Effects of a Parent-Child Interactive Program for Families on Reducing the Exposure of School-Aged Children to Household Smoking.

INTRODUCTION: Parental smoking has been identified as the major source of children's exposure to environmental tobacco smoke (ETS). Therefore, parental involvement is critical in ETS exposure prevention programs. This study examined the effects of a parent-child interactive program on reducing children's exposure to ETS at home and enhancing parents' and children's prevention strategies. METHODS: A clustered randomized controlled trial was administered to 75 families of school-aged children from six primary schools in New Taipei City, Taiwan. Families in the intervention group received a parent-child interactive intervention, and parents in the control group received written materials on tobacco hazards. Data on children's exposure and the prevention of children's exposure to ETS at home were obtained at baseline, 8-week, and 20-week or 6-month assessments. RESULTS: The percentage of children with urine cotinine levels greater than or equal to 6 ng/ml was significantly lower in the intervention group than it was in the control group at both the 8-week and 6-month assessments. The intervention significantly reduced parental smoking in the presence of children and increased parents' prevention of children's ETS exposure and children's ETS avoidance behavior from the baseline to the 20-week assessment. CONCLUSIONS: This is a preliminary study design aimed at creating a program for reducing children's ETS exposure at home. Further research to produce evidence supporting the application of the parent-child interactive program in primary schools is suggested. The theoretical basis of the intervention design can serve as a reference for nursing education and the design of health education programs.

The relationship between parental mediation and Internet addiction among adolescents, and the association with cyberbullying and depression.

OBJECTIVE: This study examined the relationships between parental mediation and Internet addiction, and the connections to cyberbullying, substance use, and depression among adolescents. METHOD: The study involved 1808 junior high school students who completed a questionnaire in Taiwan in 2013. RESULTS: Multiple logistic regression analysis results showed that adolescents who perceived lower levels of parental attachment were more likely to experience Internet addiction, cyberbullying, smoking, and depression, while adolescents who reported higher levels of parental restrictive mediation were less likely to experience Internet addiction or to engage in cyberbullying. Adolescent Internet addiction was associated with cyberbullying victimization/perpetration, smoking, consumption of alcohol, and depression. CONCLUSION: Internet addiction by adolescents was associated with cyberbullying, substance use and depression, while parental restrictive mediation was associated with reductions in adolescent Internet addiction and cyberbullying.

Effects of a community prevention intervention on public awareness, knowledge, and risk perception of club drug use by youth in Taiwan.

This study evaluated the effects of mobilizing community coalitions and implementing prevention intervention concerning public awareness, knowledge, and perception of the risks associated with club drug use by Taiwanese urban youth. A quasi-experimental design was used. Three communities in Taipei city were included in the present study. A total of 328 residents successfully participated in the baseline survey (April 2008), and 276 residents were successfully interviewed for the follow-up survey (September 2008). The generalized estimating equation (GEE) method was used. The percentage of the intervention respondents who reported having seen or heard antidrug messages increased significantly between the time of the baseline survey (63.7%) and the follow-up survey (77.4%), while the percentage of attendance at antidrug events increased from 23.1% to 38.7% during the same time interval. In addition, community knowledge and perception of the problem of club drug use by youth rose significantly between the baseline and the follow-up in the intervention communities. The study's limitations are noted.

Social influences and self-efficacy as predictors of youth smoking initiation and cessation: a 3-year longitudinal study of vocational high school students in Taiwan.

AIMS: This 3-year longitudinal study examined changes in patterns of risk factors and protective factors of smoking initiation and cessation among vocational high school students in Taipei, Taiwan. DESIGN AND SETTING: In 2000, a total of 2151 10th grade students from 16 vocational high schools were assessed and followed up in the 11th and 12th grades. Self-administered questionnaires were collected in each year to assess the pattern of changes in smoking behaviors, and risk and protective factors. FINDINGS: Of the 1654 non-smokers in the 10th grade, 227 students initiated smoking by the 12th grade. Higher risk factors such as peer smoking, peers offering cigarettes, alcohol use and lower protective factors, such as refusal self-efficacy, antismoking attitude and belief in the 10th grade predicted youth initiation by grade 12. Increases in risk factors and decreases in protective factors during the years from 10th to 12th grades were associated significantly with youth smoking initiation. Of the 494 smokers in the 10th grade, 76 students quit smoking by the 12th grade. Lower risk factors and higher protective factors in 10th grade smokers predict youth smoking cessation by grade 12. Decreases in risk factors and increases in protective factors were associated significantly with youth smoking cessation. CONCLUSIONS: The risk factors (i.e. social influences) and protective factors (i.e. self-efficacy) examined in this study predict both youth smoking initiation and youth smoking cessation.

Employment experience in relation to alcohol, tobacco, and betel nut use among youth in Taiwan.

The aim of this study is to assess the association linking employment experience with alcohol, tobacco, and betel nut involvement among youth in Taiwan. In 2004, an outreach program was conducted during weekdays to recruit youth sample in seven major geographic regions. A total of 5886 youth aged 12-18 years drawn from 26 cities or towns were assessed by a two-page anonymous self-administered questionnaire, including sociodemographic characteristics, employment-, development-, and drug-related experiences. In Taiwan, youthful experience of alcohol, tobacco, and polydrug use varies by employment status, work intensity, and job type. Holding a full-time job and working in certain settings (e.g., grocery, restaurants) were found associated with an excess of drug-using behaviors. With taking age, male gender, family context, disposable allowance, and school attendance into account, working youths were two to four times as likely to have recent drug involvement than their non-working counterparts, especially for tobacco and polydrug (OR=3.32, 95% CI: 2.58-4.27, p<0.001; OR=3.76, 95% CI: 2.76-5.13, p<0.001). Youths in the labor force emerge as a subgroup experiencing greater use of alcohol, tobacco, betel nut, and polydrug. Future prevention programs may target this high-risk group to reduce possible drug-related negative consequences in developmental and health domains in Taiwan.

Predictors of unwanted exposure to online pornography and online sexual solicitation of youth.

This study examined factors associated with the unwanted exposure to online pornography and unwanted online sexual solicitation victimization and perpetration of youth in Taiwan. A total of 2315 students from 26 high schools were assessed in the 10th grade, with follow-up performed in the 11th grade. Self-administered questionnaires were collected. Multivariate analysis results indicated that higher levels of online game use, pornography media exposure, Internet risk behaviors, depression, and cyberbullying experiences predicted online sexual solicitation victimization, while higher levels of Internet chat room use, pornography media exposure, Internet risk behaviors, cyberbullying experiences, and offline sexual harassment predicted online sexual solicitation perpetration.

The association of media exposure and media literacy with adolescent alcohol and tobacco use.

This study examined the relationship of media exposure and media literacy to alcohol and tobacco use among adolescents in Taiwan. A total of 2992 10th-grade students recruited from 26 high schools in Taipei, Taiwan, completed a questionnaire in 2010. The multivariable analysis results indicated that the students with higher alcohol and tobacco media exposure were more likely to use alcohol and tobacco and have intentions to drink and smoke, while students with higher media literacy were less likely to use alcohol and have intentions to drink and smoke.

Self-perception of body weight among high school students in Taipei, Taiwan.

Self-perception of body weight and other weight-related factors were assessed among 2665 Taipei, Taiwan high school students. A high percent of the girls (70.7%) and boys (42.2%) reported that they were too fat and these percentages were much higher than those reported by U.S. students in a recent Youth Risk Behavior Survey. In addition, only 13.2% of girls and 22.0% of boys reported being completely satisfied with their weight and the level of dissatisfaction with weight appeared to be greater than among U.S. students. Yet, in comparison to U.S. students, the Taiwanese students were considerably less likely than their U.S. counterparts to engage in weight management practices (e.g., dieting, eating less food, using diet pills). Taiwanese students with a self-perception of being too fat were more likely than those with perceptions of being just right or too thin to engage in weight management practices, to be dissatisfied with their weight, feel that they were unattractive, estimate that their same-sex peers were trying to lose weight, and have a higher body mass index. The findings from this study showed a relationship between self-perception of body size and engaging in weight control behaviors was consistent with other research. It suggested that self-perception of body weight, more so than objective weight status, was predictive of weight loss behavior and also negative psychological outcomes associated with poor body weight image. As a result, self-perception of weight may be an important point of focus for the design and implementation of clinical and public health initiatives targeted at this adolescent population as well as others.

Relationship Between Parental and Adolescent eHealth Literacy and Online Health Information Seeking in Taiwan.

This study examined the relationship between parental and adolescent eHealth literacy and its impact on online health information seeking. Data were obtained from 1,869 junior high school students and 1,365 parents in Taiwan in 2013. Multivariate analysis results showed that higher levels of parental Internet skill and eHealth literacy were associated with an increase in parental online health information seeking. Parental eHealth literacy, parental active use Internet mediation, adolescent Internet literacy, and health information literacy were all related to adolescent eHealth literacy. Similarly, adolescent Internet/health information literacy, eHealth literacy, and parental active use Internet mediation, and parental online health information seeking were associated with an increase in adolescent online health information seeking. The incorporation of eHealth literacy courses into parenting programs and school education curricula is crucial to promote the eHealth literacy of parents and adolescents.

Online gaming and risks predict cyberbullying perpetration and victimization in adolescents.

OBJECTIVES: The present study examined factors associated with the emergence and cessation of youth cyberbullying and victimization in Taiwan. METHODS: A total of 2,315 students from 26 high schools were assessed in the 10th grade, with follow-up performed in the 11th grade. Self-administered questionnaires were collected in 2010 and 2011. Multiple logistic regression was conducted to examine the factors. RESULTS: Multivariate analysis results indicated that higher levels of risk factors (online game use, exposure to violence in media, internet risk behaviors, cyber/school bullying experiences) in the 10th grade coupled with an increase in risk factors from grades 10 to 11 could be used to predict the emergence of cyberbullying perpetration/victimization. In contrast, lower levels of risk factors in the 10th grade and higher levels of protective factors coupled with a decrease in risk factors predicted the cessation of cyberbullying perpetration/victimization. CONCLUSION: Online game use, exposure to violence in media, Internet risk behaviors, and cyber/school bullying experiences can be used to predict the emergence and cessation of youth cyberbullying perpetration and victimization.

Assessing prevalence of overweight and obesity through self-reports of height and weight by high school students in Taipei, Taiwan.

This study compared consistency of age- and gender-specific self-reported height and weight and calculated body mass index among a sample of high school students in Taipei County, Taiwan to reference values for Taiwanese school-aged youth obtained through national studies. Taipei high school students provided self-reports of height and weight that were similar to national reference values. Use of self-reported height and weight in this sample appeared warranted and may reliably be used to calculate aggregate indices of body mass, overweight, and obesity. This study compared prevalence of overweight and obesity in the current sample with other adolescent populations using international criteria (International Task Force on Obesity). Using these criteria, 17.6% of boys and 9.4% of girls met the definition of overweight and 3.7% of boys and 1.6% of girls met the definition of obesity. While use of self-reported height and weight appears justified in this sample, researchers should not assume self-report measures will always be accurate. Researchers considering use of self-reported height and weight should compare their results to normative reference values when possible to increase confidence in using self-report measures of height and weight.

Predictors of the initiation and persistence of internet addiction among adolescents in Taiwan.

PURPOSE: The present study examined the psychosocial factors associated with the initiation and persistence of Internet addiction among adolescents in Taiwan. METHODS: A total of 2315 students from 26 high schools were assessed in the 10th grade, with follow-up performed in the 11th grade, in Taipei, Taiwan. Self-administered questionnaires were collected in each year to assess the pattern of changes in Internet addiction and psychosocial factors. RESULTS: Of the 1602 students without an Internet addiction in the 10th grade, 253 (15.8%) had initiated Internet addiction by grade 11. Multivariate analysis results indicated that greater engagement in online activities (i.e., social network website use, online gaming), depression, and lower school bonding in grade 10 coupled with an increase in online activities, depression, and smoking from grades 10 to 11 predicted the initiation of Internet addiction. Of the 605 students with Internet addiction in the 10th grade, the addiction had persisted for 383 students (63.3%) in grade 11. An increase in the existence of depression and alcohol use from grades 10 to 11 predicted the persistence of Internet addiction. CONCLUSIONS: Online activities, depression, and substance use were important predictors of youth initiation and of the persistence of Internet addiction.

Using media exposure to predict the initiation and persistence of youth alcohol use in Taiwan.

BACKGROUND: Youth consumption of alcohol is a major public health problem in Taiwan, yet little research has been conducted to examine the potential influence of exposure to alcohol advertising. The present study examined the prospective influence that exposure to alcohol advertising has on the initiation and persistence of youthful drinking in Taiwan. METHODS: A total of 2315 students from 26 high schools in Taipei, Taiwan were assessed in the 10th grade with follow-up conducted in the 11th grade. Self-administered questionnaires were collected in 2010 and 2011 to assess the patterns of change in youth alcohol drinking behaviors, media exposure to alcohol, and risk and protective factors. RESULTS: Of the 1712 non-drinking students in the 10th grade, 285 (16.6%) had initiated drinking by the 11th grade. Of the 590 drinkers in the 10th grade, 396 (67.1%) were persistently drinking by the 11th grade. Multivariate analysis results indicated that when other potential confounders were accounted for, greater media exposure to alcohol advertising in the 10th grade was found to be significantly associated with the initiation of alcohol use and when combined with an increase in media exposure from grades 10 to 11, this was significantly associated with the persistence of alcohol use. CONCLUSION: Exposure to alcohol advertising in the media was associated with both the initiation and the persistence of alcohol use by youth.

Association of thin-ideal media exposure, body dissatisfaction and disordered eating behaviors among adolescents in Taiwan.

OBJECTIVE: The present study examined the relationships between thin-ideal media exposure, body dissatisfaction, and disordered eating behaviors among adolescents in Taiwan. METHOD: A total of 2992 students in the 10th grade were recruited from 26 high schools in Taipei, Taiwan to complete a questionnaire in 2010. RESULTS: The results showed that the adolescents were exposed to thin-ideal messages a few times a week. Females had higher levels of thin-ideal media exposure, media pressure to be thin, thin-ideal internalization, body dissatisfaction, and disordered eating behaviors than males. Multivariate logistic regression results indicated that media pressure and thin-deal internalization significantly increased the likelihood of body dissatisfaction, while media pressure and body dissatisfaction contributed to both restrained eating and unhealthy weight control behaviors, when all other variables were controlled for.

Relationships among cyberbullying, school bullying, and mental health in Taiwanese adolescents.

BACKGROUND: This study examined the relationships among cyberbullying, school bullying, and mental health in adolescents. METHODS: In 2010, a total of 2992 10th grade students recruited from 26 high schools in Taipei, Taiwan completed questionnaires. RESULTS: More than one third of students had either engaged in cyberbullying or had been the target (cybervictim) of it in the last year. About 18.4% had been cyberbullied (cybervictim); 5.8% had cyberbullied others (cyberbully); 11.2% had both cyberbullied others and been cyberbullied (cyberbully-victim). About 8.2% had been bullied in school (victim); 10.6% had bullied others (bully); and, 5.1% had both bullied others and had been bullied in school (bully-victim). Students with Internet risk behaviors were more likely to be involved in cyberbullying and/or cybervictimization; students who had cyberbullying or victimization experiences also tended to be involved in school bullying/victimization. After controlling for sex, academic performance, and household poverty, cyber/school victims and bully-victims were more likely to have lower self-esteem, and cyber/school victims, bullies and bully-victims were at a greater risk for serious depression. CONCLUSIONS: Both cyberbullying and school bullying and/or victimization experiences were independently associated with increased depression.

Transition from alcohol to other drugs among adolescents in Taiwan: the first drinking context matters.

OBJECTIVE: This study examined the extent to which youthful alcohol consumption and the initiation of tobacco, betel nut, and other illegal drugs may differ by their first drinking context in Taiwan-a society with social norms that are more tolerant of underage drinking. METHOD: In 2004, in a nationally representative sample of 11,943 school-attending youth ages 15-18, information pertaining to sociodemographic characteristics, problem behaviors, lifetime experiences of alcohol, tobacco, betel nut, and illegal drugs, as well as psychoactive, drug-specific age of initiation, context at first use, average frequency, and recency of use, was assessed by anonymous questionnaires. RESULTS: Youth who had their first alcoholic beverages in entertainment settings or at friends' houses were more likely to become frequent drinkers. After adjustment for socioeconomic background and problem behaviors, having had the first drink in entertainment settings was associated with a faster progression into the initiation of illegal drugs (hazard ratio [HR]=2.5, 95% confidence interval [CI]: 1.5-4.0) and betel nut (HR=1.5, 95% CI: 1.1-2.1). CONCLUSIONS: Youthful drinking pattern and transition from alcohol to betel nut and illegal drugs may vary modestly by the first drinking context. This context may be recognized as a proxy variable to identify youth at a higher risk for alcohol and other drug problems and to devise context-based educational or prevention programs.

Survey of substance use among high school students in Taipei: web-based questionnaire versus paper-and-pencil questionnaire.

PURPOSE: To evaluate, using a randomized trial, whether a web-based self-administered questionnaire (web SAQ) can improve the reporting rate of substance use in adolescents compared with a paper-and-pencil self-administered questionnaire (paper SAQ). METHODS: Students of junior high, senior high, and vocational high schools in Taipei City and County were selected by a stratified, two-stage, probability proportional to size, random sampling. For each class selected, half of the students were randomly assigned to paper SAQ (n = 990) and the other half to web SAQ (n = 928). The inverse of the sampling probability for each individual was then used as sampling weight in the estimation of prevalence and logistic regression analysis. RESULTS: For readily available substances, the lifetime prevalence in the web SAQ group was significantly higher for alcohol use and borderline higher for tobacco and betel nut use compared to those of the paper SAQ group. For illicit drug use, the lifetime prevalence for the web SAQ group was significantly higher for the use of amphetamines, and borderline higher for ketamine. In multiple logistic regression analysis, the differences between the two groups in the use of alcohol, tobacco, and amphetamines remained significant. Boys, as well as both junior-high and vocational high school students who responded using the web SAQ, were more likely to report alcohol or tobacco use than those using the paper SAQ. CONCLUSIONS: Web SAQ leads to higher reporting rates of commonly used substances in adolescents compared with those of paper SAQ.