted hazard ratios ranged from 0.83 to 0.93 per standard deviation increment of social support. Adjustment for potential confounders, such as smoking and physical activity levels, eliminated the statistical significance of the associations with CHD and CVD. However, for all-cause mortality and among women free of baseline CVD, the association was modest but remained statistically significant after this adjustment (hazard ratio = 0.95 [95% confidence interval, 0.91-0.98]). No statistically significant association was observed among women with a history of CVD.

CONCLUSIONS

After controlling for potential confounding variables, higher perceived social support is not associated with incident CHD or CVD. However, among women free of CVD at baseline, perceived social support is associated with a slightly lower risk of all-cause mortality.

Loneliness and friendlessness among adolescents in 25 countries in Latin America and the Caribbean

BACKGROUND

Loneliness is a common health problem among the elderly but is not well understood in the adolescent population, especially in low- and middle-income countries (LMICs). Adolescent loneliness can have adverse impacts on short- and long-term health status.

METHODS

This study examined rates of self-reported loneliness and friendlessness among 76,982 secondary school students in 25 LMICs in Latin America and the Caribbean who participated in the Global School-based Student Health Survey (GSHS). After calculating the rates of reported loneliness and lack of close friends separately for nationally representative samples of boys and girls from each country, we used meta-analysis to pool results for prevalence rates and associations across all 25 countries and territories.

RESULTS

About 1 in 6 students (18.1% [95% CI: 16.4%, 20.0%]) reported being lonely most or all of the time and/or having no close friends, including 19.9% of girls and 16.2% of boys. Girls were more likely than boys to report being lonely most or all of the time (14.6% vs. 9.2%, p < .05), but boys were more likely than girls to report that they had zero close friends (8.7% vs. 7.2%, p < .05). However, the majority of students who reported being lonely did not report having no close friends, and the majority of students who reported having no close friends did not report being lonely most or all of the time.

CONCLUSIONS

Asking adolescents about both loneliness and friendships may capture the burden of social isolation among males and females better than a single question about loneliness. Successful interventions for reducing social isolation must be rooted in communities and integrated into comprehensive school and community health plans.

The Role of Perceived Loneliness in Youth Addictive Behaviors: Cross-National Survey Study

BACKGROUND

In the ever-growing and technologically advancing world, an increasing amount of social interaction takes place through the Web. With this change, loneliness is becoming an unprecedented societal issue, making youth more susceptible to various physical and mental health problems. This societal change also influences the dynamics of addiction.

OBJECTIVE

Employing the cognitive discrepancy loneliness model, this study aimed to provide a social psychological perspective on youth addictions.

METHODS

A comprehensive survey was used to collect data from American (N=1212; mean 20.05, SD 3.19; 608/1212, 50.17% women), South Korean (N=1192; mean 20.61, SD 3.24; 601/1192, 50.42% women), and Finnish (N=1200; mean 21.29, SD 2.85; 600/1200, 50.00% women) youths aged 15 to 25 years. Perceived loneliness was assessed with the 3-item Loneliness Scale. A total of 3 addictive behaviors were measured, including excessive alcohol use, compulsive internet use, and problem gambling. A total of 2 separate models using linear regression analyses were estimated for each country to examine the association between perceived loneliness and addiction.

RESULTS

Loneliness was significantly related to only compulsive internet use among the youth in all 3 countries (P<.001 in the United States, South Korea, and Finland). In the South Korean sample, the association remained significant with excessive alcohol use (P<.001) and problem gambling (P<.001), even after controlling for potentially confounding psychological variables.

CONCLUSIONS

The findings reveal existing differences between youths who spend excessive amounts of time online and those who engage in other types of addictive behaviors. Experiencing loneliness is consistently linked to compulsive internet use across countries, although different underlying factors may explain other forms of addiction. These findings provide a deeper understanding in the mechanisms of youth addiction and can help improve prevention and intervention work, especially in terms of compulsive internet use.

ADHD and depressive symptoms in adolescents: the role of community violence exposure

PURPOSE

Comorbid depression is common in adolescents with attention-deficit/hyperactivity disorder (ADHD). As yet, however, little is known about the factors associated with co-occurring depression in this population. To address this research gap, the current study examined the role of community violence exposure in the association between ADHD symptoms and depression.

METHODS

Data came from 505 Russian adolescents [mean age 14.37 (SD = 0.96)] who had teacher-reported information on ADHD symptoms that was collected in conjunction with the Social and Health Assessment (SAHA). Adolescent self-reports of witnessing and being a victim of community violence were also obtained while depressive symptoms were self-assessed with an adapted version of the Center for Epidemiologic Studies-Depression Scale (CES-D). Logistic regression analyses were performed to examine associations.

RESULTS

In univariable analyses, both witnessing and being a victim of violence were associated with significantly increased odds for depressive symptoms in adolescents with ADHD symptoms compared to non-ADHD adolescents who had not experienced community violence. However, in the multivariable analysis only being a victim of violence continued to be associated with significantly increased odds for depression [odds ratio (OR) 4.67, 95% confidence interval (CI) 1.33-16.35].

CONCLUSION

Exposure to community violence may be associated with depression in adolescents with ADHD symptoms. Clinicians should enquire about exposure to community violence in adolescents with ADHD/ADHD symptoms. Early therapeutic interventions to address the effects of violence exposure in adolescents with ADHD may be beneficial for preventing depression in this group.

Loneliness in young adulthood: Its intersecting forms and its association with psychological well-being and family characteristics in Northern Taiwan

Objectives

Most researchers have examined forms of loneliness as discrete and emotional distress. The approach proposed in this study captures the reality that many persons experience more than one dimension of loneliness—varying degrees coupled with their psychological well-being in a family context. This study explores the latent structure of loneliness during young adulthood and its association with psychological well-being, as well as how these are related to their family characteristics in adolescence.

Methods

Data are from 2,748 young people, a cohort sample from the Taiwan Youth Project (TYP). Loneliness was assessed by a 6-item de Jong-Gierveld short scale with emotional and social loneliness domains. We describe the clustering between loneliness domains and psychological well-being, namely depressive symptoms, self-esteem, suicidal thoughts, and alcohol use using latent class cluster analysis. In addition to incorporating the Taiwanese family context, multivariate multinomial logistic regression models included data on family cohesion and parental guan (parental control) in adolescence. This might be associated with choices in partnership and childbearing, and influence loneliness in young adulthood.

Results

Our results demonstrate a three-cluster model of loneliness involving emotional loners, serious emotional loners, and severe emotional/social loners. We also found that a feeling of serious emotional loneliness and severe emotional/social loneliness were significantly associated with psychological well-being, even adjusting for individual characteristics. Among young adults who had a partner, the married adults were significantly less likely to feel serious emotional loneliness than those who were living alone. Furthermore, young adults with stronger family cohesion during early adolescence were less likely to suffer from serious emotional loneliness (Relative risk ratios [RRR] 0.77, 95% CI 0.65–0.91) and severe emotional/social loneliness (RRR 0.54, 95% CI 0.34–0.85) in young adulthood.

Discussion

This measurement strategy provides a foundation for future research into how experts can address loneliness clusters in order to better understand psychological well-being during young adulthood and family context in adolescence. This is important because our results suggest that the various loneliness domains do not occur independently, but rather are embedded in patterns and are associated with family characteristics.

Leisure-time sedentary behavior and loneliness among 148,045 adolescents aged 12-15 years from 52 low- and middle-income countries

BACKGROUND

Loneliness is widespread in adolescents and associated with a myriad of adverse physical and mental health outcomes. Exploring variables associated with loneliness is important for the development of targeted interventions. The aim of the current study was to explore associations between leisure-time sedentary behavior (LTSB) and loneliness in adolescents from 52 low- and middle-income countries.

METHODS

Data from the Global School-based Student Health Survey were analyzed. Data on past 12-month self-perceived loneliness and LTSB were collected. Multivariable logistic regression and meta-analysis were conducted to assess the associations.

RESULTS

Among 148,045 adolescents (mean age 13.7± SD 1.0 years; 48.5% female), the prevalence of loneliness increased from 8.7% among those with 1-2 h/day of LTSB to 17.5% among those spending >8 h/day sedentary. Compared to those who engage in less than 1 h of LTSB per day, the OR (95%CI) of loneliness for 1-2 h/day, 3-4 h/day, 5-8 h/day and >8 h/day were 1.00 (0.91-1.11), 1.29 (1.15-1.45), 1.37 (1.17-1.61), and 1.66 (1.39-1.99), respectively.

LIMITATIONS

The study is cross-sectional, therefore the directionality of the relationships cannot be deduced.

CONCLUSIONS

Our data suggest that LTSB is associated with increased odds for feeling lonely in adolescence. Future longitudinal data are required to confirm/refute the findings to inform public health campaigns.

Year of study as predictor of loneliness among students of University of Gondar

Objectives

Loneliness is individual's subjective sense of lacking familial or social contact to the degree that they wanted. It is responsible for reduced quality of life. The aim of this study was to determine loneliness and its association with year of study among University of Gondar students, 2018/19. Cross-sectional study design was used on 404 Medical and Health Sciences students selected by systematic random sampling. UCLA-R loneliness score was used. A person with a mean value of 42 and above was considered as lonely. After data were collected by self-administered questionnaire, Epi-Data was used for data entry and exported to SPSS version 20.1 for analysis. Variables with p-value of 0.05 and lower were treated as significant factors in multivariable logistic regression.

Results

Prevalence of loneliness was 49.5% (95% CI 44.6–54.4%). Year of study was significantly associated with loneliness [AOR = 2.47, 95% CI (1.65–3.70)]. First-year students were having 2.47 odds of loneliness as compared to second year and above students. Loneliness prevalence was higher in the current study. This must get the attention of higher education institutions, the government and all concerned stakeholders in the education sector to design strategy on preventing and treating loneliness.

Gender/Sex as a Social Determinant of Cardiovascular Risk

The social gradient for cardiovascular disease (CVD) onset and outcomes is well established. The American Heart Association's Social Determinants of Risk and Outcomes of Cardiovascular Disease Scientific Statement advocates looking beyond breakthroughs in biological science toward a social determinants approach that focuses on socioeconomic position, race and ethnicity, social support, culture and access to medical care, and residential environments to curb the burden of CVD going forward. Indeed, the benefits of this approach are likely to be far reaching, enhancing the positive effects of advances in CVD related to prevention and treatment while reducing health inequities that contribute to CVD onset and outcomes. It is disappointing that the role of gender has been largely neglected despite being a critical determinant of cardiovascular health. It is clear that trajectories and outcomes of CVD differ by biological sex, yet the tendency for sex and gender to be conflated has contributed to the idea that both are constant or fixed with little room for intervention. Rather, as distinct from biological sex, gender is socially produced. Overlaid on biological sex, gender is a broad term that shapes and interacts with one's cognition to guide norms, roles, behaviors, and social relations. It is a fluid construct that varies across time, place, and life stage. Gender can interact with biological sex and, indeed, other social determinants, such as ethnicity and socioeconomic position, to shape cardiovascular health from conception, through early life when health behaviors and risk factors are shaped, into adolescence and adulthood. This article will illustrate how gender shapes the early adoption of health behaviors in childhood, adolescence, and young adulthood by focusing on physical activity, drinking, and smoking behaviors (including the influence of role modeling). We will also discuss the role of gender in psychosocial stress with a focus on trauma from life events (childhood assault and intimate partner violence) and work, home, and financial stresses. We conclude by exploring potential biological pathways, with a focus on autonomic functioning, which may underpin gender as a social determinant of cardiovascular health. Finally, we discuss implications for cardiovascular treatment and awareness campaigns and consider whether gender equality strategies could reduce the burden of CVD for men and women at the population level.

Somatic symptoms and internalizing problems in urban youth: a cross-cultural comparison of Czech and Russian adolescents

Background

Although the association between somatic complaints and internalizing problems (anxiety, somatic anxiety and depression) is well established, it remains unclear whether the pattern of this relationship differs by gender and in different cultures. The aim of this study was to examine cross-cultural and gender-specific differences in the association between somatic complaints and internalizing problems in youth from the Czech Republic and Russia.

Methods

The Social and Health Assessment, a self-report survey, was completed by representative community samples of adolescents, age 12-17 years, from the Czech Republic (N = 4770) and Russia (N = 2728).

Results

A strong association was observed between somatic complaints and internalizing psychopathology. Although the levels of internalizing problems differed by country and gender, they increased together with and largely in a similar way to somatic complaints for boys and girls in both countries.

Conclusion

The association between somatic symptoms and internalizing problems seems to be similar for boys and girls across cultures.

Loneliness in Treatment-Seeking Substance-Dependent Populations: Validation of the Social and Emotional Loneliness Scale for Adults-Short Version

OBJECTIVES

Loneliness is a distressing emotional experience that is likely to be prevalent among people accessing treatment for substance dependence problems. The first aim of the current study was to report on the validity of the Social and Emotional Loneliness Scale for Adults-Short Version (SELSA-S), a multidimensional measure of loneliness, for use in substance-dependent treatment populations. In order to further the understanding of loneliness among this population, loneliness was examined in relation to demographic, physical, and mental health variables.

METHODS

Participants were attending Australian residential substance dependence treatment services provided by two nongovernmental organizations (The Salvation Army and We Help Ourselves). Participants completed cross-sectional surveys (N = 316) consisting of measures of demographics, substance use, loneliness, and physical and mental health.

RESULTS

Confirmatory factor analysis revealed high factor loadings and a moderate degree of concurrent and discriminant validity and internal consistency for the SELSA-S; however, model fit indices did not meet prespecified cutoff criteria. Loneliness was deemed to be a serious problem for 69% of respondents, and 79% reported feeling lonely at least once per month.

CONCLUSIONS

Findings of this study suggest the need for further research into the validity of the SELSA-S for use with substance-dependent populations. In addition, it may be beneficial to test a range of loneliness measures in order to determine whether other measures of loneliness may be more favorable for use across this population.

Mental health profile and health-related behavior among Hong Kong Chinese university students

To better understand factors that are associated with individuals’ engagement in physical activity and other health-related behaviors, this study aimed to identify the psychological well-being profiles among Chinese university students, and explore whether engagement in physical activity and other health-related behaviors vary with different psychological well-being profiles. A battery of self-report questionnaires was completed by 2022 Chinese university students for assessing psychological well-being and health-related behaviors. Four psychological well-being profiles were identified. The vast students were mentally healthy. The students with better mental health displayed lower likelihood of engagement in unhealthy behaviors. Findings and implication of the study were discussed.

Transitional Instability Predicts Polymorphous Distress in Emerging Adults

The primary aim of this investigation is to determine the extent to which transitional instability can predict diverse markers of distress in emerging adults. Participants were 210 emerging adults, aged 18-25 who completed measures of distress that included loneliness, stress, problem drinking, and prescription medication use. One year later, they returned to complete these same measures of distress along with a measure of significant life transitions that they encountered during the past year in such domains as education, employment, residence, and relationships. Results of a structural equation modeling analysis showed that even after controlling for the potential reciprocal association between transitional instability and distress, the more transitional instability emerging adults experienced over the year, the higher their distress was at time 2. The results are consistent with models of transitional instability as a precipitant of distress in emerging adulthood.

Indirect Effects of Loneliness on Substance Use through Stress

Loneliness is associated with a range of physical health problems, and health behaviors (e.g., alcohol use) have been specified as one factor that explains the compromised health of lonely people. Accordingly, in this investigation, we sought to test direct and indirect (through stress) effects of loneliness on substance use (i.e., alcohol consumption, drinking problems, and prescription medication use) over the course of 1 year in a 2-wave longitudinal study. These effects were tested in a sample of 210 young adults who completed self-report measures of loneliness and substance use at time 1 and then completed measures of stress and substance use at time 2. The results showed that loneliness did not have prospective direct effects on substance use, but that it did have significant indirect effects, through increased stress, on all indicators of substance use. These findings highlight the important role of stress in potentially compromising the health of lonely people by increasing their propensity to engage in health risk behaviors.

Binge drinking and associated factors among school students: a cross-sectional study in Zhejiang Province, China

OBJECTIVE

To investigate the prevalence and correlating factors of binge drinking among middle and high school students in Zhejiang Province, China.

METHODS

We performed a cross-sectional study using data from a school-based survey. A total of 23 543 (response rate=97.5%) eligible adolescents from 442 different schools (including middle schools, academic high schools and vocational high schools) were asked to fill in an anonymous self-administered behaviour questionnaire between April and May 2017. Multivariable logistic regression models were used to examine the associations of sociodemographic and behavioural factors with binge drinking.

RESULTS

The mean (SD) age of participants was 15.6 (1.7) years and 51.3% were boys. The proportions of students from middle schools, academic high schools and vocational high schools were 51.9%, 27.5% and 20.6%, respectively. In total, 22.8% (95% CI 21.6 to 23.9) of students reported drinking alcohol in the past 30 days and 9.2% (95% CI 8.5 to 10.0) of students reported binge drinking (defined as drinking four or more alcoholic drinks in 1-2 hours period among girls and five or more alcoholic drinks among boys) during the past month. The prevalence of binge drinking was highest among vocational high school students (17.9% vs 6.3% and 7.7% among middle school and academic high school students, respectively). Older age, studying at high school, poor academic performance, higher levels of physical activity, excessive screen-time, loneliness, insomnia, previous suicide attempt, cigarette smoking, fighting, being bullied and sexual experience were found to be positively associated with adolescent binge drinking.

CONCLUSIONS

Binge drinking is common among middle and high school students in Zhejiang, China. Efforts to prevent binge drinking may need to address a cluster of sociodemographic and behavioural factors. Our findings provide information to enable healthcare providers to identify students at high-risk of binge drinking and to inform planning of intervention measures for at-risk students.

Social support predicts reductions in PTSD symptoms when substances are not used to cope: A longitudinal study of sexual assault survivors

BACKGROUND

After sexual assault, many college women develop symptoms of posttraumatic stress disorder (PTSD), and those who engage in substance use coping are at heightened risk for this outcome. Positively-perceived social support has been identified as an important protective factor against the development of PTSD, but received social support could involve problematic behaviors-like the encouragement of coping through use of alcohol and/or drugs-that could worsen symptoms.

METHODS

In the current study, 147 undergraduate women with a lifetime history of sexual assault completed two waves of self-report measures assessing their symptoms. We test main and interaction effects for social support and substance use coping at baseline on PTSD symptoms one month later.

RESULTS

Results suggest that social support is longitudinally associated with decreases in PTSD. Although substance use coping did not evidence a direct association with PTSD, the relationship between social support and PTSD was significantly weaker as substance use coping increased. Only support from friends (but not family members or a "special person") was associated with later PTSD, and this relationship was moderated by substance use coping.

LIMITATIONS

Substance use coping was assessed via a brief measure, and peer encouragement of coping by using alcohol and/or drugs was not directly assessed.

CONCLUSIONS

Clinicians should consider ways to increase access to social support from friends in patients with PTSD and evaluate ways that substance use coping may interfere with social support's benefits.

Physical multimorbidity and loneliness: A population-based study

Multimorbidity has been linked to a variety of negative outcomes although as yet, there has been little research on its association with loneliness. This study examined the association between physical multimorbidity (≥ 2 physical diseases) and loneliness in the general population and its potential mediators. Data came from the Adult Psychiatric Morbidity Survey 2007 (N = 7403, aged ≥16 years). Information was obtained on 20 doctor diagnosed physical conditions that were present in the previous year. An item from the Social Functioning Questionnaire (SFQ) was used to obtain information on loneliness. Multivariable logistic regression analysis was used to examine associations. An increasing number of physical diseases was associated with higher odds for loneliness. Compared to no physical diseases, the odds ratio (OR) (95% confidence interval: CI) for loneliness increased from 1.34 (1.13–1.59) to 2.82 (2.11–3.78) between one and ≥5 physical diseases. This association was particularly strong in the youngest age group (i.e. 16–44 years). The loneliness-physical multimorbidity association was significantly mediated by stressful life events (% mediated 11.1%-30.5%), anxiety (30.2%), and depression (15.4%). Physical multimorbidity is associated with increased odds for loneliness. Prospective research is now needed to further elucidate this association and the factors that underlie it.

Ostracism and Peer Victimization in Adolescents With and Without Mental Health Diagnoses in a Public Middle School Setting

To better understand adolescents experiencing peer victimization, ostracism, and emotional health problems, this study aimed to describe a cohort of middle school students identified as having school peer-related social difficulties as 2 groups: those with mental health diagnoses (MHDs; n = 17) and those without diagnoses (n = 8). Participants were administered a test battery to examine communication ability, social responsiveness, social activity, ostracism, victimization, and emotional health. Results showed that adolescents with MHDs, relative to those without, scored significantly lower on measures of communication ability, social responsiveness, and social activity but similarly on measures of victimization, ostracism, and internalizing/externalizing factors. Results suggest that adolescents with and without MHDs can endure ostracism and peer victimization to a similar extent. Because ostracism and victimization have serious morbidity in adolescents, physicians and caregivers must look for signs in all adolescents, irrespective of MHD. Recommendations for appropriate primary care management are discussed.

Increased Substance Use and Poorer Mental Health in Adolescents With Problematic Musculoskeletal Pain

Study Design Cross-sectional study. Background Adolescents with musculoskeletal pain are thought to be at greater risk of modifiable health risk behaviors, but little is known about these behaviors in adolescents with problematic pain. Objective To describe the prevalence of substance use (tobacco smoking, alcohol consumption, and illicit drugs) and poor mental health in adolescents with problematic musculoskeletal pain, compared to those without such pain. Methods Data on self-reported pain, substance use, and poor mental health were collected from 1831 year 9 students (age range, 14-16 years). Participants were considered to have problematic pain if they reported experiencing pain at least monthly over a 6-month period that also required medication or impacted 1 or more of the following: school or work, daily activities, and leisure or sporting activities. Results Almost half (46%) of the participants experienced problematic pain. Adolescents with problematic pain, compared to those without pain, reported higher substance use and poorer mental health: tobacco smoking in the last 4 weeks, 12% versus 7% (odds ratio [OR] = 1.76; 95% confidence interval [CI]: 1.25, 2.28); alcohol consumption in the last 4 weeks, 30% versus 20% (OR = 1.68; 95% CI: 1.34, 2.11); illicit drug use, 13% versus 6% (OR = 2.18; 95% CI: 1.55, 3.07); lower Mental Health Inventory scores (β = -11.43; standard error [SE], 0.96; P<.05), indicating poorer mental health; and higher Strengths and Difficulties Questionnaire total scores (β = 3.67; SE, 0.29; P<.05), indicating greater difficulties. Conclusion Adolescents with problematic pain report higher smoking, alcohol use, and use of illicit drugs and poorer mental health than adolescents without problematic pain. The experience of problematic pain could be an important consideration for substance use and chronic disease prevention. This trial is registered with the Australian New Zealand Clinical Trials Registry (reference number ACTRN12611000606987). J Orthop Sports Phys Ther 2017;47(10):705-711. doi:10.2519/jospt.2017.7441.

Gender Differences in the Transmission of Smoking From Filipino Parents to Their Offspring: The Role of Parenting, School Climate, and Negative Emotions

OBJECTIVE

This article examines gender differences in the transmission of smoking, and the role of parenting, school climate, and negative emotions in the parental smoking-adolescent smoking relationship.

METHODS

The study used a nationally representative cross-sectional data on 5,290 Filipino secondary students.

RESULTS

Results suggest that Filipino adolescents having parents who smoke, tend to smoke cigarettes. Maternal smoking affects both girls' and boys' smoking, but paternal smoking has no effect on both sexes. Further, parenting dimensions (support and knowledge), school climate (bullying victimization and peer support), and negative emotions (loneliness and anxiety) tend to moderate the effects of parental smoking on adolescent smoking. Some of these factors appear to protect adolescents from parental smoking, while others aggravate the effects of parental smoking. Conclusions/Importance: Current findings suggest important theoretical and practical implications on the relationship between parental and adolescent smoking.

The direct and indirect effect of loneliness on the development of adolescent alcohol use in the United Kingdom

Alcohol use among adolescents in the United Kingdom (UK) remains relatively high compared to those in other European countries. The present study sought to examine both the direct and indirect effect of loneliness on drinking behavior. Participants were school children (mean age 13.5 years at Time 1) participating in a Randomized Controlled Trial in the UK, who completed a battery of questionnaires examining alcohol-use indicators, loneliness, self-efficacy and sensation seeking at Time 1 and at +12 months. Loneliness at Time 1 had a substantive, though largely indirect (i.e., via self-efficacy and sensation seeking covariates), impact on alcohol-related harm at +12 months. Furthermore, Loneliness interacted with gender in the prediction of context of alcohol use, where being female and experiencing loneliness put an individual at a greater risk of unsupervised drinking. Females experiencing loneliness were also 2.9 times as likely to have had a drink in the past 30 days, and around 2.5 times as likely to have ever consumed a full drink, when compared to their male peers. The current results indicate that loneliness is an important but complex factor in adolescent drinking. There are important implications for the development of interventions to prevent underage drinking, not least that it is not appropriate to consider all underage drinkers as socially marginalised. However, for those that are, the self-medication hypothesis is potentially relevant through emotional self-efficacy.

•

Data were gathered on loneliness, self-efficacy, sensation seeking and alcohol use.

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Loneliness at Time 1 had an indirect impact on alcohol-related harm at + 12 months.

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Loneliness interacted with gender in the prediction of context of alcohol use.

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Being female and experiencing loneliness put an individual at a greater risk of unsupervised drinking.

Smoking among school-going adolescents in selected secondary schools in Peninsular Malaysia- findings from the Malaysian Adolescent Health Risk Behaviour (MyaHRB) study

BACKGROUND

A multitude of studies have revealed that smoking is a learned behaviour during adolescence and efforts to reduce the incidence of smoking has been identified as long-term measures to curb the smoking menace. The objective of this study was to determine the prevalence as well as the intra and inter-personal factors associated with smoking among upper secondary school students in selected schools in Peninsular Malaysia.

METHODS

A study was carried out in 2013, which involved a total of 40 secondary schools. They were randomly selected using a two-stage clustering sampling method. Subsequently, all upper secondary school students (aged 16 to 17 years) from each selected school were recruited into the study. Data was collected using a validated standardised questionnaire.

RESULTS

This study revealed that the prevalence of smoking was 14.6% (95% CI:13.3-15.9), and it was significantly higher among males compared to females (27.9% vs 2.4%, p < 0.001). Majority of smokers initiated smoking during their early adolescent years (60%) and almost half of the respondents bought cigarettes themselves from the store. Multivariable analysis revealed that the following factors increased the likelihood of being a current smoker: being male (aOR 21. 51, 95% CI:13.1-35), perceived poor academic achievement (aOR 3.42, 95% CI:1.50-7.37) had one or both parents who smoked (aOR 1.80, 95% CI:1.32-2.45; aOR 6.50, 95 CI%:1.65-25.65), and always feeling lonely (aOR 2.23, 95% CI:1.21-4.43). In contrast, respondents with a higher religiosity score and protection score were less likely to smoke (aOR 0.51, 95% CI:0.15-0.92; aOR 0.71, 95% CI 0.55-0.92).

CONCLUSION

This study demonstrated that the prevalence of smoking among Malaysian adolescents of school-going age was high, despite implementation of several anti-smoking measures in Malaysia. More robust measures integrating the factors identified in this study are strongly recommended to curb the smoking epidemic among adolescents in Malaysia.

Prevalence and correlates of loneliness among Chinese service industry migrant workers: A cross-sectional survey

Chinese rural-to-urban migrant workers (MWs) who are employed in service industry are a rapidly growing population in urban China. Like other MWs, service industry MWs (SIMWs) are generally excluded from the mainstream of city societies, but unlike other MWs, they are more marginalized in cities. Social isolation increases the feelings of loneliness; however, there are little empirical data on the epidemiology of loneliness of SIMWs. The present study aimed to investigate the prevalence and associated factors of loneliness among SIMWs in Shenzhen, China. By using respondent-driven sampling, 1979 SIMWs were recruited and administered with standardized questionnaires to collect data on sociodemographics, physical health, and migration-related characteristics. Loneliness and social support were measured with a single-item self-report question "Do you feel lonely often?" and Multidimensional Scale of Perceived Social Support (MSPSS), respectively. 18.3% of SIMWs reported feeling lonely often. Being aged 60 years or older (odds ratio [OR] = 2.30), marital status of "others" (OR = 2.77), being physically ill in the last 2 weeks (OR = 1.46), migrating alone (OR = 1.97), working >8 hours/day (OR = 1.06), MSPSS inside family subscale score ≤18 (OR = 1.80), and MSPSS outside family subscale score ≤38 (OR = 1.50) were significantly associated with increased risk of loneliness in SIMWs. Loneliness is prevalent in Chinese SIMWs and should be seen as a major public health issue. The high prevalence and many negative health consequences of loneliness highlight the importance of routine screening, evaluation, and treatment of loneliness in this vulnerable population.

Loneliness and its association with psychological and somatic health problems among Czech, Russian and U.S. adolescents

BACKGROUND

Loneliness is common in adolescence and has been linked to various negative outcomes. Until now, however, there has been little cross-country research on this phenomenon. The aim of the present study was to examine which factors are associated with adolescent loneliness in three countries that differ historically and culturally-the Czech Republic, Russia and the United States, and to determine whether adolescent loneliness is associated with poorer psychological and somatic health.

METHODS

Data from a school survey, the Social and Health Assessment (SAHA), were used to examine these relations among 2205 Czech, 1995 Russian, and 2050 U.S. male and female adolescents aged 13 to 15 years old. Logistic regression analysis was performed to examine if specific demographic, parenting, personal or school-based factors were linked to feeling lonely and whether lonely adolescents were more likely to report psychological (depression and anxiety) or somatic symptoms (e.g. headaches, pain).

RESULTS

Inconsistent parenting, shyness, and peer victimisation were associated with higher odds for loneliness in at least 4 of the 6 country- and sex-wise subgroups (i.e. Czech, Russian, U.S. boys and girls). Parental warmth was a protective factor against feeling lonely among Czech and U.S. girls. Adolescents who were lonely had higher odds for reporting headaches, anxiety and depressive symptoms across all subgroups. Loneliness was associated with other somatic symptoms in at least half of the adolescent subgroups.

CONCLUSION

Loneliness is associated with worse adolescent health across countries. The finding that variables from different domains are important for loneliness highlights the necessity of interventions in different settings in order to reduce loneliness and its detrimental effects on adolescent health.

Loneliness and Ethnic Composition of the School Class: A Nationally Random Sample of Adolescents

Loneliness is a public health concern that increases the risk for several health, behavioral and academic problems among adolescents. Some studies have suggested that adolescents with an ethnic minority background have a higher risk for loneliness than adolescents from the majority population. The increasing numbers of migrant youth around the world mean growing numbers of heterogeneous school environments in many countries. Even though adolescents spend a substantial amount of time at school, there is currently very little non-U.S. research that has examined the importance of the ethnic composition of school classes for loneliness in adolescence. The present research aimed to address this gap by exploring the association between loneliness and three dimensions of the ethnic composition in the school class: (1) membership of ethnic majority in the school class, (2) the size of own ethnic group in the school class, and (3) the ethnic diversity of the school class. We used data from the Danish 2014 Health Behaviour in School-aged Children survey: a nationally representative sample of 4383 (51.2 % girls) 11-15-year-olds. Multilevel logistic regression analyses revealed that adolescents who did not belong to the ethnic majority in the school class had increased odds for loneliness compared to adolescents that belonged to the ethnic majority. Furthermore, having more same-ethnic classmates lowered the odds for loneliness. We did not find any statistically significant association between the ethnic diversity of the school classes and loneliness. The study adds novel and important findings to how ethnicity in a school class context, as opposed to ethnicity per se, influences adolescents' loneliness.

Matrix metalloproteinases and psychosocial factors in acute coronary syndrome patients

Psychosocial factors have been linked to cardiovascular diseases independently of traditional risk factors. The impact of psychosocial factors on plaque destabilizing factors, such as matrix metalloproteinases (MMPs) has been proposed although scarcely studied.

OBJECTIVE

To evaluate the relationships between hostility, perceived stress and social support with MMPs activity in patients after an Acute Myocardial Infarction (AMI).

METHODS

Blood samples were obtained from 76 patients on admission, post-angioplasty, 24h, 7 days and 3 months after AMI. Hostility, perceived stress and social support were evaluated by validated questionnaires.

RESULTS

Social support was positively correlated with patientś ejection fraction (r=0.453, p=0.009). Patients with higher infarct size presented increased MMP-2 activity at admission (p=0.04). Patients with one diseased vessel had more social support than those with three diseased vessels (p=0.05). The highest values of MMP-2 and MMP-9 activity were observed at the acute event, decreasing, with the lowest activity at 3 months post-AMI (p<0.001). Only in patients with low social support, hostility correlated with MMP-2 activity, from AMI onset (r=0.645, p=0.013), to 7 days post AMI (r=0.557, p=0.038). Hostility explained up to 28% of the variance in MMP-2 activity (R(2)=0.28, p=0.005). Finally, in patients with high hostility, MMP-9 was positively correlated with IL-1β (r=0.468, p=0.02).

CONCLUSIONS

This study adds weight to the idea that two psychosocial factors, namely hostility and social support, acting jointly, may affect MMP-2 activity. Moreover, in hostile patients, there is a link between IL-1β and MMP-9. These findings support the role of psychosocial factors in plaque destabilization and in the inflammatory process in AMI.

Prevent the blue, be true to you: Authenticity buffers the negative impact of loneliness on alcohol-related problems, physical symptoms, and depressive and anxiety symptoms

This study investigated authenticity as a moderator of the association between loneliness and depressive symptoms, anxiety, physical symptoms, and alcohol-related problems. It was expected that loneliness and health outcomes would be negatively related and that relationship would be weaker among those higher in authenticity. Significant interactions emerged between authenticity and loneliness for each outcome such that authenticity mitigated the relationship between higher loneliness and negative health outcomes. Results suggest that authenticity may be an underutilized resource for lonely individuals and warrants future investigation. The potential implications are diverse and could be incorporated in college adjustment and health promotion programs.

Adolescent interpersonal relationships, social support and loneliness in high schools: Mediation effect and gender differences

The purpose of this study was to explore the associations between the qualities of different types of relationships in school, social support and loneliness in adolescence. Using a sample (N=1674) of adolescent students randomly selected from middle schools, we found boys' loneliness was influenced by the qualities of opposite-sex, teacher-student and same-sex relationships, whereas girls' loneliness was only influenced by same-sex relationships. Additionally, social support mediated the association between same-sex relationships and teacher-student relationships, and loneliness. Further, the quality of same-sex relationships showed stronger association with boys' loneliness than girls'. Finally, the quality of same-sex relationships showed the strongest association with boys' loneliness comparing with opposite-sex relationships and teacher-student relationships. These findings are discussed to illuminate the possible mechanisms by which interpersonal relationships could influence loneliness. In future research, causal relationships and other influencing factors on loneliness should be examined.

Prevalence and Social Determinants of Smoking in 15 Countries from North Africa, Central and Western Asia, Latin America and Caribbean: Secondary Data Analyses of Demographic and Health Surveys

Background

Article 20 of the World Health Organisation Framework Convention on Tobacco Control calls for a cross-country surveillance of tobacco use through population-based surveys. We aimed to provide country-level prevalence estimates for current smoking and current smokeless tobacco use and to assess social determinants of smoking.

Methods

Data from Demographic and Health Surveys done between 2005 and 2012, among men and women from nine North African, Central and West Asian countries and six Latin American and Caribbean countries were analyzed. Weighted country-level prevalence rates were estimated for ‘current smoking’ and ‘current use of smokeless tobacco (SLT) products’ among men and women. In each country, social determinants of smoking among men and women were assessed by binary logistic regression analyses by including men's and women's sampling weights to account for the complex survey design.

Findings

Prevalence of smoking among men was higher than 40% in Armenia (63.1%), Moldova (51.1%), Ukraine (52%), Azerbaijan (49.8 %), Kyrgyz Republic (44.3 %) and Albania (42.52%) but the prevalence of smoking among women was less than 10% in most countries except Ukraine (14.81%) and Jordan (17.96%). The prevalence of smokeless tobacco use among men and women was less than 5% in all countries except among men in the Kyrgyz Republic (10.6 %). Smoking was associated with older age, lower education and poverty among men and higher education and higher wealth among women. Smoking among both men and women was associated with unskilled work, living in urban areas and being single.

Conclusion

Smoking among men was very high in Central and West Asian countries. Social pattern of smoking among women that was different from men in education and wealth should be considered while formulating tobacco control policies in some Central and West Asian countries.

Alcohol and tobacco use in youth with and without chronic pain

OBJECTIVE

To compare rates of alcohol and tobacco use in youth with and without chronic pain and to identify risk factors for use.

METHODS

Participants included 186 youth (95 mixed chronic pain; 91 without chronic pain; 12-18 years old) who reported current alcohol and tobacco use, pain intensity, activity limitations, loneliness, and depressive symptoms.

RESULTS

Adolescents with chronic pain were less likely to use alcohol compared with adolescents without chronic pain (7.4% vs. 22%), and as likely to use tobacco (9% vs. 8%). Across groups, youth with higher depressive symptoms, less loneliness, and fewer activity limitations were more likely to endorse alcohol and tobacco use. Exploratory analyses revealed that risk factors for substance use differed among youth with and without chronic pain.

CONCLUSIONS

Chronic pain may not increase risk for tobacco and alcohol use in adolescents. Research is needed to understand use of other substances in this medically vulnerable population.

A Systematic Review of Loneliness and Smoking: Small Effects, Big Implications

BACKGROUND

Research supports an association between smoking and negative affect. Loneliness is a negative affective state experienced when a person perceives themselves as socially isolated and is associated with poor health behaviors and increased morbidity and early mortality.

OBJECTIVES

In this article, we systematically review the literature on loneliness and smoking and suggest potential theoretical and methodological implications.

METHODS

PubMed and PsycINFO were systematically searched for articles that assessed the statistical association between loneliness and smoking. Articles that met study inclusion criteria were reviewed.

RESULTS

Twenty-five studies met inclusion criteria. Ten studies were conducted with nationally representative samples. Twelve studies assessed loneliness using a version of the UCLA Loneliness Scale and nine used a one-item measure of loneliness. Seventeen studies assessed smoking with a binary smoking status variable. Fourteen of the studies were conducted with adults and 11 with adolescents. Half of the reviewed studies reported a statistically significant association between loneliness and smoking. Of the studies with significant results, all but one study found that higher loneliness scores were associated with being a smoker.

CONCLUSIONS/IMPORTANCE

Loneliness and smoking are likely associated, however, half of the studies reviewed did not report significant associations. Studies conducted with larger sample sizes, such as those that used nationally representative samples, were more likely to have statistically significant findings. Future studies should focus on using large, longitudinal cohorts, using measures that capture different aspects of loneliness and smoking, and exploring mediators and moderators of the association between loneliness and smoking.