Family social environment in childhood and self-rated health in young adulthood

Associations between parental relationship dissolution and child sleep: A systematic review

Parental relationship dissolution is considered one of the most common adverse childhood experiences. Although sleep is crucial for healthy development of children and very sensitive to environmental changes, it is poorly studied in the context of parental relationship dissolution. The aim of the current study was to systematically review and critically assess the existing literature on the associations between parental relationship dissolution and child sleep (0-18 years old; registered on PROSPERO (CRD42021272720)). PsycInfo, MEDLINE, Scopus, ProQuest Dissertations and Theses Global, Social Work abstracts, and Web of Science Core Collection were searched. Published empirical quantitative studies were included if they reported statistics regarding the association between parental relationship dissolution and any child sleep variable. Out of the 358 articles screened, 14 articles met inclusion criteria and reported on several sleep dimensions: sleep quality, dreams and nightmares, and sleep disorders (enuresis, night terrors, and bruxism). Out of the 14 articles, six were longitudinal studies and eight were cross-sectional studies. While most studies found that parental relationship dissolution was associated with some indices of poorer child sleep, studies were generally of low to moderate quality. Health professionals should assess child sleep in the context of a parental relationship dissolution.

Accompanying your children: Living without parents at different stages of pre-adulthood and individual physical and mental health in adulthood

Objectives

This study examined how living without parents at different stages of childhood and adolescence affects physical and mental health in adulthood.

Methods

The data came from 3,464 survey respondents aged 18–36 in the 2018 China Labor-Force Dynamics Survey. Physical health was self-rated. Mental health was measured by the Center for Epidemiological Studies Depression scale. The ordered probit and ordinary least-squares regression analyses were employed to determine the associations between growing up without parents at different stages in pre-adulthood and individual physical and mental health in adulthood.

Results

Individuals who did not live with their parents during their minor years were more likely to report worse physical and mental health in adulthood, compared to those who lived with their parents. This difference was heterogeneous among different age stages and genders.

Conclusions

Absence of parents in the household has long-term impacts on the physical and mental health of children in adulthood, especially for females. The government should make feasible institutional arrangements to avoid the separation of minor children from their parents.

The relationship between Chinese adults' self-assessments of family social status in childhood and depression: A moderated mediation model

BACKGROUND

Using the data from a large-scale Chinese national survey, this study aimed to explore the underlying mechanisms between Chinese adults' self-assessments of family social status in childhood and depression.

METHODS

The research data was from the China Family Panel Studies (CFPS) in 2020. We selected 13,430 Chinese adults aged 16-60 as participants, and used the PROCESS macro program to conduct moderated mediation analysis.

RESULTS

Chinese adults' self-assessments of family social status in childhood had a statistically significant negative predictive effect on depression. The sharing frequency of WeChat Moments played a partial mediating role in the relationship between self-assessment of family social status in childhood and depression. Furthermore, social trust moderated the direct effect of mediation model. Age moderated the second half of the mediation model, and the effect was statistically significant in the younger population (young people), but not in the older population (middle-aged people).

LIMITATIONS

This was a cross-sectional study and no causal conclusions could be drawn.

CONCLUSIONS

Chinese adults' self-assessment of family social status in childhood could affect depression in adulthood through sharing frequency of WeChat Moments. People with higher social trust can effectively buffer the adverse effect of self-assessed low family social status in childhood on depression. Age moderated the relationship between sharing frequency of WeChat Moments and depression, but this moderating effect was only significant in the younger population.

Social and Behavioral Pathways between Adverse Childhood Experiences and Poor Adult Physical Health: Mediation by Early Adulthood Experiences in a Low-Income Population

Adverse childhood experiences (ACEs) increase the risk of poor health and wellbeing in adulthood. In this study, we tested whether experiences in early adulthood-intimate partner violence (IPV), substance use, social isolation, and work instability-mediate the relationship between ACEs and poor physical health in later adulthood. Using data from a large-scale survey of Medicaid enrollees in the Portland metropolitan area, four separate mediation models were constructed to assess the indirect effects of each early adulthood experience and the proportion of the total effect on physical health accounted for by the pathway. Experiencing four or more ACEs increased the risk of poor adult physical health by 50% (RR 1.50). Considered in separate models, mediation by IPV accounted for 14.4% of the total effect; substance use mediated a similar proportion (14.0%). Social isolation was a less substantial mediator (7.6%). Work instability did not mediate the relationship between ACEs and adult physical health in our population. These findings provide evidence that IPV, substance use, and social isolation in early adulthood are part of the pathway between high ACEs and poor adult physical health. Intervening to prevent negative early adult experiences may mitigate some of the long-term effects of childhood trauma on health.

Worsening trends in self-rated health and correlates in Chinese adolescents in Hong Kong: a population-based panel study from 1999/2000 to 2014/15

OBJECTIVES

To examine the 15-year secular trends of self-rated health (SRH) and correlates in Chinese adolescents in Hong Kong.

DESIGN

A territory-wide population-based panel data study.

SETTING

Anonymised records of the annual health examination from the Student Health Service, Department of Health in Hong Kong.

PARTICIPANTS

397 324 students in Secondary 2 (US grade 8), 335 902 in Secondary 4 and 113 892 in Secondary 6 during the academic year 1999/2000 and 2014/15.

OUTCOME MEASURES

SRH and lifestyles were self-reported using standardised questionnaires. Sex-standardised and age-standardised prevalence of very poor/poor SRH and its secular annual changes across sex, grade, weight status, breakfast habits, and frequency/duration of aerobic exercises were examined. Their disparities over time were examined by interactions with the academic year in generalised estimating equations.

RESULTS

The overall prevalence of very poor/poor SRH increased from 9.3% (95% CI: 8.9% to 9.7%) in 1999/2000 to 15.5% (15.1% to 15.8%) in 2014/15. Very poor/poor SRH was more prevalent in girls (adjusted OR: 1.02), in those having unemployed parents (1.29), being overweight (1.42) or obese (2.62), eating breakfast away from home (1.27) and skipping breakfast (1.49) or doing <1 time/week or ≤60 min/week aerobic exercises (1.78 and 1.88, respectively) than others. The corresponding disparities increased over time (ratios of OR: 1.006-1.042).

CONCLUSIONS

Increasing prevalence of very poor/poor SRH from 1999/2000 to 2014/15 was found among Hong Kong Chinese adolescents, which was greater in girls, adolescents being overweight/obese and those having unemployed parents or unhealthy lifestyles. Strategies to reduce health inequality should consider multiple factors, especially modifiable factors including lifestyles.

Residents’ Living Environments, Self-Rated Health Status and Perceptions of Urban Green Space Benefits

Urban green space (UGS) could contribute to sustainable urban development. Studying residents’ perception of UGS ecological benefits could provide the empirical basis to improve UGS management and quality of life. Based on the questionnaire surveys of 432 residents in Beijing, assisted by non-parametric statistical tests, this paper assessed the relationships between residents’ living environments and self-rated health status and their impacts on residents’ perceptions of UGS ecological benefits. We paid attention to residents’ perceptions of UGS’s notable thermal environmental benefits under the climate-change backdrop. The results showed that: (1) Residents were inclined to perceive direct UGS ecological benefits better than the indirect types; (2) Residents growing up in the city had better self-rated health status than those growing up in the suburb and the village; and residents growing up in the suburb had a better understanding of the cooling benefits of green walls; (3) Residents currently dwelling in the city had a better understanding of UGS benefits, including shading, cooling by green roofs, mitigating the heat island effect and enhancing urban biodiversity, than those dwelling in the village; and (4) Residents with “very good” self-rated health status had a significantly better understanding of UGS benefits regarding shading, providing varied colors and habitats, storing carbon, purifying air, and collecting rainwater.

[Parental Separation - Is the Accumulation with Other Adverse Childhood Experiences the Main Burden? Analysis of a Representative Sample of the German Population]

INTRODUCTION

Adverse childhood experiences (ACEs) tend to co-occur. The more forms of childhood adverse are experienced, the higher are the psychological and physical impairments in adulthood. The present study therefore examines the extent to which the experience of parental separation is related to the risk of other forms of ACEs and the extent to which the accumulation of ACEs is related to impairment in adulthood.

METHODS

A cross-sectional analysis of a representative sample of the German population from the age of 18 onwards was performed (N=2466; mean age=49.5 years (18-93); f: 1368 (55.5%); m: 1098 (44.5%)). The demographic data were assessed by interview, the remaining data were collected by questionnaires. Current depressive and anxiety symptoms self-perceived somatic health and life quality were assessed, while ACEs were assessed retrospectively by the Adverse Childhood Experiences (ACE)-Questionnaire.

RESULTS

Child maltreatment and mental illness of household members, substance abuse of household members, incarceration of household members and violence against the mother were more frequent when participants reported separation of parents. Parental separation was not associated with an increased rate of psychological impairment and, in women, physical impairment when no other forms of ACEs were present.

CONCLUSION

Children and adolescents whose parents have separated more often experience other forms of ACEs than their peers. It seems to be this accumulation of ACEs that is associated with impairments in adulthood.

Revisiting the roots of attachment: A review of the biological and psychological effects of maternal skin-to-skin contact and carrying of full-term infants

During the early period of hypothesis building and empirical testing of attachment theory, a major emphasis was placed on mother-infant physical contact. In spite of this, mother-infant contact has received scant attention amongst attachment and child development researchers in the past decades. Here, a brief theoretical framework for mother-infant contact is presented, drawing on animal studies as well as human studies of preterm infants and neonates. Salient mechanisms may include an extended sensitive period during early infancy, requiring specific somatosensory stimuli for bio-behavioral homeorhesis; oxytocinergic and epigenetic pathways; kinesthetic stimuli and face-to-face proximity allowing for increased social interaction. Studies of extended human mother-full-term infant physical contact have demonstrated positive effects in multiple domains. For infants, these include sleep organization, temperature and heart rate regulation, behavioral response, crying/colic, socio-emotional development, attachment quality, speech development opportunities and mother-child interactions. For mothers, studies demonstrate improved depressive symptomatology, physiological stress regulation, contingent responsivity, breastfeeding and mother-child interactions. Parent-infant attachment quality has gained prominence as a trauma-resilience factor as well as a predictor of adult physical health. The potential role of mother-infant contact as an attachment promoting intervention as well as future research subjects are discussed. Current evidence supports the original attachment research that early maternal touch provision may influence infant socio-emotional development and attachment quality, with positive implications for mother-child relationship functioning.

The Identification of Family Social Environment Typologies Using Latent Class Analysis: Implications for Future Family-Focused Research

The family social environment is the first environment that a child experiences and has implications for children's health. However, the majority of family social environment measures do not account for its complexity. There is a need for novel approaches for assessing the family social environment that transcends the traditional way of measuring family composition and interaction. The purpose of this secondary data analysis research was to identify distinct family social environment typologies that consider both family composition and interaction and to describe the characteristics of the identified family social environment typologies. A series of latent class analysis results indicated three distinct typologies of family social environment with significant differences in family composition, family problem-solving skills, and demographic characteristics. The process used to identify the typologies and significant differences between the typologies showcases how the field could advance family-focused research by considering family composition and interaction.

Family dissolution and children's social well-being at school: a historic cohort study

Background

Family dissolution has become more common and one third of the child population in most Western countries now experience family dissolution. Studies show that children from dissolved families have lower levels of social well-being than children from intact families, but only few studies have examined the impact on social well-being specifically in the school setting. We investigated the association between family dissolution and children’s social well-being at school, including the possible influence of the child’s age at the time of the family dissolution.

Methods

We defined a historic cohort study of 219,226 children and adolescents aged 9–16 years and combined demographic registry data of family structure with questionnaire data on social well-being based on the Danish National Well-being Questionnaire completed in 2015. The definition of social well-being was constructed on the children’s perception of sense of belonging in the school setting, in the class and the school community, as well as perceptions on safety, loneliness and bullying. We examined low social well-being according to family dissolution and used multiple logistic regression analyses to adjust for parental educational level, ethnicity and siblings and further stratified for gender and age.

Results

A total of 5% of the children had a low social well-being at school. Among the 31% who lived in dissolved families, we found more children with a low level of social well-being at school (adjusted OR 1.41, 95% CI 1.36;1.47) than those in intact families; especially among those who at the time of family dissolution were in the preschool age (1.55, 95% CI 1.47;1.64).

Conclusion

Children from dissolved families had higher odds for low social well-being at school compared with children from intact families, especially those who experienced family dissolution in the preschool age. The school may be an important setting for identifying and providing help and support in children experiencing family dissolution.

Economic Inequality in Life Satisfaction and Self-perceived Health in Iranian Children and Adolescents: The CASPIAN IV Study

Background:

The purpose of this study was to assess socioeconomic status (SES) inequality in life satisfaction (LS) and good self-perceived health (SPH) in Iranian children and adolescents.

Methods:

This nationwide study was conducted as part of a fourth national school-based surveillance program performed on 14880 students aged 6–18 years who were living in urban and rural areas of 30 provinces of Iran between 2011 and 2012. Using principle component analysis, the SES of participants was constructed as single variable. SES inequality in LS and good SPH across the SES quintiles was assessed using the concentration index (C) and slope index of inequality (SII). The determinants of this inequality are investigated by the Oaxaca Blinder decomposition method.

Results:

Frequency of LS along with the SES quintiles shifted significantly from 73.28% (95% CI: 71.49, 75.08) in the lowest quintile to 86.57% (95% CI:85.20, 87.93) in the highest SES quintile. Frequency of favorable SPH linearly increased from lowest SES quintile (76.18% (95% CI: 74.45, 77.92)) to highest SES quintile (83.39% (95% CI: 81.89, 84.89)). C index for LS and good SPH was negative, which suggests inequality was in favor of high SES group. SII for LS and SPH was 15.73 (95% CI: 12.10, 19.35) and 8.21 (95% CI: 5.46, 10.96)]. Living area and passive smoking were the most contributed factors in SES inequality of LS. Also passive smoking and physical activity were the most contributed factors in SES inequality of SPH.

Conclusions:

SES inequality in LS and good SPH was in favor of high SES group. These findings are useful for health policies, better programming and future complementary analyses.

Annual Research Review: Interparental conflict and youth psychopathology: an evidence review and practice focused update

The quality of the interparental relationship is recognized as an important influence on child and adolescent psychopathology. Historically, clinically oriented research on this topic has focused on the impacts of parental divorce and domestic violence as primary interparental relationship influences on child outcomes, to the relative neglect of dimensional or qualitative features of the couple/interparental relationship for youth (child and adolescent) psychopathology. Recent research has highlighted that children are affected by attributes of interparental conflict, specifically how parents express and manage conflicts in their relationship, across a continuum of expressed severity and negativity - ranging from silence to violence. Furthermore, new evidence highlights that children's emotional, behavioral, social, academic outcomes, and future interpersonal relationships are adversely affected by conflict between parents/carers whether adults are living together or not (i.e. married or separated), or where children are or are not genetically related to their rearing parents (e.g. adoption). We review evidence and present an integrated theoretical model, highlighting how children are affected by interparental conflict and what this evidence base means for effective intervention and prevention program development, as well as the development of possible cost-benefit models. Additionally, we review policy implications of this research and highlight some very recent examples of UK-based policy focusing on addressing the interparental relationship and its impact on youth psychopathology.

Poor Health and Experiences of Being Bullied in Adolescents: Self-Perceived Overweight and Frustration with Appearance Matter

OBJECTIVE

To examine the associations between body image (actual and self-perceived weight status; feelings about appearance) and health outcomes (overall health, life satisfaction, and mental health) and between body image and experiences of being bullied.

METHODS

Participants included 8,303 children from 7th to 10th grade in the Health Behavior of School-Aged Children (HBSC) 2009-2010 data set, a large-scale sample in the United States. Several multiple linear regressions (with health outcomes as dependent variables) and multivariate logistic regressions (with being bullied or not as dependent variable) were conducted to investigate the associations between each dependent variable and the following independent variables: relationship with parents, frustration with appearance, and actual and self-perceived weight status.

RESULTS

Self-perceived underweight, self-perceived overweight (OW), and frustration with appearance were positively associated with being bullied. Frustration with appearance was a risk factor, while good relationship with parents was a protective factor, especially for psychological health outcomes. Self-perceived OW had a stronger association with the experience of being bullied than actual OW. The relationship between actual OW and being bullied might be attenuated when self-perceived OW is simultaneously considered.

CONCLUSIONS

Body image may be an important factor in the association between weight status and the experience of being bullied.

Relationship between Self-Rated Health and Lifestyle and Food Habits in Japanese High School Students

Self-rated health (SRH), a subjective assessment of health status, is extensively used in the field of public health. It is an important and valid measure that is strongly related to morbidity, mortality, longevity and health status. Adolescence is a crucial period for the formation of health status, because health-risk behaviours (e.g., skipping breakfast) are often established during this period. In this study, we investigated the relationship of SRH with lifestyle and eating habits in Japanese high school students. In this study, 1296 students aged 16-18 years from 11 high schools in Japan participated. A questionnaire was administered to these participants that included a question on SRH, five questions on demographic characteristics, six questions on lifestyle items (e.g., wake-up time), five questions on miscellaneous health issues (e.g., anorexia), and 25 questions on food habits and attitudes towards food. We examined the differences between self-rated healthy and unhealthy groups using logistic regression analysis adjusted for gender and age. A dichotomy regression analysis was performed using a stepwise elimination method. Of the 1296 respondents, 16.7% reported feeling unhealthy, 57.7% of whom were females. The self-rated healthy group had a higher frequency of eating breakfast (odds ratio (OR): 2.13; confidence interval (CI): 1.07-4.24) and liked home meals to a greater extent (OR: 3.12; CI: 1.27-7.65) than the self-rated unhealthy group. The two groups did not differ significantly in terms of other lifestyle factors or unidentified complaints. Our results suggest that liking home meals during adolescence may lead to the development of good eating habits, i.e., eating breakfast, and better SRH.

Offspring of parents who were separated and not speaking to one another have reduced resistance to the common cold as adults

Exposure to parental separation or divorce during childhood has been associated with an increased risk for physical morbidity during adulthood. Here we tested the hypothesis that this association is primarily attributable to separated parents who do not communicate with each other. We also examined whether early exposure to separated parents in conflict is associated with greater viral-induced inflammatory response in adulthood and in turn with increased susceptibility to viral-induced upper respiratory disease. After assessment of their parents' relationship during their childhood, 201 healthy volunteers, age 18-55 y, were quarantined, experimentally exposed to a virus that causes a common cold, and monitored for 5 d for the development of a respiratory illness. Monitoring included daily assessments of viral-specific infection, objective markers of illness, and local production of proinflammatory cytokines. Adults whose parents lived apart and never spoke during their childhood were more than three times as likely to develop a cold when exposed to the upper respiratory virus than adults from intact families. Conversely, individuals whose parents were separated but communicated with each other showed no increase in risk compared with those from intact families. These differences persisted in analyses adjusted for potentially confounding variables (demographics, current socioeconomic status, body mass index, season, baseline immunity to the challenge virus, affectivity, and childhood socioeconomic status). Mediation analyses were consistent with the hypothesis that greater susceptibility to respiratory infectious illness among the offspring of noncommunicating parents was attributable to a greater local proinflammatory response to infection.

Family social capital and health - a systematic review and redirection

The level (or scale) at which social capital can be conceptualised and measured ranges potentially from the macro-level (regional or country level), to the meso-level (neighbourhoods, workplaces, schools), down to the individual level. However, one glaring gap in the conceptualisation of social capital within the empirical literature has been the level of the family. Our aim in this review is to examine the family as the 'missing level' in studies on social capital and health. To do so, we conducted a systematic review on the use and measurement of this notion in the health literature, with the final intention of articulating a direction for future research in the field. Our findings are consistent with the notion that family social capital is multidimensional and that its components have distinct effects on health outcomes. Further investigation is needed to understand the mechanisms through which family social capital is related to health, as well as determining the most valid ways to measure family social capital.

New approaches to divorce with children: A problem of public health

This broad review elaborates on the most up-to-date knowledge on biochemical and psychobiological aspects of parental loss and other childhood adversities during divorce involving minor children. So far, divorce involving minor children was unfortunately considered by authorities only as a purely juridical problem, and this approach has often allowed a completely different approach according to the Courts. Now, scientific research, also making use of animal models, is demonstrating the biological basis of the problem and the indisputable consequences on the well-being and health of children. The innovative conclusion of this review is that this argument (because of its frequency and gravity) is primarily a question of public health and that it is necessary to further harmonize practices in this area.

A Longitudinal Study of the Effects of Child-Reported Maternal Warmth on Cortisol Stress Response 15 Years After Parental Divorce

OBJECTIVES

The experience of parental divorce during childhood is associated with an increased risk of behavioral and physical health problems. Alterations in adrenocortical activity may be a mechanism in this relation. Parent-child relationships have been linked to cortisol regulation in children exposed to adversity, but prospective research is lacking. We examined maternal warmth in adolescence as a predictor of young adults' cortisol stress response 15 years after parental divorce.

METHODS

Participants included 240 youth from recently divorced families. Mother and child reports of maternal warmth were assessed at 6 time points across childhood, adolescence, and young adulthood. Offspring salivary cortisol was measured in young adulthood before and after a social stress task. Structural equation modeling was used to predict cortisol response from maternal warmth across early and late adolescence.

RESULTS

Higher child-reported maternal warmth in early adolescence predicted higher child-reported maternal warmth in late adolescence (standardized regression = 0.45, standard error = 0.065, p < .01), which predicted lower cortisol response to a challenging interpersonal task in young adulthood (standardized regression = -0.20, standard error = 0.094, p = .031). Neither mother-reported warmth in early adolescence nor late adolescence was significantly related to offspring cortisol response in young adulthood.

CONCLUSIONS

Results suggest that for children from divorced families, a warm mother-child relationship after divorce and across development, as perceived by the child, may promote efficient biological regulation later in life.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier: NCT01407120.

Impact of migration origin on individual protection strategies against sexual transmission of HIV in Paris metropolitan area, SIRS cohort study, France

Background

The impact of migration and country or region of origin on sexual behaviours and prevention of the sexual transmission of HIV has been scarcely studied in France. The objective of this study was to evaluate if and how individual attitudes of prevention towards HIV infection are different according to country or region of origins in Paris area, France.

Methods

3006 individuals were interviewed in the Paris metropolitan area in 2010. Outcome variables were (i) the intention of the individual to protect oneself against HIV, and (ii) the adoption of a condom-based approach for protection against HIV. To explore factors associated with these outcomes, we constructed multivariate logistic regression models, first taking into account only demographic variables –including country of origin-, then successively adding socioeconomic variables and variables related to sexual behaviour and HIV perception and prevention behaviour.

Results

French and foreign people who have origins in Sub-Saharan Africa declared more intentions to protect themselves than French people with French parents (in foreign men, aOR = 3.43 [1.66–7.13]; in foreign women, aOR = 2.94 [1.65–5.23]), but did not declare more recourse to a condom-based approach for protection against HIV (in foreign men, aOR = 1.38 [0.38–4.93]; in foreign women, aOR = 0.93 [0.40–2.18]). Conversely, foreign women and French women from foreign origin, especially from Maghreb (Northern Africa), reported less intention of protection than French women with French parents.

Conclusions

These results underline the importance of taking culture and origins of target populations into consideration when designing information, education and communication about HIV and sexually transmitted diseases. These results also draw attention to fractions of the general population that could escape from prevention messages.

Electronic supplementary material

The online version of this article (doi:10.1186/s12889-015-2051-4) contains supplementary material, which is available to authorized users.

Effects of a prevention program for divorced families on youth cortisol reactivity 15 years later

OBJECTIVE

We examined whether an empirically based, randomised controlled trial of a preventive intervention for divorced mothers and children had a long-term impact on offspring cortisol regulation.

DESIGN

Divorced mothers and children (age 9-12) were randomly assigned to a literature control condition or the 11-week New Beginnings Program, a family-focused group preventive intervention for mothers and children in newly divorced families.

MAIN OUTCOME MEASURES

Fifteen years after the trial, offspring salivary cortisol (n = 161) was measured before and after a social stress task.

RESULTS

Multilevel mixed models were used to predict cortisol from internalizing symptoms, externalizing symptoms, group assignment and potential moderators of intervention effects. Across the sample, higher externalizing symptoms were associated with lower cortisol reactivity. There was a significant group-by-age interaction such that older offspring in the control group had higher reactivity relative to the intervention group, and younger offspring in the control group exhibited a decline across the task relative to younger offspring in the intervention group.

CONCLUSIONS

Preventive interventions for youth from divorced families may have a long-term impact on cortisol reactivity to stress. Results highlight the importance of examining moderators of program effects.

Exploration of health status, healthcare utilization, and health service expectations among Taiwanese adolescents

There have been few reports about adolescent experiences with and expectations of health service utilization in an Asian societal setting. The aim of this study is to analyze the use of healthcare services in relation to health status and explore adolescents' preferences for youth-friendly service among Taiwanese high school students. A cross-sectional questionnaire-based survey was conducted on Taiwanese adolescents aged 12–18 years in 2010.We invited participants to rate their health status, report their previous healthcare service use, and rank their health service preferences.We used logistic regression analysis to investigate the association between self-rated health status and healthcare utilization and used nonparametric analysis to compare health service preferences among sociodemographic subgroups. A total of 4,907 students (97.2 % response rate) returned valid questionnaires for analysis. Poor health status and chronic illness were most salient factors independently associated with frequent healthcare service use. Only 40 % of respondents reported having a regular doctor, and pediatrics (57.7 %) was the most commonly identified professional source of medical care. A great majority (86.2 %) of respondents made clinical visits with parents. For characteristics of youth-friendly clinician, the top-ranked items included competency and patience, while having helpful and friendly personnel was highlighted for clinical setting.

CONCLUSION

Family participation is critical in healthcare for adolescents in Asian cultures. Health service use is significantly influenced by health status and chronic illness in the general health insurance system. Understanding these background influences on expectations for healthcare may help to create youth-friendly health services that are more culturally appropriate.

Socioeconomic inequities patterns of multi-morbidity in early adolescence

BACKGROUND

Multi-morbidity such as cumulating mental health, behavioral, and school difficulties (consumptions of alcohol, tobacco, cannabis, and hard drugs, obesity, depressive symptoms, suicide attempts, involvement in violence, and low school performance) is common in early adolescence and can be favored by a number of socioeconomic factors (gender, age, nationality, family structure, parents' education, father' occupation, and income). This study assessed the concurrent roles of various socioeconomic factors in multi-morbidity defined as cumulated number of difficulties (CD) which has been partially documented.

METHODS

Adolescents from middle schools in north-eastern France (N = 1,559) completed a questionnaire measuring socioeconomic characteristics and mental health, behavioral, and school difficulties. Data were analyzed using logistic regression models.

RESULTS

Alcohol use affected 35.2% of subjects, tobacco use 11.2%, cannabis use 5.6%, hard drugs use 2.8%, obesity 10.6%, depressive symptoms 13.3%, suicide attempts 9.9%, involvement in violence 10.3%, and low school performance 8.2%. Insufficient income and non-intact families impacted most mental health, behavioral, and school difficulties with adjusted odds ratios (ORa) between 1.51 and 3.72. Being immigrant impacted illicit drugs use and low school performance (ORa 2.31-4.14); low parents' education depressive symptoms (1.42) and school performance (3.32); and manual-worker/inactive offspring low school performance (2.56-3.05). Multi-morbidity was very common: CD0 44.1%, CD1 30.8%, CD2-3 18.4%, and CD ≥ 4 6.7%. Insufficient income, divorced/separated parents, reconstructed families, and single parents played impressive roles with strong ORa gradients (reaching 4.86) from CD1 to CD ≥ 4. Being European immigrant, low parents' education, and low fathers' occupations had significant gender-age-adjusted odds ratios for CD2-3 and CD ≥ 4, but these became non-significant when adjusted for all socioeconomic factors. Older adolescents had higher risks for multi-morbidity which did not change when adjusting for all socioeconomic factors.

CONCLUSIONS

Multi-morbidity including a wide range of mental health, behavioral, and school difficulties was common in early adolescence. Insufficient income and non-intact families played impressive roles. Being immigrant, low parents' education, and low fathers' occupations also played strong roles but these were explained by insufficient income and non-intact families. Prevention against multi-morbidity should be designed to help adolescents to solve their difficulties, especially among adolescents with socioeconomic difficulties.