Clustering of smoking, alcohol drinking and cannabis use in adolescents in a rapidly developing country

Clustering of health risk behaviors among school-going adolescents in Mymensingh district, Bangladesh

BACKGROUND

Adolescents frequently engage in risky behaviors that negatively influence their health and pose a serious public health concern. This study aimed to examine the clustering pattern of health risk behaviors among school-going adolescents in Bangladesh.

METHODS

A cross-sectional study was conducted from 15 April to 27 June 2022 among 412 school-going adolescents in Mymensingh district of Bangladesh through a convenience sampling technique. Data were collected via face-to-face interviews using a modified Global School-Based Student Health Survey (GSHS) 2021 questionnaire. Cluster membership was identified using the k-means clustering algorithm. The chi-square test was adopted to explore the association between sociodemographic variables and each cluster membership. The ordinal logistic regression model was employed to examine the predictors associated with cluster membership.

RESULTS

Most of the respondents were female (55.3%) and belonged to the 16-19 years (74.5%) age group. Three behavioral clusters were identified, including Cluster 1: Low-risk taker (50.2%), Cluster 2: Moderate risk taker (39.6%), and Cluster 3: High-risk taker (10.2%). Influential factors of high-risk behavior among adolescents were significantly associated with their age (p = 0.03), father's education who were illiterate (p = 0.02), monthly family income >30000 BDT (p = 0.04), parent's those were understanding their child's problems in most of the time (p = 0.001).

CONCLUSIONS

The study found that high-risk behaviors are significantly higher among late adolescents, those whose fathers are illiterate, whose monthly income is higher, those whose parents or guardians never realize their child's complications and worries, and those whose parents or guardians never recognize what they did in their leisure time. These findings will help to develop intervention programs, policies, strategies, and curricula in school by the experts following the necessity to adopt the adolescent toward healthy behavior and help to reduce the prevalence of health risk behavior.

Prevalence and associated risk factors of cannabinoid abuse among Egyptian university students: a cross-sectional study

Global surveys have highlighted rise in consumption of cannabinoids among residents of both developed and developing countries. Cannabinoids cause severe damage to the cardiovascular, nervous, respiratory, and renal systems, and have been linked with several deaths. Despite these adverse health effects, the use of cannabinoids has rapidly increased. This work seeks to estimate the prevalence of cannabinoid abuse among Egyptian university students and explore the associated risk factors. A cross-sectional study was carried out over 3 months (1st of July-1st of October 2020) and included 2380 students. Participants were subjected to a pre-designed self-administered questionnaire that included demographic data, Addiction Severity Index, and Depression Anxiety Stress Scale. Among the participating students, 4.9% of them reported cannabinoid abuse and 41% reported smoking cigarettes. The most used substances were hashish (96.5%), Strox (41.3%), Bhang (34.4%), voodoo (34.4%), and Tramadol (31.1%). Gender and social status were also significantly related to rates of substances abuse; most illicit drug users were males (93.1%), and the majority was of low (41.3%) or moderate (50.8%) socioeconomic status. The most significant risk factors associated with substance use were positive history of family conflict (OR=6.48; CI95%: 5.08-8.64, p<0.001), encouragement by peers (OR=2.95; CI95%: 1.73-5.05, p<0.001), male gender (OR=5.46; CI95%: 2.40-12.44, p=0.001), positive history of child abuse (OR=2.85; CI95%: 1.96-3.04, p=0.001), having a stay-at-home mother (OR= 1.56, CI95%: 1.19-2.04, p=0.001), living in an urban area (OR=2.22; CI95%: 1.53-5.0, p=0.002), and positive family history of substance use (OR=1.98; CI95%: 1.48-2.08, p=0.045). This study emphasizes the possible significant rise in substance use among university students. Awareness campaigns should target both students and student families.

Current and former smokers among adolescents aged 12-17 years in Iran: a systematic review and meta-analysis

Background

Smoking, especially among adolescents, is considered a serious public health concern worldwide being associated with increased mortality. The present study was designed as the first systematic review and meta-analysis of the prevalence of current and former smoking behavior among adolescents in Iran.

Methods

Seven international scholarly databases, namely Scopus, Embase, Pubmed/Medline, ISI/Web of Science (WOS), the Cochrane Library, Psyc Info and Cinahl, were extensively searched from January 2000 to September 18, 2019. Google Scholar was also mined. Iranian databases were searched as well (namely, MagIran, Scientific Information Database (SID), and Barakatkns). The DerSimonian-Laird’s approach, via the Freeman-Tukey double arcsine method, was used to synthesize the prevalence estimates.

Results

The prevalence of current smokers among Iranian adolescents was estimated to be 9% (95% CI: 7 to 10). Stratifying based on gender, the prevalence was 12% among boys (95% CI: 10 to 14) and 6% among girls (95% CI: 5 to 8). The prevalence of former smokers among Iranian adolescents using the random-effect model was computed to be 24% (95% CI: 21 to 27).

Conclusion

The findings of this study showed that the prevalence of current and former smoking behavior among Iranian adolescents is a relevant public health concern. The country’s young population should be given more attention by health policy- and decision-makers and implementation of ad hoc prevention and control policies should be on their agenda.

Personal and Family Factors Associated With High-risk Behaviours Among Adolescents in Malaysia

PURPOSE

The objective of this study was to investigate the relationships between high-risk behaviours and personal and family factors among adolescents in Malaysia.

METHODS

A nationwide data set was examined for this secondary data analysis. The dependent variable was the degree of risk, which was measured based on the number of high-risk behaviours in which adolescents participated. Age, gender, ethnicity, self-rated academic performance, family size, parental marital status and parental academic attainment were included as independent variables. Analyses stratified by educational level were conducted. Odds ratios (ORs) were calculated using ordered logit.

RESULTS

The most common high-risk behaviour among Malaysian adolescents was physical inactivity (35.97%), followed by smoking (13.27%) and alcohol consumption (4.45%). The majority of adolescents had low risks (52.93%), while only a small proportion had high risks (6.08%). Older age was associated with increased odds of having high risks (OR: 1.26). Male adolescents had higher odds of being in a high-risk category compared to female adolescents (OR: 1.28). Compared to Malays, Chinese adolescents had higher odds of being in a high-risk category (OR: 1.71), whereas Indian adolescents had lower odds (OR: 0.65). Excellent academic performance was associated with reduced odds of participating in high-risk behaviours (OR: 0.41).

CONCLUSION

Personal factors are important determinants of high-risk behaviours. This study provides a better understanding of those adolescent groups that are at greater risk.

PRACTICAL IMPLICATIONS

An intervention directed towards reducing participation in high-risk behaviours among adolescents who have both poor academic performance and less-educated parents may yield promising outcomes.

Alcohol Use and Misuse Among School-Going Adolescents in Thailand: Results of a National Survey in 2015

The aim of this study was to assess the prevalence of alcohol use and misuse, and to identify its associated factors among in-school adolescents in the 2015 Thailand Global School-based Student Health Survey (GSHS). The sample included 5994 school-going adolescents (mean age 14.5 years, SD = 1.7) from Thailand that responded to the 2015 GSHS. Overall, 22.2% were current alcohol users, 24.3% had ever been drunk, 12.1% had drunk two or more alcoholic drinks in a day in the past 30 days and 10.8% had gotten into trouble because of drinking alcohol. In adjusted Poisson regression analysis, older age, psychological distress, current tobacco use, the consumption of one or more soft drinks a day, school truancy, having been in a physical fight in the past 12 months, and having been seriously injured in the past 12 months were associated with current alcohol use. Older age, psychological distress, current tobacco use and injury also increased the odds for lifetime drunkenness, having two or more drinks in a day and trouble resulting from drinking. Soft drink consumption and having been in a physical fight also increased the odds for lifetime drunkenness and having two or more drinks in a day and school truancy also increased the odds for lifetime drunkenness and trouble resulting from drinking. In addition. Parental tobacco use was associated with lifetime drunkenness and trouble resulting from drinking, cannabis use with trouble resulting from drinking, and parental support was protective from trouble resulting from drinking. There were no significant sex differences regarding any of the four alcohol use indicators. More than one in five school-going adolescents in Thailand use and misuse alcohol, and strategies to prevent alcohol misuse, including a cluster of risk behaviours, are needed.

Is smoking heaviness causally associated with alcohol use? A Mendelian randomization study in four European cohorts

Background

Observational studies have shown that tobacco and alcohol use co-occur, but it is not clear whether this relationship is causal.

Methods

Using data from the Avon Longitudinal Study of Parents and Children (ALSPAC) and UK Biobank, we used observational methods to test the hypothesis that smoking heaviness increases alcohol consumption. Mendelian randomization (MR) analyses were then used to test the causal relationship between smoking heaviness and alcohol consumption using 55 967 smokers from four European studies [ALSPAC, The Nord-Trøndelag Health Study (HUNT), the Copenhagen General Population Study (CGPS) and UK Biobank]. MR analyses used rs1051730/rs16969968 as a genetic proxy for smoking heaviness.

Results

Observational results provided evidence of an association between cigarettes per day and weekly alcohol consumption (increase in units of alcohol per additional cigarette smoked per day = 0.10, 95% confidence interval (CI) 0.05 to 0.15, P ≤ 0.001 in ALSPAC; and 0.48, 95% CI 0.45 to 0.52, P ≤ 0.001 in UK Biobank). However, there was little evidence for an association between rs1051730/rs16969968 and units of alcohol consumed per week across ALSPAC, HUNT, CGPS and UK Biobank (standard deviation increase in units of alcohol per additional copy of the risk allele = –0.004, 95% CI –0.023 to 0.016, P=0.708, I² = 51.9%). We had 99% and 88% power to detect a change of 0.03 and 0.02 standard deviation units of alcohol per additional copy of the risk allele, respectively.

Conclusions

Previously reported associations between smoking and alcohol are unlikely to be causal, and may be the result of confounding and/or reverse causation. This has implications for public health research and intervention research.

Cannabis and amphetamine use and socio-ecological (proximal and distal) factors among school-going adolescents in four countries in the Caribbean and four countries in South America

The study aimed to assess the prevalence of cannabis and amphetamine use and socio-ecological (proximal and distal) factors among adolescents in eight countries of the Americas. We analysed cross-sectional survey data from 44,904 adolescents [mean age 14.6 years, standard deviation (SD) = 1.4] from Argentina, The Bahamas, Barbados, Belize, Bolivia, Chile, Peru and Trinidad and Tobago that participated in the Global School-Based Student Health Survey (GSHS) in 2011-2013. The prevalence of the past month's cannabis use was 8.3% and lifetime amphetamine use was 3.0%. In adjusted mixed-effects logistic regression analysis older age, male gender, personal attributes (anxiety, suicidal ideation, current tobacco use, current alcohol use, school truancy and sexual risk behaviour) and environmental stressors (having been in a physical fight, hunger, being bullied) were positively and parental support and peer support were negatively associated with the past month's cannabis and/or lifetime amphetamine use. Measures to prevent and control cannabis and amphetamine use in this adolescent population should include personal attributes (mental health, substance use, school truancy and sexual risk behaviour), environmental stressors and parental and peer support.

The neuropsychological profiles of young psychosis patients with and without current cannabis use

INTRODUCTION

Evidence suggests that patients with psychosis who have a history of cannabis use, but currently abstain, demonstrate superior cognitive performance than patients who have never used cannabis. The present study aimed to determine the neurocognitive profiles of patients who are in adolescence or early adulthood, when both illness- and drug-onset typically occur.

METHODS

Subjects were 24 cannabis-using and 79 cannabis-naïve psychosis patients between 16 and 25 years of age. Patients and controls were administered a neurocognitive battery, indexing estimated pre-morbid intelligence, psychomotor speed, mental flexibility, verbal learning and memory, verbal fluency, sustained attention, motor and mental response, and visuospatial learning and memory.

RESULTS

While healthy controls outperformed both patient groups across most cognitive measures, no significant differences between cannabis-using and cannabis-abstinent patients were evident.

CONCLUSION

Evidently although there may be a group of patients who are diagnosed with a non-affective psychosis disorder regardless of external factors (i.e. cannabis use), some may instead have their illness precipitated through cannabis use at a young age, presenting with unique cognitive and symptomatic repercussions later in life. These results demonstrate no cognitive differences between cannabis-using patients and abstinent patients at the time of illness-onset, providing partial support for an alternative pathway to schizophrenia through early cannabis use.

Predictors of tobacco and alcohol co-use from ages 15 to 32: The Amsterdam Growth and Health Longitudinal Study

Tobacco and alcohol are often used in tandem over time, but specific predictors of course and patterns of course over time need explication. We examined differences in alcohol and tobacco course among an adolescent population as they transitioned into young adulthood across a 17-year period. Data came from participants (n = 303 for ages 15-21, n = 196 for ages 21 to 32; 52% female and 54% female, respectively) enrolled in the Amsterdam Growth and Health Longitudinal Study, an epidemiologic investigation examining disease across the life span. We utilized parallel latent growth modeling to assess the impact of sex, personality traits, cholesterol, blood pressure, and body mass index (BMI), on initial status and linear change over time in course of tobacco and alcohol. Females reported less alcohol use at adolescent baseline (β = -21.79), less increase during adolescence (β = -7.92, p < .05), slower decrease during young adulthood (β = 4.67, p < .05), and more rapid decline in tobacco use during young adulthood (β = -70.85, p < .05), relative to males. Alcohol and tobacco use baseline status' and change over time were all significantly associated with one another during both adolescence and young adulthood (p < .05; aside from alcohol baseline and slope during young adulthood). Effects of BMI, cholesterol, blood pressure, and personality traits were also observed on tobacco and alcohol course. In light of the strong, but sex dependent relationship between alcohol and tobacco course, particularly from ages 15 to 21, prevention efforts to curb heavy alcohol and tobacco use should consider targeting course taking into account biological sex and other notable covariates. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Individual-, family-, and school-level interventions targeting multiple risk behaviours in young people

BACKGROUND

Engagement in multiple risk behaviours can have adverse consequences for health during childhood, during adolescence, and later in life, yet little is known about the impact of different types of interventions that target multiple risk behaviours in children and young people, or the differential impact of universal versus targeted approaches. Findings from systematic reviews have been mixed, and effects of these interventions have not been quantitatively estimated.

OBJECTIVES

To examine the effects of interventions implemented up to 18 years of age for the primary or secondary prevention of multiple risk behaviours among young people.

SEARCH METHODS

We searched 11 databases (Australian Education Index; British Education Index; Campbell Library; Cumulative Index to Nursing and Allied Health Literature (CINAHL); Cochrane Central Register of Controlled Trials (CENTRAL), in the Cochrane Library; Embase; Education Resource Information Center (ERIC); International Bibliography of the Social Sciences; MEDLINE; PsycINFO; and Sociological Abstracts) on three occasions (2012, 2015, and 14 November 2016)). We conducted handsearches of reference lists, contacted experts in the field, conducted citation searches, and searched websites of relevant organisations.

SELECTION CRITERIA

We included randomised controlled trials (RCTs), including cluster RCTs, which aimed to address at least two risk behaviours. Participants were children and young people up to 18 years of age and/or parents, guardians, or carers, as long as the intervention aimed to address involvement in multiple risk behaviours among children and young people up to 18 years of age. However, studies could include outcome data on children > 18 years of age at the time of follow-up. Specifically,we included studies with outcomes collected from those eight to 25 years of age. Further, we included only studies with a combined intervention and follow-up period of six months or longer. We excluded interventions aimed at individuals with clinically diagnosed disorders along with clinical interventions. We categorised interventions according to whether they were conducted at the individual level; the family level; or the school level.

DATA COLLECTION AND ANALYSIS

We identified a total of 34,680 titles, screened 27,691 articles and assessed 424 full-text articles for eligibility. Two or more review authors independently assessed studies for inclusion in the review, extracted data, and assessed risk of bias.We pooled data in meta-analyses using a random-effects (DerSimonian and Laird) model in RevMan 5.3. For each outcome, we included subgroups related to study type (individual, family, or school level, and universal or targeted approach) and examined effectiveness at up to 12 months' follow-up and over the longer term (> 12 months). We assessed the quality and certainty of evidence using the Grades of Recommendation, Assessment, Development and Evaluation (GRADE) approach.

MAIN RESULTS

We included in the review a total of 70 eligible studies, of which a substantial proportion were universal school-based studies (n = 28; 40%). Most studies were conducted in the USA (n = 55; 79%). On average, studies aimed to prevent four of the primary behaviours. Behaviours that were most frequently addressed included alcohol use (n = 55), drug use (n = 53), and/or antisocial behaviour (n = 53), followed by tobacco use (n = 42). No studies aimed to prevent self-harm or gambling alongside other behaviours.Evidence suggests that for multiple risk behaviours, universal school-based interventions were beneficial in relation to tobacco use (odds ratio (OR) 0.77, 95% confidence interval (CI) 0.60 to 0.97; n = 9 studies; 15,354 participants) and alcohol use (OR 0.72, 95% CI 0.56 to 0.92; n = 8 studies; 8751 participants; both moderate-quality evidence) compared to a comparator, and that such interventions may be effective in preventing illicit drug use (OR 0.74, 95% CI 0.55 to 1.00; n = 5 studies; 11,058 participants; low-quality evidence) and engagement in any antisocial behaviour (OR 0.81, 95% CI 0.66 to 0.98; n = 13 studies; 20,756 participants; very low-quality evidence) at up to 12 months' follow-up, although there was evidence of moderate to substantial heterogeneity (I² = 49% to 69%). Moderate-quality evidence also showed that multiple risk behaviour universal school-based interventions improved the odds of physical activity (OR 1.32, 95% CI 1.16 to 1.50; I² = 0%; n = 4 studies; 6441 participants). We considered observed effects to be of public health importance when applied at the population level. Evidence was less certain for the effects of such multiple risk behaviour interventions for cannabis use (OR 0.79, 95% CI 0.62 to 1.01; P = 0.06; n = 5 studies; 4140 participants; I² = 0%; moderate-quality evidence), sexual risk behaviours (OR 0.83, 95% CI 0.61 to 1.12; P = 0.22; n = 6 studies; 12,633 participants; I² = 77%; low-quality evidence), and unhealthy diet (OR 0.82, 95% CI 0.64 to 1.06; P = 0.13; n = 3 studies; 6441 participants; I² = 49%; moderate-quality evidence). It is important to note that some evidence supported the positive effects of universal school-level interventions on three or more risk behaviours.For most outcomes of individual- and family-level targeted and universal interventions, moderate- or low-quality evidence suggests little or no effect, although caution is warranted in interpretation because few of these studies were available for comparison (n ≤ 4 studies for each outcome).Seven studies reported adverse effects, which involved evidence suggestive of increased involvement in a risk behaviour among participants receiving the intervention compared to participants given control interventions.We judged the quality of evidence to be moderate or low for most outcomes, primarily owing to concerns around selection, performance, and detection bias and heterogeneity between studies.

AUTHORS' CONCLUSIONS

Available evidence is strongest for universal school-based interventions that target multiple- risk behaviours, demonstrating that they may be effective in preventing engagement in tobacco use, alcohol use, illicit drug use, and antisocial behaviour, and in improving physical activity among young people, but not in preventing other risk behaviours. Results of this review do not provide strong evidence of benefit for family- or individual-level interventions across the risk behaviours studied. However, poor reporting and concerns around the quality of evidence highlight the need for high-quality multiple- risk behaviour intervention studies to further strengthen the evidence base in this field.

Prevalence and predictors of tobacco use among Bhutanese adolescents

Purpose

The purpose of this paper is to examine the prevalence of tobacco use and associated factors influencing the use of tobacco among adolescents in a school setting.

Design/methodology/approach

A cross-sectional descriptive study was conducted amongst Bhutanese adolescents studying at high schools in the district of Wangdue Phodrang in May 2016. A total of 378 eighth-grade students from four schools participated in the study. A self-administered questionnaire was used to collect data. Bivariate and multivariate logistic regressions were carried out to describe the predictors of tobacco use.

Findings

Of the 378 student participants, 52.90 percent were girls and 47.10 percent boys. The age ranged from 11 to 19 years, and the majority lived in school hostels (82 percent). The prevalence of smoking was 10.80 percent while smokeless tobacco users constituted 11.10 percent in the month preceding the study. Gender, tobacco use by siblings and friends, ever having tried alcohol, consumption of alcohol in the last 30 days, previous experimentation with cigarettes/bidi and smokeless tobacco/baba (p-value <0.05) were significantly related to the use of tobacco among students. In multivariate analysis, tobacco use by friends (AdjOR=1.09; 95%CI=0.01–2.48), ever having tried alcohol (AdjOR=2.24; 95%CI=1.75–3.72), current alcohol use (AdjOR=2.63; 95%CI=1.52–4.31), experimentation with cigarettes/bidi (AdjOR =39.46; 95%CI=11.91–90.63) or with smokeless tobacco/baba (AdjOR=32.61; 95%CI=11.78–90.30) were observed as the strong predictors of current tobacco use among adolescents.

Originality/value

These study results re-emphasized the rising public health concern of tobacco use among younger boys and girls. The findings may help the Bhutanese policy makers and managers to better understand the present situation of adolescent tobacco use and its associated determinants, and formulate appropriate tobacco control strategies for adolescents.

Smoking among adolescents is associated with their own characteristics and with parental smoking: cross-sectional study

BACKGROUND

This study aimed to analyze the association between smoking during adolescence and the characteristics of smoking and alcohol consumption among their parents.

DESIGN AND SETTING

Cross-sectional study in Londrina (PR), Brazil.

METHODS

The subjects comprised 1,231 adolescents aged 14-17 years. The adolescents and their parents answered a self-report questionnaire that asked for sociodemographic information and data on smoking and alcohol consumption. Multiple logistic regression models were used to analyze associations between smoking among adolescents and their characteristics (age, sex, period of the day for attending school, alcohol consumption and socioeconomic level) and their parents' characteristics (smoking, alcohol consumption, age and education level), adjusted according to the adolescents' characteristics (sex, age and socioeconomic level).

RESULTS

The prevalence of smoking among adolescents was 3.4% (95% confidence interval, CI: 2.4-4.4). Adolescents whose mothers or fathers were smokers were 2.0 and 2.5 times more likely to be smokers, respectively. The prevalence of smoking among adolescents with a smoking mother was 7.1% (95% CI: 2.6-10.7) and a smoking father, 5.4% (95% CI: 1.6-8.5). There were significant associations between smoking adolescents and age [5.2% (95% CI: 3.3-6.6)], studying at night [9.6% (95% CI: 4.0-15.5)] and alcohol consumption [69.0% (95% CI: 55.0-83.0)]. It was observed that the number of alcoholic beverage doses consumed was higher among smoking adolescents (P = 0.001).

CONCLUSION

Adolescent smoking was associated with smoking by their parents, regardless of the gender of the parents or adolescents. Age, alcohol consumption and studying at night are characteristics of adolescents that can contribute towards smoking.

Predictors of smoking among primary and secondary school students in Botswana

This study seeks to determine the prevalence and risk factors for smoking among students aged 12–18 years in two cities in Botswana. Using a sample of 2554 students we adapted the Global Youth Tobacco Survey (GYTS) methodology to assess students' smoking practices, knowledge, beliefs and attitudes. Logistic regression models were used to evaluate factors associated with smoking. The results revealed that 10% of students were current tobacco smokers with 29% reporting having tried smoking. Self-image and acceptance by peers were the strongest predictors of smoking overall (adjusted Odds Ratio [aOR]: 3.13, 95%, Confidence Interval [CI]: 2.67–3.66). Intention to smoke or to continue to smoke and perceived norms in conformity with smoking were also independently associated with smoking (aOR: 1.81, 95% CI: 167–2.11 and aOR: 1.31, 95% CI: 1.10–1.57, respectively). Perceived prevalence and exposure to smoking by peers and family and access to tobacco products was stronger among females (aOR: 1.69, 95% CI: 1.52–1.91) compared to males (aOR: 0.93, 95% CI: 0.70–1.24). Our results indicate that anti-tobacco interventions in Botswana should prioritize intra-personal factors associated with smoking. Our findings also suggest that different interventions targeting male and female students should be explored.

Psychosocial determinants of clustering health-compromising behaviors among Saudi male adolescents

BACKGROUND AND OBJECTIVES

To assess whether the clustering of six specific health-compromising behaviors, namely, low fruit consumption, high sweet consumption, infrequent tooth brushing, physical inactivity, fighting and smoking, varied by different psychosocial determinants such as life satisfaction, peer relationships, self-confidence, and future orientation among male adolescents in Saudi Arabia.

PATIENTS AND METHODS

A representative stratified cluster random sample of 1335 Saudi Arabian male adolescents living in the city of Riyadh answered a questionnaire on health-related behaviors. Poisson regression models were constructed separately for younger (13-14-years-old) and older (17-19-years-old) adolescents to assess variations between explanatory psychosocial variables and the clustering of six health-compromising behaviors, adjusting for father's education.

RESULTS

Older adolescents who perceived high levels of life satisfaction had a lower rate of clustering of multiple health-compromising behaviors compared to those reporting lower levels (RR: 1.22; 95%CI: 1.09-1.37), and the respective difference between those with high and those with middle levels of satisfaction was marginally non-significant (RR: 1.08; 95%CI: 0.98-1.19). Younger adolescents who reported that they felt "less than always" self-confident were more likely to have high clustering of health compromising behaviors compared to those who were always confident (RR: 1.08; 95%CI: 1.01-1.21). The clustering of multiple health-compromising behaviors was marginally associated with the frequency of evening meetings among older adolescents (RR: 1.03; 95%CI: 1.01-1.04 for each extra meeting), while the respective association among younger adolescents was marginally non-significant (RR: 1.02; 95%CI: 0.99-1.05). The association between clustering of health-compromising behaviors and future orientation was non-significant among both younger and older adolescents.

CONCLUSIONS

Clustering of health-compromising behaviors was found to be associated with perceived life satisfaction and peer relationships among older male Saudi adolescents and with self-confidence among younger male Saudi adolescents in Riyadh.

The Relationship between Smoking and Unhealthy Weight Control Behaviors among Korean Adolescents: The Tenth Korea Youth Risk Behavior Web-Based Survey, 2014

Background

Adolescent smoking is positively related to weight control attempts, especially by unhealthy methods. The co-occurrence of smoking and unhealthy weight control behaviors may cause serious health problems in adolescents. This study examined the relationship of smoking with unhealthy weight control behaviors among Korean adolescents.

Methods

This cross-sectional study involved 31,090 students of grades 7 to 12, who had tried to reduce or maintain their weight during the 30 days prior to The Tenth Korea Youth Risk Behavior Web-based Survey, 2014. Data on height, weight, weight control methods, smoking, alcohol intake, living with one's family, and perceived economic status were obtained through self-report questionnaires. ‘Unhealthy weight control behaviors’ were subcategorized into ‘extreme weight control behaviors’ and ‘less extreme weight control behaviors.’

Results

The smoking rates were 13.3%±0.4% in boys and 3.8%±0.2% in girls. Current smokers were more likely to engage in extreme weight control behaviors (odds ratio [OR], 1.47; 95% confidence interval [CI], 1.09 to 2.00 in boys, and OR, 2.05; 95% CI, 1.59 to 2.65 in girls) and less extreme weight control behaviors (OR, 1.23; 95% CI, 1.07 to 1.40 in boys, and OR, 1.47; 95% CI, 1.22 to 1.76 in girls) compared to non-smokers among both boys and girls.

Conclusion

Current smoking is independently related to a high likelihood of engaging in unhealthy weight control behaviors among Korean adolescents. This relationship is stronger for girls than for boys. Extreme weight control behaviors have a stronger relationship with current smoking than less extreme weight control behaviors.

Substance use among Palestinian youth in the West Bank, Palestine: a qualitative investigation

Background

Youth health risk behaviors, including substance use (psychoactive substances including alcohol and illicit drugs), have been the subject of relatively limited study to date in Middle Eastern countries. This study provides insights into the perceived prevalence and patterns of alcohol and drug use among Palestinian youth.

Methods

The study was based on ten focus groups and 17 individual interviews with youth aged 16–24 years (n = 83), collected as part of the formative phase of a cross-sectional, population representative study of risk taking behaviors among Palestinian youth in the West Bank in 2012. Qualitative analysis was used to code detailed notes of focus groups and interviews.

Results

Most participants reported that substance use exists, even in socially conservative communities. Almost all participants agreed that alcohol consumption is common and that alcohol is easily available. The top alcoholic drinks referred to by the study participants were vodka, whisky, beer, and wine. Most participants claimed that they drink alcohol to cope with stress, for fun, out of curiosity, to challenge society, and due to the influence of the media. Participants were familiar with illicit drugs and knew of youth who engaged in drug use: marijuana, cocaine, and heroin were mentioned most frequently. Study participants believed that youth use drugs as a result of stress, the Israeli occupation, inadequate parental control, lack of awareness, unhappiness, curiosity, and for entertainment. Many participants were unaware of any local institutions to support youth with substance use problems. Others expressed their distrust of any such institution as they assumed them to be inefficient, profit-driven, and posing the risk of potential breaches of confidentiality.

Conclusions

Although this study uses a purposive sample, the results suggest that substance use exists among Palestinian youth. Risk behaviors are a concern given inadequate youth-friendly counseling services and the strong cultural constraints on open discussion or education about the impact of high risk behaviors. These barriers to treatment and counseling can exacerbate the health and social consequences of alcohol abuse and illicit drug use.

The prevalences of and association between nonmedical prescription opioid use and poor sleep among Chinese high school students

The purpose of this study was to investigate the prevalences of and association between nonmedical prescription opioid use (NMPOU) and sleep quality among Chinese high school students. A cross-sectional study was conducted in Chongqing high school students in 2012, and questionnaires from 18,686 students were completed and eligible for this study. Demographic and NMPOU information was collected using a self-administered questionnaire. The Chinese Pittsburgh Sleep Quality index (CPSQI) was used to assess the occurrence of poor sleep. Among the total sample, 18.0% were classified as poor sleepers (27.4% of the subjects with past-month NMPOU), and the prevalences of lifetime, past-year and past-month NMPOU were 14.6, 4.6 and 2.8% across the entire sample, respectively. The most commonly used medicine was licorice tablets with morphine (9.1, 2.5 and 1.5% for lifetime, past-year and past-month, respectively), followed by cough syrup with codeine, Percocet, diphenoxylate and tramadol. After adjustment for potential confounders, the association between past-month NMPOU and poor sleep remained significant (AOR = 1.47, 95% CI 1.17 to 1.85). Programs aimed at decreasing NMPOU should also pay attention to sleep quality among adolescents.

Correlates for psycho-active substance use among boarding secondary school adolescents in Enugu, South East, Nigeria

Background

Psycho-active substance use among adolescents is a national and global problem and its attendant effects on adolescents cannot be overemphasized.

The objectives of this study are to determine the prevalence and pattern of psychoactive substance use among adolescents; the substances involved and the extent of the problem in this locale.

Methods

This is a cross-sectional study that assesses the pattern of psychoactive substance use among secondary school adolescents in Enugu, south East, Nigeria. The study was carried out among adolescents attending six secondary boarding schools in Enugu metropolis of Enugu State of Nigeria.

The WHO Student Drug Use Questionnaire was adapted for this study.

Data were analyzed using the Statistical Package for Social Sciences program (SPSS), version 17. Chi-square and multivariate regression were used as a test of significance for qualitative variables. A p-value less than 0.05 were accepted as significant for each statistical test.

Results

Out of 900, a total of 896 respondents, comprising 400 and 82 boys (482) (53.8 %) and 400 and 14 girls (414) (46.2 %) completed the questionnaires. This gave a response rate of 99.6 %.

The study revealed that the prevalence of current use for psychoactive substances ranges from 0.4 to 34.9 % while that for life use ranges from 0.8 to 63.5 %. The least being cannabis and the most being kola nuts.

Kola nut is the most widely used psychoactive substance both for current use, past year use and the respondents’ life time use. It shows a lifetime prevalence of 63.5 % and a current use prevalence of 34.9 %.

More than half of the users of each of the psychoactive substances take it occasionally, using them on 1–5 days in a month. On the other hand, almost one-quarter of the users of each of the substances take it on 20 or more days in a month.

Conclusion

The study revealed that the prevalence of current use for psychoactive substances ranges from 0.4 to 34.9 % while that for life use ranges from 0.8 to 63.5 %. The least being cannabis and the most being kola nuts.

Electronic supplementary material

The online version of this article (doi:10.1186/s12887-016-0615-9) contains supplementary material, which is available to authorized users.

Psychoactive substances use and associated factors among middle and high school students in the North Center of Morocco: a cross-sectional questionnaire survey

BACKGROUND

Data on psychoactive substance (PAS) consumption among adolescents in the North Center of Morocco are not at all available. Therefore, the current study aimed at investigating the prevalence and the determinants of psychoactive substances use among middle and high school students in this region.

METHODS

A cross-sectional study was conducted from April 2012 to November 2013 in public middle and high schools in the North Central Region of Morocco. An anonymous self-administered questionnaire was used to assess psychoactive substances use among a representative sample of school students from the 7th to the 12th grade, aged 11-23 years, selected by stratified cluster random sampling. Factors associated with psychoactive substance use were identified using multivariate stepwise logistic regression analyses.

RESULTS

A total of 3020 school students completed the questionnaires, 53.0 % of which were males. The overall lifetime smoking prevalence was 16.1 %. The lifetime, annual and past month rates of any psychoactive substance use among the study subjects were 9.3, 7.5, and 6.3 % respectively. Cannabis recorded the highest lifetime prevalence of 8.1 %, followed by alcohol 4.3 %, inhalants 1.7 %, psychotropic substances without medical prescription 1.0, cocaine 0.7, heroine 0.3, and amphetamine with only 0.2 %. Psychoactive substance use was associated with males more than females. The risk factors identified by multivariate stepwise logistic regression analyses were being male, studying in secondary school level, smoking tobacco, living with a family member who uses tobacco, and feeling insecure within the family.

CONCLUSIONS

The prevalence among all school students reported by the current study was comparable to the national prevalence. Efforts to initiate psychoactive substance prevention programs among school students should be made by designing such programs based on the significant factors associated with psychoactive substance use identified in this study.

Associations between depression risk, bullying and current smoking among Chinese adolescents: Modulated by gender

This school-based study aimed to investigate the prevalence of being at risk for depression, bullying behavior, and current smoking among Chinese adolescents in order to explore gender differences in the vulnerability of adolescents with these behaviors to develop a smoking habit. A total of 35,893 high school students sampled from high schools in eighteen cities in China participated in the study from 2011 to 2012. Overall, the prevalence of current smoking was estimated at 6.4%. In total, 1.7% (618) of the participants admitted to bullying others, 5.8% (2071) reported being bullied, 3.5% (1269) were involved in both bullying others and being bullied, and 5.6% (2017) were at high risk for depression. Logistic regression analysis indicated that among girls, with high depression risk, bullying others, being bullied, and both bullying others and being bullied were independently and positively associated with current smoking habits, while the final results among boys showed that bullying others and both bullying others and being bullied were independently associated with an increased risk of current smoking. School-based prevention programs are highly recommended, and we should focus on high-risk students, particularly girls with high risk of depression or involved in school bullying and boys who are involved in school bullying.

Electronic cigarette use among adolescents: a cross-sectional study in Hong Kong

Background

Little is known about electronic cigarette (e-cigarette) use among Chinese adolescents. We examined the prevalence of current (past 30-day) e-cigarette use and its associated factors in a large sample of adolescents in Hong Kong.

Methods

We analyzed data of the School-based Survey on Smoking among Students 2012/13 from a representative sample of 45,857 secondary school students (mean age: 14.8 ± 1.9). We conducted chi-square tests and t-test to compare current e-cigarette use by covariates. We used multivariable logistic regression to examine the association between current e-cigarette use and demographic variables, parental smoking, peer smoking, knowledge about the harm of cigarette smoking, attitudes toward cigarette smoking, cigarette smoking status, use of other tobacco products, and alcohol consumption.

Results

Overall, 1.1 % of students reported current e-cigarette use. Of e-cigarette users, 11.7 % were never-cigarette smokers, 15.8 % were experimental cigarette smokers, 39.3 % were former cigarette smokers, and 33.2 % were current cigarette smokers. Current e-cigarette use was associated with male sex, poor knowledge about the harm of smoking, cigarette smoking, use of other tobacco products, and alcohol consumption.

Conclusions

Surveillance and intervention efforts should address a wide range of tobacco products, including e-cigarettes. Tobacco cessation programs should also address alcohol use collectively. Policies prohibiting e-cigarette sales to minors may help prevent e-cigarette uptake among adolescents.

Waterpipe smoking among secondary school students in Hong Kong

OBJECTIVES

To examine the prevalence of waterpipe smoking and its associated factors among adolescents in Hong Kong.

METHODS

We analyzed data of the School-based Survey on Smoking among Students 2012/2013 from a representative sample of 45,857 secondary school students in Hong Kong (mean age 14.8, SD 1.9). We conducted Chi-square tests and t test to compare current (past 30 days) waterpipe users and nonusers by sociodemographic variables and other covariates. Univariate and multivariable logistic regression models were used to examine the factors associated with current waterpipe smoking.

RESULTS

Overall, 1.2 % of students reported current waterpipe smoking, of whom 43 % reported concurrent use of cigarettes. Waterpipe was the most popular alternative tobacco product (non-cigarette) used by students. Current waterpipe smoking was associated with older age, male sex, higher self-perceived family financial status, poor knowledge about the harm of cigarette smoking, positive attitudes toward smoking, current cigarette smoking, other tobacco use, and alcohol consumption.

CONCLUSIONS

Waterpipe smoking was the most popular alternative tobacco product among Hong Kong adolescents. Despite the low prevalence, it should be routinely monitored. Education programs and cessation interventions need to address waterpipe smoking in addition to cigarette smoking.

Smoking, heavy drinking, and depression among U.S. middle-aged and older adults

OBJECTIVE

To examine the relationship between smoking, heavy drinking and depression among U.S. middle-aged and older adults.

METHOD

Individual-level data came from 1992-2012 waves of the Health and Retirement Study. Smoking was ascertained from self-reported cigarette smoking status at the time of interview. Heavy drinking was defined as one or more drinks per day on average or four or more drinks on any occasion in the past three months for women, and two or more drinks per day on average or four or more drinks on any occasion in the past three months for men. Depression was defined as scoring three and above on the eight-item Center for Epidemiologic Studies Depression Scale. Cox proportional hazards regressions were performed to examine the relationship between smoking, heavy drinking and depression.

RESULTS

Compared to non-smokers, smokers free from depression and heavy drinking at baseline were 20% (95% confidence interval: 12-28%) and 34% (20-50%) more likely to develop depression and engage in heavy drinking during follow-up period, respectively. Compared to non-depressed participants, participants with depression who were nonsmokers and non-heavy drinkers at baseline were 41% (14-74%) and 18% (6-31%) more likely to smoke and engage in heavy drinking during follow-up, respectively. Compared to non-heavy drinkers, heavy drinkers who were nonsmokers at baseline were 60% (26-104%) more likely to smoke during follow-up.

CONCLUSION

Health promotion programs in midlife and older age should be mindful of the associations between smoking, heavy drinking and depression in order to improve intervention effectiveness.

Growth Trajectories of Health Behaviors from Adolescence through Young Adulthood

Based on nine waves of data collected during a period of 17 years (1990-2007), the present study explored different developmental trajectories of the following unhealthy behaviors: regular smoking, lack of regular exercise, lack of daily fruit intake, and drunkenness. A baseline sample of 1195 13-year-old pupils was from 22 randomly selected schools in the Hordaland County in western Norway. Latent class growth analysis revealed three developmental trajectories. The first trajectory was a conventional trajectory, comprising 36.3% of participants, who showed changes in smoking, physical exercise, fruit intake, and drunkenness consistent with the prevailing age specific norms of these behaviors in the Norwegian society at the time. The second trajectory was a passive trajectory, comprising 25.5% of participants, who reported low levels of both healthy and unhealthy behaviors during the 17-year period. The third trajectory was an unhealthy trajectory, comprising 38.2% of participants, who had high levels of unhealthy behaviors over time. Several covariates were examined, but only sex and mother's and father's educational levels were found to be significantly associated with the identified trajectories. While these findings need to be replicated in future studies, the identification of the different trajectories suggests the need to tailor intervention according to specific needs.

Colour Vision Impairment in Young Alcohol Consumers

Alcohol consumption among young adults is widely accepted in modern society and may be the starting point for abusive use of alcohol at later stages of life. Chronic alcohol exposure can lead to visual function impairment. In the present study, we investigated the spatial luminance contrast sensitivity, colour arrangement ability, and colour discrimination thresholds on young adults that weekly consume alcoholic beverages without clinical concerns. Twenty-four young adults were evaluated by an ophthalmologist and performed three psychophysical tests to evaluate their vision functions. We estimated the spatial luminance contrast sensitivity function at 11 spatial frequencies ranging from 0.1 to 30 cycles/degree. No difference in contrast sensitivity was observed comparing alcohol consumers and control subjects. For the evaluation of colour vision, we used the Farnsworth-Munsell 100 hue test (FM 100 test) to test subject’s ability to perform a colour arrangement task and the Mollon-Reffin test (MR test) to measure subject’s colour discrimination thresholds. Alcohol consumers made more mistakes than controls in the FM100 test, and their mistakes were diffusely distributed in the FM colour space without any colour axis preference. Alcohol consumers also performed worse than controls in the MR test and had higher colour discrimination thresholds compared to controls around three different reference points of a perceptually homogeneous colour space, the CIE 1976 chromaticity diagram. There was no colour axis preference in the threshold elevation observed among alcoholic subjects. Young adult weekly alcohol consumers showed subclinical colour vision losses with preservation of spatial luminance contrast sensitivity. Adolescence and young adult age are periods of important neurological development and alcohol exposure during this period of life might be responsible for deficits in visual functions, especially colour vision that is very sensitive to neurotoxicants.

Does a reduction in alcohol use by Dutch high school students relate to higher use of tobacco and cannabis?

Background

Substance use of adolescents was investigated in a region around Amsterdam, the Netherlands, in the period 2005–2009. The study was intended to find out to what extent behaviour related to different substances are interrelated and how trends develop in different subgroups.

Methods

Two cross-sectional surveys were conducted among Dutch students in the second and fourth year of secondary school, aged 13-16 [n = 1,854 in 2005; n = 2,088 in 2009] by making use of an online questionnaire including questions about alcohol consumption, tobacco use (smoking behaviour) and cannabis use. Two educational levels were included.

Results

Decreases in alcohol consumption, tobacco and cannabis use were found between 2005 and 2009. The strongest decline was seen in alcohol consumption. Last month drinking decreased from 61.8 % in 2005 to 36.5 % in 2009. Last month binge drinking decreased from 38.7 % in 2005 to 24.0 % in 2009. Reduced alcohol consumption was found among boys and girls, for all ages and in both educational levels. Changes were strongest among 13-year-olds. Weekly or daily smoking declined between 2005 and 2009 among 13-year-olds, girls and students in the lower schooling level. Last month cannabis use decreased among girls and students in the higher schooling level. In both 2005 and 2009 clustering with alcohol consumption was found for the use of other substances.

Conclusions

Between 2005 and 2009 alcohol consumption strongly decreased among high school students. This may be due to the national prevention campaign which in the same period highlighted the importance of not drinking before the age of 16. The decrease in smoking and cannabis use between 2005 and 2009 may be due to clustering with alcohol consumption. A reduction in the use of alcohol in adolescence did not lead to replacement by tobacco or cannabis use.

To suppress, or not to suppress? That is repression: controlling intrusive thoughts in addictive behaviour

Research to understand how individuals cope with intrusive negative or threatening thoughts suggests a variety of different cognitive strategies aimed at thought control. In this review, two of these strategies--thought suppression and repressive coping--are discussed in the context of addictive behaviour. Thought suppression involves conscious, volitional attempts to expel a thought from awareness, whereas repressive coping, which involves the avoidance of thoughts without the corresponding conscious intention, appears to be a far more automated process. Whilst there has been an emerging body of research exploring the role of thought suppression in addictive behaviour, there remains a dearth of research which has considered the role of repressive coping in the development of, and recovery from, addiction. Based on a review of the literature, and a discussion of the supposed mechanisms which underpin these strategies for exercising mental control, a conceptual model is proposed which posits a potential common mechanism. This model makes a number of predictions which require exploration in future research to fully understand the cognitive strategies utilised by individuals to control intrusive thoughts related to their addictive behaviour.

Exploring comorbid use of marijuana, tobacco, and alcohol among 14 to 15-year-olds: findings from a national survey on adolescent substance use

BACKGROUND

Understanding the patterns of comorbid substance use, particularly among adolescents, is necessary to address resulting harm. This study investigated the prevalence of comorbid use of marijuana, tobacco and binge drinking among 14 to 15-year-olds. The study also examined the relationship between comorbid substance use and behaviour frequency and explored common underlying risk factors for comorbid substance use.

METHODS

A nationally representative sample of 3,017 New Zealand Year 10 students completed self-report measures of marijuana use, tobacco use, binge drinking and socio-demographic characteristics in the 2012 Youth Insights Survey (YIS). Weighted population estimates were calculated. Ordinal logistic regression models were constructed to a) investigate the relationship between comorbidity and substance use behaviour frequency, and b) profile those with the greatest degree of comorbid substance use.

RESULTS

In the past month, one-in-twenty (4.7%) students had engaged in all three substance use behaviours, 5.8% in two, and 11.9% in one. Around half of adolescents who had engaged in one had also engaged in another, with three-quarters of tobacco-users also using marijuana and/or binge drinking. Respondents who reported a greater degree of comorbidity were likely to engage in substance use behaviour more frequently. Comorbid substance use was significantly predicted by gender, ethnicity, school decile status, past week income, social connectedness, and parental monitoring and rule enforcement.

CONCLUSIONS

The results identify a core group of adolescents sharing common characteristics who frequently engage in comorbid substance use behaviours. More sophisticated and wider interventions addressing multiple substances are required, especially for marijuana and tobacco use.

Demographic and socio-economic factors associated with multiple health risk behaviours among adolescents in Serbia: a cross sectional study

BACKGROUND

The aim of this study was to examine the relationships between demographic and socioeconomic characteristics and engaging in multiple risk behaviours among adolescents in Republic of Serbia.

METHODS

This study presents a cross sectional study of 683 adolescents aged 15 to 19 attending high school. The database from the 2006 National Health Survey was used. As a measure of demographic and socio-economic characteristics: age, type of settlement, family structure, having one's own room, school success and the household wealth index were used. Multivariate logistic regression model was performed.

RESULTS

Boys were more than twice as likely to engage in multiple risk behaviours than girls. Adolescents who were older (OR = 5.82, 95% CI = 3.21-10.54, boys; OR = 3.76, 95% CI =1.77-7.99, girls) and adolescents who achieved low or moderate (OR = 1.82, 95% CI = 1.02-3.26, boys; OR = 3.36, 95% CI =1.51-7.44, girls) school success had significantly higher risk than younger ones and those with high school success. Also, boys who came from a richer class households (OR = 3.14, 95% CI =1.02-9.66) and girls from incomplete family (OR = 5.07, 95% CI = 2.06-12.50) had higher risk than boys from the poorest households and girls from complete family.

CONCLUSIONS

Further preventive interventions in Serbia should be gender and age specific, oriented towards older adolescents, those who have low or moderate school success, boys from richer class households and girls who live in incomplete families.

Role of personal and family factors in alcohol and substance use among adolescents: an international study with focus on developing countries

Most studies examining adolescent alcohol and substance use or abuse hardly include samples from developing countries. To bridge some gap, the prevalence and associated social correlates of alcohol and substance use and abuse was examined among a cohort of school-going adolescents sampled from seven developing countries. Alcohol and substance abuse was measured using the CRAFFT instrument, independent socio-demographic correlates were determined using regression models. A total of 2454 adolescents completed the study, among which 40.9% reported using either alcohol or at least one other substance during the previous 12 months. This was mostly alcohol (37.8%), followed by marijuana/hashish (8.6%) and other substances (8.1%). Among the adolescents who reported using at least one substance, 45% (18.3% of total sample) had CRAFFT scores indicative of problematic or hazardous substance use. Several personal and family factors were independently associated with use/abuse, and the modifiable nature of these factors calls for appropriate intervention strategies.

Correlates of current smoking among Malaysian secondary school children

Cigarette smoking in adolescent is a significant public health problem, leading to the risk of addiction, morbidity, and mortality in the long term. This study determined the prevalence and correlates of current smoking among adolescent school children. A nationwide school-based survey among 25 507 students between Forms 1 to 5 (aged 12-17) was conducted using a 2-stage cluster sampling design. The prevalence of current smoking was 11.5%. Multivariable logistic regression analysis revealed that current smoking was significantly associated with males (adjusted odds ratio [aOR] = 3.25; 95% confidence interval [CI] = 1.87, 4.98), current drinking (aOR = 2.34; 95% CI = 1.46, 3.74), drug used (aOR = 2.97; 95% CI = 1.24, 7.11), and being bullied (aOR = 1.41; 95% CI = 1.00, 1.98) at least once in the past 12 months. Smoking is associated with several behaviors that pose risks to adolescents, such as social issues and smoking-related health problems. Thus, early and integrated prevention programs that address multiple risk behaviors simultaneously are required.

Cervical cancer screening adherence among HIV-positive female smokers from a comprehensive HIV clinic

HIV-positive women are at elevated risk for developing cervical cancer. While emerging research suggests that gynecologic health care is underutilized by HIV-positive women, factors associated with adherence to Pap testing, especially among HIV-positive female smokers are not well known. We utilized baseline data from a smoking cessation trial and electronic medical records to assess Pap smear screening prevalence and the associated characteristics among the HIV-positive female participants (n = 138). 46 % of the women had at least 1 Pap test in the year following study enrollment. Multiple logistic regression analysis indicated that younger age, African American race, hazardous drinking, increased number of cigarettes smoked per day, and smoking risk perception were associated with non-adherence to Pap smear screening. Cervical cancer screening was severely underutilized by women in this study. Findings underscore the importance of identifying predictors of non-adherence and addressing multiple risk factors and behavioral patterns among HIV-positive women who smoke.

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.

Systematic review and meta-analysis: prevalence of alcohol use among young people in eastern Africa

Objective

Systematic review and meta-analysis of published studies of alcohol use among young people (age 15–24 years) in eastern Africa to estimate prevalence of alcohol use and determine the extent of use of standardised screening questionnaires in alcohol studies.

Methods

Five databases (MEDLINE, EMBASE, Global Health, Africa-wide, and PsycINFO) were searched for publications until 30th June 2013. Results were summarised using the guidelines on preferred reporting items for systematic reviews and meta-analyses (PRISMA) and on quality assessment using the modified quality assessment tool for systematic reviews of observational studies (QATSO). Heterogeneity was assessed using the I² statistic (DerSimonian-Laird).

Results

We identified 2785 potentially relevant studies, of which 56 were eligible for inclusion. Only two studies (4%) used the standardised Alcohol Use Disorder Identification Test (AUDIT) questionnaire, and six studies (13%) used the Cut down, Annoyed, Guilt, Eye opener (CAGE) questionnaire. The reported median prevalence of alcohol use was ever-use 52% [interquartile range (IQR): 20–58%], use in the last month 28% (IQR: 17–37%), use in the last year 26% (IQR: 22–32%), and problem drinking as defined by CAGE or AUDIT 15% (IQR: 3–36%). We observed high heterogeneity between studies, with the highest prevalence of ever use of alcohol among university students (82%; 95%CI: 79–85%) and female sex workers (66%; 95%CI: 58–74%). Current use was most prevalent among male sex workers (69%; 95%CI: 63–75%).

Conclusions

Reported alcohol use and problem drinking were common among diverse groups of young people in eastern Africa, indicating the urgent need for alcohol-focused interventions in this population. Few studies have used standardised alcohol screening questionnaires. Epidemiological research to investigate alcohol-focused interventions in young people should aim to apply such questionnaires that should be validated for use in this population.

Health risk behavior pattern among students from Cartagena, Colombia: prevalence and associated variables

The aim of the study was to determine the prevalence and variables associated with the pattern of risky health behavior (PRHB) among adolescent students in Cartagena, Colombia. A cross-sectional study was designed to investigate PRHB in a random cluster sample of students from middle and high schools. The associations were adjusted by logistic regression. A total of 2,625 students participated in this research, with ages from 10 to 20 years, mean=13.8 years (SD=2.0), and 54.3% were women. A total of 332 students reported PRHB (12.7%, 95%CI 11.4-14.0). Age over 15 years (OR=2.19, 95%CI 1.72-2.79), not being heterosexual (OR=1.98, 95%CI 1.36-2.87), poor/mediocre academic performance (OR=1.87, 95%CI 1.47-2.38), family dysfunction (OR=1.78, 95%CI 1.40-2.28) and male gender (OR=1.58, 95%CI 1.24-2.01) were associated with PRHB. One in every eight students presented a PRHB. It is important to pay greater attention to students who are over 15 years of age, male, not heterosexual, with a poor/mediocre academic performance and a dysfunctional family.

Psychoactive substances use and associated factors among Axum University students, Axum Town, North Ethiopia

BACKGROUND

The use of substances such as alcohol, khat leaves and tobacco have long been recognized as one of the leading causes of human suffering and become one of the rising major public health and socio-economic problems worldwide. Even though substances use occurs in all segments of all societies, it is more spreading in an alarming rate among the young generation. This study aimed to establish the prevalence and associated factors of substances use among undergraduate students in Axum University.

METHODS

Institution based quantitative cross sectional study design was conducted among Axum University students in April 2012. A sample of 764 students was selected by using multi- stage sampling technique. Data were collected using pre- tested self- administered questionnaires. The data were cleaned, coded, entered into EPI-INFO version 3.5.1 and transferred and analysed using SPSS computer soft ware package version 20.

RESULTS

The lifetime prevalence of khat chewing, alcohol drinking and cigarette smoking among the study participants were 28.7%, 34.5% and 9.5% respectively. Similarly, the current prevalence of khat chewing, alcohol drinking and cigarette smoking were 27.9%, 32.8% and 9.3% respectively. The commonest reasons for khat, alcohol and cigarette using were to keep alert while reading 40.6%, for relaxation 65.5% and to relief stress 37.7% respectively. Having peer friends who chew khat was strongly and positively associated with khat use [AOR: 10.18, 95%CI: (5.59, 18.54)].Family members and peer friends alcohol use were strongly associated with alcohol drinking [AOR: 2.61, 95%CI: (1.56, 4.34) and [AOR: 14, 95%CI: (8.09, 24.24)] respectively. Ever alcohol use was strongly associated with cigarette smoking [AOR: 6.54, 95%CI: (2.66, 16.05)].

CONCLUSION

This study revealed that psychoactive substances use became an urgent problem among undergraduate university students. Universities need to monitor and teach their students with special focus on fresh man students, about the health risks and socioeconomic problems associated with psychoactive substances use.

The importance of family relations for cannabis users: the case of serbian adolescents

BACKGROUND

Adolescence is transitional stage of physical and mental human development occuring between childhood and adult life. Social interactions and environmental factors together are important predictors of adolescent cannabis use. This study aimed to examine the relationship between the social determinants and adolescents behavior with cannabis consumption.

METHODS

A cross sectional study as part of the European School Survey Project on Alcohol and other Drugs was conducted among 6.150 adolescents aged 16 years in three regions of Serbia, and three types of schools (gymnasium, vocational - professional, and vocational - handicraft) during May - June 2008. A multivariate logistic regression analysis was carried out to obtain adjusted odds ratios with 95% confidence intervals in which the dependent variable was cannabis consumption non-user and user.

RESULTS

Among 6.7% of adolescents who had tried cannabis at least one in their lives, boys were more involved in cannabis use than girls, especially boys from gymnasium school. Well off family, lower education of mother, worse relations with parents were significantly associated with cannabis use (P < 0.05). Behaviors like skipping from schools, frequent evening outs, and playing on slot machines were also related to cannabis use (P < 0.05).

CONCLUSIONS

The study confirmed the importance of family relationship development. Drug use preventive programmes should include building interpersonal trust in a family lifecycle and school culture.

Cannabis use and its socio-demographic correlates among in-school adolescents in Zambia

Background

Cannabis dependence in adolescents predicts increased risks of using other illicit drugs, poor academic performance and reporting psychotic symptoms. The prevalence of cannabis use was estimated two decades ago in Zambia among secondary school students. There are no recent estimates of the extent of the problem; further, correlates for its use have not been documented in Zambia. The objective of study was to estimate the current prevalence of cannabis use and its socio-demographic correlates among in-school adolescents.

Methods

We conducted secondary analysis of data that was obtained from the 2004 Zambia Global School-Based Health Survey. Logistic regression analysis was conducted to identify the socio-demographic factors associated with cannabis use.

Results

A total of 2,257 adolescents participated in the survey of which 53.9% were females. The overall prevalence of self reported ever-used cannabis was 37.2% (34.5% among males and 39.5% among females). In multivariate analysis, males were 8% (AOR = 0.92; 95% CI [0.89, 0.95]) less likely to have ever smoked cannabis. Compared to adolescents aged 16 years or older, adolescents aged 14 years were 45% (AOR = 1.45; 95% CI [1.37, 1.55]) more likely, and those aged 15 years were 44% (AOR = 0.56; 95% CI [0.53, 0.60]) less likely to report to have ever smoked cannabis. Other factors that were significantly associated with cannabis use were history of having engaged in sexual intercourse (AOR = 2.55; 95% CI [2.46, 2.64]), alcohol use (AOR = 4.38; 95% CI [4.24, 4.53]), and having been bullied (AOR = 1.77; 95% CI [1.71, 1.83]). Adolescents who reported being supervised by parents during free time were less likely to have smoked cannabis (AOR = 0.92; 95% CI [0.88, 0.95]).

Conclusions

The use of cannabis is prevalent among Zambian in-school adolescents. Efforts to prevent adolescents’ psychoactive drug use in Zambia should be designed considering the significant factors associated with drug use in the current study.