Policy responses to multiple risk behaviours in adolescents

The experience of adolescence process among French teenager pregnancies: a mixed-methods study

PURPOSE

Teenage pregnancy remains a significant global public health concern worldwide. However, it presents a complex phenomenon in developed countries, carrying potential short- and long-term consequences for both mothers and children.

METHODS

This mixed method study used data from the French cross-sectional study "Portraits of adolescents", which included 6000 girls aged between 13 and 17 years. The quantitative approach involved comparisons between a subgroup with an history of pregnancy and their peers, examining their lived-experience and mental health. The qualitative approach investigated the question "What does being a teenager mean for you?" specifically for the girls who reported an history of pregnancy.

RESULTS

Teenage pregnancies presented elevated rates of mental health disorders, including dark thoughts, depression, self-harm, participating in dangerous games, attempting suicide and increased use of psychoactive substances. With limited support, in comparison to their peers. The qualitative approach revealed three major themes: "being in action", "a way of feeling", and "quality of relationship".

CONCLUSION

This vulnerable subgroup of adolescents suggests the need for a coordinated multidisciplinary healthcare approach, given their limited parental and friend support, with a high risk of experiencing poor mental health. Additionally, these findings portray a "silent sufferer" population characterized by difficulties recognizing or managing emotions due to difficulties in expressing their emotional distress.

YouTube vloggers set the stage: How public (non)compliance with COVID-19 regulations affects adolescents

INTRODUCTION

YouTube vloggers may be important socialization figures, yet their influence on adolescents' health-related behaviors and cognitions is largely untested. In this two-study mixed-method project, we first assessed the extent of (non)compliance to COVID-19 regulations by vloggers on YouTube and how viewers reacted to this. Second, we experimentally assessed the effects of vlogger behavior paired with viewer evaluations on adolescents' COVID-19-related attitudes, intentions, and behavior.

METHODS

For Study 1, we coded 240 vlogs of eight popular Dutch vloggers on YouTube recorded in the period of February 2020-March 2021. For our 2 × 2 between-subjects experiment in Study 2, Dutch adolescents (N = 285, Mage = 12.99, SD = 1.02, 41.8% girls) were randomly assigned to conditions in which they saw vlogs showing either compliance or noncompliance to COVID-19 regulations, and to conditions in which they saw either supportive or dismissive comments under these vlogs.

RESULTS

Study 1: Vloggers' noncompliance with COVID-19 regulations was not uncommon and received relatively more viewer support than compliance, suggesting that portrayed noncompliance may be potentially influential. Study 2: Adolescents were more worried about COVID-19 after they watched a compliant (vs. noncompliant) vlogger. Also, vlogger noncompliance decreased adolescents' perceived importance of COVID-19 regulations and rule-setting for adolescents who identified strongly with the vloggers they watched.

CONCLUSIONS

Vloggers' (non)compliance affects adolescents' COVID-19-related worrying, and attitudes and behavior of adolescents who identify with vloggers strongly. This seems concerning given the sometimes harmful and risky behaviors vloggers portray online but could potentially also be employed to encourage healthy behaviors.

Autism, autistic traits and multiple risk behaviours in adolescence: a longitudinal birth cohort study

BACKGROUND

Multiple risk behaviours (MRBs), typically beginning in adolescence, are associated with increased risk of adverse health and social outcomes. The association between autism and MRBs is little understood.

METHODS

Data were from the Avon Longitudinal Study of Parents and Children, an UK-based longitudinal, birth cohort study. Exposures were diagnosed autism and four autistic traits: social communication difficulties, pragmatic language, repetitive behaviours and reduced sociability. Outcomes were participation in up to 14 risk behaviours, including alcohol consumption, smoking, risky sexual behaviours and physical inactivity. Outcome data were collected at ages approximately 12, 14, 16 and 18.

RESULTS

Up to 4300 participants were included in latent basis growth curve analyses with adjustment for confounders. Social communication difficulties were associated with an above average level of MRBs engagement at ~12 years (mean difference β 0.26; 95% CI 0.13-0.40), and above average rate of engagement from ages ~12-18 (β 0.08; 95% CI 0.02-0.13). Repetitive behaviours were associated with above average levels of engagement in MRBs at ~12 years (β 0.24; 95% CI 0.09-0.38). Contrastingly, reduced sociability was associated with a reduced rate of engagement in MRBs from ages ~12-18 (β -0.06; 95% CI -0.11 to -0.02). In sex-specific analyses, persisting differences in MRB engagement patterns from ages ~12-18 were observed in males with social communication difficulties and females with reduced sociability temperament.

CONCLUSIONS

Having elevated levels of some autistic traits appear to have differentiated effects on MRB engagement patterns. These findings could reflect difficulties fitting in and/or coping mechanisms relating to difficulties with fitting in.

Parenting, emotion regulation, and externalizing symptomatology as adolescent antecedents to young adult health risk behaviors

This study used longitudinal data to elucidate how trajectories of negative parenting across adolescence are associated with young adult health risk behaviors (HRBs) by testing difficulties with emotion regulation and externalizing symptomatology as sequential underlying mediators. The sample included 167 adolescents (53% males, M_age  = 14 at Time 1 and M_age  = 18 at Time 5) who were assessed five times. Adolescents self-reported on negative parenting, emotion regulation, externalizing symptomatology, and engagement in HRBs. Results suggest that increasingly negative parenting across adolescence has adverse consequences for emotion regulation development and in turn, externalizing symptomatology, which confers risk for young adult HRBs. Results offer insights towards mechanisms for prevention and intervention and public health policy aimed at reducing the prevalence and consequences of engagement in HRBs.

Cluster Analysis of Sleep Time and Adolescent Health Risk Behaviors

Adolescents are prone to multiple health risk behaviors. These might lead to insufficient sleep, which is inconducive to adolescent growth. Therefore, this study explored the impact of a cluster of adolescent health risk behaviors on sleep time, providing a reference for designing relevant intervention measures. From November to December 2019, a stratified cluster sampling method was used to sample middle and high schools in 4 functional districts of Chongqing, China. A total of 8546 participants were selected for a questionnaire survey. Two-step clustering helped identify the health risk behavior clusters. Multivariate logistic regression models helped examine the association between the different clusters and sleep time. The rate of insufficient sleep was 65.8%. Three types of clusters were identified, namely (1) high-risk (poor) cluster (17.3%), (2) low physical activity (medium) cluster (55.1%), and (3) low-risk (good) cluster (27.6%). The high-risk and low physical activity clusters showed that the adjusted OR values of 1.471 (1.266-1.710) and 1.174 (1.052-1.310) were significantly associated with insufficient sleep (P < .001). Adolescent health risk behaviors were clustered, and different clusters had different sleep time. Schools authorities and healthcare practitioners should formulate effective intervention measures according to the characteristics of different clusters to promote healthy growth among adolescents.

The potential of intervention-based community development programs in reducing multiple health risk behaviors among adolescent: A scoping review of the latest RCTs

Background: Adolescents are more likely than adults to engage in risky health behaviors such as smoking, drinking, and sexual activity. Community development plays a role in reducing adolescents’ personal, cognitive, and social skill deficits. A review of the effectiveness of community-development interventions is required to advance our understanding of how the intervention reduce health risk behaviors. This study analyze type and effectiveness of adolescents’ community development programs reduce multiple health risk behaviors among adolescents. Methods: This scoping review used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR). With a date range of 2015–2021, searches were conducted in PubMed, EBSCO, and ProQuest using keywords (((Life skill education) OR (community development)) AND ((health risk behavior) OR (risk behavior)) AND ((adolescent) OR (adolescence) OR (teenagers) OR (teens) OR (youth))). After title and abstract checking, full-text retrieval, and data extraction, data were synthesized based on the main objectives. The most important data were tabulated. Results: Most studies showed that community development–based interventions effectively reduce adolescents’ health risk behaviors, including risky sexual behaviors, drug and alcohol use. Interventions were carried out in schools, places of worship, and communities, involving adolescents, educational institutions, health professionals, religious leaders, and families. Conclusion: This review can assist community health nurses, policymakers, researchers, and teachers in developing and implementing effective community-development programs that ensure knowledge, attitudes, and skills transfer to reduce health risk behaviors.

Cluster analysis of risky behaviors among the youth in Western Iran: Determining correlates and comparing clusters based on severity of disability and attitude toward mental health help-seeking

BACKGROUND AND AIMS

The objectives of the study were (i) cluster analysis of risky behaviors; (ii) determining correlates; and (iii) comparing clusters with regard to the attitude toward mental health help seeking.

METHODS

The current cross-sectional study is a part of the first phase of the Persian Youth Cohort. From October 2014 to January 2017, 2990 individuals from Ravansar City in western Iran completed structured interviews and national and international standard questionnaires. The obtained data were analyzed using two-stage cluster analysis, multinomial logistic regression analysis, and Chi-square test.

RESULTS

This model provided three distinct clusters: (i) low-risk group with mild distress, (ii) high-risk group with high distress, and (iii) violent group with medium distress. Some sociodemographic and lifetime psychiatric disorders were the correlates of unhealthy clusters (P < 0.05). Compared to the reference cluster, a higher number of members in unhealthy clusters were suffering from medium to severe disability. Nevertheless, the participants in these clusters were less inclined to mental health help seeking.

CONCLUSIONS

More than half of the youth were suffering from suicidal and violent behaviors. Since high-risk participants are less inclined to mental health help seeking, the health policymakers can successfully utilize the results in planning general health programs.

Mental health and risky sexual behaviors among Chinese college students: a large cross-sectional study

BACKGROUND

College students are at-risk populations of mental health problems and risky sexual behaviors. However, little literature focuses on the association between mental health problems and risky sexual behaviors. Our study examined the association between mental health problems (depressive symptoms, suicide, and mental disorders) and risky sexual behaviors among a large sample of Chinese college students.

METHODS

A total of 49,728 Chinese college students (47.5% male) eventually participated in the analysis. A self-administered questionnaire was used to measure mental health, risky sexual behaviors (casual sex, no condom use at last sexual intercourse, group-sex, and a high number of sexual partners), and other sociodemographic characteristics. Logistic regression analysis was used to explore the relationship between mental health and risky sexual behaviors. To ensure the data is representative of the nation's statistics, all analyses were weighed.

RESULTS

The prevalence of depressive symptoms, suicide ideation and suicide attempts, and mental disorders was 42.83%, 41.29%, and 7.74%, respectively. 26.13% of participants were sexually active in the previous twelve months. Nearly 35% of sexually active participants were engaged in risky sexual behaviors. Logistic regression results demonstrated that mental health problems were associated with risky sexual behaviors after adjusting confounders.

LIMITATIONS

cross-sectional analysis; The self-reported variables may be subject to recall bias and fraud.

CONCLUSIONS

There is a relatively high prevalence of mental health problems and risky sexual behaviors amongst Chinese college students. A significant association between mental health problems and risky sexual behaviors was suggested by our study. Our findings support the importance of advocating for mental and reproductive healthcare for college students.

Can We Reverse this Trend? Exploring Health and Risk Behaviours of Grade 12 Cohorts of Ontario Students from 2013-2019

Adolescents engage in multiple health risk behaviours that put them at risk of future chronic disease. By the time students graduate from secondary school, they may be engaging in behaviours that set them on a particular health trajectory. It is important to monitor the co-occurrence of health risk behaviours of cohorts of grade 12 students over time to highlight important areas for intervention. The purpose of this study was to examine trends in health and risk behaviours over six waves among subsequent cohorts of grade twelve students from Ontario, Canada. A total of 44,740 grade 12 students participated in the COMPASS study across the six waves (2013/14 to 2018/19), and self-reported movement (physical activity, screen time, sleep), dietary (fruit and vegetables, breakfast), and substance use (smoking, vaping, binge drinking, and cannabis use) behaviours. Over 91.0% of students reported engaging in three or more health risk behaviours, with increases in the number of students reporting inadequate sleep, not eating breakfast on every school day, and vaping over time. Although modest, the wave 6 cohort reported slightly more risk behaviours compared with the wave 1 cohort, highlighting the importance of multidimensional health promotion strategies across multiple settings.

Multiple Health Risk Factors in Vocational Education Students: A Systematic Review

Health risk factors such as tobacco smoking, inadequate fruit intake, inadequate vegetable intake, risky alcohol consumption, physical inactivity, obesity, anxiety and depression often commence during adolescence and young adulthood. Vocational education institutions enrol many students in these age groups making them an important setting for addressing multiple health risk factors. This systematic review examined (i) co-occurrence of health risk factors, (ii) clustering of health risk factors, and (iii) socio-demographic characteristics associated with co-occurrence and/or clusters of health risks among vocational education students. MEDLINE, PsycINFO, EMBASE, CINAHL and Scopus were searched to identify eligible studies published by 30 June 2020. Two reviewers independently extracted data and assessed methodological quality using the National Heart, Lung and Blood Institute Quality Assessment Tool. Five studies assessed co-occurrence and three studies clustering of health risks. Co-occurrence of health risk factors ranged from 29–98% and clustering of alcohol use and tobacco smoking was commonly reported. The findings were mixed about whether gender and age were associated with co-occurrence or clustering of health risks. There is limited evidence examining co-occurrence and clustering of health risk factors in vocational education students. Comprehensive assessment of how all these health risks co-occur or cluster in vocational education students is required.

Declining health risk exposure among Chicago public high school students: Trends from the Youth Risk Behavior Survey 1997-2017

There have been improvements nationally in teenagers' self-reported health risk since the 1990s. This study provides an overview of trends in substance use, sexual health, violence and victimization, and suicide risk among Chicago Public High School (CPS) students over a 20-year period. We compared responses to 29 identically worded items from the 1997, 2007, and 2017 Chicago Youth Risk Behavior Survey (YRBS) in the four domains. We show changes in responses across individual items, mean changes across the four domains, and change in the proportion of students with highest risk exposure (≥10 affirmative responses). Analyses control for CPS students' grade, sex, and race/ethnicity. Reductions in substance use, sexual health risk, and violence and victimization (30, 40% and 40% in the mean number of affirmative responses, respectively) were observed. Suicide risk showed an initial improvement from 1997 to 2007, only to worsen by 2017 and show little difference from 1997. There was an approximate 70% decrease in the likelihood of being in the high multiple risk category (≥10 affirmative responses) in 2017 compared to 1997 (OR 0.33; CI 0.22-0.49). In alignment with national trends, our study documents significant improvement in Chicago public high school students' long-term health risk exposure over the 20-year study period, with the notable exception of suicide risk. This study emphasizes the need to invest in strategies both inside and outside of the classroom to mitigate the effect of adversity and promote protective factors, which are at the root of academic success and overall wellbeing.

Clustering of health risk behaviors among adolescents in Kilifi, Kenya, a rural Sub-Saharan African setting

BACKGROUND

Adolescents tend to experience heightened vulnerability to risky and reckless behavior. Adolescents living in rural settings may often experience poverty and a host of risk factors which can increase their vulnerability to various forms of health risk behavior (HRB). Understanding HRB clustering and its underlying factors among adolescents is important for intervention planning and health promotion. This study examines the co-occurrence of injury and violence, substance use, hygiene, physical activity, and diet-related risk behaviors among adolescents in a rural setting on the Kenyan coast. Specifically, the study objectives were to identify clusters of HRB; based on five categories of health risk behavior, and to identify the factors associated with HRB clustering.

METHODS

A cross-sectional survey was conducted of a random sample of 1060 adolescents aged 13-19 years living within the area covered by the Kilifi Health and Demographic Surveillance System. Participants completed a questionnaire on health behaviors which was administered via an Audio Computer-Assisted Self-Interview. Latent class analysis on 13 behavioral factors (injury and violence, hygiene, alcohol tobacco and drug use, physical activity, and dietary related behavior) was used to identify clustering and stepwise ordinal logistic regression with nonparametric bootstrapping identified the factors associated with clustering. The variables of age, sex, education level, school attendance, mental health, form of residence and level of parental monitoring were included in the initial stepwise regression model.

RESULTS

We identified 3 behavioral clusters (Cluster 1: Low-risk takers (22.9%); Cluster 2: Moderate risk-takers (67.8%); Cluster 3: High risk-takers (9.3%)). Relative to the cluster 1, membership of higher risk clusters (i.e. moderate or high risk-takers) was strongly associated with older age (p<0.001), being male (p<0.001), depressive symptoms (p = 0.005), school non-attendance (p = 0.001) and a low level of parental monitoring (p<0.001).

CONCLUSION

There is clustering of health risk behaviors that underlies communicable and non-communicable diseases among adolescents in rural coastal Kenya. This suggests the urgent need for targeted multi-component health behavior interventions that simultaneously address all aspects of adolescent health and well-being, including the mental health needs of adolescents.

Behaviour change interventions to reduce risky substance use and improve mental health in children in care: the SOLID three-arm feasibility RCT

Background

Looked-after children and care leavers (henceforth children in care) are young people placed under the care of local authorities, often because of a history of family abuse and/or neglect. These young people have significantly increased risk of substance use and mental health problems compared with peers.

Aim

The Supporting Looked After Children and Care Leavers In Decreasing Drugs, and alcohol (SOLID) trial aimed to investigate the feasibility of a definitive randomised controlled trial comparing two behaviour change interventions to reduce risky substance use (illicit drugs and alcohol) in and improve the mental health of children in care aged 12–20 years.

Methods

The study consisted of two phases: (1) a formative phase that adapted the motivational enhancement therapy and social behaviour and network therapy interventions for use with children in care and (2) a three-arm pilot randomised controlled trial (comparing motivational enhancement therapy, social behaviour and network therapy and usual care), and a linked process and economic (return on investment) evaluation. Trial feasibility was compared with prespecified STOP/GO criteria.

Setting

Six local authority areas in the north-east of England.

Participants

Children in care (aged 12–20 years) who screened positive for drug and/or alcohol use within the last 12 months were eligible for the trial. The formative and process evaluations included children in care, carers, social workers, and drug and alcohol workers.

Outcome measures

The primary outcomes were recruitment and retention rates at 12 months’ follow-up. Baseline and 12-month follow-up questionnaires measured self-reported drug and alcohol use, mental health and health-related quality of life. The process evaluation considered acceptability and engagement with the interventions and trial procedures.

Results

Formative findings (n = 65) highlighted the need for interventions to increase the emphasis on therapeutic relationships, use creative methods of engagement and support the identification of treatment goals wider than substance misuse. Within the randomised controlled trial, of 860 participants screened, 211 (24.5%) met the inclusion criteria. One hundred and twelve (53%) of the 211 eligible children were recruited and randomised. Just 15 of the 76 (20%) participants allocated to intervention attended any of the motivational enhancement therapy of social behaviour and network therapy sessions, and 60 (54%) participants completed the 12-month follow-up. The screening and recruitment of children in care required significantly more time and resource investment by researchers and children’s services than planned. The process evaluation (n = 116) demonstrated that, despite participants engaging in risky substance use, they did not often acknowledge this nor felt that they needed help. Children in care had complex, chaotic lives and children’s services departments were less research mature and extremely stretched; this, coupled with the multiple steps in the intervention pathway and study protocol, resulted in low adherence to the intervention and the trial.

Conclusions

The SOLID trial demonstrated successful engagement with children in care to adapt the motivational enhancement therapy and social behaviour and network therapy interventions. However, the pilot randomised controlled trial found that a definitive trial is not feasible. The current screen, refer and treat pathway for children in care did not work. There is an urgent need to radically rethink how we deliver therapeutic services for children in care. A pragmatic evaluation design, coupled with additional research resource for children’s services, is needed to evaluate these novel models of care at scale.

Trial registration

This study is registered as PROSPERO CRD42018098974 and Current Controlled Trials ISRCTN80786829.

Funding

This project was funded by the National Institute for Health Research (NIHR) Public Health Research programme and will be published in full in Public Health Research; Vol. 8, No. 13. See the NIHR Journals Library website for further project information.

Prevalence of high-risk behaviors in reproductive age women in Alborz province in 2019 using unmatched count technique

Background

Our knowledge on the prevalence of high-risk behaviors among women of Alborz is not reliable due to the sensitivity of the issue. This study aimed to estimate the prevalence of seven risk behaviors among the reproductive age women in Alborz Province, Iran.

Method

In this cross-sectional study, 2000 women were randomly selected from a registered healthcare system in 2019. A researcher-made questionnaire was used to collect the required data. The prevalence of the risk behaviors including drug abuse, hookah, alcohol drinking, tobacco smoking, extramarital intercourse, and gambling was estimated using the unmatched count technique, and the prevalence rate was reported at a 95% confidence interval.

Results

The response rate for this study was 95%. The estimated prevalence for drug abuse, hookah, alcohol drinking, tobacco smoking, extramarital intercourse, and gambling were 3% (95%CI: 2.78 to 3.22), 10.5% (95%CI: 10.29 to 10.71), 7% (95%CI: 6.78 to 7.22), 10% (95%CI: 9.78 to 10.22), 8.7% (95%CI, 8.29 to 8.71), and 7.5% (95%CI, 4.71 to 7.28), respectively.

Conclusion

High risk behaviors are highly prevalent among Iranian women. Enforcing laws, prohibition, marketing restrictions, increasing taxation, expanding treatment, promoting condom distribution and providing community-based service are recommended to reduce the effects of high risk behaviors among women.

Blurring the boundaries between synthesis and evaluation. A customized realist evaluative synthesis into adolescent risk behavior prevention

Realist methodologies have been increasingly advocated for the investigation of complex social issues. Public health programs, such as those designed to prevent adolescent risk behavior, are typically considered complex. In conducting a realist review of the empirical literature relating to such programs, we encountered several challenges, including (a) an overabundance of empirical evidence, (b) a problematic level of heterogeneity within and between methodological approaches, (c) discrepancies between theoretical underpinnings and program operationalization, (d) homogeneity of program outcomes, with very little variation in program effectiveness, and (d) a paucity of description relating to content and process. To overcome these challenges, we developed a customized approach to realist evidence synthesis, drawing on the VICTORE (Volition, Implementation, Contexts, Time, Outcomes, Rivalry, and Emergence) complexity checklist and incorporating stakeholder engagement as primary data to achieve greater depth of understanding relating to contextual and mechanistic factors, and the complex interactions between them. Here we discuss the benefits of this adapted methodology alongside an overview of the research through which the methodology was developed. A key finding from this research was that combining the complexity checklist with primary data from stakeholder engagement enabled us to systematically interrogate the data across data sources, uncovering and evidencing mechanisms which may otherwise have remained hidden, giving greater ontological depth to our research findings. This paper builds on key methodological developments in realist research, demonstrating how realist methodologies can be customized to overcome challenges in developing and refining program theory from the literature, and contributes to the broader literature of innovative approaches to realist research. HIGHLIGHTS: Published reporting standards for realist review provide a set of guiding principles for conducting realist research. However, these are not recommended to be used in a prescriptive sense, and customization of the methodology to account for potential idiosyncrasies within a specific evidence base is accepted. A small number of papers within the existing literature have used each of the two key adaptions discussed within this study, though reasons for doing so have not been considered in any great depth. Furthermore, combining both of these adaptions to take an evaluative approach to realist synthesis is novel to this work and lends greater ontological depth to the research findings than may otherwise have been achieved. This study builds on key methodological developments in realist research, demonstrating how realist methodologies can be customized to overcome challenges in developing and refining program theory from the literature, and contributes to the broader literature of innovative approaches to realist research.

Scaling up Evidence-Based Interventions in US Public Systems to Prevent Behavioral Health Problems: Challenges and Opportunities

A number of programs, policies, and practices have been tested using rigorous scientific methods and shown to prevent behavioral health problems (Catalano et al., Lancet 379:1653-1664, 2012; National Research Council and Institute of Medicine, 2009). Yet these evidence-based interventions (EBIs) are not widely used in public systems, and they have limited reach (Glasgow et al., American Journal of Public Health 102:1274-1281, 2012; National Research Council and Institute of Medicine 2009; Prinz and Sanders, Clinical Psychology Review 27:739-749, 2007). To address this challenge and improve public health and well-being at a population level, the Society for Prevention Research (SPR) formed the Mapping Advances in Prevention Science (MAPS) IV Translation Research Task Force, which considered ways to scale up EBIs in five public systems: behavioral health, child welfare, education, juvenile justice, and public health. After reviewing other efforts to scale up EBIs in public systems, a common set of factors were identified as affecting scale-up in all five systems. The most important factor was the degree to which these systems enacted public policies (i.e., statutes, regulations, and guidance) requiring or recommending EBIs and provided public funds for EBIs. Across systems, other facilitators of scale-up were creating EBIs that are ready for scale-up, public awareness of and support for EBIs, community engagement and capacity to implement EBIs, leadership support for EBIs, a skilled workforce capable of delivering EBIs, and data monitoring and evaluation capacity. It was concluded that the following actions are needed to significantly increase EBI scale-up in public systems: (1) provide more public policies and funding to support the creation, testing, and scaling up of EBIs; (2) develop and evaluate specific frameworks that address systems level barriers impeding EBI scale-up; and (3) promote public support for EBIs, community capacity to implement EBIs at scale, and partnerships between community stakeholders, policy makers, practitioners, and scientists within and across systems.

Making a Case for Integrating Evidence-Based Sexual Risk Reduction and Mental Health Interventions for Adolescent Girls

Recently identified as the top concern of teens, mental health issues now compete with sexual health risks as major threats to the well-being of adolescent females. Depression and anxiety can lead to or compound the negative repercussions of sexual behavior choices that result in disproportionately high rates of sexually-transmitted infections (STIs), hetero-sexually acquired HIV, and unplanned pregnancy rates in girls ages 15-19. There are a limited number of CDC- and DHHS-recognized HIV/STI and teen pregnancy evidence-based interventions (EBIs) targeted to adolescent girls of diverse races/ethnicities and none that simultaneously address common mental health disorders. The Health Improvement Project for Teens (HIPTeens), a manualized gender-specific sexual risk reduction intervention, and the Creating Opportunities for Personal Empowerment (COPE) Program, a manualized cognitive-behavioral skills intervention that reduces depression and anxiety, are recognized by national agencies as strong EBIs that have successfully improved their targeted outcomes. Baseline data from the HIPTeens clinical trial revealed that a substantial portion of the more than 700 girls enrolled had moderate to high levels of depressive symptoms as well as other mental health challenges (e.g., binge drinking and eating, cannabis use). Thus, there is an urgent need to combine EBIs, such as HIPTeens and COPE, to curtail these leading public health problems confronting today's adolescents.

Epidemiological trends and risk factors for tobacco, alcohol and drug use among adolescents in Scotland, 2002-13

BACKGROUND

This study estimates trends in prevalence, and patterns, of individual and multiple substance use between 2002 and 2013 amongst adolescents in Scotland.

METHODS

The study uses data from 134 387 participants of the biennial national 'Scottish Schools Adolescent Lifestyle and Substance Use Survey' on smoking, alcohol and illicit drug use. Current regular use and current heavy use of smoking, alcohol, illicit drugs and multiple substances was measured. Time trends in the prevalence of each outcome were estimated using univariate and multivariate logistic regression.

RESULTS

Regular smoking, alcohol, illicit drug and multiple substance use declined significantly amongst adolescents in Scotland. However, multivariate analyses that focussed upon high-risk levels of these behaviours revealed an upward linear trend in heavy alcohol (OR = 1.06; 95% CI: 1.04, 1.07) and heavy illicit drug (OR = 1.04; 95% CI: 1.00, 1.08) use (P < 0.05). Non-white pupils were more likely to be involved in individual and multiple substance use than ethnically white British pupils. In comparison to pupils from the least deprived socioeconomic quintile, pupils from the most deprived quintile had increased odds of 1.41 (95% CI: 1.02, 1.97; P < 0.05) and 1.62 (95% CI: 1.14, 2.29; P < 0.05) of being regular and heavy multiple substance users, respectively.

CONCLUSIONS

Further effort is required to tackle heavy alcohol and heavy illicit drug use amongst adolescents in Scotland. Prevention strategies should be informed by the risk profiles of substance misusers and evidence around the clinical and cost-effectiveness of preventive interventions.

Psychopathology is associated with reproductive health risk in European adolescents

Background

Reproductive and mental health are key domains of adolescent wellbeing but possible interrelationships are poorly understood. This cross-sectional study evaluated the association between psychopathology and reproductive health risk among European adolescents.

Methods

A structured self-report questionnaire was delivered to 12,395 pupils of 179 randomly selected schools in 11 European countries within the EU funded “Saving and Empowering Young Lives in Europe” (SEYLE) project. The questionnaire included items about sexual initiation and reproductive health risk factors, such as number of sexual partners, frequency of condom use, and pregnancy involvement. Psychopathology was evaluated with validated instruments and/or ad-hoc questions.

Results

Of 11,406 respondents (median age 15; interquartile range [IQR] 14–15; 57% females), 18.8% reported sexual initiation. Sixty percent of them also reported at least one reproductive risk factor. Sexual initiation was significantly more common among pupils older than 15 years (38% versus 13.2% younger pupils) and males (21.3% versus 16.9% females). It was also more common among pupils with depression (age/sex-adjusted odds ratio [aOR] 1.871), anxiety (aOR 2.190), severe suicidal ideation (aOR 2.259), self-injurious behaviour (aOR 2.892), and suicide attempts (aOR 3.091). These associations were particularly strong among pupils ≤15 years old and, for overt psychopathology, among pupils with low non-sexual risk behaviour profile and females. Depression (aOR 1.937), anxiety (aOR 2.282), severe suicidal ideation (aOR 2.354), self-injurious behaviour (aOR 3.022), and suicide attempts (aOR 3.284) were associated with higher reproductive health risk, defined by an increasing number of coexisting reproductive risk factors.

Conclusions

These findings suggest an alignment between mental and reproductive health risk and support the value of cross-domain collaboration in adolescent health. The association between psychopathology and reproductive health risk, as well as its variations with age, sex, and associated risk behaviours, should be considered when designing health-promoting or disease-preventing interventions for adolescents.

Behavioral risk factor clusters among university students at nine universities in Libya

OBJECTIVES

This study identifies and describes the clustering of 5 behavioral risk factors (BRFs) among university students. We also investigated whether cluster membership is associated with the students' self-rated academic performance and self-rated health.

MATERIAL AND METHODS

A sample of 1300 undergraduates at 6 universities and 3 colleges in Libya completed a self-administered questionnaire that assessed BRFs (nutrition, physical activity, alcohol consumption, smoking, illicit drug use, inadequate sleep). A two-step cluster analysis generated student clusters with similar lifestyles.

RESULTS

Two contrasting clusters of almost even size emerged (after exclusion of alcohol and illicit drug use due to very low prevalence). Cluster 1 comprised students with higher engagement in all forms of physical activity, higher levels of health consciousness, greater daily fruit/vegetable intake and better sleep patterns than students in cluster 2. Only as regards the consumption of sweets, cluster 1 students had less favorable practices than cluster 2 students. The prevalence of smoking was equally low in both clusters. Students in cluster 2, depicting a less healthy lifestyle, were characterized by a higher proportion of women, of students with less income and of higher years of study. Belonging to cluster 2 was associated with lower self-rated health (OR: 0.46, p < 0.001) and with lower self-rated academic performance (OR: 0.66, p < 0.001).

CONCLUSION

Preventive programs should not address BRFs in isolation and should particularly target students with clustering of BRFs using specifically tailored approaches.

Dieting predicts engagement in multiple risky behaviours among adolescent Canadian girls: a longitudinal analysis

OBJECTIVES

We investigated associations between dieting and other health-compromising behaviours among adolescent girls, both cross-sectionally and longitudinally. The behaviours considered included smoking, binge drinking, and breakfast-skipping, and clusters of these.

METHODS

Data for 3386 adolescent Ontario girls were drawn from COMPASS, a school-based study, which collects self-reported measures of weight, dieting, and other health-related factors. Multilevel logistic regression models were used to investigate relationships between dieting at baseline and smoking, binge drinking, and breakfast-skipping, as well as clusters of these behaviours at baseline and 2 years later.

RESULTS

Baseline dieters were at an elevated risk of smoking and binge drinking (RR = 1.8 and 1.5, respectively) by follow-up compared to non-dieters. Further, dieting was associated with combinations of these behaviours, with the highest risks for smoking/breakfast-skipping (RR = 1.64) and smoking/binge drinking (RR = 1.55). Over one in two (58%) girls reported dieting at baseline and four in five baseline dieters reported dieting 2 years later. Seven in ten girls were dieting at one or both time points. Baseline dieters were more likely to engage in a greater number of risky behaviours, regardless of what the actual behaviours were.

CONCLUSION

Dieting is longitudinally associated with engagement in other risky behaviours among adolescent girls. These findings suggest that dieting may be an early risk factor for engagement in other risky behaviours and highlight the need for comprehensive prevention strategies to target shared underlying drivers. In addition, attention is needed to the potential for well-meaning weight-related initiatives to promote dieting.

Correlates of sexual initiation among European adolescents

Background

Sexuality is a physiological component of adolescent development, though early initiation is associated with reproductive health risk. This study aimed at identifying correlates and predictors of sexual initiation in a large multinational cohort of European adolescents.

Methods

A questionnaire addressing socio-demographics, behaviours, mental health and sexual activity, was delivered to 11,110 adolescents recruited from 168 randomly selected schools in 10 European countries between 2009 and 2011. A follow-up questionnaire was delivered after 12 months. The longitudinal association of baseline risk behaviors, psychological attributes and contextual vulnerabilities, with sexual initiation during follow-up was evaluated through simple and multivariable age/sex stratified logistic regression. Multinomial logistic regression measured the association between predictors and sexual initiation with or without coexisting reproductive risk factors, such as multiple partners or infrequent condom use.

Results

Baseline sexual experience was reported by 19.2% of 10,757 respondents (median age 15; IQR 14–15; females 59.6%). This was significantly more frequent among pupils older than 15 (41%) and males (20.8%). Of 7,111 pupils without previous experience who were available at follow-up (response rate 81.8%), 17% reported sexual initiation, without differences between females and males. Baseline smoking (age/sex adjusted odds ratio [aOR] 3.63), alcohol use (aOR 2.95), illegal drugs use (aOR 2.72), and poor sleep (aOR 1.71) predicted sexual initiation. Stratified analyses showed a particularly strong association in case of younger and female pupils, and, among girls, when initiation was reported together with multiple partners and/or infrequent condom use. Externalizing (i.e. conduct and hyperactivity) symptoms independently predicted sexual initiation. Internalizing difficulties (i.e. emotional and peer problems) were negatively associated with early and risky sexual initiation among boys. Significant predictors included also being bullied, fighting, truancy, and low parental involvement.

Conclusions

Adolescent sexual behaviours are related to non-sexual risk behaviours, psychological difficulties and contextual vulnerabilities. While gateway effects explain some associations, a comprehensive model is needed to understand adolescent sexual behaviours, their physical, mental, and social health outcomes, and their potential positive effects on wellbeing. Tailored interventions may need to consider younger girls as a particularly vulnerable group in view of a strong association between non-sexual and sexual behaviors.

DNA methylation from birth to late adolescence and development of multiple-risk behaviours

BACKGROUND

Risk behaviours in adolescence are linked to poor educational attainment and health and other outcomes in young adulthood. We explored whether there are molecular mechanisms associated with the development, or the result, of multiple risk behaviours (MRBs).

METHODS

MRBs (antisocial behaviour and delinquency, traffic-related risk behaviour, risky sexual behaviour, lack of exercise) and their sumscore were characterized based on self-reported questions at age 7 and 17 within the ARIES subsample of the ALSPAC birth cohort, and were linked to DNA methylation at over 485,000 CpG sites at ages 0,7 and 17. Associations were determined for participants with complete data (n = 227-575).

RESULTS

There was weak evidence of associations between cumulative MRBs and methylation at cg01783492 and cg16720578 at age 17. DNA methylation at age 17 was associated with risky sexual behaviour (cg22883332), lack of exercise (cg03152353, cg20056908, cg20571116) and substance use (cg02188400, cg13906377). No associations between DNA methylation and individual risk behaviours at age 7 were observed. DNA methylation at age 7 might predispose for traffic-related risk behaviour (cg24683561) and substance use (cg08761410) at age 17.

LIMITATIONS

Main limitations are absence of information on directly measured blood cell type proportions and tissue specificity, and a modest sample size.

CONCLUSIONS

Cumulative MRB in late adolescence was associated with effects on DNA methylation. More specifically, risky sexual behaviour and sedentary behaviour are associated with changes in DNA methylation, while DNA methylation in childhood may predict later traffic-related risky behaviour. For substance use effects in both temporal directions were observed.

Marijuana use among youths in Mississippi, United States

Background Increased use of marijuana among youths in Mississippi, United States is of great concern to Public Health in the 21st century. This study examined the prevalence of marijuana use according to gender, race and ethnicity. Method The data for this study was obtained from Youth Risk Behavior Surveillance System (YRBSS) for 2015, a cross-sectional survey of the Mississippi High School Students, which examined the prevalence and trends in the use of marijuana according to gender, race and ethnicity. The trends in the percentage of students that reported the use of marijuana and its product was examined by univariate t-test statistical analysis at p < 0.05. The frequency distribution was used to determine the percentage differences in the groups. Results The students that ever used marijuana was 39.4% in Blacks, 39.1% in Hispanics and 31.0% in Whites. A total of 13.7% male and female (4.8%) used marijuana before 13 years of age. In addition, the students currently using marijuana include Blacks (10.9%), Hispanic (13.7%) and Whites (7.2%). Approximately 9.7% of students ever used the synthetic product, which was higher in Hispanic (18.7%) when compared to Blacks (8.8%) and Whites (9.1%). Conclusion The use of marijuana is significantly higher among the male youth in Mississippi than females, which is a major public health concern. Furthermore, there was higher rates of smoking marijuana in Hispanics and Blacks when compared to White youth.

Use of alcohol, tobacco and illicit drugs among ethnic Norwegian and ethnic minority adolescents in Hordaland county, Norway: the youth@hordaland-survey

OBJECTIVE

To describe potential differences in unhealthy behaviours among ethnic Norwegian adolescents and minority adolescents from countries within the European Union, European Economic Area or US (EU/EEA countries) and adolescents from non-EU/EEA countries. Specifically, we aimed to investigate ethnic differences in use of alcohol, tobacco and illicit drugs, and potential confounding due to socio-demographic characteristics.

DESIGN

Cross-sectional population-based study of adolescents aged 16-19 (N = 10,122), with self-reported ethnicity as grouping variable, and self-reported use of alcohol, tobacco and illicit drugs as dependent variables.

RESULTS

We found that minority adolescents from EU/EEA and non-EU/EEA countries differed from ethnic Norwegian adolescents on important indicators of unhealthy behaviours. Compared to Norwegian adolescents, adolescents from EU/EEA were more likely to report having tried to smoke, to be a daily smoker and to ever having tried an illicit drug (adjusted odds ratio (OR) ranging from 2.01 to 3.74). They were, however, less likely to have tried snus (a form of smokeless tobacco; adjusted OR 0.64; confidence interval (CI) 95% 0.43-0.97) and to report daily snus use (adjusted OR 0.31; CI95% 0.15-0.67). There were no differences in having tried alcohol. Non-EU/EEA adolescents were less likely to have ever tried alcohol (OR 0.24; CI95% 0.18-0.31), snus (OR 0.47; CI95% 0.34-0.65) and to smoke (0.68; CI95% 0.52-0.91), and less likely to report daily snus use (OR 0.36; CI95% 0.21-0.62) compared to Norwegian adolescents. There were no differences with regard to having tried illicit drugs and reporting being a daily smoker. All differences observed were robust to adjustment for age, gender and family socio-economic status.

CONCLUSION

The presents study identified important differences in unhealthy behaviours across different ethnic groups in Norway. The differences in the prevalence of unhealthy behaviours among ethnic minorities are still relevant in a public health perspective, and potential mechanisms should be investigated further.

Behavioural correlates of energy drink consumption among adolescents: A review of the literature

Despite regulatory measures on the labelling of energy drinks (EDs), their consumption among adolescents continues to grow in popularity, but teachers increasingly report significant behavioural concerns among students who disclose habitual ED consumption. A review of papers published between January 2010 and October 2016 was undertaken to determine whether an association between adverse behaviour and consumption of ED exists. Findings indicate that ED consumption among adolescents is associated with alcohol and substance use, risky behaviours and psychological states including sensation seeking, depression and anxiety symptoms. ED consumption impacts negatively on executive functions and increases hyperactivity/inattention symptoms among adolescents. An inverse association between ED consumption and sleep duration exists. The findings highlight the need for greater awareness of the potential risk of ED consumption among adolescents.

Assessing Variations in Developmental Outcomes Among Teenage Offspring of Teen Mothers: Maternal Life Course Correlates

This study investigated potential heterogeneity in development among offspring (age 17) of teen mothers and maternal life course as correlates of variation. Using latent class analysis, subgroups of developmental outcomes were identified. Maternal standing in two life course realms (i.e., socioeconomic and domestic) was considered as a potential explanation for heterogeneity in offspring's development. Offspring reported on measures assessing their psychological, academic, and behavioral development. Teen mothers reported on measures of life course realms. Three subgroups of developmental outcomes were identified: on track (52%), at risk (37%), and troubled (11%). Findings suggest that economic hardship and number of pregnancies among teen mothers distinguish developmental patterns among teenage offspring, whereas teen mothers' educational attainment and marital status do not.

What is best practice in sex and relationship education? A synthesis of evidence, including stakeholders' views

OBJECTIVES

Sex and relationship education (SRE) is regarded as vital to improving young people's sexual health, but a third of schools in England lacks good SRE and government guidance is outdated. We aimed to identify what makes SRE programmes effective, acceptable, sustainable and capable of faithful implementation.

DESIGN

This is a synthesis of findings from five research packages that we conducted (practitioner interviews, case study investigation, National Survey of Sexual Attitudes and Lifestyles, review of reviews and qualitative synthesis). We also gained feedback on our research from stakeholder consultations.

SETTINGS

Primary research and stakeholder consultations were conducted in the UK. Secondary research draws on studies worldwide.

RESULTS

Our findings indicate that school-based SRE and school-linked sexual health services can be effective at improving sexual health. We found professional consensus that good programmes start in primary school. Professionals and young people agreed that good programmes are age-appropriate, interactive and take place in a safe environment. Some young women reported preferring single-sex classes, but young men appeared to want mixed classes. Young people and professionals agreed that SRE should take a 'life skills' approach and not focus on abstinence. Young people advocated a 'sex-positive' approach but reported this was lacking. Young people and professionals agreed that SRE should discuss risks, but young people indicated that approaches to risk need revising. Professionals felt teachers should be involved in SRE delivery, but many young people reported disliking having their teachers deliver SRE and we found that key messages could become lost when interpreted by teachers. The divergence between young people and professionals was echoed by stakeholders. We developed criteria for best practice based on the evidence.

CONCLUSIONS

We identified key features of effective and acceptable SRE. Our best practice criteria can be used to evaluate existing programmes, contribute to the development of new programmes and inform consultations around statutory SRE.

Bidirectional relationship between time preference and adolescent smoking and alcohol use: Evidence from longitudinal data

INTRODUCTION

Scholarly interest in time preference as a potential predictor of risky health behaviors in adolescents has increased in recent years. However, most of the existing literature is limited due to the exclusive reliance on cross-sectional data, precluding the possibility of establishing the direction of causality. Using longitudinal data from the Korea Youth Panel Survey (2003-7), which followed up a nationally representative sample of 3449 adolescents aged 14years for five years, this study examines a bidirectional relationship between time preference and smoking and drinking behaviors among adolescents.

METHODS

We used discrete time hazard models of smoking and drinking initiation as a function of time preference measured at the baseline and fixed-effects ordered logit model of time preference, respectively. Our measure of time preference was derived from the survey question on a hypothetical choice between immediate enjoyment today and likely higher scores on an exam tomorrow.

RESULTS

The overall results provide evidence on the bidirectional relationship; that is, higher time discounting (i.e., greater relative preference for present utility over future utility) results in an increased risk of engaging in smoking and drinking, and conversely, adopting such behaviors leads to a higher discount rate.

CONCLUSIONS

The bidirectional relationship may function as a mechanism for adolescents to engage in increased smoking and drinking or additional negative health behaviors via gateway effects, strengthening the case for preventing the initiation of risky health behaviors among adolescents.

Alcohol Use, Socioeconomic Status and Risk of HIV Infections

The present study investigated the associations among alcohol use, socioeconomic status (SES), and human immunodeficiency virus (HIV) status, in the South African context. It was hypothesized that SES (predictor; measured as median split asset score) and alcohol use in the past 12 months (predictor) would interact such that current drinkers of low SES would be at an increased risk of testing HIV-positive (outcome). Nationally representative, cross-sectional survey data from 2005 (N = 16,110), 2008 (N = 13,055), and 2012 (N = 25,979) were analyzed using multinomial regression models. Current drinkers of low SES had an elevated risk of HIV infection in all survey years, ranging from a relative risk ratio (RRR) of 1.94 (95% confidence interval (CI) 1.29-3.00, t = 2.93, p = 0.002) in 2012 to RRR of 3.51 (95% CI 2.02-6.08, t = 4.47, p < 0.001) in 2008. Targeting preventive strategies to alcohol users of low SES could help reduce HIV burden and associated socioeconomic differences.

Intraclass correlation values for adolescent health outcomes in secondary schools in 21 European countries

BACKGROUND

Cluster randomised controlled trials (CRCTs) are increasingly used to evaluate the effectiveness of interventions for improving health. A key feature of CRCTs is that individuals in clusters are often more alike than individuals in different clusters, irrespective of treatment. This similarity within clusters needs to be taken into account when planning CRCTs to obtain adequate sample sizes, and when analysing clustered data to obtain correct estimates.

METHODS

Nationally representative data from 15 to 16 year olds were analysed, from 21 of the 35 countries that participated in the 2007 European School Survey Project on Alcohol and Other Drugs. Within country school level intra-class correlation coefficients (ICCs) were calculated for substance use (self-reported alcohol use, regular alcohol use, binge drinking, any smoking, regular smoking, and illicit drug use) and psychosocial health (depressive mood and self-esteem). Unadjusted and adjusted ICCs are presented. ICCs are adjusted for student sex and socioeconomic status.

RESULTS

ICCs ranged from 0.01 to 0.21, with the highest (0.21) reported for regular smoking. Within country school level ICCs varied substantially across health outcomes, and among countries for the same health outcomes. Estimated ICCs were consistently higher for substance use (range 0.01-0.21), than for psychosocial health (range 0.01-0.07). Within country ICCs for health outcomes varied by changes in the measurement of particular health outcomes, for example the ICCs for regular smoking (range 0.06-0.21) were higher than those for having smoked at all in the last month (range 0.03-0.17).

CONCLUSIONS

For school level ICCs to be effectively utilised in informing sample size requirements for CRCTs and adjusting estimates from meta-analyses, the school level ICCs need to be both country and outcome specific.

What do young people think about their school-based sex and relationship education? A qualitative synthesis of young people's views and experiences

OBJECTIVES

Although sex and relationship education (SRE) represents a key strand in policies to safeguard young people and improve their sexual health, it currently lacks statutory status, government guidance is outdated and a third of UK schools has poor-quality SRE. We aimed to investigate whether current provision meets young people's needs.

DESIGN

Synthesis of qualitative studies of young people's views of their school-based SRE.

SETTING

Eligible studies originated from the UK, Ireland, the USA, Australia, New Zealand, Canada, Japan, Iran, Brazil and Sweden.

PARTICIPANTS

Studies of students aged 4-19 in full-time education, young adults ≤19 (not necessarily in full-time education) or adults ≤25 if recalling their experiences of school-based SRE.

RESULTS

-69 publications were identified, with 55 remaining after quality appraisal (representing 48 studies). The synthesis found that although sex is a potent and potentially embarrassing topic, schools appear reluctant to acknowledge this and attempt to teach SRE in the same way as other subjects. Young people report feeling vulnerable in SRE, with young men anxious to conceal sexual ignorance and young women risking sexual harassment if they participate. Schools appear to have difficulty accepting that some young people are sexually active, leading to SRE that is out of touch with many young people's lives. Young people report that SRE can be negative, gendered and heterosexist. They expressed dislike of their own teachers delivering SRE due to blurred boundaries, lack of anonymity, embarrassment and poor training.

CONCLUSIONS

SRE should be 'sex-positive' and delivered by experts who maintain clear boundaries with students. Schools should acknowledge that sex is a special subject with unique challenges, as well as the fact and range of young people's sexual activity, otherwise young people will continue to disengage from SRE and opportunities for safeguarding and improving their sexual health will be reduced.

Effectiveness of Positive Youth Development Interventions: A Meta-Analysis of Randomized Controlled Trials

Positive youth development is thought to be essential to the prevention of adolescent risk behavior and the promotion of thriving. This meta-analysis examined the effects of positive youth development interventions in promoting positive outcomes and reducing risk behavior. Ten databases and grey literature were scanned using a predefined search strategy. We included studies that focused on young people aged 10-19 years, implemented a positive youth development intervention, were outside school hours, and utilized a randomized controlled design. Twenty-four studies, involving 23,258 participants, met the inclusion criteria and were included in the analysis. The impact of the interventions on outcomes including behavioral problems, sexual risk behavior, academic achievement, prosocial behavior and psychological adjustment were assessed. Positive youth development interventions had a small but significant effect on academic achievement and psychological adjustment. No significant effects were found for sexual risk behaviors, problem behavior or positive social behaviors. Intervention effects were independent of program characteristics and participant age. Low-risk young people derived more benefit from positive youth development interventions than high-risk youth. The studies examined had several methodological flaws, which weakened the ability to draw conclusions. Substantial progress has been made in the theoretical understanding of youth development in the past two decades. This progress needs to be matched in the intervention literature, through the use of high-quality evaluation research of positive youth development programs.

Investigating the relationship between substance use and sexual behaviour in young people in Britain: findings from a national probability survey

BACKGROUND

Health risk behaviours are prominent in late adolescence and young adulthood, yet UK population-level research examining the relationship between drug or alcohol use and sexual health and behaviour among young people is scarce, despite public health calls for an integrated approach to health improvement. Our objective was to further our understanding of the scale of and nature of any such relationship, using contemporary data from Britain's third National Survey of Sexual Attitudes and Lifestyles (Natsal-3).

METHODS

Analyses of data from Natsal-3, a stratified probability survey of 15 162 men and women (3869 aged 16-24 years), undertaken in 2010-2012, using computer-assisted personal interviewing, were carried out. Logistic regression was used to explore associations between reporting (1) frequent binge drinking (≥weekly), (2) recent drug use (within past 4 weeks) or (3) multiple (both types of) substance use, and key sexual risk behaviours and adverse sexual health outcomes. We then examined the sociodemographic profile, health behaviours and attitudes reported by 'risky' young people, defined as those reporting ≥1 type of substance use plus non-condom use at first sex with ≥1 new partner(s), last year.

RESULTS

Men and women reporting frequent binge drinking or recent drug use were more likely to report: unprotected first sex with ≥1 new partner(s), last year; first sex with their last partner after only recently meeting; emergency contraception use (last year) and sexually transmitted infection diagnosis/es (past 5 years). Associations with sexual risk were frequently stronger for those reporting multiple substance use, particularly among men. The profile of 'risky' young people differed from that of other 16-24 years old.

CONCLUSIONS

In this nationally representative study, substance use was strongly associated with sexual risk and adverse sexual health outcomes among young people. Qualitative or event-level research is needed to examine the context and motivations behind these associations to inform joined-up interventions to address these inter-related behaviours.

The correlates and course of multiple health risk behaviour in adolescence

Background

Health risk behaviours often co-occur in adolescence. This may be partially explained by a set of common risk and protective factors. The current study examines the association between risk behaviours throughout adolescence and identifies common risk factors for multiple risk behaviour in late adolescence.

Methods

We use data from the Longitudinal Study of Young People in England. We examined the association between risk behaviours at age 14 (n = 15,588), age 16 (n = 12,416) and age 19 (n = 9,548). The associations between age 19 risk behaviour and earlier risk behaviours and risk and protective factors were assessed longitudinally. Health risk behaviours included smoking, alcohol use, illicit drug use, delinquency and unsafe sexual behaviour.

Results

All risk behaviours were found to be associated with other risk behaviours with associations weakening through adolescence. A number of sociodemographic, interpersonal, school and family factors at age 14 predicted risk behaviour and multiple risk behaviour at 19, though predictors for heavy alcohol use often differed from other health risk behaviours. Past risk behaviour was a strong predictor of age 19 risk behaviour though many involved in only one form of risk behaviour in mid-adolescence do not progress to multiple risk behaviour.

Conclusions

Our findings reaffirm the links between health risk behaviours, but these diminish throughout adolescence with multiple risk behaviour usually initiated in mid-adolescence. Multiple risk behaviour is initiated in early or mid adolescence with a number of common risk factors explaining the co-occurrence of risk behaviours.

The period prevalence of risk behavior co-occurrence among Canadians

INTRODUCTION

While the benefits of complying with health recommendations is well documented, a considerable proportion of Canadians engage in multiple modifiable risk behaviors. The purpose of this multi-wave longitudinal study was to identify the individual period prevalence and co-occurrence of multiple modifiable risk behaviors, particularly excessive alcohol consumption, physical inactivity, and tobacco use, within a nationally representative sample of Canadians.

METHODS

Secondary data analysis was conducted on the first seven cycles of the National Population Health Survey. This longitudinal sample included 15,167 Canadians aged 12years of age or older. Gender-specific criteria were employed to define excessive alcohol consumption. Individuals expending <3.0kcal/kg/day during their leisure-time and smoking cigarettes (daily or occasionally) met the criteria for physical inactivity and tobacco use, respectively.

RESULTS

The period prevalence of the Canadian general population that participated in multiple risk behaviors was 21.5% in cycle 7. The most common pairwise combination of co-occurring risk behaviors was physical inactivity and smoking. The proportion of Canadians reporting the co-occurrence of all three risk behaviors in cycle 7 was 2.6%.

CONCLUSIONS

Understanding patterns of modifiable risk behaviors is an initial step in developing and implementing public health interventions. The co-occurrence of these three risk behaviors is a viable concern for one in five Canadians. For these individuals, the likelihood of encountering premature morbidity and mortality is escalated. As the majority of Canadians reported being physically inactive, allocating limited resources towards enhancing leisure-time physical activity levels could have significant population-level implications for improving the health of Canadians.

School-level variation in health outcomes in adolescence: analysis of three longitudinal studies in England

School factors are associated with many health outcomes in adolescence. However, previous studies report inconsistent findings regarding the degree of school-level variation for health outcomes, particularly for risk behaviours. This study uses data from three large longitudinal studies in England to investigate school-level variation in a range of health indicators. Participants were drawn from the Longitudinal Study of Young People in England, the Me and My School Study and the Research with East London Adolescent Community Health Survey. Outcome variables included risk behaviours (smoking, alcohol/cannabis use, sexual behaviour), behavioural difficulties and victimisation, obesity and physical activity, mental and emotional health, and educational attainment. Multi-level models were used to calculate the proportion of variance in outcomes explained at school level, expressed as intraclass correlations (ICCs) adjusted for gender, ethnicity and socio-economic status of the participants. ICCs for health outcomes ranged from nearly nil to .28 and were almost uniformly lower than for attainment (.17-.23). Most adjusted ICCs were smaller than unadjusted values, suggesting that school-level variation partly reflects differences in pupil demographics. School-level variation was highest for risk behaviours. ICCs were largely comparable across datasets, as well as across years within datasets, suggesting that school-level variation in health remains fairly constant across adolescence. School-level variation in health outcomes remains significant after adjustment for individual demographic differences between schools, confirming likely effects for school environment. Variance is highest for risk behaviours, supporting the utility of school environment interventions for these outcomes.

Smoking, alcohol consumption, and drug use among adolescents with psychiatric disorders compared with a population based sample

This study investigated frequencies of smoking, alcohol use, and illicit drug use by diagnostic category in 566 adolescent psychiatric patients, comparing this sample with 8173 adolescents from the general population in Norway who completed the Young-HUNT 3 survey. Frequencies of current alcohol use were high in both samples but were lower among psychiatric patients. Compared with adolescents in the general population, adolescents in the clinical sample had a higher prevalence of current smoking and over four times higher odds of having tried illicit drugs. In the clinical sample, those with mood disorders reported the highest frequencies of smoking, alcohol use, and illicit drug use, whereas those with autism spectrum disorders reported the lowest frequencies. Our results show an increased prevalence of risky health behaviors among adolescents with psychiatric disorders compared with the general population. The awareness of disorder-specific patterns of smoking and substance use may guide preventive measures.

The effect of noncognitive traits on health behaviours in adolescence

This paper investigates the relationship between personality traits and health behaviours in adolescence using a large and recent cohort study. In particular, we investigate the impact of locus of control, self-esteem and work ethics at ages 15-16 years on the incidence of health behaviours such as alcohol consumption, cannabis and other drug use, unprotected and early sexual activity and sports and physical activity. We use matching methods to control for a very rich set of adolescent and family characteristics, and we find that personality traits do affect health behaviours. In particular, individuals with external locus of control, low self-esteem or with low levels of work ethics seem more likely in engage in risky health behaviours.

Annual research review: Harms experienced by child users of online and mobile technologies: the nature, prevalence and management of sexual and aggressive risks in the digital age

AIMS AND SCOPE

The usage of mobile phones and the internet by young people has increased rapidly in the past decade, approaching saturation by middle childhood in developed countries. Besides many benefits, online content, contact or conduct can be associated with risk of harm; most research has examined whether aggressive or sexual harms result from this. We examine the nature and prevalence of such risks, and evaluate the evidence regarding the factors that increase or protect against harm resulting from such risks, so as to inform the academic and practitioner knowledge base. We also identify the conceptual and methodological challenges encountered in this relatively new body of research, and highlight the pressing research gaps.

METHODS

Given the pace of change in the market for communication technologies, we review research published since 2008. Following a thorough bibliographic search of literature from the key disciplines (psychology, sociology, education, media studies and computing sciences), the review concentrates on recent, high quality empirical studies, contextualizing these within an overview of the field.

FINDINGS

Risks of cyberbullying, contact with strangers, sexual messaging ('sexting') and pornography generally affect fewer than one in five adolescents. Prevalence estimates vary according to definition and measurement, but do not appear to be rising substantially with increasing access to mobile and online technologies, possibly because these technologies pose no additional risk to offline behaviour, or because any risks are offset by a commensurate growth in safety awareness and initiatives. While not all online risks result in self-reported harm, a range of adverse emotional and psychosocial consequences is revealed by longitudinal studies. Useful for identifying which children are more vulnerable than others, evidence reveals several risk factors: personality factors (sensation-seeking, low self-esteem, psychological difficulties), social factors (lack of parental support, peer norms) and digital factors (online practices, digital skills, specific online sites).

CONCLUSIONS

Mobile and online risks are increasingly intertwined with pre-existing (offline) risks in children's lives. Research gaps, as well as implications for practitioners, are identified. The challenge is now to examine the relations among different risks, and to build on the risk and protective factors identified to design effective interventions.

A systematic review of effective interventions for reducing multiple health risk behaviors in adolescence

We systematically searched 9 biomedical and social science databases (1980-2012) for primary and secondary interventions that prevented or reduced 2 or more adolescent health risk behaviors (tobacco use, alcohol use, illicit drug use, risky sexual behavior, aggressive acts). We identified 44 randomized controlled trials of universal or selective interventions and were effective for multiple health risk behaviors. Most were school based, conducted in the United States, and effective for multiple forms of substance use. Effects were small, in line with findings for other universal prevention programs. In some studies, effects for more than 1 health risk behavior only emerged at long-term follow-up. Integrated prevention programs are feasible and effective and may be more efficient than discrete prevention strategies.

Income-related inequality in health and health-related behaviour: exploring the equalisation hypothesis

Background

Previous studies have found the socioeconomic gradient in health among adolescents to be lower than that observed during childhood and adulthood. The aim of this study was to examine income-related inequalities in health and health-related behaviour across the lifespan in England to explore ‘equalisation’ in adolescence.

Methods

We used five years of data (2006–2010) from the Health Survey for England to explore inequalities in six indicators: self-assessed general health, longstanding illness, limiting longstanding illness, psychosocial wellbeing, obesity and smoking status. We ran separate analyses by age/gender groups. Inequality was measured using concentration indices.

Results

Our findings for longstanding illnesses, psychosocial wellbeing and obesity were consistent with the equalisation hypothesis. For these indicators, the extent of income-related inequality was lower among late adolescents (16–19 years) and young adults (20–24 years) compared to children and young adolescents (under 15 years), mid- and late-adults (25–44 and 45–64 years) and the elderly (65+ years). The remaining indicators showed lower inequality among adolescents compared to adults, but higher inequality when compared with children.

Conclusions

Our work shows that inequalities occur across the life-course but that for some health issues there may be a period of equalisation in late adolescence and early adulthood.

Targets for primary prevention: cultural, social and intrapersonal factors associated with co-occurring health-related behaviours

OBJECTIVE

Multiple studies have identified clusters of co-occurring health-related behaviours. Little is known, however, about factors associated with such clusters. This study aims to identify these factors and to assess whether their effects are in accordance with the Theory of Triadic Influence (TTI).

DESIGN

A cross-sectional study using a representative sample (N = 3497) of the Dutch population aged 19-40.

MAIN OUTCOME MEASURES

Our data concerned 18 health-related behaviours combined in three clusters (Health, Alcohol and Delinquency) and 30 non-behaviour-specific (i.e. ultimate or distal) cultural, social and intrapersonal factors. The three clusters were used as outcomes in regression analyses.

RESULTS

Descriptive Norms of Friends and Gender were associated with all three behaviour clusters. Furthermore, Having Parents who Smoke or Consume Alcohol was associated with, respectively, the Health and Alcohol clusters. Self-Control and past Parental Monitoring were associated with the Health and Delinquency clusters. Effect sizes were moderate to large (r²: 0.05 to 0.22).

CONCLUSION

Factors with a moderate to large association with several behaviour clusters were identified. These factors were located within the social and intrapersonal stream of the TTI, not within the cultural stream.

A newly identified group of adolescents at "invisible" risk for psychopathology and suicidal behavior: findings from the SEYLE study

This study explored the prevalence of risk behaviors (excessive alcohol use, illegal drug use, heavy smoking, reduced sleep, overweight, underweight, sedentary behavior, high use of Internet/TV/videogames for reasons not related to school or work, and truancy), and their association with psychopathology and self-destructive behaviors, in a sample of 12,395 adolescents recruited in randomly selected schools across 11 European countries. Latent class analysis identified three groups of adolescents: a low-risk group (57.8%) including pupils with low or very low frequency of risk behaviors; a high-risk group (13.2%) including pupils who scored high on all risk behaviors, and a third group ("invisible" risk, 29%) including pupils who were positive for high use of Internet/TV/videogames for reasons not related to school or work, sedentary behavior and reduced sleep. Pupils in the "invisible" risk group, compared with the high-risk group, had a similar prevalence of suicidal thoughts (42.2% vs. 44%), anxiety (8% vs. 9.2%), subthreshold depression (33.2% vs. 34%) and depression (13.4% vs. 14.7%). The prevalence of suicide attempts was 5.9% in the "invisible" group, 10.1% in the high-risk group and 1.7% in the low-risk group. The prevalence of all risk behaviors increased with age and most of them were significantly more frequent among boys. Girls were significantly more likely to experience internalizing (emotional) psychiatric symptoms. The "invisible" group may represent an important new intervention target group for potentially reducing psychopathology and other untoward outcomes in adolescence, including suicidal behavior.

Preventing substance misuse: study protocol for a randomised controlled trial of the Strengthening Families Programme 10-14 UK (SFP 10-14 UK)

BACKGROUND

Prevention of alcohol, drug and tobacco misuse by young people is a key public health priority. There is a need to develop the evidence base through rigorous evaluations of innovative approaches to substance misuse prevention. The Strengthening Families Programme 10-14 is a universal family-based alcohol, drugs and tobacco prevention programme, which has achieved promising results in US trials, and which now requires cross-cultural assessment. This paper therefore describes the protocol for a randomised controlled trial of the UK version of the Strengthening Families Programme 10-14 (SFP 10-14 UK).

METHODS/DESIGN

The trial comprises a pragmatic cluster randomised controlled effectiveness trial with families as the unit of randomisation, with embedded process and economic evaluations. Participating families will be randomised to one of two treatment groups - usual care with full access to existing services (control group), or usual care plus SFP 10-14 UK (intervention group). The trial has two primary outcomes - the number of occasions that young people report having drunk alcohol in the last 30 days, and drunkenness during the last 30 days, both dichotomised as 'never' and '1-2 times or more'. The main follow-up is at 2 years past baseline, and short-term and intermediate outcomes are also measured at 9 and 15 months.

DISCUSSION

The results from this trial will provide evidence on the effectiveness and cost-effectiveness of an innovative universal family-based substance misuse prevention programme in a UK context.

TRIAL REGISTRATION

Current Controlled Trials ISRCTN63550893.

The saving and empowering young lives in Europe (SEYLE) randomized controlled trial (RCT): methodological issues and participant characteristics

Background

Mental health problems and risk behaviours among young people are of great public health concern. Consequently, within the VII Framework Programme, the European Commission funded the Saving and Empowering Young Lives in Europe (SEYLE) project. This Randomized Controlled Trial (RCT) was conducted in eleven European countries, with Sweden as the coordinating centre, and was designed to identify an effective way to promote mental health and reduce suicidality and risk taking behaviours among adolescents.

Objective

To describe the methodological and field procedures in the SEYLE RCT among adolescents, as well as to present the main characteristics of the recruited sample.

Methods

Analyses were conducted to determine: 1) representativeness of study sites compared to respective national data; 2) response rate of schools and pupils, drop-out rates from baseline to 3 and 12 month follow-up, 3) comparability of samples among the four Intervention Arms; 4) properties of the standard scales employed: Beck Depression Inventory, Second Edition (BDI-II), Zung Self-Rating Anxiety Scale (Z-SAS), Strengths and Difficulties Questionnaire (SDQ), World Health Organization Well-Being Scale (WHO-5).

Results

Participants at baseline comprised 12,395 adolescents (M/F: 5,529/6,799; mean age=14.9±0.9) from Austria, Estonia, France, Germany, Hungary, Ireland, Israel, Italy, Romania, Slovenia and Spain. At the 3 and 12 months follow up, participation rates were 87.3% and 79.4%, respectively. Demographic characteristics of participating sites were found to be reasonably representative of their respective national population. Overall response rate of schools was 67.8%. All scales utilised in the study had good to very good internal reliability, as measured by Cronbach’s alpha (BDI-II: 0.864; Z-SAS: 0.805; SDQ: 0.740; WHO-5: 0.799).

Conclusions

SEYLE achieved its objective of recruiting a large representative sample of adolescents within participating European countries. Analysis of SEYLE data will shed light on the effectiveness of important interventions aimed at improving adolescent mental health and well-being, reducing risk-taking and self-destructive behaviour and preventing suicidality.

Trial registration

US National Institute of Health (NIH) clinical trial registry (NCT00906620) and the German Clinical Trials Register (DRKS00000214).

Cigarette smoking and alcohol drinking in a representative sample of English school pupils: cross-sectional and longitudinal associations

OBJECTIVE

The aim of our study was to examine cross-sectional and longitudinal associations between cigarette smoking and alcohol drinking, in a representative sample of English pupils.

METHOD

Data from 13,635 school pupils in the Longitudinal Study of Young People in England (LSYPE) on usage of cigarettes from 2004 (typical age 14) to 2006 (age 16) and alcohol from 2004 to 2007 (age 17), analyzed with latent growth curve models.

RESULTS

The weighted percentage of pupils drinking alcohol increased from 26% at age 14 to 71% by age 17, smoking from 12% to 27% by age 16. Pupils with lower socio-economic status were more likely to smoke but less likely to drink alcohol regularly. Both behaviors were positively correlated at age 14, adjusted for several confounding factors. The rate of increase over time was also positively correlated.

CONCLUSION

Cigarette smoking and alcohol drinking are already correlated by age 14, are socio-economically patterned, and 'move together' during adolescence. Future studies and interventions should be targeted at a younger age range, to identify early smoking and potentially hazardous alcohol drinking patterns.