Cigarette smoking and its risk factors among elementary school students in Beijing.

OBJECTIVES. This study investigated patterns of and risk factors for smoking among elementary school children in Beijing, China. METHODS. In 1988, anonymous questionnaires were administered to a multistage stratified cluster sample of 16996 students, aged mostly 10 to 12, in 479 fourth- to sixth-grade classes from 122 Beijing elementary schools. RESULTS. Approximately 28% of boys and 3% of girls had smoked cigarettes. The most frequently cited reasons for smoking initiation were "to imitate others'' behavior" and "to see what it was like." Girls were more likely to get cigarettes from home than to purchase their own. Having close friends who smoked and being encouraged by close friends to smoke were strong risk factors for smoking. Smoking was also associated with lower parental socioeconomic status; having parents, siblings, or teachers who smoked; buying cigarettes for parents; performing poorly in school; and not believing that smoking is harmful to health. CONCLUSIONS. Gender differences in smoking prevalence among adolescents in China are larger than those among US teenagers, whereas the proximal risk factors for smoking are similar. Major efforts are needed to monitor and prevent smoking initiation among Chinese adolescents, particularly girls.     

Parental Immigration Status is Associated with Children’s Health Care Utilization: Findings from the 2003 New Immigrant Survey of US Legal Permanent Residents

Our objective was to examine the association between parental immigration status and child health and health care utilization. Using data from a national sample of immigrant adults who had recently become legal permanent residents (LPR), children (n = 2,170) were categorized according to their parents’ immigration status prior to LPR: legalized, mixed-status, refugee, temporary resident, or undocumented. Logistic regression with generalized estimating equations was used to compare child health and health care utilization by parental immigration status over the prior 12 months. Nearly all children in the sample were reported to be in good to excellent health. Children whose parents had been undocumented were least likely to have had an illness that was reported to have required medical attention (5.4 %). Children whose parents had been either undocumented or temporary residents were most likely to have a delayed preventive annual exam (18.2 and 18.7 %, respectively). Delayed dental care was most common among children whose parents had come to the US as refugees (29.1 %). Differences in the preventive annual exam remained significant after adjusting for socioeconomic characteristics. Parental immigration status before LPR was not associated with large differences in reported child health status. Parental immigration status before LPR was associated with the use of preventive annual exams and dental services. However, no group of children was consistently disadvantaged with respect to all measures.     

Smokeless Tobacco Use in Adolescents: The Cardiovascular Health in Children (CHIC II) Study

Smokeless tobacco has seen a resurgence of popularity among adolescents despite its association with oral cancer and altered cardiovascular function. This study examined age, gender, ethnicity, self-esteem, physical activity, parental smoking, and socioeconomic status as predictors of smokeless tobacco use among middle school children. Subjects included 1,211 youth (White (64%), Black (24%), Hispanic (6%), and Other (6%); age 12.2) participating in the Cardiovascular Health in Children and Youth (CHIC II) study. All data were collected by questionnaire. Factors related to ever using smokeless tobacco included older age (p < .001), being male (p < .001), lower self-esteem (p < .001), and having parents who currently (p = .02) or formerly (p = .05) smoked. Hispanics reported a higher current usage rate than other ethnic groups (p < .001). White youth in the lowest socioeconomic status were most likely to be experimental users (p = .007), while those in the high socioeconomic status were more likely to be current users (p = .006). Physical activity was not associated with smokeless tobacco use.     

The impact of migratory separation from parents on the health of adolescents in the Philippines

In the Philippines, as in several other low and middle-income countries in the world, it is usual for parents to leave the country to work abroad in order to improve the situation of their children who remain behind. However, stressful life events such as the separation from a parent are known to have a severe impact on physical and mental health of children. This study, conducted in 2008–2009, explored health consequences of migratory separation for remaining-behind adolescent children, comparing them with those whose parents remained at home. Participants were 205 high school students from the Philippines. It was found that adolescents with a parent abroad, particularly the mother, reported poorer physical health than those with both parents at home, while socioeconomic status did not have impact. The parent–abroad adolescents reported a high level of missing their parent(s) and felt emotionally lonelier than the parent-at-home group. Emotional loneliness and stress due to parental absence were associated with poorer health. Avoidant coping appeared to moderate the parental absence-health relationship. Paradoxically, it seems that, although many parents work abroad to improve the lot of their children, the latter suffer emotional stress and physical health detriments. While Lazarus and Folkman’s (1984) cognitive stress model is generally applicable for migratory separation, cultural aspects need attention, both in theoretical implementation and interpretation. Limitations and implications are further discussed.     

Orientations in adolescent use of information and communication technology: a digital divide by sociodemographic background, educational career, and health

AIMS: The role of information and communication technology (ICT) in adolescents' lives was studied, with emphasis on whether there exists a digital divide based on sociodemographic background, educational career, and health. The assumption was that some groups of adolescents use ICT more so that their information utilization skills improve (computer use), while others use it primarily for entertainment (digital gaming, contacting friends by mobile phone). METHODS: Data were collected by mailed survey from a nationally representative sample of 12- to 18-year-olds (n=7,292; response 70%) in 2001 and analysed using ANOVA. RESULTS: Computer use was most frequent among adolescents whose fathers had higher education or socioeconomic status, who came from nuclear families, and who continued studies after compulsory education. Digital gaming was associated with poor school achievement and attending vocational rather than upper secondary school. Mobile phone use was frequent among adolescents whose fathers had lower education or socioeconomic status, who came from non-nuclear families, and whose educational prospects were poor. Intensive use of each ICT form, especially of mobile phones, was associated with health problems. High social position, nuclear family, and a successful educational career signified good health in general, independently of the diverse usage of ICT. CONCLUSIONS: There exists a digital divide among adolescents: orientation to computer use is more common in educated well-off families while digital gaming and mobile phone use accumulate at the opposite end of the spectrum. Poorest health was reported by mobile phone users. High social background and success at school signify better health, independently of the ways of using ICT.     

Health behaviour among adolescents in Denmark: influence of school class and individual risk factors

AIMS: The aim of this study was to assess the relative influence of school class on health behaviour among adolescents versus that of the family's socioeconomic status and individual factors among adolescents. METHODS: The material comprised 3,458 students in grades 8 and 9 in 244 school classes. Data were collected through questionnaires completed by the students and by their class teacher and information from the school physician. Multilevel analysis was used to indicate the relative significance of individual and school class characteristics. RESULTS: We find no consistent pattern between the mother's socioeconomic status and the included health behaviour measurements; however, adolescents from the lower socioeconomic groups had a higher risk of unhealthy dietary habits and adolescents whose mothers were unemployed had a significantly lower risk of drinking alcohol weekly versus all other adolescents. Not living with both biological parents, focusing on friends, and not being very academically proficient were associated with an increased risk of harmful health behaviour. Health behaviour varied substantially between school classes, especially for daily smoking, weekly alcohol consumption, and use of hashish and other euphoriants. Circumstances in the school class more profoundly influenced risk behaviour among adolescents (smoking, alcohol consumption, and use of hashish or other euphoriants) than their dietary habits (eating breakfast, frequent intake of fruit and vegetables, and frequent intake of soft drinks). CONCLUSIONS: The school class had the relatively strongest influence on adolescents' risk behaviour (smoking, alcohol intake, and use of hashish or other euphoriants), whereas family circumstances comprised the strongest influence on dietary habits.     

Tobacco use among immigrant and nonimmigrant adolescents: individual and family level influences

PurposeTo identify individual and family level characteristics that might explain differences in rates of tobacco use among immigrant and nonimmigrant adolescents.MethodsData for analysis come from a probability sample of 5401 adolescents aged 12–18 years participating in the Ontario Health Survey (OHS). Three groups were compared: (a) adolescents born in Canada to Canadian-born parents (n = 3886), (b) adolescents born in Canada to immigrant parents (n = 1233), and (c) adolescents born outside of Canada (n = 282). Discrete, multilevel logistic regression was used in the analysis.ResultsAdolescents born outside of Canada report the lowest rates of tobacco use, despite greater economic hardship. A negative association emerges between family socioeconomic status and tobacco use among adolescents born in Canada but not among adolescents born outside of Canada. Immigrant youth are less likely to affiliate with peers who smoke and are more likely to come from families where parents do not smoke: these differences partially explain the decreased rates of tobacco use among immigrant adolescents.ConclusionsAlthough subject to greater economic hardship, immigrant youth are less likely to engage in tobacco use. Protective factors associated with immigrant family life, such as lower rates of parental tobacco use and less exposure among immigrant adolescents to peers who smoke, may counteract some of the negative effects of poverty and social hardship. Future research should begin to address the processes that lead to adaptive outcomes among adolescents from immigrant families, despite greater exposure to social disadvantage.     

Socioeconomic health inequalities among a nationally representative sample of Danish adolescents: the role of different types of social relations

STUDY OBJECTIVE: To investigate the role of different types of social relations in adolescent health inequalities. DESIGN: Cross sectional study. Measures included family social class, indices of social relations to parents, friends, teachers, and school. SETTING: Random sample of 55 schools in Denmark. PARTICIPANTS: Nationally representative sample of 5205 students from grades 5, 7, and 9. MAIN OUTCOME MEASURES: Self reported physical and psychological symptoms. RESULTS: Adolescents from families of lower socioeconomic position reported more physical and psychological symptoms. This ranged from 40% increased odds for multiple physical symptoms among less advantaged girls, to 90% increased odds of multiple psychological symptoms for less advantaged boys. Relationships with friends or teachers showed small social class differences, while strong and consistent social class differences were found in the ways adolescents reported their own and their parents relations to school. For example, girls from families of lower socioeconomic position were more than four times as likely to report their parents unwilling to attend school meetings (odds ratio=4.54, 95% confidence intervals: 2.68 to 7.69). Poorer relations with parents, peers, teachers, and school were all associated with worse health. Patterns of parent-child relations with the school were the greatest contributors to socioeconomic differences in physical and psychological symptoms. CONCLUSIONS: The school is one of the first important social institutions directly experienced by children and socioeconomic differences in how adolescents and their parents relate to the school may be part of the cascade of early life influences that can lead to later social and health disadvantage.     

Acculturation and the health and well-being of U.S. immigrant adolescents

PURPOSE: To examine the association of acculturation, as measured by language spoken at home, with the health, psychosocial, school, and parental risk factors of adolescents of various racial/ethnic groups. METHODS: Using the U.S. component of the 1997-98 World Health Organization Study of Health Behavior in School Children, bivariate and multiple logistic regression analyses were conducted of records for adolescents in four racial/ethnic groups to explore the relationship between the language spoken at home and outcome variables regarding health status and risks, psychosocial and school risk factors, and parental factors. Data were analyzed using Software for the Statistical Analysis of Correlated Data (SUDAAN). RESULTS: Adolescents of all racial and ethnic groups who primarily speak a language other than English at home are at elevated risk for psychosocial risk factors such as alienation from classmates and being bullied, and parental risk factors such as feeling that their parents are not able or willing to help them. Those who speak a combination of languages are also at risk for being bullied and for high parental expectations. Language spoken at home is generally not associated with health and safety measures for adolescents across racial/ethnic groups. CONCLUSIONS: Adolescents whose primary language at home is not English experience higher psychosocial, school, and parental risks than non-Hispanic white English-speakers. New immigrant youths of all races and ethnic groups would potentially benefit from preventive and risk-reduction services.