Independent associations between residential neighbourhood and school characteristics and adolescent mental health in the Netherlands

This study examined associations between characteristics of the residential neighbourhood and the school and adolescent mental health, including the moderating role of family socioeconomic status (SES) and family support. Nationally representative Dutch data from adolescents aged 12–16 (N = 6422) were analysed through cross-classified multilevel models. Findings showed that school characteristics are more strongly linked to adolescent mental health than residential neighbourhood characteristics. More specifically, higher levels of school SES were associated with more hyperactivity-inattention problems, while higher levels of school social disorder were related to more conduct problems and more peer relationship problems. Further, higher levels of school SES were associated with more emotional symptoms only for adolescents with a relatively low family SES. Higher levels of neighbourhood SES were associated with fewer peer relationship problems. Overall, there was little evidence for the moderating role of family SES or family support.     

Are Adolescent Girls With a Physical Disability at Increased Risk for Sexual Violence?

BACKGROUND: The purpose of this study was to investigate whether US female adolescents who self-reported having a physical disability or long-term health problem were more likely to report having been physically forced to have sexual intercourse than US female adolescents without a physical disability or long-term health problem. METHODS: Using data from the 2005 U.S. National Youth Risk Behavior Survey (YRBS), we employed logistic regression analyses to estimate the association between physical disability (and other variables) and the risk for sexual violence among US high school girls. RESULTS: Female high school students who reported a physical disability or long-term health problem were more likely to report having been physically forced to have sexual intercourse than those who did not (19.6% vs 9.4%;χ² = 14.51, p = .003). Results from our multivariate analysis reveal that this association remained significant (adjusted odds ratio [AOR], 1.57; 95% confidence interval [CI], 1.10–2.23) after adjusting for certain demographic characteristics, physical health problems, behavioral health risks, and violent conduct. CONCLUSIONS: Our findings suggest that adolescent girls in the United States with a physical disability or long-term health problem may be at increased risk for sexual violence. It is important that national efforts to reduce sexual violence consider how to address the unmet needs of children and adolescents with disabilities. As most adolescent girls spend the majority of their time in a school setting, it is of particular importance that school health professionals are aware of the current findings.     

抑郁障碍青少年自杀行为预测因素研究进展

近年来,青少年自杀行为的发生率逐年升高,成为威胁青少年身心健康乃至生命的严重公共卫生问题。抑郁障碍青少年是自杀行为发生的高危人群。研究从影响抑郁障碍青少年自杀行为的个人心理因素、家庭因素以及学校和社会因素3个方面进行综述,为青少年自杀行为的有效预防提供科学依据。     

Co-Occurrence of Substance Use and Loneliness as a Risk Factor for Adolescent Hopelessness

ABSTRACT: This research among a sample of 1,915 Mississippi adolescents investigated whether lonely adolescents who use illicit substances were at increased risk of hopelessness. Relative risk of scoring within the severe hopelessness range was 6.9 for non-substance users who were lonely and 4.2 for substance users who were not lonely. Yet, relative risk for severe hopelessness in substance-using lonely adolescents was 25.2. Lonely, substance-using adolescents were 25 times more likely to be severely hopeless than the reference group composed of non-substance using, not-lonely adolescents. Lonely adolescents who get drunk also were 15.9 times more likely to be severely hopeless than the reference group. Because hopelessness often is an indicator of suicidal behavior, these results may have important implications for school health adolescent suicide prevention efforts.     

Midwestern rural adolescents' oral sex experience

BACKGROUND: This study examined the prevalence of oral sexual activity in rural Midwestern adolescents. We also examined the correlates of a series of risk behaviors with oral sexual activity. METHODS: A questionnaire based on the Youth Risk Behavior Surveillance System was distributed to 2121 rural middle and high school students in grades 6–12 across 5 rural counties in a Midwestern state. The schools within districts were stratified by grade level and a stratified random sample of schools was used (n = 49). RESULTS: A total of 2000 (94%) students completed the survey. The rural adolescents were: male (51%), White (85%), with an average age of 14.7 years (SD = 1.9). Overall, one‐fourth (26%) of the students had engaged in sexual intercourse (8% of middle school and 39% of high school students). Slightly more than one‐fourth of the students (29%) had engaged in oral sex (9% of middle school and 44% of high school students). Logistic regression was used to calculate adjusted odds ratios and found 3 risk behaviors were statistically significantly associated with oral sexual behavior: ever having had sexual intercourse (16.6 times more likely to engage in oral sex), having drunk alcohol in the past 30 days (2.2 times more likely), and having smoked 1 or more cigarettes in the past 30 days (2.0 times more likely). CONCLUSIONS: Oral sexual activity is an established component of many rural adolescents' sexual experiences. These findings have important implications for sex education programs targeted to rural adolescent youths.     

Adolescent Weight Management and Perceptions: An Analysis of the National Longitudinal Study of Adolescent Health

Researchers investigated contemporary weight management activities and weight perceptions among adolescents and determined the effects of school health education on these perceptions and activities. This national, random sample of more than 6,500 adolescents (grades 7-12) measured perceived weight, weight change efforts, weight change activities, Body Mass Index, and health education for weight management. Results indicate that most adolescents: 1) take part in efforts to manage their weight, although many struggle with perceiving their weight; 2) engage in appropriate weight change efforts; and 3) report receiving school health education that positively effects some aspects of their weight management behavior. Thus, adolescents are concerned about weight and perceptions of weight and are engaging in a variety of weight change activities for weight maintenance and weight change. School health education appears to have some effect in improving adolescent health behavior, and discussion centers on this topic.     

Health-compromising behaviors among Vietnamese adolescents: the role of education and extracurricular activities

PURPOSE: To examine the prevalence of unhealthy behaviors among a cohort of Vietnamese adolescents in California; to examine the relationship between these behaviors and school-related variables (school performance, educational risk behaviors, higher-education aspirations, and participation in extracurricular activities); and to assess the differences that may exist between males and females with regard to these factors. METHODS: We conducted telephone interviews with 783 Vietnamese adolescents, aged 12-17 years, recruited through telephone listings from four California counties where large Vietnamese populations reside: San Francisco, Santa Clara, Los Angeles, and Orange. Of the 783 completed interviews, 60.8% were conducted in English and 39.2% in Vietnamese. The main outcome measure is a health risk behavior scale that includes adolescents' reports of ever smoking a cigarette, sedentary vs. active lifestyle, consumption of fruits and vegetables, consumption of foods high in fat, ever drinking alcohol, and ever engaging in sexual behavior. Multiple regression analyses were employed to estimate the association among the demographic variables, acculturation, school performance, aspirations, extracurricular activities, and the overall health risk. RESULTS: Females were significantly more sedentary than males. Over one-quarter (29%) of the females reported not having participated in vigorous physical activity on 3 or more days per week, compared with just 18% of the males. Most adolescents reported they had never tried cigarettes (84%), never used alcohol (77%), and never had sex (97%). Males were more likely than females to report a higher frequency of experimentation with smoking and drinking. Overall, school performance and participation in extracurricular activities were significantly related to the health risk behavior scale. Adolescents who demonstrated at least one educational risk (ever skipped school or ever sent out of the classroom) were more likely to engage in other risky behaviors. Also, older and more acculturated adolescents were at increased risk of engaging in health-compromising behaviors. Analysis by gender revealed that the variables age, educational risk, and chance of attending college were all related to health risk behavior for both males and females. Among the boys, those who reported achieving an average grade of B or better had a decreased risk of engaging in health-compromising behaviors; however, neither extracurricular activities nor acculturation was related to health-compromising behaviors in boys. Among the girls, the reverse was true: lack of participation in extracurricular activities was related to health-compromising behaviors, whereas grades were not a significant risk factor. CONCLUSIONS: Among sampled Vietnamese adolescents in California, health risk behaviors are common and inversely related to some school performance indicators. Using these indicators to identify high-risk groups could allow targeted educational programs or interventions for the mitigation of health-compromising behaviors.     

Access to medical care for adolescents: results from the 1997 Commonwealth Fund Survey of the Health of Adolescent Girls.

PURPOSE: This study examined the factors associated with access to care among adolescents, including gender, insurance coverage, and having a regular source of health care. METHODS: Analyses were done on the 1997 Commonwealth Fund Survey of the Health of Adolescent Girls, a nationally representative sample of in-school adolescents in 5th through 12th grade. Access to health care, missing needed care, and whether the adolescent had private time with their provider were assessed. Cochran-Mantel-Haenszel chi-square statistics were computed using SUDAAN. RESULTS: Nearly a third of the 6748 adolescents surveyed had missed needed care. The most common reason for missing care was not wanting a parent to know (35%). Girls were more likely than boys to miss care (29% vs. 24%). Most adolescents reported using a source of primary health care (92%); girls were more likely than boys to use a physician's office rather than another site (65% vs. 60%). Eleven percent of adolescents reported having no health insurance. Uninsured adolescents were more likely to have missed needed care (46% vs. 25%) [corrected]. CONCLUSIONS: Certain groups of adolescents have less access to health care. Girls have more emotional barriers, such as not wanting parents to know about care, and embarrassment. Adolescents without health insurance are at high risk for missing care because of financial strain. States, insurers, and advocates can influence policies around confidentiality and insurance coverage to address these issues.     

Adolescents' Sleep Behaviors and Perceptions of Sleep

Background:  Sleep duration affects the health of children and adolescents. Shorter sleep durations have been associated with poorer academic performance, unintentional injuries, and obesity in adolescents. This study extends our understanding of how adolescents perceive and deal with their sleep issues.
Methods:  General education classes were randomly selected from a convenience sample of three high schools in the Midwest. Three hundred eighty-four ninth- to twelfth-grade students (57%) completed a self-administered valid and reliable questionnaire on sleep behaviors and perceptions of sleep.
Results:  Most respondents (91.9%) obtained inadequate sleep (≤ 9 hours) on most school nights of the week, with 10% reporting less than 6 hours of sleep each week night. The majority indicated that not getting enough sleep had the following effects on them: being more tired during the day (93.7%), having difficulty paying attention (83.6%), lower grades (60.8%), increase in stress (59.0%), and having difficulty getting along with others (57.7%). Some students reported engaging in harmful behaviors to help them sleep: taking sleeping pills (6.0%), smoking a cigarette to relax (5.7%), and drinking alcohol in the evening (2.9%). Students who received fewer hours of sleep were significantly more likely to report being stressed (p = .02) and were more likely to be overweight (p = .04).
Conclusions:  Inadequate sleep time may be contributing to adolescent health problems such as increased stress and obesity. Findings indicate a need for sleep hygiene education for adolescents and their parents. A long-term solution to chronic sleep deprivation among high school students could include delaying high school start times, such as was done successfully in the Minneapolis Public School District.     

重庆市青少年网络成瘾及影响因素分析

目的了解重庆市青少年网络成瘾状况及影响因素,为制订干预性措施提供依据。方法采用网络成瘾量表(IAS)对重庆市3 968名青少年进行匿名问卷调查。结果本次调查发放问卷4 064份,回收问卷3 975份,回收率为97.8%;纳入统计的有效问卷为3 968份,有效率为99.8%;已接触并使用网络的有3 308人,占总人数的83.4%,其中325人符合网络成瘾诊断标准(总分≥50分),网络成瘾发生率为9.8%;从未接触过网络的有659人,其中,初中生492人,占74.7%,大学生中只有2人未接触过网络;女性、有较多朋友、户籍农村是青少年网络成瘾保护因素,年级、上网时间长、有自杀行为、学习负担重是青少年网络成瘾危险因素。结论青少年是网络成瘾行为的高危人群,需动员教育、卫生部门以及学生和家长共同参与开展干预活动。     

Prevalence and correlates of mental health problems and treatment among adolescents seen in primary care

PurposeIn this study, we describe the characteristics of adolescents with mental health problems among those presenting to primary care clinics in urban areas.MethodsThe sample included 1,076 adolescents aged 12–18 years who presented to federally qualified community health clinics in urban cities in the Midwest. Bivariate and multivariate logistic regression analyses were conducted to examine the associations between having a mental health problem with demographic characteristics, health-related variables, and other risk and promotive factors. We also examined the use of health services and involvement in activities among those with mental health problems.ResultsApproximately 14% of adolescents screened positive for a mental health problem; among those with a mental health problem, 42.8% received mental health services in the past 3 months. In the multivariate logistic regression analysis, adolescents who were female, with poorer grades, fair to poor self-reported health, using drugs, and lower parental monitoring were more likely to have a mental health problem. In bivariate analyses, adolescents with mental health problems were less likely to participate in school activities and community activities and more likely to use emergency room services.ConclusionsAdolescents with mental health problems were more likely to have several other difficulties including poor grades, poor self-rated health, drug/alcohol use, and sexual activity. This study highlights the importance of screening youth with multidimensional needs and referring them to the appropriate services.     

Mental health characteristics and health-seeking behaviors of adolescent school-based health center users and nonusers

BACKGROUND: The purpose of this study is to compare the mental health risk profile and health utilization behaviors of adolescent school‐based health center (SBHC) users and nonusers and discuss the role that SBHCs can play in addressing adolescent health needs. METHODS: The sample included 4640 students in grades 9 and 11 who completed the California Healthy Kids Survey between fall 2000 and spring 2005 at 4 high schools in Alameda County, California. Chi‐squared tests of significance and multivariate logistic regression were used to compare characteristics of SBHC users and nonusers and identify demographic, health status, and behavioral characteristics predictive of SBHC use. RESULTS: Controlling for demographic variables and general health status, students who reported frequent feelings of sadness, trouble sleeping, suicide ideation, alcohol or marijuana use, the recent loss of a close friend or relationship, or other difficult life event were significantly more likely to seek SBHC services than their peers. Neither health insurance status nor a student's “usual” source of health care was predictive of general SBHC use, but being on public assistance or having no insurance was predictive of a student seeking SBHC mental health services. CONCLUSIONS: These findings suggest that SBHCs are able to attract students with the most serious mental health concerns and can play an important role in meeting needs that might otherwise go unmet. The provision of SBHC mental health services in particular may fill a need among adolescents with public or no insurance.     

Gender, age, and behavior differences in early adolescent worry

Early adolescents in the United States are increasingly exposed to a culture of worrisome messages. A degree of adolescent worry is normal, but the likelihood of a young person being anxious or depressed increases with the perceived number of worries. This study examined the effect of age, gender, and worry behavior on frequency of 8 adolescent worries. Data were obtained from 1,004 9- to 13-year-old students visiting 10 health education centers in 7 states. Students responded via individual, electronic keypads. Multivariate logistic regression revealed that boys worry more about the future, whereas girls worry more about being liked or being overweight. The oldest adolescents worry most about their appearance, being overweight, their friends, and problems at home. Adolescents who prefer talking to parents when worried are less likely to worry about being liked, while those who keep worries to themselves have more worries about grades. Those who turn to parents for information are less likely to worry about being liked, failure, their future, and their friends than those who turn to other sources (teachers, Internet, and friends). Recommendations are given to assist health educators and other school staff to recognize frequent worriers and plan school-based approaches to address their needs.     

Associations Between Poor Health and School-Related Behavior Problems at the Child and Family Levels: A Cross-Sectional Study of Migrant Children and Adolescents in Southwest Urban China

BACKGROUND: Due to urbanization in China, the numbers of migrant children and adolescents in urban environments have increased. Previous studies have indicated that children and adolescents are more likely to suffer from health problems and poor school achievement. The present study identified associations between poor health and school-related behavior problems (ie, learning attitudes and learning disabilities [LL], antisocial behavior and risk behavior [AR], and social adaptation and role function [SR]) at the child and family levels. METHODS: A cross-sectional design was used. Seven hundred and eighty-one participants were recruited in inclusive settings. Correlational analysis was conducted to assess the associations between demographic variables and the primary study variables. Logistic regression analysis was used to determine which study factors were the strongest predictors of general health problems. RESULTS: School-aged migrants who had poorer health tended to be more likely to suffer from school-related behavior problems. Poor health was also found to hinder scholastic achievement in migrant children and adolescents through a higher prevalence of school-related behavior problems, including negative learning attitudes and learning disabilities, antisocial behavior and risk behavior, and social maladjustment. Health risk factors included inappropriate parental education methods, fewer classmates, and less social support. CONCLUSIONS: Health and individual risk factors should be explored further to determine their causal role in migrant children and adolescents with school-related behavior problems. These results have implications for future school health education for these students.     

High-risk behaviors associated with early smoking: results from a 5-year follow-up

Purpose: To compare grade 7 nonsmokers, experimenters, and smokers on the basis of prevalence of other problem behaviors at both grade 7 and grade 12.

Methods: Based on longitudinal self-report data from 4327 California and Oregon students, we used logistic regression to develop weighted estimates of the prevalence of academic difficulties, substance use, and delinquent behavior within the three smoking status groups at grades 7 and 12. Huber variance estimates, which adjust for weighting and clustering of observations, were used to assess the statistical significance of differences across groups.

Results: Compared with nonsmokers, early smokers were at least 3 times more likely by grade 12 to regularly use tobacco and marijuana, use hard drugs, sell drugs, have multiple drug problems, drop out of school, and experience early pregnancy and parenthood. These adolescents were also at higher risk for low academic achievement and behavioral problems at school, stealing and other delinquent behaviors, and use of predatory and relational violence. Early experimenters were at significantly greater risk for these problems as well, although to a lesser extent than smokers. Importantly, the higher risk among experimenters and smokers of experiencing many of these problems was evident as early as grade 7.

Conclusions: Early experimenters and smokers are more likely than nonsmokers to experience various problem behaviors by grade 12, with many of these problems evident as early as grade 7. Results suggest that substance use programs that target multiple problems in addition to smoking may be most effective for these high-risk adolescents.     

青少年性知识态度和行为的性别差异

目的　系统分析中学生性知识、态度及行为的性别差异 ,为开展青少年性教育提供一定的参考依据。　方法对陕西省西乡县高中一、二年级的学生进行问卷调查。　结果　男生知识总分高于女生。男女生知识获得的主要途径基本相同 ,大多数来自医学书刊和生理卫生课。男生知识来源较女生广泛 ,尤其来源于录像和街头广告明显多于女生 ;女生知识来源于家庭明显多于男生。除了在中学生谈恋爱上男女均持较宽容的态度外 ,在其它性态度上 ,男生明显比女生开放。男女生性行为的发生率无显著性差异 ( 4 .5 %和 2 .4 % ) ,但其它与性有关的行为男生多于女生。　结论　青少年在性知识、态度和行为以及对性教育的需求上确实存在性别上的差异 ,在对青少年进行性教育的过程中应考虑到这一点     

Seasonal variation in adolescent conceptions, induced abortions, and late initiation of prenatal care.

The monthly distribution of conceptions among adolescents and the proportion of adolescent pregnancies that are voluntarily terminated by induced abortion by month of conception are the objects of this study. Additionally, seasonal variations in the timing of initiation of prenatal care services by adolescents are investigated. Vital records files of single live births, fetal deaths, and induced terminations of pregnancy to residents in the State of South Carolina, 1979-86, were aggregated to estimate conceptions. There was a significant difference between adolescents and adults in the monthly distribution of conceptions. The peak month of adolescent conceptions coincided with the end of the school year. Pregnancies of adolescents occurring at this time further demonstrated later access of prenatal care services than conceptions occurring at other times of the year, most notably during the school term. These findings suggest that there is considerable opportunity for improving the availability of reproductive health care services for adolescents. The results specifically suggest the potential benefit of increasing adolescent pregnancy prevention efforts prior to high-risk events and increasing the availability of and access to health care and counseling services to adolescents during the school recess months of the summer.     

Profiles of violent youth: substance use and other concurrent problems.

OBJECTIVES: This study examined the prevalence of various violent behaviors among high school-age adolescents, the co-occurrence of teenage violence with other public health problems, and gender differences in violence. METHODS: Longitudinal data for more than 4500 high school seniors and dropouts from California and Oregon were used to develop weighted estimates of the prevalence of violent behavior and its co-occurrence with other emotional and behavioral problems. RESULTS: More than half the sample had engaged in violence during the last year, and one in four had committed predatory violence. Boys were more likely than girls to engage in most types of violence, but both were equally prone to violence within the family. Violent youth were more likely than their peers to have poor mental health, use drugs, drop out of school, and be delinquent. Violent boys were more likely than violent girls to commit nonviolent felonies and sell drugs, but less likely to have poor mental health or become a parent. Prevalence estimates for violence co-occurring with three or more other problems ranged from 4% to 21%. CONCLUSIONS: Teenage violence typically coexists with additional emotional and behavioral problems. Programs must consider the broader public health context in which violence occurs.     

Implications of racial and gender differences in patterns of adolescent risk behavior for HIV and other sexually transmitted diseases

CONTEXT: Sexual and substance use behaviors covary in adolescence. Prevalence of HIV and other sexually transmitted diseases (STDs) differs according to race and gender, yet few studies have systematically investigated risk behavior patterns by subgroup, particularly with nationally representative data. METHODS: A priori considerations and K-means cluster analysis were used to group 13,998 non-Hispanic black and white participants in the National Longitudinal Study of Adolescent Health, Wave 1, according to self-reported substance use and sexual behavior. Multinomial logit analyses examined racial and gender differences by cluster. RESULTS: Among 16 clusters, the two defined by the lowest risk behaviors (sexual abstinence and little or no substance use) comprised 47% of adolescents; fewer than 1% in these groups reported ever having received an STD diagnosis. The next largest cluster-characterized by sexual activity (on average, with one lifetime partner) and infrequent substance use-contained 15% of participants but nearly one-third of adolescent with STDs. Blacks were more likely than whites to be in this group. Black males also were more likely than white males to be in three small clusters characterized by high-risk sexual behaviors (i.e., having had sex with a male or with at least 14 partners, or for drugs or money). Black females generally were the least likely to be in high-risk behavior clusters but the most likely to report STDs. CONCLUSIONS: Adolescents' risk behavior patterns vary by race and gender, and do not necessarily correlate with their STD prevalence. Further investigation of adolescents' partners and sexual networks is needed.