Adaptation and Validation of the Hooked on Nicotine Checklist (HONC) with Spanish Adolescents

INTRODUCTION

The expansion of new tobacco consumption formats and electronic vapor products threatens to reverse the trend of declining smoking rates that had been observed among younger people in recent decades. Early detection in the health sector requires screening tools that have been adapted and validated in our context. This study aims to translate, culturally adapt, pilot and empirically validate the Hooked on Nicotine Checklist (HONC) with Spanish adolescents.

METHODS

The process of translation and cultural adaptation included the following stages: direct translation, synthesis of translations, back translation, consolidation with a committee of experts and pre-test, along with a cognitive interview, which served as pilot testing. Empirical validation was conducted with a sample of 1027 adolescents aged between 12 and 18 (M=15.40; SD=1.638).

RESULTS

The results obtained confirm that the HONC is a brief, clear and easy-to-understand tool, with appropriate psychometric properties. A Cronbach's alpha value of 0.90 was obtained. Sensitivity, specificity, PPV and NPV indices reached values of 0.56, 0.94, 0.79 and 0.83, respectively. Cut-off point 1 is the one reaching the best balance between the two values. CFA showed a model good overall fit.

CONCLUSION

This study makes the Spanish version of the HONC available to researchers and clinicians, so that it can be used with sufficient psychometric guarantees.

Waterpipe use among adolescents. Possible implications and related variables

Substance use in waterpipe (generally tobacco or cannabis) constitutes an increasingly popular practice. It has become an emerging public health problem, with serious consequences at both pulmonary and addiction levels. Despite the growing concern it raises, few studies have been carried out in Spain to analyze this new practice from an early age. The aim of this study is to have new data about waterpipe use among adolescents and to analyze its possible implications and related variables. A survey was conducted among secondary school students from the Galician community. A total of 7,613 students aged 12-18 years (M = 14.97; SD = 1.69) participated. The CRAFFT, the AUDIT and the CAST were used to screen the risky use of other substances. The rates of waterpipe tobacco and cannabis use are at worrying levels (19.4% and 8.5%, respectively, for the last year), with significantly higher rates of risky substance use, drunkenness and binge drinking. The low perception risk is striking. Waterpipe use is a widespread practice in adolescence. In addition to serious health implications, is a clear indicator of a problematic underlying consumption. The low perception of risk, the "botellón" or the lack of family control are elements to take into account in community prevention.

Underage Problem Gambling: With Whom, Where and Why

BACKGROUND

Underage gambling is a widespread phenomenon with its own characteristics that differentiate it from adult gambling. In addition, problem gambling has shown a remarkable prevalence in previous studies. The present study examines underage gambling behaviour, studying its characteristics, as well as motivational and contextual aspects, and estimating the volume of problem gambling and possible moderating variables.

METHOD

A sample of 9,681 students aged between 12 and 17 years old reported their involvement in gambling and filled in the Brief Adolescent Gambling Screen (BAGS), with 4,617 of them completing a questionnaire about gambling behaviours.

RESULTS

Almost a quarter (23.5%) of the students reported having gambled in their lifetime (16.2% in-person, 1.4% online and 6% in both modalities), and 1.9% presented symptoms of problem gambling (BAGS ≥ 4). In-person gamblers preferred sport-betting machines, usually gambled in bars, and did not have their age checked. Online gamblers reported mainly sports betting, doing so on websites and paying with PayPal-like services and credit cards. Most gambled with friends and to win money. Problem gamblers were similar but gambled more frequently.

CONCLUSIONS

These results present an image of the gambling situation among minors and, more importantly, of its context and related variables.

Gaming habits and symptoms of video game addiction in Spanish adolescents

Gaming disorder has been receiving increased attention since its inclusion in the ICD-11. However, there are still few studies on minors in the Spanish context. The present study aimed to explore the gaming habits and symptomatology of gaming disorder in this population, as well as analyzing the relationship between both. Gaming habits were assessed such as frequency and weekly hours played, and the Game Addiction Scale for Adolescents was applied to a sample of 3748 students between 12 and 17 years old. It was found that 13.5% presented symptoms of problematic gaming and 3.3% a possible video game addiction. There was also a relationship between gambling habits and the presence of addiction symptoms. These results are compared to other studies and the heterogeneity of data available in the field is highlighted. Additionally, the implications of the results for preventive actions carried out by developers and families are discussed.

Hábitos de juego y síntomas de adicción a los videojuegos en adolescentes españoles

El trastorno por uso de videojuegos ha recibido mayor atención desde su inclusión en la CIE-11. Sin embargo, apenas hay investigación en menores de edad en el contexto español. El presente trabajo tiene como objetivo de explorar los hábitos de uso de videojuegos y la sintomatología del trastorno por uso de videojuegos en esta población, así como analizar la relación entre ambos. Los hábitos fueron evaluados como la frecuencia y las horas semanales jugadas y la “Escala de adicción al juego para adolescentes” (GASA) fue aplicada a una muestra de 3748 estudiantes de entre 12 y 17 años. Los resultados mostraron que el 13,5% presentaba síntomas de juego problemático y el 3,3% una posible adicción a los videojuegos. También fue encontrada una relación entre los hábitos de juego y la presencia de síntomas de adicción. Estos resultados se comparan con los de otros estudios y se pone de manifiesto la heterogeneidad de datos disponibles en este ámbito. Además, se discuten las implicaciones de los resultados para posibles acciones preventivas llevadas a cabo por desarrolladores y familias.

Bullying and Cyberbullying among Students with Cochlear Implants

Bullying is a significant problem for young people nowadays, regardless of their identity, culture, or background. Although the scientific evidence warns of a greater impact of bullying on vulnerable groups such as cochlear implant (CI) users, few specific studies have been carried out in this regard. As such, the fundamental objective of this study was to estimate the prevalence of both traditional bullying and cyberbullying among Spanish adolescents and young people with CI. Parents with children CI users were also invited to participate to explore their perspective concerning the victimization of their children. The information was collected using one survey for students aged 11-23 year (n = 102) and another for parents (n = 127). Beyond the frequency and types of bullying suffered or the methods used for coping with victimization, results also show lower rates of bullying when students were asked specifically with a single-item question than when applying multi-item questionnaires. The results are discussed in terms of the broader international bullying and victimization literature.

Minors and Online Gambling: Prevalence and Related Variables

Substantial access to the Internet by minors has brought about consequences that are not always positive. The increase of online gambling or betting is one of those. Although in most cases online gambling by minors does not result in a disorder, it does imply a higher probability of developing a gambling disorder in adulthood, and it can cause economic, family, school and social problems. The aim of this study, carried out in the Galician region of Spain with a sample of 3772 students aged between 12 and 17 years, was to estimate the prevalence of online gambling in minors; to characterize the profile of online gamblers; to explore the differences in Internet and smartphone usage habits, online risky practices, problematic Internet use and parental involvement between online gamblers and non-online gamblers; and to analyse the relation between online gambling and academic performance. The results revealed that 6.5% of Galician adolescents are online gamblers, a figure that has more than tripled over seven years. 9 out of 10 online gamblers are male, and their mean age is 15. Online gamblers had significantly higher rates of problematic Internet use, active sexting, cyberbullying, or contacting strangers through the Internet. Furthermore, online gamblers had higher scores on impulsiveness, lower scores on assertiveness, and were lacking parental control. These data show that online gambling is not an isolated problem, so prevention should be understood in a comprehensive manner.

Empirical validation of the CRAFFT Abuse Screening Test in a Spanish sample

The CRAFFT Substance Abuse Screening Instrument, developed by the Center for Adolescents Substance Abuse Research (CeASAR) (Knight et al., 1999), is a screening tool for high-risk alcohol and drug risk consumption designed for use with adolescents. Since its publication it has been the subject of translations and validations in different countries, populations and contexts that have demonstrated its enormous potential. However, there is still no empirical validation study that would ensure its good psychometric performance in Spain. The aim of this paper is to develop an adapted version of the CRAFFT in Spanish and to analyze its psychometric properties in a sample of Spanish adolescents. For this purpose an individual interview was conducted on 312 adolescents aged between 12 and 18 years of age (M = 15.01; SD = 1.83) from the Galician community. The interview included a part of the Adolescent Diagnostic Interview (ADI) and the Problem Oriented Screening Instrument for Teenagers (POSIT). The results obtained, similar to those found in other countries, allow us to report that the Spanish version of the CRAFFT has a good psychometric behaviorproperties. It was found to have a satisfactory internal consistency with a Cronbach’s alpha value of .74. In terms of sensitivity and specificity, values of 74.4% and 96.4% respectively, were obtained and the area under the ROC curve was .946. The Spanish version of the CRAFFT is made available to researchers and professionals in the field of addictive behaviors, so that it can be used with the necessary psychometric guarantees.

Effectiveness of an educational intervention to improve the safety culture in primary care: a randomized trial

Background

Fostering a culture of safety is an essential step in ensuring patient safety and quality in primary care. We aimed to evaluate the effectiveness of an educational intervention to improve the safety culture in the family and community medicine teaching units in an Atlantic European Region.

Methods

Randomized study conducted in family and community medicine teaching units in Galicia (Spain). Participants were all fourth-year residents and their tutors (N = 138). Those who agreed to participate were randomized into one of two groups (27 tutors/26 residents in the intervention group, 23 tutors/ 23 residents in the control one).All were sent the Survey on Patient Safety Culture. After that, the intervention group received specific training in safety; they also recorded incidents over 15 days, documented them following a structured approach, and had feedback on their performance. The control group did not receive any action. All participants completed the same survey four months later. Outcome measures were the changes in safety culture as quantified by the results variables of the Survey: Patient Safety Grade and Number of events reported.

We conducted bivariate and adjusted analyses for the outcome measures. To explore the influence of participants’ demographic characteristics and their evaluation of the 12 dimensions of the safety culture, we fitted a multivariate model for each outcome.

Results

Trial followed published protocol. There were 19 drop outs. The groups were comparable in outcome and independent variables at start. The experiment did not have any effect on Patient safety grade (− 0.040) in bivariate analysis. The odds of reporting one to two events increased by 1.14 (0.39–3.35), and by 13.75 (2.41–354.37) the odds of reporting 3 or more events. Different dimensions had significant independent effects on each outcome variable.

Conclusion

A educational intervention in family and community medicine teaching units may improve the incidents reported. The associations observed among organizational dimensions and outcomes evidence the complexity of patient safety culture measurement and, also, show the paths for improvement. In the future, it would be worthwhile to replicate this study in teaching units from different settings and with different health professionals engaged.

Trial registration

It was retrospectively registered with (ISRCTN41911128, 31/12/2010).

Electronic supplementary material

The online version of this article (10.1186/s12875-018-0901-8) contains supplementary material, which is available to authorized users.

Cannabis use among adolescents: Risk pattern, implications and possible explanatory variables

In contrast to the achievements with other substances, it has not yet been possible to reduce the levels of cannabis use, the most used illegal substance among Spanish adolescents. The objective of this paper consists of updating levels of use (incorporating ages 12 and 13), estimating high-risk use and analyzing possible associated variables. For this purpose, a correlational method was used consisting of the administration of a survey to compulsory secondary school and high school students from the autonomous community of Galicia (Spain) in 2016. Results obtained from a sample of 3,882 Galician adolescents aged 12 to 18 (M = 14.52; SD = 1.72) reveal that the percentage of adolescents currently using tobacco and cannabis is higher than that of those using tobacco alone (12.7% vs 10.5%). This implies not only a higher probability of using other illegal substances, but also of developing rather high-risk use pattern, binge drinking or even experiencing problematic Internet use or cyberbullying. From a preventive perspective, the results reveal that personal variables such as self-esteem, assertiveness, social skills or impulsiveness have really weak explanatory power compared with other variables related to the setting of rules and limits by parents. One of the main conclusions of this paper is the need to adopt a comprehensive prevention approach.

Psychometric validation of the POSIT for screening alcohol and other drugs risk consumption among adolescents

Early detection of alcohol and drug abuse among adolescents is decisive not only for rapid referral and intervention in cases of risk, but also as an indicator for use in the evaluation of prevention programs and public policies to reduce consumption. One of the most widely-used screening instruments in the world is the Problem Oriented Screening Instrument for Teenagers (POSIT) (Rahdert, 1991), whose substance use and abuse subscale (POSITUAS) is a brief tool of enormous applied potential. However, there is still no empirical validation study that would ensure its good psychometric performance in Spain. The aim of this paper is to analyse the psychometric properties of POSITUAS among Spanish adolescents. For this purpose, 569 students aged between 12 and 18 years (M = 14.71; SD = 1.79) were personally interviewed. The study sample was selected through two-stage sampling. The results obtained, using the Adolescent Diagnostic Interview (Winters & Henly, 1993) as the gold criterion, allow us to inform that the Spanish version of the POSITUAS has excellent psychometric behaviour, both at the level of internal consistency (a  = .82) as well as regards sensitivity (94.3%) and specificity (83.9%), with an area under the ROC curve of .953. Also, the realisation of a Confirmatory Factor Analysis allows for verifying the one-dimensional character of the scale. As a result, POSITUAS is made available to researchers and professionals in the field of addictive behaviours for use with a minimum of psychometric guarantees.

The relationship between consumption of alcohol and other drugs and problematic Internet use among adolescents

Alcohol and drug use among adolescents has been causing great concern for decades in Spain and in the European Union as a whole. In addition, the technology boom experienced over the last two decades has contributed to the emergence of a new public healthcare issue: problematic Internet use. The increasing importance that both problems have been gaining in recent years has led some authors to analyze the relationship between alcohol and the consumption of other drugs alongside problematic Internet use, and to provide relevant empirical evidence. Based on a sample of 3,882 Spanish adolescents aged between 12 and 18, the results obtained confirm that there is a relationship between the consumption of alcohol (measured by the AUDIT) and other drugs (measured by the CRAFFT and the CAST), and problematic Internet use (measured by the EUPI-a). Problematic Internet users among them not only have more significant levels of substance use, but also a three-times greater chance of developing hazardous drug use (39.4% vs 13.3%). This highlights the need to develop transversal prevention capable of acting on the common variables to both issues, beyond developing programs focused on specific behaviors. In this sense, values-based education and life skills training should be given priority in prevention.

Binge drinking among adolescents: prevalence, risk practices and related variables

According to the last Survey on Drug Use among Secondary School Students (ESTUDES 2014-2015), consumption levels of alcohol and other substances have decreased in the last years in Spain. However, available data on binge drinking remain worrying, given the negative consequences related with this pattern. The aim of this paper is to analyse binge drinking among adolescents, providing updated data on prevalence in addition to information about the consequences and some predictive factors of binge drinking. A correlational method was used for this purpose, comprised of administering a survey to Compulsory Secondary School, High School and Vocational Training students. Based on a sample of 3,419 Galician adolescents aged between 12 and 18 years (M = 14.57; SD = 1.76), the results show that binge drinking is a common and global practice, with few socio-demographic differences but related with a wide range of risk practices. Furthermore, variables such as consumption expectancies, consumption by family and friends, as well as curfew time and allowance money have been identified as interesting predictive factors that should be taken into account at the preventive level.

Patterns of Alcohol Consumption in Spanish University Alumni: Nine Years of Follow-Up

The aim of this study was to empirically identify different profiles of Spanish university alumni, based on their alcohol use over 9 years, and to further characterize them. A cohort study was carried out between 2005 and 2015 among university students (Compostela Cohort-Spain; n₂₀₁₅ = 415). Alcohol consumption was measured using the Alcohol Use Disorder Identification Test (AUDIT). A two-stage cluster analysis, based on their AUDIT total scores was carried out separately for males and females. The further characterization of every profile was based on demographic data, age at onset of alcohol use, positive alcohol-related expectancies, tobacco and cannabis use, as well as their answers to some European Addiction Severity Index items. Five different clusters were identified: Low users (29.2%), Moderated users (37.2%), At-risk users (14.2%), Decreasing users (13.2%) and Large users (6.2%) for females, and Low users (34.4%), At-risk users (25.6%), High-risk users (15.6%), Decreasing users (14.4%) and Large users (10.0%) for males. Being a cannabis user or a smoker was positively associated to those more hazardous clusters in both genders. Regarding females, significant differences in the age of onset and high positive expectancies were found. However, there were few significant differences among the groups in relation to their employment status and social relations. The results reveal the existence of different typologies of alcohol users among university alumni, with differences among males and females. Modifying positive expectancies, limiting access to alcohol at a young age, and reducing uses of other substances uses are key to promote healthier alcohol use profiles and to prevent hazardous uses.

Screening of Problematic Internet Use Among Spanish Adolescents: Prevalence and Related Variables

The opportunities and challenges related to Internet use continue to grow, as well as the social concern around problematic Internet use (PIU), online risky behaviors, and the intensive use of Internet, mainly among adolescents. The aim of this study was to conduct a general screening of PIU in a large sample of school-based adolescents in Spain (n = 40,955), providing updated prevalence data of PIU and different online risky practices, as well as rates of Internet and social network use. Differences between problematic and nonproblematic users were explored in terms of demographics, parental control, and motivations for using. The association between PIU and the involvement in other online risky behaviors was also analyzed, as well as the role of intensive use. The findings show that the global prevalence of PIU among Spanish adolescents is 16.3 percent although this is higher among females, those in their late teens, intensive users, and those without parental control. Logistic regression confirmed that both PIU and intensive use are risk factors for being involved in any online risky behavior. A tentative explanation could be that there is a common deficit of personal and social skills underlying PIU, intensive use, and most online risky practices. From our perspective, value-based education and life skills training are the best way to reach responsible and sensible use of Internet among adolescents. Parents, schools, institutions, and adolescents themselves are called upon to actively engage in facing this problem.

Adverse events analysis as an educational tool to improve patient safety culture in primary care: a randomized trial

Background

Patient safety is a leading item on the policy agenda of both major international health organizations and advanced countries generally. The quantitative description of the phenomena has given rise to intense concern with the issue in institutions and organizations, leading to a number of initiatives and research projects and the promotion of patient safety culture, with training becoming a priority both in Spain and internationally. To date, most studies have been conducted in a hospital setting, even though primary care is the type most commonly used by the public, in our experience.

Our study aims to achieve the following:

- Assess the registry of adverse events as an education tool to improve patient safety culture in the Family and Community Teaching Units of Galicia.

- Find and analyze educational tools to improve patient safety culture in primary care.

- Evaluate the applicability of the Hospital Survey on Patient Safety Culture by the Agency for Healthcare Research and Quality, Spanish version, in the context of primary health care.

Design and methods

Discussion

The most significant limitations on the project are related to selecting a tool to measure the safety environment, the training calendar of residents in Family and Community Medicine in last year of studies and the no-answer bias inherent to research conducted through self-administered surveys.

The development and application of a safety culture in the health sector, specifically in primary care, is as yet limited. Thus, identifying the strengths and weaknesses in the safety environment may assist in designing strategies for improvement in the primary care health centers of our region.

Trial registration

ISRCTN: ISRCTN41911128

A new ELISA for determination of potency in snake antivenoms

A competitive ELISA for potency determination of bothropic equine antivenom was developed and compared to the conventional in vivo ED(50) assay, with the aim of partially substituting the in vivo assay in the monitoring of antivenom immunoglobulin levels. On this purpose, blood samples were taken at different times during and after the immunization protocol of the lot of horses used for production of snake antivenom at the Instituto de Higiene, Uruguay. Both the competitive ELISA and the ED(50) assay were performed on those samples. In addition, a group of five commercial pepsin-digested antivenoms were tested by both methods. A significant (P<0.001) correlation (Pearson's r=0.957) was found between the ELISA titres and the corresponding ED(50) values, indicating that the in vitro test can estimate the neutralizing antibody capacity of the sera as well as the in vivo assay. By means of this new ELISA, it was found that the immunized animals maintained good venom antibody titres, in the order of 20-50% of the maximum achieved, even 10 month after the end of the immunization schedule. The main advantage of our ELISA design is its ability to correctly estimate the neutralization capacity of crude hyperimmune plasma and antivenom sera independently of their antibody composition in terms of whole IgG or F(ab')(2) fragment.

An attenuated Salmonella Enteritidis strain derivative of the main genotype circulating in Uruguay is an effective vaccine for chickens

We have recently reported that Salmonella enterica serovar Enteritidis (S. Enteritidis) strains circulating in Uruguay, are unevenly distributed among different genetic subtypes, with a predominant genotype that is a common contaminant of poultry-derived food and that accounts for the vast majority of human cases of food-borne disease. Herein, we describe the construction of a genetically-defined aroC derivative (LVR02) of a local strain of S. Enteritidis belonging to the major genetic type. We demonstrated the attenuation and the immunogenicity of that strain in a mouse model, and evaluated it as a vaccine for commercial layer chickens. LVR02 proved to be stable, attenuated, innocuous, immunogenic and to induce protective immunity against a S. Enteritidis challenge when used for oral vaccination. A single oral dose of LVR02 administered to newly hatched chickens induced protection against oral challenge with the parental virulent strain, preventing systemic and persistent intestinal infection and significantly reducing the shedding of the challenge strain in birds' feces. A second vaccine dose at 15 days post-hatching boosted the immunogenicity of the vaccine, and strengthened the protection achieved with a single dose. This strain may represent the basis of a live vaccine to be included in national control programs to reduce circulation of this pathogen in the country.

Intranasal immunization with a colloid-formulated bacterial extract induces an acute inflammatory response in the lungs and elicits specific immune responses

Nonspecific stimulation of lung defenses by repeated oral administration of immunomodulators, such as bacterial extracts, has shown potential for the prevention of respiratory tract infections. Here, we show that intranasal (i.n.) immunization with a bacterial extract formulated as a colloid induces an acute inflammatory response in the lungs characterized by increased production of CCL and CXCL chemokines and a major influx of dendritic cells (DCs) and neutrophils, with a higher proportion of DCs showing an activated phenotype (high CD80/CD86 expression). Cytokine levels measured in bronchoalveolar-lavage samples showed a small increase in the production of tumor necrosis factor alpha and similar levels of the other cytokines measured (interleukin 10 [IL-10], IL-12, and gamma interferon [IFN-gamma]) in immunized mice compared with control mice. However, the recall response of primed animals after antigenic challenge induced increased expression of IL-12 and IFN-gamma mRNAs in lung homogenates. Overall, all these effects were not due to the lipopolysaccharide content in the bacterial extract. Furthermore, we found that three i.n. doses administered 2 to 3 weeks apart were enough to elicit long-lasting specific serum immunoglobulin G (IgG) and secretory IgA antibody responses. Assessment of IgG subclasses showed a balanced pattern of IgG1-IgG2a responses. The serum total IgE concentrations were also elevated in immunized mice 2 weeks after the third dose, but they significantly decreased soon afterwards. Our results suggest that simple formulations of bacterial extracts administered i.n. are highly immunogenic, eliciting local and systemic immune responses, and may serve as the basis for cost-effective immunotherapies for the prevention and treatment of respiratory infections.