Smoking and Menstrual Problems in 16-Year-Olds

The British Birth Cohort Study (BCS70) is a cohort study which follows all the people born in England, Scotland and Wales in the week of 5–11 April 1970. The data described here were from the postal questionnaires returned by 2181 young women aged between 16 and 16½ in 1986.

Thirty-nine per cent of the respondents had never smoked, 39% had smoked at some time and 22% were regular smokers. Most of the respondents indicated that they had one or more of the following symptoms associated with menstruation: pain, depression, irritability, headaches, cramps. Analysis of the data showed that regular smokers were significantly more likely than those who had never smoked to have all these symptoms. Whilst the percentage of ‘sometime smokers’ experiencing pain, depression and headaches fell between smokers and ‘never-smokers’, the percentage experiencing unpleasant symptoms in general, irritability and cramps was the same as for regular smokers.

If causality could be demonstrated, messages about immediate health problems such as these might be more powerful health education to young women than information about long-term risks.

Suicide risk linked with clinical consultation frequency, psychiatric diagnoses and psychotropic medication prescribing in a national study of primary-care patients

BACKGROUND

Little is known about the precursors of suicide risk among primary-care patients. This study aimed to examine suicide risk in relation to patterns of clinical consultation, psychotropic drug prescribing, and psychiatric diagnoses.

METHOD

Nested case-control study in the Clinical Practice Research Datalink (CPRD), England. Patients aged ⩾16 years who died by suicide during 2002-2011 (N = 2384) were matched on gender, age and practice with up to 20 living control patients (N = 46 899).

RESULTS

Risk was raised among non-consulting patients, and increased sharply with rising number of consultations in the preceding year [⩾12 consultations v. 1: unadjusted odds ratio (OR) 6.0, 95% confidence interval (CI) 4.9-7.3]. Markedly elevated risk was also associated with the prescribing of multiple psychotropic medication types (⩾5 types v. 0: OR 62.6, CI 44.3-88.4) and with having several psychiatric diagnoses (⩾4 diagnoses v. 0: OR 31.1, CI 19.3-50.1). Risk was also raised among patients living in more socially deprived localities. The confounding effect of multiple psychotropic drug types largely accounted for the rising risk gradient observed with increasing consultation frequency.

CONCLUSIONS

A greater proportion of patients with several psychiatric diagnoses, those prescribed multiple psychotropic medication types, and those who consult at very high frequency might be considered for referral to mental health services by their general practitioners. Non-consulters are also at increased risk, which suggests that conventional models of primary care may not be effective in meeting the needs of all people in the community experiencing major psychosocial difficulties.

Emergency department contact prior to suicide in mental health patients

OBJECTIVES

To describe attendance at emergency departments (EDs) in the year prior to suicide for a sample of mental health patients. To examine the characteristics of those who attended (particularly those who attended frequently) prior to suicide.

DESIGN

Case review of ED records for 286 individuals who died within 12 months of mental health contact in North West England (2003-2005).

METHOD

Cases identified through the National Confidential Inquiry into Suicide were checked against regional EDs to establish attendance in the year prior to death. Records were examined to establish the number of attendances, reason for the final, non-fatal attendance, treatment offered and outcome.

RESULTS

One hundred and twenty-four (43%) individuals had attended the ED at least once in the year prior to their death, and of these, 35 (28%) had attended the ED on more than three occasions. These frequent attenders died by suicide significantly sooner after their final, non-fatal attendance than other attenders. A clinical history of alcohol misuse was also associated with early death following ED attendance.

CONCLUSIONS

Over 40% of our clinical sample attended an ED in the year prior to death, and some individuals attended particularly frequently. EDs may therefore represent an important additional setting for suicide prevention in mental health patients. The majority of attendances prior to suicide were for self-harm or to request psychiatric help. Clinicians should be alert to the risk associated with such presentations and to the possible association between frequent attendance and suicide.

Saying "no" to cigarettes: a reappraisal of adolescent refusal skills

The principles of social inoculation developed in the late 1940s and later presented as a theory combined with Bandura's self-efficacy construct in the 1970s led to a series of smoking-prevention programmes for young people based on refusal skills. The present study examines refusal skills developed by young people who have not been taught such a programme. The survey was carried out by self-completed questionnaires administered to whole classes of 11-15-year-olds in two secondary schools in northern England. Harter's Self-Perception Profile for Children was used. Responses from 743 (365 boys and 378 girls) were analysed. Smoking prevalence reflected the national prevalence pattern for the age group at the time of the survey. Girls were at greater risk than boys of being repeatedly offered a cigarette and more likely than boys to accept it after more than two offers. Girls with high self-perception scores for all domains except social competence were at lowest risk of being offered a cigarette. For boys this only applied in the context of behavioural conduct. However, the factor most strongly related to multiple offers of cigarettes was having a best friend who smoked. Never smokers were most likely to have simply said "No, thank you" to proffered cigarettes but most had used several responses, boys generally using more refusal mechanisms than girls did. Cigarette refusal among young people is a complex process and programmes must be variable in order to meet specific circumstances, such as refusing a cigarette from one's best friend.

Cigarette advertising and onset of smoking in children: questionnaire survey

OBJECTIVE

To investigate uptake of smoking in a cohort of 11 to 12 year olds related to awareness of advertised cigarette brands named.

DESIGN

Self completed questionnaires administered to whole classes of schoolchildren in June 1993 and June 1994.

SETTING

Primary, middle, and secondary schools in the north and south of England.

SUBJECTS

1450 pupils aged 11 and 12 years at the time of the first survey.

MAIN OUTCOME MEASURES

Onset of smoking and brands smoked by the second survey related to cigarette brands named in the first one. Less advertised brands were used as the base for calculating odds ratios.

RESULTS

Girls who named the most advertised brands-namely, Benson and Hedges alone (odds ratio = 2.50, 95% confidence interval = 1.18 to 5.30) or Benson and Hedges and Silk Cut (2.15, 1.04 to 4.42) in the first survey were at greatest risk of taking up smoking by the second one. The difference was similar but not significant for boys. Boys and girls who named the least advertised brands in the first survey were at no greater risk of taking up smoking by the second survey than those who named no brands (boys odds ratio = 0.49 (0.24 to 1.01); girls 0.79 (0.38 to 1.62)). New smokers were more likely to smoke any available brand (29.5%) or a less advertised brand such as Embassy (24.6%) than the most advertised ones, Benson and Hedges (19.7%) and Silk Cut (14.8%). Established smokers were more selective, only 15% smoking any available brand and 38.3% smoking Benson and Hedges.

CONCLUSIONS

Cigarette advertising appears to increase children's awareness of smoking at a generic level and encourages them to take up the behaviour, beginning with any cigarettes which are available and affordable.

Risk factors in the adjustment of siblings of children with cancer

The study investigated the psychological adjustment of 99 siblings of children with cancer. At 6 months post-diagnosis, 24 siblings had scores in the borderline or clinical range on parent- and teacher-completed measures of behavioural adjustment and were reported to have shown negative changes in behaviour since diagnosis. The results of logistic regression analysis indicated that problems in adjustment were related to the degree of disruption of family life occasioned by the illness, the resources available to the family to cope with the effects of such disruption on siblings and siblings' perceptions of negative interpersonal effects on their lives.

Parental smoking and the nutrient intake and food choice of British teenagers aged 16-17 years

STUDY OBJECTIVE

To examine the association between parental smoking habits and the nutrient intake and food choice of teenagers aged 16-17 years, allowing for differences in teenage smoking and the social class and regional distribution of the participants.

DESIGN

Data were collected from the 1970 longitudinal birth cohort, cross-sectionally at 16-17 years. The smoking habits of teenagers were evaluated from a questionnaire completed by the subjects themselves, and the smoking habits of parents by interview. The nutrient and food intakes of teenagers were quantitatively assessed using a four day unweighed dietary diary.

SETTING

The participants were distributed throughout Britain.

PARTICIPANTS

A subsample of 1222 males and 1735 females was isolated from respondents to the 1970 birth cohort 16-17 year data collection sweep undertaken in 1986-87.

MAIN RESULTS

Parental smoking habits were associated with different dietary patterns among teenagers regardless of whether the teenagers themselves smoked. Dietary differences noted were similar to those observed previously among smokers, with lower intakes of fibre, vitamin C, vitamin E, folates, and magnesium in particular reported among both males and females in households where parents were smokers. These lower intakes were associated with lower intakes of fruit juices, wholemeal bread, and some vegetables.

CONCLUSION

Teenagers who lived with parents who smoked had different nutrient and food intakes to those with non-smoking parents, and teenagers exposed to parental smoking appeared to have similar dietary patterns to teenagers who themselves smoked.

The diet and body weight of British teenage smokers at 16-17 years

OBJECTIVE

To examine the influence of teenage smoking habits on nutrient intake, food choice and body size.

DESIGN

Data was collected cross-sectionally: smoking habits were evaluated by questionnaire; heights and weights were measured and dietary intakes were quantitatively assessed via 4-day unweighed dietary diaries.

SUBJECTS

The subjects studied (n = 3430) were participants in the 1970 Longitudinal Birth Cohort, and were nationally distributed throughout Britain.

RESULTS

Male and female smokers consumed significantly (P < 0.005) more alcohol and less fibre, thiamin and vitamin C than occasional or never smokers. Male smokers also consumed significantly more fat when expressed as a percentage of energy intake, and significantly less non-milk extrinsic sugar (P < 0.01) and iron (P < 0.005) than occasional or never smokers. Regular and occasional female smokers consumed significantly (P < 0.005) less protein and calcium than never smokers, and regular smokers also reported lower intakes of zinc, selenium, riboflavin, carotene and folates (P < 0.005) and iodine (P < 0.01) than never or occasional smokers. Both male and female smokers were less likely to be consumers of puddings, biscuits and wholemeal bread, but were more likely (P < 0.005) to consume alcoholic beverages and coffee. Intakes of chips, alcoholic beverages and coffee were significantly (P < 0.005) higher among smokers and intakes of puddings, fruit, fruit juices and breakfast cereals lower. Regular female smokers also consumed significantly (P < 0.005) fewer vegetables. Smoking habit did not appear to be related to body size in this cohort.

CONCLUSION

The diets of teenage smokers, particularly teenage girls, appear to be significantly different to those of non-smokers, but smoking was not related to body size. Lower intakes of antioxidant nutrients, fruits, vegetables and cereals by teenage smokers are of particular concern.

Blood pressure and smoking: observations on a national cohort

The reasons why adult smokers have lower blood pressure than non-smokers have not been determined. It is possible that low blood pressure might precede the onset of smoking. This study investigates this hypothesis in a national cohort study in Britain. Blood pressures and pulse rates taken on a sample of 5019 members of the British Birth Cohort Study (BCS 70) at the age of 10 years were analysed in relation to self reported smoking behaviour at age 16+ years. Prospectively, those children who had lower diastolic blood pressure or pulse rate at age 10 were more likely to have smoked by age 16+ years. Using analysis of variance, pulse rate was significantly related to smoking in young men (p < 0.001). Seventy per cent of those with lower pulse (below the 10th centile), 58% with medium pulse, and 52% with the higher pulse (above the 90th centile) had ever smoked by age 16+ years. In young women, pulse rate (p = 0.003), diastolic pressure (p = 0.024), and systolic pressure (p = 0.032) at age 10 were all significantly related to smoking at age 16. This longitudinal study found that lower blood pressure and slower pulse rate were related to the onset of smoking in children. More research is needed on this new observation.

Is health locus of control related to health education activity

Analysis of responses of 1922 teachers indicated that Multidimensional Health Locus of Control scale was a suitable instrument for assessing their health beliefs. The results suggest that health belief is not linked to whether teachers teach about cancer and, by implication, health generally.

Cancer education and the primary school teacher in England and Wales

Many adult behaviors and attitudes develop in early childhood. There is a growing acceptance of the need for health education of children of primary school age. Cancer is an important topic within health education, and this study was designed to assess the level of cancer education in schools. Data were collected from a randomly selected sample of over 1,000 teachers of children in primary school years 3-6 (ages 7-11 years). Cancer had been taught about by 18% of the sample, and their pupils' ages had no significant effect on whether they had taught about cancer. Cancer was most often taught about in response to a real-life situation, and the majority of the teachers did not use cancer education resources to help them. The study sought to ascertain why so many teachers had taught about cancer. It appears that concerns over their own lack of personal knowledge, and a perceived lack of resources, were the most common reasons. The young age of the pupils was also a deterrent to cancer education, especially among the teachers of the younger pupils. The results indicate various interventions that may increase the level of primary-school-based cancer education. These include improving teachers' awareness of cancer education issues and providing appropriate cancer education resources.

Children who have a parent with cancer: a pilot study

This British pilot study was undertaken to determine whether the children of cancer patients experience problems and anxieties related to the parent's diagnosis and treatment. The data were collected by means of semistructured interviews with 24 adolescent children (16 sons, eight daughters) whose parents' cancers had been diagnosed between two and six years previously (mean four years). Self-report questionnaires to assess adolescent anxiety were also completed at the interviews. The results show that some of the children experienced problems and anxieties related to their parents' cancers that affected their school lives, sports and leisure activities, family lives, and relationships. Factors that were significantly associated with high anxiety scores were: inability to discuss the parent's illness with parents; having to spend less time with friends; having to spend less time on sport and leisure activities; deterioration in schoolwork; and continuing anxiety over the parent's illness.