Sexual orientation and migration intentions among rural, exurban and urban adolescents in Iceland.

Rural areas have often been assumed to be somewhat hostile territory for sexual minorities. As a result, moving to an urban area may be an integral part of "coming out" for those living in a rural area. However, surprisingly few quantitative studies have examined the level of rural-to-urban migration intent among sexual minorities. In this study, we examined the migration expectations of adolescents in Iceland, a country characterised by a heavy urban concentration and a scattered rural population, strong international ties and comparatively high levels of formal rights and public acceptance of sexual minorities. Based on a population sample of 2,858 students aged 15-16 years, we found no evidence of greater overall migration expectations among rural or exurban lesbian, gay, bisexual and questioning (LGBQ) youth than their urban counterparts. However, while urban LGBQ youth were more likely to move abroad, young people in other areas are more likely to move domestically. The results are discussed in the context of prior studies of sexual minorities in rural areas and migration expectations among rural youth.

Suicidal risk and sexual orientation in adolescence: a population-based study in Iceland.

AIM: Suicidality is an important public health problem, particularly among lesbian, gay, and bisexual (LGB) adolescents and young adults. The purpose of the present study is to compare the rate of suicide ideations and attempts among LGB adolescent to that of non-LGB adolescents in a population-based sample, and to identify important protective factors as well as risk factors Method: We used the Icelandic data set from the 2009/2010 Health Behaviour in School-aged Children (HBSC) study. The sample consisted of 3813 grade 10 Icelandic adolescents; 1876 girls and 1937 boys. The participants were asked about attraction and/or activity, as well as about suicidal ideation and/or attempts. The questionnaire also included various other items regarding health and lifestyle. RESULTS: LGB adolescents were five to six times more likely to have had frequent suicidal ideations. Factors that were associated with less suicide ideations and fewer attempts were easy communication and liking school. The LGB girls were six times more likely to have had frequent suicide attempts, whilst the LGB boys were 17 times more likely to have attempted suicide that often. No specific protective or risk factors were identified for suicidality in LGB adolescents other than bullying. CONCLUSIONS: Adolescents that had engaged in heterosexual activity and those that had LGB attraction had similarly heightened risk for suicidality, but sexually active LGB adolescents were far more likely to have suicidal ideations or to have attempted suicide.

How a Scoville aneurysm clip fought in the Cold War and helped to establish neurosurgery in Iceland.

It can be said that the specialty of neurosurgery in Iceland had its beginnings on November 30, 1971, with the arrival of a huge American C-130 Hercules aircraft. It was carrying a small package containing Scoville aneurysm clips. They were sent to the late Bjarni Hannesson (1938-2013), who had received his neurosurgical training in 1967-1971 at the Dartmouth-Hitchcock Medical Center (then known as Mary Hitchcock Memorial Hospital and located in Hanover, New Hampshire). He used one to clip the right posterior communicating artery aneurysm of a 34-year-old fisherman, who recovered well. The apparent reason for the use of such a huge aircraft for such a small payload is to be found in the sociocultural politics of the Cold War. It involved the continued presence of the American base at Keflavík, where the C-130 landed. The base was under pressure to be closed by Iceland's left-leaning, nominally communist government. The C-130's arrival generated welcome publicity for the continued operation of the American base, which is still there.

Multiple substance use and self-reported suicide attempts by adolescents in 16 European countries.

Substance use and suicide attempts are high-risk behaviors in adolescents, with serious impacts on health and well-being. Although multiple substance use among young people has become a common phenomenon, studies of its association with suicide attempts are scarce. The present study examines the association between multiple substance use and self-reported suicide attempts in a large multinational sample of adolescent students in Europe. Data on multiple substance use (tobacco, alcohol, tranquillizers/sedatives, cannabis, other illegal drugs) and self-reported suicide attempts were drawn from the 2007 European School Survey Project on Alcohol and Other Drugs (ESPAD). The ESPAD survey follows a standardized methodology in all participating countries. The present study is based on 45,086 16-year-old adolescents from 16 countries that had used the optional "psychosocial module" of the questionnaire, thereby including the question on suicide attempts. Logistic regression analyses were performed to examine the associations of any self-reported suicide attempt (dependent variable) with substance use controlling for country and gender. The strongest association with self-reported suicide attempts was for any lifetime tranquillizer or sedative use (odds ratio 3.34, 95 % confidence interval 3.00-3.71) followed by any lifetime use of illegal drugs other than cannabis (2.41, 2.14-2.70), 30-day regular tobacco use (2.02, 1.84-2.21), 30-day frequent alcohol use (1.47, 1.32-1.63) and any 30-day cannabis use (1.37, 1.18-1.58). The odds ratio of reporting a suicide attempt approximately doubled for every additional substance used. These findings on the association between multiple substance use, including legal drugs (tranquillizers or sedatives and tobacco), and the life-threatening behavior of suicide attempts provide important cues for shaping prevention policies.

Screen-based activities and physical complaints among adolescents from the Nordic countries.

BACKGROUND: A positive association between time spent on sedentary screen-based activities and physical complaints has been reported, but the cumulative association between different types of screen-based activities and physical complaints has not been examined thoroughly. METHODS: The cross-sectional association between screen-based activity and physical complaints (backache and headache) among students was examined in a sample of 31022 adolescents from Denmark, Sweden, Norway, Finland, Iceland and Greenland, as part of the Health behaviour in school-aged children 2005/06 (HBSC) study. Daily hours spent on screen-based activities and levels of physical complaints were assessed using self-reports. RESULTS: Logistic regression analysis indicated that computer use, computer gaming and TV viewing contributed uniquely to prediction of weekly backache and headache. The magnitude of associations was consistent across types of screen based activities, and across gender. CONCLUSION: The observed associations indicate that time spent on screen-based activity is a contributing factor to physical complaints among young people, and that effects accumulate across different types of screen-based activities.

The Problem with Low-Prevalence of Bullying.

This paper tests the hypothesis of whether being bullied in an environment where bullying is infrequent decreases adolescents' life satisfaction. Analyses were based on the international standard questionnaire from the 2005/2006 Health Behaviour in School-aged Children study (HBSC). The sample included answers from 183,736 children in 35 Western, industrialized countries. Our results show that the negative effects of being bullied on the life satisfaction of individuals are stronger in schools and countries where bullying is less frequent. We therefore conclude that the prevalence of bullying in the students' surroundings may act as a mediating variable explaining the relationship between bullying and life satisfaction.

Adolescent alcohol and cannabis use in Iceland 1995-2015.

INTRODUCTION: Over the past two decades, alcohol consumption of Icelandic adolescents has decreased dramatically. The aim of this study was to quantify the extent of this reduction and compare it with the trend in cannabis use over a 20 year period and to identify possible explanations. METHODS: We used data from the Icelandic participants to the European School Survey Project on Alcohol and Other Drugs study (collected via paper-and-pencil questionnaires in classrooms). The sample included all students in the 10th grade (54-89% response rate). RESULTS: The percentage of participants who had never used alcohol during their lifetime rose from 20.8% in 1995 to 65.5% in 2015. Similarly, there was a decline in the proportion of students who had consumed alcohol 40 times or more, from 13.7% to 2.8%. During the same period, the number of students who had never used cannabis rose from 90.2% to 92.0%. In contrast, we found a small, but statistically significant, increase in the prevalence of those who had used cannabis 40 times or more, from 0.7% in 1995 to 2.3% in 2015. Parental monitoring increased markedly between 1995 and 2015, but availability of alcohol decreased. Perceived access to cannabis and youth attitudes towards substance use remained unchanged. DISCUSSION: Although Iceland has enjoyed success in lowering alcohol use among adolescents over the past decades, and somewhat fewer claim to have ever tried cannabis, there has been a threefold increase among heavy users of cannabis. Increased parental monitoring and decreased availability of alcohol explain some of the changes seen.

Social justice, access and quality of healthcare in an age of austerity: users' perspective from rural Iceland.

Iceland is sparsely populated but social justice and equity has been emphasised within healthcare. The aim of the study is to examine healthcare services in Fjallabyggð, in rural northern Iceland, from users' perspective and evaluate social justice, access and quality of healthcare in an age of austerity. Mixed-method approach with transformative design was used. First, data were collected with questionnaires (response rate of 53% [N=732] in 2009 and 30% [N=415] in 2012), and analysed statistically, followed by 10 interviews with healthcare users (2009 and 2014). The results were integrated and interpreted within Bronfenbrenner's Ecological Model. There was significantly less satisfaction with accessibility and variety of healthcare services in 2012 after services downsizing. Solid primary healthcare, good local elderly care, some freedom in healthcare choice and reliable emergency services were considered fundamental for life in a rural area. Equal access to healthcare is part of a fundamental human right. In times of economic downturn, people in rural areas, who are already vulnerable, may become even more vulnerable and disadvantaged, seriously threatening social justice and equity. With severe cutbacks in vitally important healthcare services people may eventually choose to self-migrate.

Family structure and adolescent cigarette smoking in eleven European countries.

AIMS: This study seeks to establish (1) if different types of non-traditional family structures are related equally to adolescent cigarette smoking; (2) if each type of family structure is related equally to adolescent smoking in different countries and (3) if differences in such patterns can be explained by the prevalence of such family structures in each country. DESIGN: Self-reported cigarette smoking among 33 978 students in Cyprus, France, Hungary, Iceland, Ireland, Lithuania, Malta, Slovak Republic, Slovenia, Sweden and the United Kingdom is analysed with multi-level hierarchical regression models. FINDINGS: Adolescents living with both biological parents smoke less than those living with single mothers, who in turn smoke less than those living with single fathers, mothers-stepfathers, or with neither biological parent. Living with fathers-stepmothers is associated with less smoking than living with single fathers, mother-stepfathers, or with neither biological parent, but does not differ from living with both biological parents or single mothers. The effects of living with single mothers, single fathers, or with neither biological parent are stronger in countries where such family types are less common. Differences in the strength of effects between countries become non-significant once the prevalence of each family type has been taken into account. CONCLUSIONS: Adolescents living with both biological parents smoke less than their counterparts in most other family types, and adolescents living with single mothers or fathers-stepmothers smoke less than those living in other non-traditional family structures. The strength of this pattern varies inversely with the prevalence of such households in each country.

Psychological distress during unemployment and beyond: social support and material deprivation among youth in six northern European countries.

Psychological distress is a serious problem among unemployed youth, and may lead to various social and psychological problems. In this study, we examine patterns of distress among previously unemployed youth that have experienced five different labor market outcomes over a period of 6 months in Denmark, Finland, Iceland, Norway, Scotland and Sweden. We find that moving beyond unemployment is associated with less distress, in particular among those who have found permanent employment, but also among those who have found temporary employment, have returned to school, or are staying at home. Perceptions of material deprivation and parental emotional support directly affect distress in all labor market outcomes, and mediate the effects of various other factors on such distress. The effects of socio-demographic characteristics, living arrangements, unemployment history and attitudes, and parental support are found to be specific to gender and labor market outcomes, while the effects of material deprivation are uniform across all such categories. Further studies are needed to disentangle structural and individual effects, the causal complexities involved in processes of social support, and to determine the extent to which such models equally predict psychological distress among the unemployed and other groups of youth.

Alcohol culture, family structure and adolescent alcohol use: multilevel modeling of frequency of heavy drinking among 15-16 year old students in 11 European countries.

OBJECTIVE: Frequency of heavy alcohol use among adolescents is examined by family structure and propensity toward heavy alcohol use on the individual level, and by alcohol availability and drinking patterns among adolescents on the societal level. The analysis includes direct effects and moderating effects of societal-level indicators on individual-level associations between family structure and frequency of heavy alcohol use. METHOD: The study drew upon self-reports from 34,001 students in Cyprus, France, Hungary, Iceland, Ireland, Lithuania, Malta, the Slovak Republic, Slovenia, Sweden and the United Kingdom participating in the 1999 European School Survey Project on Alcohol and Other Drugs study. Distinctions were drawn between adolescents living with both parents, a single mother, a single father, a mother and stepfather, a father and stepmother, and neither biological parent. The multilevel analysis estimated the effects of societal-level factors on the intercepts and slopes of individual-level regression models. RESULTS: Adolescents living with both biological parents engaged less frequently in heavy alcohol use than those living in any other arrangements. Living with a single mother was associated with less heavy drinking than living with a single father or with neither biological parent. National beer sales figures and societal patterns of heavy adolescent alcohol use predicted more frequent heavy drinking and greater effects of living in nonintact families. CONCLUSIONS: Adolescent heavy drinking is more common in all types of nonintact families. The adverse effect of living in nonintact families is greater in societies where alcohol availability is greater and where adolescents drink more heavily.

The effects of changes in the World Health Organization's International Classification of Diseases on suicide rates in 71 countries, 1950-1999.

The World Health Organization (WHO) provides annual mortality statistics from 1950 onward based on the International Classification of Diseases (ICD). In this paper we evaluate the effects of ICD form revisions on suicide rates for 71 countries. The changes between ICD-6, ICD-7, ICD-8, and ICD-9 did not have an overall effect on reported suicide rates. The transitions to ICD-8 and ICD-9 were, however, associated with country-specific changes in the suicide rate in some countries. The change from ICD-9 to ICD-10 was associated with an overall change of -.73 suicides per 100,000 inhabitants. It is recommended that researchers using the WHO mortality data for longitudinal cross-national studies control for the ICD form used at different time points.

Individual and country-level effects of cannabis-related perceptions on cannabis use. A multilevel study among adolescents in 32 European countries.

PURPOSE: The present article investigated individual and aggregated effects of cannabis-related perceptions and other cannabis-related indicators on 12-month cannabis use prevalence and frequency among 15-16 year olds using multilevel analysis across 32 European countries. METHODS: Data on cannabis use, perceptions of availability, risks and friends' use as well as socio-demographic characteristics were taken from the 2007 European School Survey Project on Alcohol and Other Drugs. At the country level, aggregated measures of the perceptions were used. Data on cannabis price and 12-month cannabis use prevalence in the total population were taken from the World Drug Report. The analytical sample comprised 86,107 students (82.5% of the overall 2007 international database). RESULTS: Strong and persistent individual-level effects were identified for perceived availability, perceived harm, and the number of cannabis using friends. The effects on cannabis use prevalence and frequency were more pronounced than country-level effects. At the country level, aggregated perceived peer consumption and population prevalence were significant predictors, whereas price was not found to be related to both outcome variables. The association between perceived friends' use and cannabis use was moderated by aggregated perceived availability. CONCLUSIONS: Proximal influences related to the immediate social situation seem to be more strongly associated with cannabis use than do distal influences related to social contexts, emphasizing the importance of personal attitudes and perceptions in substance use behavior. Prevention programs may focus on informing adolescents about the potential risks of cannabis and on correcting misperceptions of social norms. Policy measures may target on reducing visibility of drug use.

[Accidents on Iceland's most dangerous roads]. / Slys á hættulegustu vegum landsins.

OBJECTIVE: The objective of this paper was to identify the most dangerous segments of the Icelandic road system in terms of the number of accidents pr km and the rate of accidents pr million km travelled. First to identify the segments where the number of accidents is highest and where the risk of the individual traveller is the greatest. Second to evaluate if the association between the number and the rate of accidents is positive or negative. Third to identify the road segments that are the most dangerous in the sense of many accidents and great risk to individual travellers. MATERIAL AND METHODS: Main roads outside urban centers were divided into 45 segments that were on average 78 km in length. Infrequently travelled roads and roads within urban centers were omitted. Information on the length of roads, traffic density and number of accidents was used to calculate the number of accidents per km and the rate of accidents per million km travelled. The correlation between the number and rate of accidents was calculated and the most dangerous road segments were identified by the average rank order on both dimensions. RESULTS: Most accidents pr km occurred on the main roads to and from the capital region, but also east towards Hvolsvöllur, north towards Akureyri and in the Mideast region of the country. The rate of accidents pr million km travelled was highest in the northeast region, in northern Snæfellsnes and in the Westfjords. The most dangerous roads on both dimensions were in Mideast, northern Westfjords, in the north between Blönduós and Akureyri and in northern Snæfellsnes. CONCLUSION: Most accidents pr km occurred on roads with a low accident rate pr million km travelled. It is therefore possible to reduce accidents the most by increasing road safety where it is already the greatest but that would however increase inequalities in road safety. Policy development in transportation is therefore in part a question of priorities in healthcare. Individual equality in safety and health are not always fully compatible with economic concerns and the interests of the majority.

[The role of alcohol consumption in adolescent emergency room visits at Landspitali University Hospital, Iceland]. / Tháttur áfengis í komum unglinga á slysa- og brádadeild Landspítala.

OBJECTIVE: The records of the emergency room of Landspitali University Hospital in Iceland provide important information on the prevalence and incidence of various problems. The objective of this research is to evaluate the reliability of data concerning the visits of adolescents under the influence of alcohol. DATA AND METHODS: Records of visits to the Emergency Room of Landspitali University Hospital by 14-16 year old capital region adolescents are compared with the results of a survey in early 2003. The correspondence between hospital records and adolescent self-reports is compared to the correspondence between records and self-reports of the presence of alcohol in visits. RESULTS: In all cases students report more emergency room visits than are recorded by Landspitali University Hospital. The difference is 4.2% (+/- 0.6%) in accident visits and 2.2% (+/- 0.2%) in violence visits. In the case of the presence of alcohol in visits the difference is 9.3% (+/- 0.4%) between hospital records (0.2%) and adolescent self-reports (9.5%). CONCLUSION: The records of Landspitali University Hospital are not a valid source of information on alcohol-related problems among adolescents. About one in ten adolescents in the capital region of Iceland claim to have visited an emergency room because of their own alcohol consumption but hospital records of the presence of alcohol only include about 1/60 of that number.

Contrast effects in perceived risk of substance use.

Adolescent perceptions of the risks associated with the use of licit and illicit substances have important implications for policy and research. However, the methodological properties of the most popular risk measures in school surveys in Europe and the United States are not well understood. This study examines the potential contrast effects of risk measures of "heavy" and frequent substance use on perceived risks of occasional, moderate, and "experimental" use. Responses to 11 measures of the perceived risk of occasional smoking, moderate drinking, and experimental use of illicit substances were compared between two question forms administered to a split-half sample of all Icelandic ninth (14-15 years of age) and tenth (15-16 years of age) grade students present in class on the day of administration in March 2003 (N = 7099). In one form, only these 11 questions were used, while the other form also contained 13 questions on the perceived risk of heavy smoking, heavy drinking, and regular use of illicit substances. The longer form is found to decrease response rates and suppress estimates of perceived risk of experimental illicit substance use. Question form and perceived risks of heavy and regular use generally do not affect the multivariate effects of perceived risks of occasional, moderate, and experimental substance use on lifetime abstinence from each substance. It is argued that measures of perceived risks of heavy and regular substance use are less useful for prevention policy and research than are corresponding measures of occasional, moderate, and experimental substance use, and including the former in the same instrument may adversely affect the measurement of the latter constructs.