Abstract: Although most people in developed countries experience sexual initiation during adolescence, little is known about inter-country variability in the psychosocial correlates of early initiation. Population-based samples of 15-year-olds (n = 6,111, 52% female) who participated in the Health Behaviors in School-Aged Children Study (Finland, Scotland, France and Poland, 1997/1998) or the National Longitudinal Study of Adolescent Health (United States, 1996) self-reported sexual intercourse experience and physical (headaches, trouble sleeping) or psychological (unhappiness, loneliness, sadness, moodiness) symptoms. Analyses were conducted stratified by gender. Sexual initiation prevalence and symptoms scores varied significantly across nations. In adjusted models, sexual initiation was not related to symptoms among boys in any nation, but significantly positively related to symptoms among girls in Poland and the US. Results support variability by gender and nation in the relationship between adolescents' sexual initiation and physical/psychological symptoms. Empirically investigating specific features of national contexts that generate these differences should be explored further.
Abstract: Aim Although inclusive education of disabled children is now an accepted practice, it is often challenged by negative peer attitudes. We undertook an interventional study aimed at improving students' attitudes towards their disabled peers. Method The participants were students from the 7th grade of twelve paired schools (1509 students from 62 classes; age 12-13y), randomly allocated to an intervention group (205 males, 285 females) or a control group (132 males, 165 females). The intervention consisted of a mandatory comprehensive educational project on disability. The Chedoke-McMaster Attitudes Towards Children with Handicaps Scale (CATCH) was used to assess children's attitudes before (T0) and after (T1) intervention. The hierarchical structure of the data was taken into account by adjusting standard deviations and using linear multilevel models. Results Seven hundred and eighty-four students had at least one score on the three domains (cognitive, affective, behavioural) of the CATCH at T0 and T1. The final scores were higher than baseline scores (total scores, intervention group: baseline score 25.6 (SD=5.4), final score 26.8 (5.9), p<0.001; Control group: baseline 25.2 (5.4), final 26.0 (5.7), p<0.009) with no significant difference between the intervention and control groups. Individual score changes over time were associated with baseline score (p<0.001 for total and all sub-scores). Lower improvement in attitudes was found in students from schools with special units for their peers with cognitive impairment for total (p=0.013), affective (p<0.001), and behavioural (p=0.001) scores, while higher improvement existed for the cognitive domain (p=0.029). Interpretation Although we found no effect of our intervention, we found an improvement in attitudes in the intervention and control groups that could be a result of the nature of the scales and questionnaires the students had to complete before the intervention.
Abstract: BACKGROUND: Puberty is a transition period making physiological development a challenge adolescents have to face. Early pubertal development could be associated with higher risks of poor health. Our objective was to examine risk behaviours, physical and psychological determinants associated with early menarche (<11 years). METHODS: Early menarche was assessed in the Health Behaviour in School-aged Children French cross-sectional survey. Data were collected in 2006 by anonymous self-reported standardized questionnaire from a nationally representative sample of 1072 15 years old girls in school classrooms. Family environment, school experience, physical and psychological factors, risk behaviours (substance use and sexual initiation) were recorded. Logistic regression models were applied (analysing for crude and adjusted relationships between early menarche and risk behaviours controlled for family context). RESULTS: Median age at menarche was 13.0 years; 57 girls (5.3%) were early-matured. Controlled for familial environment, early menarche was associated with having had more than two life-drunkenness episodes (adjusted OR = 2.5 [1.3-4.6]), early sexual initiation (adjusted OR = 2.8 [1.3-6.0]) and overweight (adjusted OR = 7.3 [3.6-14.9]). CONCLUSION: Early-maturing girls may affiliate with older adolescents, hence engage in risk behaviours linked to their appearance rather than their maturity level. Factors associated with early menarche highlight the need to focus attention on early-matured girls to prevent further health problems linked to risk behaviours.
Abstract: OBJECTIVE: To describe age at onset of menarche in a large nationally representative sample of French schoolgirls. PATIENTS AND METHODS: Age at onset of menarche was assessed in the Health Behaviour in School-aged Children French cross-sectional survey. Data were collected in 2006 by anonymous self-reported standardized questionnaire. Median age at onset of menarche was estimated using Kaplan-Meier's method from a nationally representative sample of 2323 13 and 15 years old girls in school classrooms. Mean and standard deviation was also reported in the 1059 15 years old girls who had already experienced menarche. RESULTS: Median age at onset of menarche was 12.8 years (interquartile range: 12.0-13.6), as was mean age at onset of menarche (standard deviation 1.2 years). DISCUSSION AND CONCLUSION: Age at onset of menarche and its variability (as measured by standard deviation) have decreased in most developed countries and seems stabilised at 13.0+/-0.5 years: our results are in line with this trend. The age limit of 9 years seems more coherent to define early menarche in French girls. These results may have an important impact on medical management of early pubertal development.
Abstract: Please cite this paper as: Gaudineau A, Ehlinger V, Nic Gabhainn S, Vayssiere C, Arnaud C, Godeau E. Use of emergency contraceptive pill by 15-year-old girls: results from the international Health Behaviour in School-aged Children (HBSC) study. BJOG 2010; DOI: 10.1111/j.1471-0528.2010.02627.x. Objective To describe emergency contraceptive pill (ECP) use and variation across countries/regions; and to explore personal and contextual factors associated with ECP use and differences across countries/regions. Design Data were obtained from 11 countries/regions in the 2006 Health Behaviour in School-aged Children cross-sectional study. Setting Data were collected by self-report questionnaire in school classrooms. Population The analysis is based on 2118 sexually active 15-year-old girls. Methods Contraceptive behaviours were compared across countries/regions by chi-square tests. Individual factors related to ECP use were investigated with separate logistic regression models. Multilevel random-intercept models allowed the investigation of individual and contextual effects, by partitioning the variance into student, school and country/region levels. Main outcome measures ECP use at last sexual intercourse. Results ECP use rate varied significantly across countries/regions. Poor communication with at least one adult (odds ratio [OR] 1.62 [1.12-2.36], P = 0.011) and daily smoking (OR 1.46 [1.00-2.11], P = 0.048) were independently associated with ECP use in comparison with condom and/or birth-control pill use. Sexual initiation at 14 years or later (OR 2.02 [1.04-3.93], P = 0.039), good perceived academic achievement (OR 1.69 [1.04-2.75], P = 0.035) and daily smoking (OR 1.63 [1.01-2.64], P = 0.045) were associated with higher levels of ECP use in comparison with unprotected girls. The country-level variance remained significant in both comparisons. Conclusions These data document the large heterogeneity in rates of ECP use between countries/regions. These differences could not be explained by individual or contextual factors, and raise further questions in relation to ECP access for adolescents and their education in its appropriate use.
Abstract: OBJECTIVES: This study examined which individual and national factors affect condom use among adolescents. STUDY DESIGN: Multilevel analysis. METHODS: This study reviewed the data on bullying, alcohol use and condom use provided by 18 European countries and subnational entities in the Health Behaviour in School-Aged Children survey. Another eight contextual variables were also analysed. Three multilevel logistic regression models were applied consecutively (analysing for crude geographical and school variance in condom use, adjusting for gender and adjusting all variables for one another). RESULTS: Among the 15-year-olds studied, 7.0% of the total variance in condom use was explained by school-related factors (intraschool-level correlation) and 5.8% by national/subnational factors. In the empty model, condom use was significantly associated with gender, alcohol consumption, predominant national religion and national prevalence of human immunodeficiency virus (HIV). In the full model, there was also a significant association with the Human Development Index ranking, gross domestic product, Gini coefficient and the Gender-related Development Index. CONCLUSIONS: This study suggests that while alcohol, gender, human development level, income, religion and HIV prevalence affect condom use in young Europeans, these factors do not explain all or even most of the variation. Nonetheless, since some of these factors are not traditionally associated with young people's sexual and reproductive health, these findings should enable more nuanced health policy programming.
Abstract: AIM: To explore factors associated with students' attitudes towards their peers with disabilities. METHOD: All 7th grade students (aged 12-13y) from 12 schools in the Toulouse area were invited to participate (n=1509). Attitudes were measured using the Chedoke-McMaster Attitudes Towards Children with Handicaps (CATCH) questionnaire (affective, behavioural, cognitive, and total scores). Personal characteristics, including KIDSCREEN quality of life scores, were recorded. Data regarding information about disabilities received from parents and the media and acquaintance with people with disabilities constituted the 'disability knowledge' factors. The characteristics of the schools were obtained from the local education authority. Multivariate multilevel linear regression analyses were conducted to explore the associations between CATCH scores and these three groups of factors. RESULTS: Responses from 1135 students (612 females, 523 males; mean age 12y 8mo SD 7mo; age range 10y 8mo-15y) were studied (75.2% of the students approached). Factors independently associated with more positive attitudes were being a female, having a good quality of life, being friends with a child with disabilities, or having received information about disabilities from parents and the media. Presence in the school of a special class for children with cognitive disabilities was independently associated with more negative attitudes. INTERPRETATION: This cross-sectional study identified different personal and environmental factors upon which interventions aimed at improving students' attitudes towards their peers with disabilities could be based.
Abstract: OBJECTIVE: To examine trends in the prevalence of monthly alcohol use and lifetime drunkenness among 15 year olds in 20 European countries, the Russian Federation, Israel, the United States of America, and Canada. METHODS: Alcohol use prevalence and drunkenness were assessed in the Health Behavior in School-aged Children Survey conducted in each country in 1998, 2002, and 2006. Trends were determined using the Cochran-Mantel-Haenszel test for trends. RESULTS: Average monthly alcohol use across all countries declined from 45.3% to 43.6% and drunkenness declined from 37.2% to 34.8. There was substantial variability across countries, with decreases in some countries and increases or no change in use or drunkenness in others. The overall decline was greater among boys, from 41.2% to 36.7% than among girls, 33.3% to 31.9%. In most of the countries where drinking or drunkenness increased, it was due mainly to increases among girls. CONCLUSIONS: Trends in alcohol use and drunkenness varied by country. Drinking and drunkenness remained higher among boys than girls, but the gap between boys and girls declined and girls appear to be catching up with boys in some countries.
Abstract: AIMS: To investigate the associations between well-known, cost-effective tobacco control policies at country level and smoking prevalence among 15-year-old adolescents. DESIGN: Multi-level modelling based on the 2005-06 Health Behaviour in School-aged Children Study, a cross-national study at individual level, and with country-level variables from the Tobacco Control Scale and published country-level databases. SETTING: Twenty-nine European countries. PARTICIPANTS: A total of 25 599 boys and 26 509 girls. MAIN OUTCOME MEASURES: Self-reported regular smoking defined as at least weekly smoking, including daily smoking (dichotomous). FINDINGS: Interaction effects between gender and smoking policies were identified, therefore boys and girls were analysed separately. Large cross-national differences in smoking prevalence were documented. Intraclass correlations (ICC) of 0.038 (boys) and 0.035 (girls) were found. In the final multi-level model for boys, besides the significance of the individual variables such as family affluence, country-level affluence and the legality of vending machines were related significantly to regular smoking [b(country affluence) = -0.010; b(partial restriction vending machines) = -0.366, P < 0.05]. Price policy was of borderline significance [b(price policy) = -0.026, P = 0.050]. All relationships were in the expected direction. The model fit is not as good for girls; only the legality of vending machines had a borderline significance in the final model [b(total ban vending machines) = -0.372, P = 0.06]. CONCLUSIONS: For boys, some of the currently recommended tobacco control policies may help to reduce smoking prevalence. However, the model is less suitable for girls, indicating gender differences in the potential efficacy of smoking policies. Future research should address this issue.
Abstract: This paper traces the history of the HBSC study from its origins in the early 1980's to the present day describing how it was first conceptualised scientifically and how this influenced issues of study design. The challenges of managing a cross-national study are explained as are changes and adaptations over time with growth of the study from 3 to over forty country members. The key partnership with the World Health Organisation and its benefits are presented. With developments in scientific management and theoretical perspectives, HBSC has made a substantial contribution to the area of youth health. The last decade has seen increased dissemination to policy makers and evidence that scientific information arising from the study has influenced strategic policy development and practical health improvement programmes. This paper considers some of the key success factors and challenges for the study as it attempts to maximise its scientific output and channels the research findings into health improvement for young people. Future challenges for the study are also considered.
Abstract: OBJECTIVES: To present comparative data on sexual initiation, and condom use and contraceptive pill use at last intercourse among adolescents in Europe, Israel and Canada. METHODS: Data were collected by self-report questionnaire from nationally representative samples of 15 year olds in school classrooms in two cross-national surveys undertaken in 24 countries in 2001/02 and 30 countries in 2005/06. RESULTS: In 2005/06 almost 27% of those surveyed had had sex and almost 86% reported using condoms or the contraceptive pill at last intercourse. This reflects little change since 2001/02 in prevalence of sexual initiation and a general increase in being well-protected at last intercourse. There were wide variations with up to a third of sexually active 15 year olds in some countries at risk for either Sexually Transmitted Infections or pregnancy, or both. CONCLUSIONS: Most adolescents were well protected against Sexually Transmitted Infections and pregnancy, but an important minority remain at risk, with very wide cross-national differences.
Abstract: OBJECTIVES: To identify and report cross-national patterns in contraceptive use among sexually active adolescents. DESIGN: A cross-national cross-sectional survey. SETTING: Data were collected in 2002 by self-report questionnaire from students in school classrooms. PARTICIPANTS: A cluster sample of 33,943 students aged 15 years from 24 countries. MAIN OUTCOME MEASURES: International standardized questions on ever having had sexual intercourse and contraceptive use at last sexual intercourse. RESULTS: The percentages of students reporting having had sexual intercourse ranged from 14.1% in Croatia to 37.6% in England; 82.3% of those who were sexually active reported that they used condoms and/or birth control pills at last intercourse. Condom use only was most frequent and ranged from 52.7% in Sweden to 89.2% in Greece. Dual use of condoms and contraceptive pills was also relatively frequent, ranging from 2.6% in Croatia to 28.8% in Canada. The use of contraceptive pills was most frequent in northern and western Europe. No contraceptive use at last intercourse was reported by 13.2% of students. CONCLUSIONS: A substantial minority of 15-year-olds have engaged in sexual intercourse. Condom use is the most frequent method of contraception reported by the sexually active respondents, followed by the dual use of condoms and contraceptive pills and contraceptive pills only. The proportions of poorly protected and unprotected youth remain high, and attention to international policy and practice determinants of young sexual behavior and contraceptive use is required.
Abstract: OBJECTIVE: Inspite of unquestionable progress, the protection of girls at first sexual intercourse is still not perfect. The main risks are well known (sexually transmitted infections [STIs], unwanted pregnancies, psychological consequences) and seem to be higher in the case of early sexual initiation. The aim of this epidemiological study is to analyse factors associated with early heterosexual intercourse (age 15 or before) among girls, considered as risk factors for pregnancies and STIs. POPULATION AND METHODS: Our data come from the 2002 international survey Health Behaviour in School-aged Children (HBSC)/WHO. The questionnaire is completed anonymously in class and measures health, health behaviours and their contexts among 11-, 13- and 15-year-old students. Only the 15 year-olds are asked about their sexual behaviour. In France, 1264 15-year-old (plus or minus six months) girls have answered the survey. RESULTS: Two hundred and twenty-four girls (17,7 %) state they have already had sexual intercourse. Among these, 88,4 % say that condoms and/or pills were used at last sexual intercourse. Multivariate analysis (n=1159) show that seven variables are significantly and independently linked to a higher frequency of early sexual intercourse: single-parent or reconstructed family, repeated drunkenness, daily smoking, cannabis experimentation, frequent evenings out, negative life appreciation and early menarche. DISCUSSION AND CONCLUSION: Identifying factors associated with early sexual initiation should help professionals to better take care of those high risk adolescent girls.
Abstract: This study aimed to identify instruments for measuring children's attitudes towards their peers with disabilities that are suitable for use in epidemiological studies and to report on their psychometric properties. A literature review was conducted to identify instruments measuring at least one of the three components of children's attitudes (affective, behavioural, or cognitive measures) towards peers with disabilities and which are intended for self-completion by children. Criteria used to appraise these instruments were appropriateness, acceptability, validity, reliability, internal consistency, and test-retest reliability. Of the 19 instruments matching the inclusion criteria, 16 measured only one attitude component (affective, n=4; behavioural, n=5; cognitive, n=7); one measured cognitive and behavioural components; and two (Acceptance Scale and Chedoke-McMaster Attitudes Towards Children with Handicaps Scale [CATCH]) measured all three components. The majority of instruments, and those most widely used, were developed in the 1970s and 80s and so do not cover some aspects relevant to current culture, although they are still being used in research. Acceptable levels of validity and reliability were reported. Detailed descriptions of the initial validation process were available for the Acceptance Scale, Adjective Checklist, CATCH, and Peer Attitudes Towards the Handicapped Scale. The Acceptance Scale and CATCH seem to be the most complete instruments among those identified as they include all three attitude components and have appropriate psychometric properties.
Abstract: The schooling of young people with cancer poses various problems, similar to those experienced by disabled or chronically ill children. Published data on this subject in the medical literature comes mainly from studies carried out in the USA and the UK. Cancer and its treatment can cause both direct (learning difficulties or other disabilities...) and indirect (discrimination...) problems. Academic failure, and other problems linked to school absenteeism, can affect the future of adolescents with cancer. Sustaining schooling during the illness enables such patients to avoid falling behind academically, and to maintain his or her social status as a student. Due to the organisation of treatment regimes, education is provided in three environments : in hospital (during in-patient stays), at home (generally whilst the patient is convalescing), or at school. Paediatric oncologists have underlined the importance of establishing links between hospital and educational personnel (with parental approval), and suggest that a teachers'illness information manual should be produced. School re-entry is recommended as soon as possible. During the illness, the patient's presence in class is dependent on his or her general health, the progress of the cancer, and the treatment regime being followed. School absenteeism, inevitable during treatment periods and the year following diagnosis, is often associated with academic problems or failure. While many cancer patients worry about their school work and future educational progress, such problems remain rare. In the long term, the educational level of childhood or adolescent cancer survivors remains similar to that of the general population. In order to understand the issues surrounding the schooling of young cancer patients in France, long-term multi-centre studies, focusing on adolescents, must be initiated.
Abstract: BACKGROUND: Modern guidelines for the management of asthma state that asthmatic patients should be strongly advised not to smoke. However, it remains unclear to what extend young people with asthma actually behave like this. This study compares the prevalence of daily smoking between 15-year adolescents with diagnosed asthma and without asthma, and evaluates to what extent risk factors for smoking play a comparable role in the smoking behaviour of these two groups. METHODS: The study is part of the 2001-2002 international HBSC study. Besides questions about health behaviour, individual and social resources, a set of asthma questions were included in six countries. RESULTS: Adolescents with diagnosed asthma are more likely to be daily smokers than non-asthmatic adolescents. In asthmatic and non-asthmatic adolescents, similar associations with risk factors are found for daily smoking (drunkenness, cannabis use, low life satisfaction, spending evenings with friends, having smoking parents and peers). Diagnosed asthmatics are more prone to score high on these factors than non-asthmatics. CONCLUSIONS: Smoking in adolescents with asthma is a public health problem. Smoking prevention efforts directed towards young people should pay attention to young people with asthma and the curative sector should increase their efforts to motivate asthmatic adolescents not to smoke.
Abstract: Adolescence is often the time of experimentation with psychoactive substances, sometimes leading to more regular use. This paper gives an update of drug consumptions by the young adolescents, from results of recent general population surveys in France, and focuses on the specificity of this consumption when compared to that of older adolescents. It shows that regular uses of such substances usually do not start before the age of 14, but that early initiated adolescents show a higher risk of moving towards more intensive or problematic uses. Through presenting the limitations of such surveys, the authors discuss the nature of the link observed between early experimentation and level of use: while acknowledging the unquestionable prognostic value of early initiation to predict future problematic use, they show that its interpretation should be made with caution when based on such transversal epidemiological surveys.
Abstract: BACKGROUND: Asthma diagnosed in children shows wide geographical variations. Large scale surveys identify children with diagnosed asthma, but neglect the group of youngsters with multiple asthmatic complaints. METHODS: A short validated asthma questionnaire was included in six national surveys of the Health Behaviour in School-Aged Children Study. Prevalence rates are presented by country, gender and age. Gender and age differences are analysed using binary and multinomial logistic regressions controlling for age and smoking. RESULTS: Large country differences are observed in the prevalence rates of diagnosed asthma (8.6%-20.9% in boys, 6.9%-18.5% in girls) and young people with "asthma-like symptoms" (9.6%-20.2% in boys, 9.2%-23.1% in girls). When controlling for age and smoking, significant gender differences are observed (more diagnosed asthma in boys, more asthmatic symptoms in girls). Age differences were observed in adolescents with "asthma-like symptoms", but not in diagnosed asthma. CONCLUSIONS: Using a short asthma questionnaire, large differences in diagnosed asthma and wheezing symptoms are observed between the countries. A considerable group of youngsters with "asthma-like symptoms" is detected in all countries, and may be an unrecognised risk group in health promotion.
Abstract: BACKGROUND: Daily smoking adolescents are a public health problem as they are more likely to become adult smokers and to develop smoking-related health problems later on in their lives. METHODS: The study is part of the four-yearly, cross-national Health Behaviour in School-aged Children study, a school-based survey on a nationally representative sample using a standardised methodology. Data of 4 survey periods are available (1990-2002). Gender-specific daily smoking trends among 14-15 year olds are examined using logistic regressions. Sex ratios are calculated for each survey period and country. Interaction effects between period and gender are examined. RESULTS: Daily smoking prevalence in boys in 2002 ranges from 5.5% in Sweden to 20.0% in Latvia. Among girls, the daily smoking prevalence in 2002 ranges from 8.9% in Poland to 24.7% in Austria. Three daily smoking trend groups are identified: countries with a declining or stagnating trend, countries with an increasing trend followed by a decreasing trend, and countries with an increasing trend. These trend groups show a geographical pattern, but are not linked to smoking prevalence. Over the 4 surveys, the sex ratio has changed in Belgium, Switzerland, and Latvia. CONCLUSION: Among adolescents in Europe, three groups of countries in a different stage of the smoking epidemic curve can be identified, with girls being in an earlier stage than boys. In 2002, large differences in smoking prevalence between the countries have been observed. This predicts a high mortality due to smoking over 20-30 years for some countries, if no policy interventions are taken.
Abstract: BACKGROUND: The impact of living conditions on health is not well known, but health inequalities observed in adults seem partly determined by behaviours and health status at an earlier stage, and more particularly during adolescence. So, our aim was to study adolescents' health and their health behaviours function to family socioeconomic status. METHODS: We analysed French data from the international survey "Health Behavior in School-aged Children" carried out in a representative sample of adolescents aged 13 and 15 years in 1998. A self-administered questionnaire was completed by the adolescents who answered questions concerning their health, health behaviours, and their families' socio-economic status. RESULTS: Adolescents from blue-collar families were more numerous to report to be in "fairly good health" or "not very good health" (OR = 1.40, CI 95% = 1.12-1.74) and to be overweight or obese (OR = 1.85, CI 95% = 1.25-2.24) than those from executive families. They were also more numerous to have bad health behaviours than those from executive families. CONCLUSION: This study has established that, in adolescents, differences in health, health behaviours, types of consumption and physical activities depended on the families' socio-economic status.
Abstract: BACKGROUND: Posttraumatic stress disorder (PTSD) has been studied largely among adults and in the context of intentional, collective experiences such as war and terrorism. Far less is known about PTSD among adolescents and resulting from massive industrial accidents. Such an accident in Toulouse, France, 10 days after the World Trade Center disaster, provided an opportunity to examine its effects among adolescents already sensitized by media coverage of the World Trade Center disaster. OBJECTIVES: (1) To assess the presence of symptoms consistent with PTSD (SCW-PTSD) among adolescents in Toulouse after a massive industrial accident, (2) to determine the "excess" of SCW-PTSD among those directly exposed vs those nondirectly exposed, and (3) to examine dosage effects for exposure and the cumulative effect on PTSD of accident-related experiences.Design, Setting, and PARTICIPANTS: A survey containing questions on exposure and SCW-PTSD was administered to students aged 11 years, 13 years, 15 years, and 17 years who were enrolled in randomly selected, grade-stratified classrooms from schools for directly exposed students (n = 577) in Toulouse and nondirectly exposed students (n = 900) in the region.Main Outcome Measure The prevalence of SCW-PTSD among directly exposed and nondirectly exposed students. RESULTS: Nine months after the industrial accident, 44.6% of 11- and 13-year-old directly exposed students and 28.5% of 15- and 17-year-old directly exposed students still showed SCW-PTSD, compared with 22.1% of 11- and 13-year-old nondirectly exposed students and 4.4% of 15-year-old nondirectly exposed students. Among 11- and 13-year-olds, the likelihood of having SCW-PTSD was higher for girls who were enrolled in elementary schools, were personally injured, and had severe damage at home, as opposed to boys who were high-school students without severe damage at home or personal injury. Among the 15- and 17-year-olds, being a girl, 17 years old, and personally injured increased the likelihood of having SCW-PTSD, as opposed to 15-year-old boys who were not injured. The effects of injuries were cumulative: students injured personally and with an injured family member were more likely to have SCW-PTSD than those experiencing either personal or family injury but not both. Excess of SCW-PTSD attributable to direct exposure was 50.5% for 11-year-olds, 49.3% for 13-year-olds, and 73.5% for 15-year-olds. CONCLUSIONS: A substantial proportion of Toulouse adolescents still had SCW-PTSD 9 months after the accident. Directly exposed students were far more likely to show SCW-PTSD than those nondirectly exposed, but both groups had SCW-PTSD at rates that were higher than expected. The symptoms were associated with demographic characteristics and direct experiences of trauma. Higher rates applied to students who were personally injured with injured family members and severe damage at home. Students with these characteristics predictive of SCW-PTSD should be given prompt attention to avoid long-lasting effects.
Abstract: OBJECTIVE: International studies show a rise in drunkenness among young people in recent years. In this study the number of drunkenness occasions among 15-year old students in 22 countries is reported. The cross-national association between drunkenness, on the one hand, and the frequency of alcohol intake and the preference for distilled spirits, on the other, is described. Variation between countries is examined on the basis of national characteristics, including national prevention policies. METHOD: Data on alcohol use were taken from the 1998 World Health Organization (WHO) collaborative, cross-national survey on Health Behaviour of School-Aged Children. The multinational representative sample consisted of 10,951 male and 11,451 female (drinking) students. County characteristics were derived from the WHO Global Alcohol Database. Hierarchical Generalized Linear Model was used to analyze the effects of country characteristics on individual drunkenness. RESULTS: The lifetime prevalence of drunkenness was 57.1% for males and 50.4% for females. The number of drunkenness occasions showed a significant variation in the 22 countries. The correlation between drunkenness and preference for distilled spirits was positive in 21 countries and strong (Spearman's p > 0.40) in some eastern countries. Geographic location turned out to be an important country-level association with drunkenness and its predictors. Southern European countries showed moderate associations, whereas strong associations were found in Scandinavia, the Baltic countries and Russia. CONCLUSIONS: Cultural differences in alcohol use exist, and frequency of alcohol intake and use of spirits influence drunkenness. Despite the potential influence of preventive policy measures on drunkenness, no preventive effect of the measures included in this study was found.
Abstract: BACKGROUND: Multiple risk behavior plays an important role in the social etiology of youth injury, yet the consistency of this observation has not been examined multinationally. OBJECTIVE: To examine reports from young people in 12 countries, by country, age group, sex, and injury type, to quantify the strength and consistency of this association. SETTING: World Health Organization collaborative cross-national survey of health behavior in school-aged children. PARTICIPANTS: A multinational representative sample of 49 461 students aged 11, 13, and 15 years. MAIN EXPOSURE MEASURES: Additive score consisting of counts of self-reported health risk behaviors: smoking, drinking, nonuse of seat belts, bullying, excess time with friends, alienation at school and from parents, truancy, and an unusually poor diet. MAIN OUTCOME MEASURE: Self-report of a medically treated injury. RESULTS: Strong gradients in risk for injury were observed according to the numbers of risk behaviors reported. Overall, youth reporting the largest number (> or =5 health risk behaviors) experienced injury rates that were 2.46 times higher (95% confidence interval, 2.27-2.67) than those reporting no risk behaviors (adjusted odds ratios for 0 to > or =5 reported behaviors: 1.00, 1.22, 1.48, 1.73, 1.98, and 2.46, respectively; P<.001 for trend). Similar gradients in risk for injury were observed among youth in all 12 countries and within all demographic subgroups. Risk gradients were especially pronounced for nonsports, fighting-related, and severe injuries. CONCLUSIONS: Gradients in risk for youth injury increased in association with numbers of risk behaviors reported in every country examined. This cross-cultural finding indicates that the issue of multiple risk behavior, as assessed via an additive score, merits attention as an etiological construct. This concept may be useful in future injury control research and prevention efforts conducted among populations of young people.
