Knowledge, attitudes and self-care practices related to sun protection among secondary students in Australia

The aim of this research was to ascertain changes in sun-related knowledge, attitudes and self-care practices among Australian secondary school students between 1993 and 1996. Two cross-sectional surveys of sun-related attitudes, beliefs and behavior of young people aged 12-17 years of age, were conducted in 1993 and 1996. Over 80% of adolescents at both time periods knew about the issues related to skin cancer prevention, frequency of burning and burning on cloudy days. Adolescent attitudes had shifted positively in the areas of staying inside in 1996 [relative risk (RR): 1.13; 95% confidence interval (CI): 1.09-1.17] and staying under shade in 1996 (RR: 1.16; 95% CI: 1.13-1.18). Desire for a moderate or dark tan was lower in 1996 (45%) than in 1993 (50%). Respondents reported that they were less likely to wear brief clothing to get a suntan in 1996 (RR: 0.81; 95% CI: 0.78-0.84) and were significantly more likely to stay in the shade in 1996 (RR: 1.19; 95% CI: 1.16-1.23). We conclude that there has been a shift in attitudes towards use of shade and avoidance of unnecessary exposure, and away from use of sunscreens and sunglasses. The results suggest that adolescents may be more ready to accept structural changes that move desired activities out of the sun.     

Use of alcohol,tobacco and illicit drugs among ethnic Norwegian and ethnic minority adolescents in Hordaland county,Norway: the youth@hordaland-survey

Objective: To describe potential differences in unhealthy behaviours among ethnic Norwegian adolescents and minority adolescents from countries within the European Union, European Economic Area or US (EU/EEA countries) and adolescents from non-EU/EEA countries. Specifically, we aimed to investigate ethnic differences in use of alcohol, tobacco and illicit drugs, and potential confounding due to socio-demographic characteristics.

Design: Cross-sectional population-based study of adolescents aged 16–19 (N?=?10,122), with self-reported ethnicity as grouping variable, and self-reported use of alcohol, tobacco and illicit drugs as dependent variables.

Results: We found that minority adolescents from EU/EEA and non-EU/EEA countries differed from ethnic Norwegian adolescents on important indicators of unhealthy behaviours. Compared to Norwegian adolescents, adolescents from EU/EEA were more likely to report having tried to smoke, to be a daily smoker and to ever having tried an illicit drug (adjusted odds ratio (OR) ranging from 2.01 to 3.74). They were, however, less likely to have tried snus (a form of smokeless tobacco; adjusted OR 0.64; confidence interval (CI) 95% 0.43–0.97) and to report daily snus use (adjusted OR 0.31; CI95% 0.15–0.67). There were no differences in having tried alcohol. Non-EU/EEA adolescents were less likely to have ever tried alcohol (OR 0.24; CI95% 0.18–0.31), snus (OR 0.47; CI95% 0.34–0.65) and to smoke (0.68; CI95% 0.52–0.91), and less likely to report daily snus use (OR 0.36; CI95% 0.21–0.62) compared to Norwegian adolescents. There were no differences with regard to having tried illicit drugs and reporting being a daily smoker. All differences observed were robust to adjustment for age, gender and family socio-economic status.

Conclusion: The presents study identified important differences in unhealthy behaviours across different ethnic groups in Norway. The differences in the prevalence of unhealthy behaviours among ethnic minorities are still relevant in a public health perspective, and potential mechanisms should be investigated further.     

Seven‐year trends in sun protection and sunburn among Australian adolescents and adults

Aims : To examine the change in sun protective behaviours and sunburn of Australians over a seven‐year period, in the context of sustained skin cancer prevention campaigns and programs. Methods : Weekly cross‐sectional telephone interviews of Australians were conducted throughout summer in 2010/11 for comparison with 2003/04 and 2006/07. In 2010/11, n=1,367 adolescents (12–17 years) and n=5,412 adults (18–69 years) were interviewed about their sun‐related attitudes, weekend sun protection and sunburn. Multivariate analyses adjusted for key demographics, temperature, cloud, wind and ultraviolet radiation (UVR) to assess change in outcomes over time. Results : There were consistent improvements in adolescents’ and adults’ attitudes, intentional tanning and incidence of sunburn over time. Behavioural changes were variable. Adults spent less time outdoors during peak UVR compared to past surveys, while adolescents were less likely to be outdoors compared with 2006/07. Sunscreen use and wearing of long sleeves increased among adults, but hat wearing decreased for both age groups, as did leg cover by adolescents since 2003/04. There has been a sustained decrease in weekend sunburn among adolescents and adults. Conclusions : The findings suggest improvements in skin cancer prevention attitudes of Australians over time. Australians’ compliance with sun protection during summer has improved in some areas, but is still far from ideal. The sustained decrease in weekend sunburn among adolescents and adults is encouraging, but further improvements are required.     

Postpartum Depression in Adolescent and Adult Mothers: Comparing Prenatal Risk Factors and Predictive Models

Our objective was to assess whether postpartum depression risk factors differ between adolescent and adult mothers and to evaluate the need for adolescent specific screening instruments. We performed a retrospective cohort study using data from the Rhode Island Pregnancy Risk Assessment Monitoring System, 2004–2008. We identified maternal age specific risk factors using weighted logistic regression and developed predictive models using a forward selected weighted logistic regression. Notable differences in odds ratios were observed for risk factors such as maternal race (OR Hispanic vs. White: 0.99, 95 % CI 0.49–1.99 among adolescents; 3.32, 95 % CI 2.01–5.49 among adults), pre-pregnancy alcohol use (OR use vs. non-use: 2.04, 95 % CI 1.08–3.86 among adolescents; 0.49, 95 % CI 0.33–0.73 among adults), and pregnancy intention (OR unintended vs. intended: 1.05, 95 % CI 0.37–2.97 among adolescents; 2.67, 95 % CI 1.51–4.74 among adults). In predictive models, adolescent postpartum depressive symptoms were most influenced by prior depression and social support while adult postpartum depressive symptoms were associated with risk factors including maternal race, pregnancy intention, SES, prior depression, mental health during pregnancy, stressors, and social support. We were able to identify similarities and dissimilarities in risk factors for postpartum depressive symptoms among adolescents and adults. Predictive models developed in the general population of pregnant women performed poorly among adolescents relative to age specific predictive models, suggesting that current screening tools may not adequately identify high risk adolescents.     

Tobacco Use and Other Risk Behaviors among Adolescents in an STD Clinic

Background. This study examined the potential for tobacco use and other health risk behavior interventions in the context of an urban sexually transmitted diseases (STD) clinic.Methods. A cross-sectional survey of two populations. Adolescents seen at an STD clinic or at the teen clinic of a community health center completed a self-administered computer survey in 1996. Risk behaviors, attitudes, and readiness to stop smoking were analyzed for 225 patients at the STD clinic and 248 patients at the teen clinic.Results. Compared with adolescents in the teen clinic, adolescents in the STD clinic were more likely to have smoked frequently (OR 1.7, 95% CI 1.1, 3.0), used any illegal drug (OR 2.7, 95% CI 1.3, 5.5), recently binged on alcohol (OR 1.7, 95% CI 1.0, 2.8), and had more than 10 lifetime sexual partners (OR 1.9, 95% CI 1.0, 3.4). Weapon carrying, readiness to stop smoking, and attitudes toward smoking did not differ between sites.Conclusions. Cigarette smoking and other health risk behaviors are more prevalent among adolescents in an STD clinic than among adolescents in a community health center. STD clinics are potential sites for cigarette, alcohol, and drug use interventions among “hard to reach” adolescents.     

Adolescent Caffeine Use,ADHD, and Cigarette Smoking

The purpose of this study was to describe the prevalence of adolescent caffeine use and its association with attention deficit hyperactivity disorder (ADHD) and cigarette smoking. A total of 448 adolescents between the ages of 13 and 21 years consecutively presenting for routine, well-child care were studied. Twenty-four percent had a pre-existing diagnosis of ADHD, and 47% reported a positive lifetime history of cigarette smoking. Eighty-five percent of participants reportedly consumed a caffeinated beverage within the past 30 days; 38% had consumed 1+ cups of caffeinated coffee, and 78% had consumed 1+ glasses of another caffeinated beverage other than coffee (e.g., tea or soft drinks). After controlling for sociodemographic and other potential confounding factors, an ADHD diagnosis and a positive lifetime smoking history were significantly associated with caffeine use: Adolescents with ADHD were nearly twice as likely to use more caffeine than were adolescents without ADHD (odds ratio [OR] = 2.08; 95% confidence interval [CI] = 1.23, 3.50, p = .006); lifetime smokers were 80% more likely to use more caffeine than were adolescents who had never smoked (OR = 1.80; 95% CI = 1.16, 2.79, p = .009). Caffeine use is elevated among adolescents diagnosed with ADHD and those who have ever tried cigarette smoking. Although caffeine is a non-illicit psychostimulant, these findings add to the emerging data on substance use behaviors among adolescents with ADHD. Health care professionals who work with adolescents with ADHD should regularly screen for both cigarette and caffeine use among their patients.     

An epidemiological study of sleep quality in adolescents in South China: a school-based study

Background This study explored the prevalence of disturbed sleep and investigated its distribution characteristics and associated factors in adolescents in South China. Methods Junior middle school and senior high school students (n= 1221) were recruited from schools in Shanghai, China. Students completed a questionnaire using the Pittsburgh Sleep Quality Index and factors associated with disturbed sleep. Results The prevalence of a tendency towards poor sleep was 34.32% [95% confidence interval (CI): 31.66–36.98] with no significant difference between genders. This tendency increased with age, yielding a significant group effect (P < 0.01). In middle school and high school, the propensity towards poor sleep was 31.34% (95% CI: 28.29–34.39) and 42.22% (95% CI: 36.92–47.52) respectively. The factors associated with poor sleep were more television viewing during weekdays [odds ratio (OR): 1.56, CI: 1.36–1.71], more frequent computer/Internet use (OR: 1.25, CI: 1.08–1.39), earlier school starting time (OR: 1.12, CI: 1.07–1.28), and more time on homework during weekdays (OR: 1.78, CI: 1.51–1.98) and weekends (OR: 1.35, CI: 1.21–1.52) Conclusions A tendency towards poor sleep is common in adolescents in South China and its incidence increases with age. The factors associated with this phenomenon indicate that poor sleep in adolescents could be improved, at least partly, by reducing the use of visual technologies and by changing school timetables.     

Prevalence of sexual intercourse among school-going adolescents in Coast Province, Kenya

A study was carried out to estimate the prevalence and associated factors of sexual intercourse among school adolescents in Coast Province, Kenya. Data were obtained through the Kenya Global School-Based Health Survey. Overall the prevalence of sexual intercourse within the last 12 months was 14.9% (22.2% in males and 5.0% in females). Among males, the protective factors against having sex were being of age < 15 years (OR = 0.60, 95% CI 0.58, 0.62) and ever been drunk (OR = 0.63, 95% CI 0.59, 0.67). The risk factors for having sex among males were ever smoked (OR = 2.05, 95% CI 1.92, 2.19), having close friends (OR = 1.68, 95% CI 1.56, 1.81), currently drinking alcohol (OR = 1.13, 95% CI 1.06, 1.20), ever used drugs (OR = 2.36, 95% CI 2.24, 2.49) and parental supervision (OR = 1.30, 95% CI 1.25, 1.34). Meanwhile among female respondents, parental supervision was protective (OR = 0.88, 95% CI 0.81, 0.94) and the only risk factor was ever used drugs (OR = 2.85, 95% CI 2.57, 3.15). It is suggested that public health interventions aimed to promote adolescent sexual health should be designed with the appreciation of the factors associated with sexual activity in due consideration.     

Prevalence of youth access to alcohol, guns, illegal drugs, or cigarettes in the home and association with health-risk behaviors

PURPOSE: To describe the prevalence of access to alcohol, guns, drugs, or cigarettes in the home and its association with related health-risk behaviors among adolescents.METHODS: We analyzed cross-sectional data from the 1995 in-home survey of the National Longitudinal Study on Adolescent Health which used a nationally representative school-based sample (N = 6,504) of adolescents in grades 7-12. We used logistic regression analysis, adjusted for gender, race/ethnicity and age, to examine the associations between access to alcohol, guns, drugs, and cigarettes in the home and the practice of risk behaviors involving those variables.RESULTS: Overall, 1,817 (28%) adolescents reported having easy access to alcohol in the home, 1,616 (25%) had access to a gun, 189 (3%) had access to drugs, and 2,067 (32%) had access to cigarettes. Associations were found between easy home access to alcohol and drinking during the past 12 months (Adj. OR = 2.16, 95% CI = 1.89-2.47), ever being drunk at school (Adj. OR = 2.33, 95% CI = 1.85-2.95, and ever driving drunk (Adj. OR = 1.64, 95% CI = 1.29-2.09). Access to a gun at home was associated with carrying a gun to school (Adj. OR = 2.54, 95% CI = 1.40-4.64). Associations were also found between access to drugs and cigarettes in the home and ever using drugs and smoking regularly.CONCLUSIONS: Easy access to alcohol, guns, and cigarettes in the home is prevalent among adolescents and may increase involvement in risky behaviors. Limiting access therefore is important in order to reduce the occurrence of health-risk behaviors associated with substance use, deliquency and injury among adolescents.     

Risk-Accepting Personality and Personal Protective Equipment Use Within the Agricultural Health Study

ABSTRACT

Pesticide exposures can be reduced by use of personal protective equipment as well as proper mixing and application practices. The authors examined the effects of risk-accepting personality on personal protective equipment (PPE) use and mixing and application practices among private pesticide applicators and their spouses within the Agricultural Health Study (AHS) in Iowa and North Carolina and commercial applicators in Iowa. The AHS follow-up questionnaire included four questions designed to assess attitudes toward risk. Analysis was limited to those who were currently working on a farm or registered as a commercial applicator and indicated current pesticide use (n?=?25,166). Respondents who answered three or more questions in the affirmative (private applicators: n?=?4160 [21%]; commercial applicators: n?=?199 [14%]; spouses: n?=?829 [23%]) were classified as having a risk-accepting personality. Logistic regression was used to evaluate specific work practices associated with risk-accepting attitudes. Among private applicators, the likelihood of using any PPE when mixing or loading pesticides was lower among risk-acceptors compared to risk-averse individuals (odds ratio [OR] = 0.72, 95% confidence interval [CI]: 0.65–0.79). A similar relationship was observed among commercial applicators (OR = 0.77, 95% CI: 0.34–1.77) but not among spouses (OR = 1.09, 95% CI: 0.90–1.33). Among private applicators, risk-acceptors were more likely than the risk-averse to apply pesticides within 50 feet of the home (OR = 1.21, 95% CI: 1.01–1.44), compared to further than ¼ mile. These findings suggest that the decisions to use personal protective equipment and properly handle/apply pesticides may be driven by risk-accepting personality traits.

[Supplementary materials are available for this article. Go to the publisher's online edition of Journal of Agromedicine for the following free supplemental resource: Adjusted odds ratios of PPE use and risk accepting personality traits among participants currently applying pesticides in the Agricultural Health Study (1999–2005)]     

Prevalence and correlates of condom use at last sexual intercourse among in-school adolescents in urban areas of Uganda

OBJECTIVES: Correct and consistent condom use remains an important public health intervention against the spread of Human Immunodeficiency Virus and other sexually transmitted infections. There is paucity of information on sexual behaviour of in-school adolescents in Uganda. We, therefore, used secondary data of the Uganda Global School-based Health Survey (UGSHS) conducted in 2003 to determine the prevalence and correlates of condom use at last sexual intercourse in urban areas of Uganda. METHODS: A two-stage cluster sampling technique was used to obtain a representative sample. Altogether 1709 students participated in the survey in urban areas of whom 179 (14.9% of males, and 7.9% of females) had sexual intercourse within 12 months before the survey. RESULTS: Overall 77.3% (79.7% of male, and 72.3% of female) adolescents used a condom at last sexual intercourse. Adolescents who drank alcohol and used drugs were 64% (OR = 1.64, 95% CI 1.54, 1.75) and 68%, (OR = 1.68, 95% CI 1.56, 1.81) more likely to have used a condom, respectively. Meanwhile, adolescents who ever got drunk, and who reported to ever had 2 or more sex partners were 55% (OR = 0.45, 95% CI 0.42, 0.48) and 35% (OR = 0.65, 95% CI 0.62, 0.68) less likely to have used a condom compared to those who had never got drunk, and who ever had 1 sex partner, respectively. Finally, adolescents who reported receiving no parental supervision were 45% (OR = 0.55, 95% CI 0.53, 0.58) less likely to have used a condom compared to those who reported receiving parental supervision. CONCLUSIONS: Parental supervision may be effective in promoting condom use among adolescents. Furthermore, drinking alcohol was associated with condom use probably due to peer pressure and easy access of condoms in drinking places as condoms are not actively promoted in schools. There is need for further research on how in-school adolescents could access condoms.     

Ten-Year Changes in Healthy Eating Attitudes in the SUN Cohort

Objective: The objective of this study was to assess the within-subject longitudinal changes in self-perceived healthy eating attitudes after 10 years of follow-up and to identify predictors of long-term changes in a middle-aged adult cohort.

Methods: Four thousand five hundred seventy-two participants completed a validated food frequency questionnaire (FFQ) at baseline and after 10 years of follow-up. The FFQ was expanded with a brief 10-item questionnaire about eating attitudes with 2 possible answers: yes or no. A baseline score and a 10-year score were calculated with these 10 items (range from 0 to 10). Participants were categorized into 3 groups according to this score. Linear and logistic regressions were used to examine changes at follow-up and associations between baseline characteristics and improvement in the score.

Results: After 10 years of follow-up, a statistically significant favorable change (p < 0.001) was achieved in all questions about eating attitudes, particularly in these items: “Do you try to eat less sweets and pastries?” (12%), “Do you try to eat less meat?” (11.1%), and “Do you try to reduce your fat intake?” (10%). Being female (odds ratio [OR] = 1.19, 95% confidence interval [CI], 1.02–1.39), being 35–50 or ≥ 50 years old (OR = 1.24, 95% CI, 1.07–1.44 and OR = 1.74, 95% CI, 1.38–2.18, respectively), a high level of physical activity (OR for third vs first tertile = 1.20, 95% CI, 1.02–1.41), and a higher Mediterranean diet score (OR for second and third tertiles = 1.18, 95% CI, 1.01–1.37 and OR = 1.26, 95% CI, 1.04–1.52, respectively) were associated with a higher probability of improving the eating attitudes score, while a low body mass index (BMI; OR = 0.71, 95% CI, 0.51–1.00) and snacking between meals (OR = 0.84, 95% CI, 0.73–0.97) were associated with a lower probability of improving their score.

Conclusions: The eating attitudes of the participants in the Seguimiento Universidad de Navarra (SUN) cohort became more favorable after 10 years of follow-up. Certain sociodemographic or clinical variables may predict a positive change.     

Substance use and risky sexual behaviours among sexually experienced Ghanaian youth

ABSTRACT: BACKGROUND: The association between risky sexual behaviours and substance uses among Ghanaian youth were investigated. METHODS: An in-school cross-sectional representative survey was conducted among 12-18-year- old youth in Ghana in 2008 (N=1165, response rate =90%). Logistic regression analyses were employed to investigate the association between substance use (tobacco use, drunkenness, marijuana use, other drug uses) and risky sexual behaviours (sexual debut, condom use and number of sexual partners). RESULTS: Of all adolescents, 25% (28% boys and 23% girls) were sexually experienced. The mean age for first sexual intercourse was 14.8 years (14.4 years for boys and 15.1 years for girls). Among the sexually experienced, 31% had multiple sexual partners. Older age (OR=3.4, 95% CI=1.7-3.4) and rural residency (OR=1.5, 95% CI=1.1-2.1) were independently associated with sexual debut while only older age (OR=2.4, 95% CI=1.7-3.4) was associated with condom use. Additionally, smoking (OR=3.7, 95% CI=2.0-6.8), tawa use (OR=2.4, 95% CI=1.3-4.7), tobacco use (OR=2.8, 95% CI=1.7-4.7) drunkenness (OR=1.7, 95% CI=1.1-2.8) and marijuana use (OR=3.3, 95% CI=1.6-7.0) were independently associated with sexual debut. Furthermore, all substance uses studied were associated with having one or multiple sexual partners. CONCLUSION: Substance use seems to be a gateway for risky sexual behaviours among Ghanaian adolescents. Public health interventions should take into account the likelihood of substance use among sexually experienced adolescents.     

Major depressive episode and physical health in adolescents and young adults: results from a population-based interview survey

BACKGROUND: This paper aimed to investigate associations between major depressive episode (MDE) and chronic illness, disability, self-perceived health and number of sick-days among adolescents and young adults in the general population. METHODS: The Finnish Health Care Survey 1996 was a cross-sectional nationwide epidemiological study. A random sample of 509 adolescents and 433 young adults was interviewed in 1996. DSM-III-R MDE during the past 12 months was defined using The University of Michigan Composite International Diagnostic Interview Short-Form algorithm. Data on physical health were gathered in the interview. RESULTS: In multivariable logistic regression, chronic illness [odds ratio (OR) 1.78; 95% confidence interval (CI) 1.03, 3.05], poor self-rated health (OR 2.26; 95% CI 1.01, 5.07), more than three sick-days in the past 6 months (OR 1.72; 95% CI 1.02, 2.92) and respiratory allergies (OR 2.40; 95% CI 1.00, 5.75) were associated with MDE. Among 15- to 19-year-olds, disabling chronic illness was related to MDE (OR 2.59; 95% CI 1.06, 6.36), and thoughts of death were more prevalent in the presence of chronic illness among those with MDE [35.2% versus 65.7%; F(1,67) P = 0.024]. Migraine was associated with MDE among young adults (OR 6.18; 95% CI 1.14, 30.8). CONCLUSIONS: Symptoms of depression should be investigated among adolescents with chronic illness or frequent sick-days. The degree of reported disability should be noted. Young people with both chronic illness and depressive symptoms should be assessed for thoughts of death and possible suicidality.     

Factors associated with self-reported pneumococcal immunization among adults 65 years of age or older in the Minneapolis-St. Paul metropolitan area

BACKGROUND: As part of a 3-year demonstration project to improve pneumococcal polysaccharide vaccine (PPV) coverage among older adults, the Minnesota Department of Health conducted a baseline evaluation of knowledge, attitudes, and beliefs among the general public regarding PPV. METHODS: A random-digit dialing telephone survey was conducted among community-dwelling adults age 65 years or older in three metropolitan counties in Minnesota during April through June 1998. RESULTS: Three hundred fifty-three interviews were completed; self-reported PPV coverage was 59% (95% CI 54%, 64%). Nearly all (94%) respondents reported at least one medical visit in the past year. Unvaccinated respondents expressed willingness to be vaccinated if they knew about PPV's safety, dosage, and preventive role. In a final multivariate regression model, factors associated with PPV vaccination included awareness of PPV (OR 7.8; CI 2.1, 29.2; P = 0.002), opinion that receiving PPV is "very important" (OR 8.3; CI 3.2, 21.6; P < 0.001), awareness that Medicare covers PPV (OR 5.1; CI 1.9, 13.8; P = 0.001), physician ever offering PPV (OR 21.7; CI 6.2, 76.6; P < 0.001), and physician regularly offering PPV (OR 3.9; CI 1.1, 13.7; P = 0.03). CONCLUSIONS: Respondents were significantly influenced by their physician offering PPV. Therefore, providers' practices are a critical target for improving PPV coverage. Educational efforts to inform patients about PPV and to address misconceptions (e.g., safety, efficacy, Medicare coverage) also may improve vaccination levels.     

Family Meals and Diet Quality Among Children and Adolescents in North Carolina

ObjectiveTo examine the relationship between diet quality and frequency of family meals throughout childhood and adolescence.MethodsCross-sectional study of children ages birth through 17 years (n = 1,992) using data from the 2010 North Carolina Child Health and Monitoring Program. Multiple logistic regression was used to estimate the associations between family meals and fruit intake, vegetable intake, and sugar-sweetened beverage intake among younger children, older children, and adolescents.ResultsIn adjusted analyses, participating in ≥ 5 family meals/wk was associated with less sugar-sweetened beverage intake among younger (OR 2.04; CI 1.06–3.93) and older children (OR 2.12; 95% CI 1.27–3.55), greater vegetable intake among older children (OR 1.87; 95% CI 1.08–3.24) and adolescents (OR 1.81; 95% CI 1.14–2.88), and greater fruit intake among adolescents (OR 2.11; 95% CI 1.40–3.19).Conclusions and ImplicationsStrategies to encourage families to establish regular family meals early in life and continue them throughout childhood and adolescence is warranted.     

Age and menopausal effects of hormonal birth control and hormone replacement therapy in relation to breast cancer risk

It is unclear whether breast cancer risk varies by age and menopausal status in relation to use of hormonal birth control (HBC) and hormone replacement therapy (HRT), taken singly or cumulatively. The authors utilized data from 1,478 cases and 1,493 controls aged 20-98 years with known menopausal status, who had participated in a population-based, case-control study conducted on Long Island during 1996-1997. Exogenous hormone use over the lifecourse was assessed by use of memory aids. The authors examined associations among women in these subgroups: premenopausal (n = 968), postmenopausal <65 years (n = 1,045), and postmenopausal > or = 65 years (n = 958). Among premenopausal women, risk was increased for ever use of HBC (odds ratio (OR) = 1.37, 95% confidence interval (CI): 1.04, 1.81) or HRT (OR = 1.81, 95% CI: 1.17, 2.81) and was pronounced among women reporting use of both HBC and HRT (OR = 2.59, 95% CI: 1.50, 4.46), long-term HRT use (OR = 3.93, 95% CI: 1.43, 10.84), or estrogen-plus-progestin therapy (OR = 3.51, 95% CI: 1.45, 8.49). There was no effect of ever HBC use among postmenopausal women aged less than 65 years, but risk was modestly elevated for more than 5 years of HRT use (OR = 1.41, 95% CI: 1.00, 1.99). Among postmenopausal women aged 65 years or more, odds ratios for HBC or HRT use were around the null. These results emphasize that timing of exogenous hormone use is important. Women who used these hormones before menopause had elevated risks, but the harmful effects began to decline with age after menopause.     

Socio‐economic gradients in self‐reported diabetes for Indigenous and non‐Indigenous Australians aged 18–64

Objective : To examine and compare socio‐economic gradients in diabetes among Indigenous and non‐Indigenous Australians. Methods : I analysed weighted data on self‐reported diabetes and a range of socio‐economic status (SES) measures for 5,417 Indigenous and 15,432 non‐Indigenous adults aged 18–64 years from two nationally representative surveys conducted in parallel by the Australian Bureau of Statistics in 2004–05. Results : After adjusting for age, diabetes prevalence was significantly higher among those of lower SES in both Indigenous and non‐Indigenous populations. The age‐ and sex‐adjusted odds ratios (OR) for diabetes for the lowest versus the highest SES group were similar for the two populations on many variables. For example, the OR for the lowest quintile of equivalised household income (compared with quintiles 3–5 combined) was 2.3 (95% CI 1.6–3.4) for the Indigenous population and 2.0 (95% CI 1.5–2.8) for the non‐Indigenous population. However, Indigenous people of high SES had greater diabetes prevalence than low SES non‐Indigenous people on every SES measure examined. Conclusion : Socio‐economic status explains some but not all of the difference in diabetes prevalence between Indigenous and non‐Indigenous Australians. Other factors that may operate across the socio‐economic spectrum, such as racism, stress, loss and grief, may also be relevant and warrant further examination. Implications : Indigenous Australians do not constitute a homogeneous group with respect to socio‐economic status or diabetes prevalence, and this diversity must be recognised in developing measures to redress Indigenous health disadvantage.     

Effect of Perioperative Probiotics and Synbiotics on Postoperative Infections After Gastrointestinal Surgery: A Systematic Review With Meta‐Analysis

Background: Bacterial infection following gastrointestinal surgery remains a common morbidity. The aim of this study was to estimate the effect of the perioperative use of probiotics and synbiotics on postoperative infections. Materials and Methods: We searched PubMed, Embase, and the Cochrane Library to identify pertinent randomized controlled trials (RCTs). The primary outcome was postoperative infection rate. The secondary outcomes were length of hospital and intensive care unit (ICU) stay, length of antibiotic therapy, and mortality. The pooled outcomes were calculated using random effects models. Results: Twenty‐eight RCTs involving 2511 patients were included in this systematic review. The incidence of infectious complications was lower among patients who received probiotics/synbiotics than among the controls (odds ratio [OR] = 0.35; 95% confidence interval [CI], 0.24–0.50), particularly regarding respiratory (OR = 0.44; 95% CI, 0.28–0.68), urinary tract (OR = 0.30; 95% CI, 0.16–0.55), and wound infections (OR = 0.58; 95% CI, 0.42–0.80). The lengths of hospital stay (mean difference [MD] = ?3.20; 95% CI, ?4.87 to ?1.54) and duration of antibiotic therapy (MD = ?3.40; 95% CI, ?4.67 to ?2.13) were shorter for patients who received probiotics/synbiotics than for controls. There were no significant differences in mortality (OR = 1.19; 95% CI, 0.52–2.74) or length of ICU stay (MD = ?0.46; 95% CI, ?1.07 to 0.14) between the compared groups. Conclusion: Probiotics and synbiotics may prevent postoperative infections in patients undergoing gastrointestinal surgery. However, the results need to be interpreted with caution due to the risk of bias in the included studies and the potential publication bias.     

E-cigarette and waterpipe use in two adolescent cohorts: cross-sectional and longitudinal associations with conventional cigarette smoking

Alternative tobacco products are increasing in popularity. An important question is whether their use is associated with or even leads to conventional smoking, but large-scale (European) studies are scarce. In two cohorts of Dutch adolescents (Cohort I n = 6819, mean age = 13.8 SD = 1.1, 48.2% female; Cohort II n = 2758, mean age = 17.3 SD = 1.8, 61.3% female), we investigated use of electronic (e)-cigarettes with nicotine, e-cigarettes without nicotine and waterpipe. Generalized estimating equation modelling was conducted with ever conventional smoking as the dependent variable (0 = no, 1 = yes) and ever alternative tobacco use as the independent variable, correcting for clustering within schools, age, sex and education in both cohorts. In a subsample (n = 2100), the association between alternative tobacco use at baseline and conventional smoking 6 months later was tested, taking into account smoking propensity (based on personality, susceptibility to peer pressure and smoking intentions). Ever use prevalence was 13.7% for e-cigarettes with nicotine, 29.4% for e-cigarettes without nicotine and 22.1% for waterpipe in Cohort I and 12.3, 27.6 and 45.3% respectively in Cohort II. Ever smokers had tried alternative tobacco products more often than never smokers. Among never-smoking adolescents at baseline, alternative tobacco use predicted ever smoking 6 months later (e-cigarettes with nicotine OR 11.90 95% CI 3.36–42.11; e-cigarettes without nicotine OR 5.36 95% CI 2.73–10.52; waterpipe OR 5.36 95% CI 2.78–10.31). This association was strongest for adolescents with a low baseline risk of smoking. Experimenting with alternative tobacco products is common among Dutch youth. Alternative tobacco use predicts (future) smoking, especially among adolescents with a low smoking propensity.