Cultural identity, acculturation, and mental health among adolescents in east London's multiethnic community

STUDY OBJECTIVE: To investigate cultural identity as a risk factor for mental health problems among adolescents. DESIGN: A cross sectional school based population survey. Mental health problems were measured using the strengths and difficulties questionnaire. Pupils were classified into one of four cultural identity types on the basis of friendship and clothing choices. SETTING: East London. PARTICIPANTS: 2623 adolescents (aged 11-14) from a representative sample of 28 schools in east London. RESULTS: In comparison with marginalised adolescents who chose friends from neither their own or other cultures, fewer mental health problems were found among adolescents making culturally integrated friendship choices (friends from own and other cultures: OR = 0.6, 0.4 to 0.9), boys making integrated friendship choices (OR = 0.45, 0.22 to 0.91), and specifically among Bangladeshi pupils with integrated friendship choices (OR = 0.15, 0.04 to 0.55). CONCLUSION: As measures of cultural identity, integrated friendship choices overall, and specifically for boys and Bangladeshi pupils, are associated with lower levels of adolescent mental health problems.     

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.     

A randomised controlled trial of clinics in secondary schools for adolescents with asthma

Aim To test the hypothesis that delivery of a programme of asthma care in nurse‐led clinics in school would improve access to care and health outcomes compared with care in general practice. Methods Pupils at four secondary schools in Bristol, North Somerset and South Gloucestershire, UK, were included in the randomized controlled trial. Another two schools were included to control for any cross‐contamination between school clinic attenders and general practice attenders in the trial schools. Pupils in trial schools were randomly assigned to receive an invitation for an asthma review at school or in general practice. Schools were stratified for deprivation and covered rural, urban and suburban populations. Pupils with asthma were identified using a screening questionnaire and then cross‐referenced with practice prescribing records. Four school nurses with additional specialist asthma training ran the school clinics weekly. Consultations concentrated on the needs and interests of adolescents and followed national guidelines for treatment changes. Reviews were arranged at 1 and 6 months, with an additional 3‐month review if needed. The pupil's GP was kept informed. General practice care was according to the practice's usual treatment protocols. Primary outcomes were the proportion of pupils who had had an asthma review in 6 months, health‐related quality of life and level of symptoms. Secondary outcomes were pupil knowledge and attitude to asthma, inhaler technique, the proportion taking inhaled steroids daily, school absence due to asthma, PEFR and pupil preference for the setting of care. Sample size was calculated to have an 80% chance of showing an increase from 40% to 60% having a review in 6 months and half a standard deviation improvement on the quality of life measure. Analysis was on an intention to treat basis. Results School clinic pupils were more likely to attend (91% vs. 51%). However, symptom control or quality of life were no better. School clinic pupils knew more about asthma, had a more positive attitude and better inhaler technique. Absence and PEFR showed no difference. 63% who attended school clinics preferred this model but, taking both groups together, just over half would prefer to attend their GP for follow‐up. Cost of care (including practice, school clinic, hospital and medication) was £32.10 at school, £19.80 at the trial practices and £18.00 at control practices. Conclusions Previous evaluations of nurse‐led asthma clinics in practice have also failed to show improvements in outcomes, though process measures do improve. This may be due to the need for nurses to refer patients to doctors for changes in medication, rather than doing this themselves. Some weaknesses in study design that may have affected outcome, but the essential conclusion is that nurse‐led asthma clinics in school are not cost effective. The study does suggest that such clinics can reach a high proportion of adolescents, but for asthma at least this does not result in any measurable improvement in outcome.     

Reproductive health in school-based health centers: findings from the 1998–99 census of school-based health centers

PURPOSE: To describe the state of reproductive health services, including access to contraception and health center policies, among school-based health centers (SBHCs) serving adolescents in the United States METHODS: We examined questionnaire data on provision of reproductive health services from the 1998-99 Census of School-Based Health Centers (response rate 70%). We examined 551 SBHCs in schools with high or middle school grades. We used logistic regression to define factors independently associated with services and policies. RESULTS: Most SBHCs (76%) were open full-time; over one-half (51%) of centers had opened in the past 4 years. Services provided, either on-site or by referral, included gynecological examinations (95%), pregnancy testing (96%), sexually transmitted disease (STD) diagnosis and treatment (95%), Human Immunodeficiency Virus (HIV) counseling (94%), HIV testing (93%), oral contraceptive pills (89%), condoms (88%), Depo-Provera (88%), Norplant (78%), and emergency contraception (77%). Counseling, screening, pregnancy testing, and STD/HIV services were often provided on-site (range 55%-82%); contraception was often provided only by referral (on-site availability = 3%-28%). SBHCs with more provider staffing were more likely to provide services on-site; rural SBHCs and those serving younger grades were less likely to provide these services on-site. Over three-quarters (76%) of SBHCs reported prohibitions about providing contraceptive services on-site; the sources of these prohibitions included school district policy (74%), school policy (30%), state law (13%), and health center policy (12%). While SBHCs generally required parental permission for general health services, many allowed adolescents to access care independently for certain services including STD care (48%) and family planning (40%). Older SBHCs were more likely to allow independent access.CONCLUSIONS: SBHCs provide a broad range of reproductive health services directly or via referral; however, they often face institutional and logistical barriers to providing recommended reproductive health care.     

A survey on occupational health nursing activities and evaluation in TOHOKU area]

We did a mail survey in 1998 in Tohoku district. We sent questionnaires to approximately 300 Occupational Health (OH) nurses and got 132 replies. Occupations of respondents were 66 public health nurses and 57 nurses. More than 70% did not have a managerial position. About 40% were respondents without colleagues in nursing occupations. Full time occupational physicians were in 40% of companies, and semi-full time occupational physicians were in 60%. Respondents citing good coordination in the former were 60%, and in the latter were 80%. Of all business activities occupying OH nursing employees, persons who performed more than 90% of the tasks numbered more than 30%. Persons not satisfied with present employment positions were 80%. Reasons for dissatisfaction in declining order of incidence were work duties, contract conditions for employment, and personal relations. Planning and summary of OH nursing activities were carefully done highly. For the OH nursing activity evaluation, we examined guidelines for business locations by observing them from the OH nursing aspect and the OH nursing job itself. Guidelines considered for business locales from the OH nursing vantage point show numerically, for example, rates of examinees with abnormal findings, work absenteeism, etc, and expectations as to whether or not health conditions are conspicuously reflected in productivity. Conversely, from the OH nursing vantage point for guidelines on business locales, while receiving affirmative economic evaluation of occupational health and safety measures, progress (process) should also be included in the object of evaluation. Furthermore, guidelines should be mindful of the need to have qualitative and quantitative changes in health behavior of workers and perspectives on health.     

Social equalization in the health of youth. The role of the school

BACKGROUND: A study was made of the role of the school in the process of social equalization in the health of pre-adolescents and adolescents in the city of Bern, Switzerland. METHODS: Questionnaire data obtained from 578 13-year-olds and 476 15-year-olds within the frame of the evaluation of a health-promoting schools project were transformed to 30 indicators of well-being at school, health, emotional well-being, life-skills, and health behaviour and attitudes. RESULTS: Multiple logistic regression with gender, social class, ethnicity, and school climate as independent variables revealed the disappearance of social gradients by 15 years of age and the emergence of new inequalities related mainly to gender and school climate. CONCLUSIONS: The school contributes to the social equalization of the health of adolescents but creates at the same time new disparities, with probably long-lasting consequences. The factors determining the school climate have to be studied more in depth.     

Effect of the curriculum including the computer use on work capacity and health status of older schoolchildren

Formation of computer skills + of pupils is one of the most acute tasks for school today. The relationship between the functional state of the central nervous system, visual analyser and efficiency of pupils with age, have been established. Motivation for work with the computer and quality of the computer video-terminal has been established. Questionnaires given to about 500 pupils have shown that the majority of pupils show an interest to working with computers: 82.5% of 13-14-year old and 70% of 16-17-year old adolescents. Efficiency of pupils becomes more stable with age. The highest number of astheno-neurotic tic symptoms and fatigue complaints are registered in pupils with a low interest to working with computers, as well as in pupils dealing with computers of low quality (of the type Personal Computer 0010). Duration of pupils' work with computers should be no longer than 30 minutes.     

云浮市大中学生健康危险行为调查

了解云浮市青少年健康危险行为流行特征,为制定青少年健康危险行为综合性干预措施提供科学依据.方法 采用多阶段分层整群随机抽样方法,抽取云浮市2 666名大中学生进行健康危险行为问卷调查.结果 初中生骑自行车违规、动手打架、自我伤害的发生率分别为45.79%,16.85%,10.65%,均高于初中以上学生.高职学生不能每天吃早餐、运动时间不足、非安全游泳、现在吸烟、现在喝酒、游戏成瘾、赌博行为的发生率分别为47.87%,57.38%,12.79%,15.41%,42.79%,23.11%,25.57%,均高于其他学段学生.10.39%的学生无任何健康危险行为,具有4种及以上危险行为的高职学生比例(35.74%)高于其他学段的学生.与具有1种健康危险行为的人群相比,同时具有4种及以上危险行为的男生动手打架发生风险最高(OR=65.01),女生网络成瘾发生风险最高(OR=77.54).结论 云浮市青少年健康危险行为多发现象表现突出,应开展针对性的健康促进活动,加强健康指导.     

Mental health problems among pregnant and non-pregnant youth

OBJECTIVE: To estimate the prevalence of mental health problems in primiparous adolescents and to compare their mental health profile with the profile of sexually active adolescents who have never gotten pregnant. METHODS: Cross-sectional study that compared two groups of adolescents aged 13 to 17 years from a city in Southern Brazil, 2003-2004. The sample included 207 primiparous who attended prenatal care programs in urban public services, and 308 sexually active students from state public schools who had never gotten pregnant. A screening instrument to identify mental health problems in adolescents (Brazilian version of the Youth Self-Report) was applied to the participants together with a questionnaire on risk factors for pregnancy in adolescence. Statistical analysis included Chi-square tests, Fisher's exact test, Mann Whitney's U and logistic regression models. RESULTS: Pregnant and non-pregnant adolescents did not differ in the prevalence of total mental health problems (24.6% vs. 27.3%; p=0.50). Compared to the group of never pregnant adolescents, the group of primiparous presented higher prevalence of anxious/depressive symptoms (24.2% vs. 15.3%; p=0.01) and withdrawn/depressed symptoms (13.0% vs., 4.5%; p<0.001) and there was a greater number of tobacco users (21.3% vs. 11.0%; p=0.002). These differences were confirmed by logistic regression models controlled for maternal education. CONCLUSIONS: Anxiety and depression symptoms and tobacco use were more frequent in pregnant adolescents in comparison to non-pregnant. These problems require special attention from prenatal care services in order to avoid potential damages for the health of mothers and their children.     

School nurses' perceptions of and experience with school health research

This survey examined school nurses' perceptions of and experience with school health research. A random sample of school nurses who were either members of the school nurse section of the American School Health Association (ASHA) or members of the National Association of School Nurses (NASN) comprised the sample (n = 590). The response rate was 81%; the nurses were all females. A plurality held masters degrees (40%) and had worked an average of 12.0 years as a school nurse. Most (67%) were employed at the elementary school level. Slightly more than one-third (37%) had ever been involved in a research study as a school nurse. Perceived barriers to engaging in research were lack of time, clerical help, and money. Perceived benefits of school nurses engaging in research were: adds new knowledge on school nursing issues (97%), benefits the health care of children at school (93%), and helps peers do their job better (86%). School nurses also indicated they would become involved in research if someone would assist them (78%).     

Personal health documents in school health education: a feasibility study

AIMS: To examine the feasibility of a school intervention using a personal health document adapted for adolescents. Methods: The health document was developed in close cooperation with groups of adolescents and tested among seventh-grade students at two junior high schools (n = 339). The document was presented to the students by their regular teachers. For evaluation, an adolescent questionnaire was used at baseline and after one year. RESULTS: After one year, 87% of adolescents reported having written in the health document, and 77% reported having had classes with discussions on subjects in the document. The health document was perceived as useful by 35% of the adolescents. Factors significantly related to personal usefulness were being born outside Sweden, experiencing fair treatment by teachers, being a nonsmoker, and having a positive school experience. CONCLUSIONS: Implementation of a personal health document in junior high-school health education was feasible and well accepted.     

Danish pupils' perceived satisfaction with the health dialogue: Associations with the office and work procedure of the school health nurse

The aim is to identify how environmental factors, perceivedby the pupils, are associated with the pupils' perceived satisfactionwith a good health dialogue. This article focuses on the pupils'perception of the health office and the work procedure of theschool health nurses. The present article is based on data fromthe 1994 Danish part of the WHO-collaborative study Health Behaviourin School-aged Children. A nation-wide random sample of pupils11, 13 and 15 years old (n = 4046) answered a standardized questionnaireabout perceived health, health behaviour, social situation,the school as a workplace and the health dialogue. The finalmodel of the multivariate logistic regression analysis revealedeight predictor variables of perceived satisfaction with thehealth dialogue and three confounder variables. The predictorswere: comfortable health office OR = 1.20 (95% CI 1.11–1.30),pupils sat by the desk OR = 1.12 (95% CI 1.03–1.23), pupilsinfluenced the content of the dialogue yes/no: OR = 1.43 (95%CI 1.27–1.60), yes/don't know: OR = 0.80 (95% CI 0.72–0.89),sufficient time OR = 1.33 (95% CI 1.23–1.44), the schoolhealth nurse listened carefully OR = 1.24 (95% CI 1.13–1.35),the school health nurse talked a lot OR = 0.91 (95% CI 0.85–0.98),gave good advice OR = 1.28 (95% CI 1.18–1.43), let thepupils talk OR = 1.17 (95% CI 1.07–1.28). The confounderswere: pupils' sex: female OR = 1.23 (95% CI 1.14–1.33);and age: low age OR = 1.20 (95% CI 1.07–1.35) or highage OR = 0.84 (95% CI 0.76–0.93), but not medium age,high school satisfaction OR = 1.53 (95% CI 1.31–1.77),and low school satisfaction OR = 0.74 (95% CI 0.63–0.87).     

The school health nurse's assessment of a successful health dialogue

The purpose of this paper is to achieve a deeper understanding of the learning processes that occur within a regular health dialogue between pupils and school health nurse from the school health nurse's perspective. The study used a grounded theory approach for the data collection and analysis. Eight experienced school health nurses were interviewed using a semistructured 'interview guide'. The interviews were audio recorded and transcribed verbatim. A detailed analysis presented the processes involved and the core category emerged as creating a communicative room to learn about health. The core category contained factors related to competencies, authenticity, reflective openness and environmental support, which was the basis for learning processes and a successful health dialogue. This paper adds to our understanding of the processes in school health nursing and the learning about health which takes place within a health dialogue.     

Relationship between asthma or asthma-related symptoms and school problems among French children attending kindergarden

BACKGROUND: The impact of chronic respiratory symptoms on school performance has been studied less than its impact on children's health. Our survey explored the relationship between chronic respiratory symptoms and school problems among children attending kindergarten. It assessed the impact of school absenteeism, sport practise in a club and health care access for school problems among pupils with chronic respiratory symptoms. METHODS: A population-based study was carried out by school physicians on a representative sample of pupils attending third-year kindergarten, in Alsace - France. Assessments included school problems, sociodemographic and health care access characteristics. Health conditions, notably chronic respiratory symptoms, were asked to include the pupils in one of the three study groups: physician-diagnosed asthma, asthma-related symptoms not associated with diagnosed asthma, and without current health problems (controls). Logistic regression was used to compare the odds ratio of school problems for the three study groups, overall and stratified by income. RESULTS: The 2,632 included pupils aged 5 to 6 Years, were assigned to the three groups according to their respiratory status: 179 with diagnosed asthma, 176 with asthma related symptoms and 2,277 healthy pupils. Diagnosed asthma was not linked with school problems. The overall association between asthma related symptoms and school problems was significant (OR=1.5, 95% CI: 1.0-2.2). After adjustment, this association persisted among pupils whose mother's education level was intermediary (technical or vocational diploma) (OR=2.3, 95% CI: 1.2-4.6). Among the diagnosed asthma group, pupils practising a sport in a club had less school problems than those not taking part in sports (ORadjusted=0.2, 95% CI: 0.03-0.8). CONCLUSION: In our study, asthmatic children were not at higher risk of school problems. So developing programs preventing school problems which focus on asthmatic children is not needed. Among the pupils having a mother with an intermediary education level, asthma-related symptoms were associated with school problems. It is important to identify unknown asthmatics to institute to treatment for their respiratory symptoms in order to prevent the consequences of the functional impact of asthma on their scholarship.     

Externalizing and internalizing problems at school as signs of health-damaging behaviour and incipient marginalization

This study aimed to investigate whether behavioural or emotional problems in adolescents detected by their teachers are signs of a common psychosocial maladjustment and of the beginning of social marginalization. Altogether, 171 pupils (15 years of age) from the eastern part of Finland participated in the survey. Behavioural and emotional problems and academic achievements were assessed separately by two teachers. Pupils filled in a questionnaire about alcohol use, smoking, physical exercise and fitness, self-rated health, psychosomatic symptoms, social relationships and future educational plans. Results showed that poor success at school and the absence of or limited educational plans were associated with both externalizing and internalizing problems. Externalizing problems were associated with health-damaging behaviour and with bullying others. Internalizing problems were associated with poor perceived health and a low level of exercise, with mental symptoms, and with problems in social relationships. Thus, the pupils in both problem groups had a clustering of different risk factors. We conclude that the accumulation in adolescents of self-reported health-damaging behaviour, problems related to school, to future educational plans and to social relationships are already obvious in pupils with externalizing and/ or internalizing problems detected by their teachers at the age of 15 years. The capacity of teachers to identify pupils at risk as early as possible should therefore be utilized. The development of a vicious circle might be prevented through early intervention at school, by offering pupils guidance, counselling and treatment.     

Adolescents' health status in the economically good families and health-promotion programs

The paper raises the topical problem of the health status of adolescents aged 13-17 years (9-11-form pupils of a lyceum and 1-year students of an university) from economically good families. Despite high family incomes, the adolescents' health status remains to be relatively poor. As high as 7% of the pupils are apparently healthy. The paper analyzes reasons for poor health in the adolescents and generalizes the experience with their rehabilitation without giving up their studies at the educational establishment. Psychotherapy, acupuncture, massage, phyto- and aromatic therapy, etc. have been applied. A health-promotion proprogram has been developed for adolescents in the Russian Federation.     

Health inequalities: self-reported complaints and their predictors in pupils from Belgium

BACKGROUND: This paper identifies socioeconomic and sociodemographic predictors of respiratory/allergic health problems and subjective complaints in adolescents in Belgium. METHODS: A cross-sectional analysis of the 1998 cross-national study "Health Behaviour of School aged Children" (HBSC) in French-speaking Belgium was undertaken. The survey was based on a self-completed questionnaire concerning various aspects of physical, emotional and social health. The five health problems (asthma, any other respiratory difficulty, allergy, poor subjective health, overweight and depressed feeling) were considered present when a positive reply was given to close-end questions stating if the pupils suffered, or have suffered from these problems during the last six months. We analysed a representative sample of 12,012 pupils aged 11 to 19 years in fifth and sixth grades of primary school, and in all six grades of secondary school. RESULTS: socioeconomics gradients were found for subjective ill health, depressed state and overweight (p<0.01). Depressed state and overweight were linearly associated with a family economic score. Respiratory difficulties and allergies were observed mainly in pupils in technical training. CONCLUSION: Pupils with a lower economic score have a higher prevalence of subjective complaints. It remains important to define determinants of subjective ill health and moreover, to act upon these results by increasing accessibility to health services when necessary, by adapting some others to young people and by tailoring interventions to objective and self-perceived needs.     

A study of depression among Alexandria preparatory school adolescents.

Using a constructed Arabic version of Children Depression Inventory (CDI), screening of a stratified random sample of 1% (1561) of Alexandria Preparatory school adolescents was carried out. The prevalence of depressive scorers was 10.25% of total sample. A sub-sample of depressed scorers (111 pupils) were compared with controls (non-depressed scorers) matched on age and sex to study a variety of personal, familial, medical and scholastic ecological variables. Pupils neuroticism scorers were most predictive of depressive scorers where they explained 59.79% of the variance. Other ecological factors including peer and sibling relationships, introversive and lie scale scorers and scholastic performance explained an additional 14.87% of the variance. Using Beck Depression Inventory (BDI) and Mother-Father relationship check list, a sub-sample of depressed pupils' mothers were compared with controls of non-depressed pupils' mothers (42 mothers for each). Results indicated a strong positive correlation between pupils, CDI scores and their mothers BDI scores. On the other hand poor mother-father relationship was significantly associated with depressive scores of pupils. Findings, pointed to the need for reconsideration of school mental health program, since the presented medical and social services to depressed pupils were very poor.     

Mental health screening in schools

BACKGROUND: This article discusses the importance of screening students in schools for emotional/behavioral problems. METHODS: Elements relevant to planning and implementing effective mental health screening in schools are considered. Screening in schools is linked to a broader national agenda to improve the mental health of children and adolescents. Strategies for systematic planning for mental health screening in schools are presented. RESULTS: Mental health screening in schools is a very important, yet sensitive, agenda that is in its very early stages. Careful planning and implementation of mental health screening in schools offers a number of benefits including enhancing outreach and help to youth in need, and mobilizing school and community efforts to promote student mental health while reducing barriers to their learning. CONCLUSIONS: When implemented with appropriate family, school, and community involvement, mental health screening in schools has the potential to be a cornerstone of a transformed mental health system. Screening, as part of a coordinated and comprehensive school mental health program, complements the mission of schools, identifies youth in need, links them to effective services, and contributes to positive educational outcomes valued by families, schools, and communities.