Evaluation of a Brief Intervention for Promoting Mental Health among Employees in Social Enterprises: A Cluster Randomized Controlled Trial.

Evidence on the effectiveness of workplace mental health promotion for people with disabilities is limited. This study aimed to evaluate the effectiveness of a brief mental health promotion intervention in social enterprises. It had a non-blinded cluster randomized controlled trial design with follow-up one and four months after the intervention. In total 196 employees agreed to participate (86 intervention and 110 control). Empowerment was the main outcome; secondary outcomes were resilience, palliative behavior, determinants of four coping strategies of mental health, quality of life, and life satisfaction. A brief participant satisfaction survey was conducted after the intervention. No significant intervention effect on empowerment was found. However, at one month follow-up, significant favorable effects were found on perceived social support for coping strategies for mental health and on palliative behavior. At four months follow-up, favorable intervention effects were found on quality of life, but unfavorable effects were found on unjustified worrying. In addition, the intervention was well received by the employees. This brief intervention might be a promising first step to improve mental health in people with disabilities working in social enterprises. Nevertheless, additional monitoring by professionals and managers working in the organizations might be needed to maintain these effects.

The Relationship Between Pain Severity and Alcohol Use Among School-Aged Children and Adolescents: The Moderating Role of Drinking Motives.

Objective: Evidence from adult samples suggests a co-occurrence between pain and alcohol abuse. However, studies in adolescents are scarce and results are inconsistent, with some studies observing heightened and others observing reduced alcohol consumption in adolescents suffering from pain. We hypothesized that in adolescents the association between pain and alcohol use will be moderated by drinking motives. Methods: Data from a large representative sample of Flemish school children and adolescents (N = 10,650, 50.8% boys, age range = 10-21 years, Mage = 14.33 years) were collected as part of the World Health Organization collaborative Health Behaviour in School-Aged Children (HBSC) survey. Pain severity was graded based on a pediatric pain classification system that accounts for both pain intensity and disability. Alcohol consumption was operationalized using two variables: frequency of drinking and drunkenness. The Drinking Motives Questionnaire-Revised was used to capture drinking motives; it assesses four motive categories (enhancement, coping, social, and conformity). Results: Findings indicated that higher pain severity was associated with greater frequency of alcohol use and drunkenness. However, drinking motives moderated this association. The positive association between pain severity and drinking frequency was stronger in case of high conformity motives. Likewise, the association between pain severity and drunkenness frequency was stronger at high levels of conformity motives and reached significance only at high levels of coping motives. Conclusions: Our findings suggest that specific drinking motives are linked to problematic alcohol use in adolescents with pain. Future studies using a longitudinal design are needed to draw conclusions about direction of effects.

Who does not cut down? Comparing characteristics and drinking motives of drinkers and abstainers during the exam periods.

OBJECTIVE: Drinking alcohol during the exams can affect academic performance and future career options, but is rarely investigated. Drinking motives, sociodemographics and personality characteristics are investigated in nonabstainers and weekly drinkers during the exams. PARTICIPANTS: 7,181 Belgian university students who anonymously responded to an email invitation to an online survey. METHODS: Logistic regressions and mixed design analysis of variance on cross-sectional data. RESULTS: One-third of the students continued drinking during the exams, with 40% drinking weekly. Nonabstainers were mainly men, elder, internally motivated when drinking, and housed with parents or independently. Weekly drinkers were similar, except mainly housed in student apartments or independently. Personality characteristics were nonsignificant. All drinking motives were less pronounced during the exams, with smaller differences for internal motives. CONCLUSIONS: Mainly linked to internal drinking motives, drinking during the exams in higher education is underestimated. The characteristics and motives of students doing so can be used in future interventions.

Trends in Tobacco Smoking among Czech School-aged Children from 1994 to 2014.

OBJECTIVE: The aim of the article is to examine trends in tobacco consumption among the Czech school-age population. METHODS: For the analysis, data from the Czech Health Behaviour in School-aged Children project, conducted between 1994 and 2014 were used. Trends in tobacco smoking were determined separately for boys and girls, applying the binary logistic regression with survey period as an independent variable for the smoking status. RESULTS: The analysis showed that there have been significant changes in adolescent tobacco smoking for the recent 20 years. While the share of current school-aged smokers was continuously increasing since the mid-1990s, the trend reached its peak in the mid-2000s. CONCLUSION: In recent years, the prevalence of adolescent smokers has significantly declined in the Czech Republic. Despite this recent decline, adolescent smoking remains a major challenge for the national health policy.

The role of community social capital in the relationship between socioeconomic status and adolescent life satisfaction: mediating or moderating? Evidence from Czech data.

BACKGROUND: The concept of social capital has been extensively used to explain the relationship between socioeconomic status (SES) and adolescent health and well-being. Much less is known about the specific mechanism through which social capital impacts the relationship. This paper investigates whether an individual's perception of community social capital moderates or mediates the association between SES and life satisfaction. METHODS: This study employs cross-sectional data from the 2009-2010 Czech Health Behaviour in School-Aged Children survey: a WHO Collaborative Cross-National Study (HBSC). A sample of 4425 adolescents from the 5th, 7th and 9th grade (94.5% school response rate, 87% student response) was used to perform multilevel analysis. RESULTS: We found that pupils' life satisfaction was positively related to both family affluence and perceived wealth. Moreover, we found the cognitive component of social capital to be positively associated with life satisfaction. Additionally, a significant interaction was found, such that the social gradient in life satisfaction was flattened when pupils reported high levels of perceived community social capital. CONCLUSIONS: The present findings suggest that community social capital acts as an unequal health resource for adolescents, but could potentially represent opportunities for public health policy to close the gap in socioeconomic disparities.

Context matters: Student-perceived binge drinking norms at faculty-level relate to binge drinking behavior in higher education.

BACKGROUND: Binge drinking in higher education is an important problem. To target binge drinking in students it is necessary to study the social context of students. Faculties (i.e., colleges or schools in Northern American education) are social contexts in which students behave, but little is known about how the faculty structure relates to monthly binge drinking. This study investigates the relationship with student-perceived binge drinking norms at faculty-level in addition to known personal determinants. METHODS: Data were collected in 7181 students within 22 faculty-level units, using an anonymous online survey. Multilevel analyses were used to investigate the relationship of both individual-level determinants (e.g., perceived norms, social drinking motives) and student-perceived binge drinking norms at faculty-level on monthly binge drinking. RESULTS: Two-third (62.2%) of the sample were female and the mean age was 21.06 (SD=2.85) years. In males, significant faculty-level variance in monthly binge drinking was found. At faculty-level, only same-sex student-perceived binge drinking norms showed a positive relationship (OR=2.581; 95%CI=[1.023,6.509]). At individual level, both opposite- and same-sex perceived binge drinking norms, and social drinking motives positively related to monthly binge drinking. In females, no significant faculty-level variance was found. Only individual-level determinants positively related to monthly binge drinking. No cross-level interactions were found. CONCLUSION: Besides individual determinants, especially in men, faculties are relevant environmental structures and networks to take into account when targeting binge drinking in higher education.

Health promotion interventions in social economy companies in Flanders (Belgium).

BACKGROUND: Disadvantaged groups are often not reached by mainstream health promotion interventions. Implementing health promotion (HP) interventions in social economy companies, can be an opportunity to reach those people. The implementation of these interventions in social economy companies was studied. Factors that could be related to the implementation of HP and being supportive towards implementation in the future, were investigated. METHODS: An online, quantitative survey was sent to all 148 sheltered and social workshops in Flanders. In the questionnaire, the status of HP interventions and characteristics of the workshop were explored. Personal factors (such as attitudes towards HP, behavioural control, social norms and moral responsibility) were asked to the person responsible for implementation of HP interventions. Univariate and multivariate logistic regressions were performed. RESULTS: Respondents of 88 workshops completed the questionnaire. Almost 60% of the workshops implemented environmental or policy interventions. Having a positive attitude towards HP, being more morally responsible, and having the subjective norm that employees are positive towards health promotion at work, were related to being more supportive towards the implementation of HP in the univariate analyses. Only attitude stayed significantly related to being more supportive towards the implementation of HP in the multivariate analyses. CONCLUSIONS: Sheltered and social workshops are open to HP interventions, but more can be done to optimize the implementation. To persuade persons responsible for the implementation of HP to invest more in HP, changing attitudes concerning the benefits of health promotion for the employee and the company, is an important strategy.

Socioeconomic inequalities in the impact of tobacco control policies on adolescent smoking. A multilevel study in 29 European countries.

INTRODUCTION: There are concerns that tobacco control policies may be less effective in reducing smoking among disadvantaged socioeconomic groups and thus may contribute to inequalities in adolescent smoking. This study examines how the association between tobacco control policies and smoking of 15-year-old boys and girls among 29 European countries varies according to socioeconomic group. METHODS: Data were used from the Health Behaviour in School-aged Children (HBSC) study conducted in 2005/2006 comprising 50,338 adolescents aged 15 years from 29 European countries. Multilevel logistic regression analyses were conducted to assess the association of weekly smoking with components of the Tobacco Control Scale (TCS), and to assess whether this association varied according to family affluence (FAS). Analyses were carried out per gender and adjusted for national wealth and general smoking rate. RESULTS: For boys, tobacco price was negatively associated with weekly smoking rates. This association did not significantly differ between low and high FAS. Levels of tobacco-dependence treatment were significantly associated with weekly smoking. This association varied between low and high FAS, with higher treatment levels associated with higher probability of smoking only for low FAS boys. For girls, no tobacco policy was significantly associated with weekly smoking, irrespective of the FAS. CONCLUSIONS: Results indicated that most tobacco control policies are not clearly related to adolescent weekly smoking across European countries. Only tobacco price seemed to be adequate decreasing smoking prevalence among boys, irrespective of their socioeconomic status.

Does the association between different dimension of social capital and adolescent smoking vary by socioeconomic status? a pooled cross-national analysis.

OBJECTIVES: To analyze how dimensions of social capital at the individual level are associated with adolescent smoking and whether associations differ by socioeconomic status. METHODS: Data were from the 'Health Behaviour in School-aged Children' study 2005/2006 including 6511 15-year-old adolescents from Flemish Belgium, Canada, Romania and England. Socioeconomic status was measured using the Family Affluence Scale (FAS). Social capital was indicated by friend-related social capital, participation in school and voluntary organizations, trust and reciprocity in family, neighborhood and school. We conducted pooled logistic regression models with interaction terms and tested for cross-national differences. RESULTS: Almost all dimensions of social capital were associated with a lower likelihood of smoking, except for friend-related social capital and school participation. The association of family-related social capital with smoking was significantly stronger for low FAS adolescents, whereas the association of vertical trust and reciprocity in school with smoking was significantly stronger for high FAS adolescents. CONCLUSIONS: Social capital may act both as a protective and a risk factor for adolescent smoking. Achieving higher levels of family-related social capital might reduce socioeconomic inequalities in adolescent smoking.

Trends in the co-occurrence of tobacco and cannabis use in 15-year-olds from 2002 to 2010 in 28 countries of Europe and North America.

BACKGROUND: Cannabis and tobacco use frequently co-occur. Adolescents who consume both substances experience more respiratory distress and psychosocial problems and are less likely to stop compared with those who use either tobacco or cannabis alone. This study examined time trends in tobacco and cannabis use among 15-year-olds in Europe and North America between 2002 and 2010. METHODS: Twenty-eight countries were included and merged into six regions based on their welfare systems. Adolescents (n = 142 796) were divided in four 'user groups': 'no-users', 'tobacco and cannabis users', 'tobacco-only users' and 'cannabis-only users'. Prevalence rates are reported by study-wave and region. Logistic regressions with study wave as independent variable were used to study trends in the user groups and regions. Interaction effects between time and gender were considered. RESULTS: Overall, tobacco use, and concurrent tobacco and cannabis use decreased by 3 and 3.7%, respectively, but prevalence rates varied by region. Only in North America, an interaction effect between time and gender was found in tobacco and cannabis users. CONCLUSIONS: Although this study demonstrates a decrease in tobacco and cannabis use in most regions, it also shows that the use of both substances is related. Therefore, studying the co-occurring use of tobacco and cannabis is necessary.

Tracking and predictors of screen time from early adolescence to early adulthood: a 10-year follow-up study.

PURPOSE: To examine tracking of weekday and weekend screen time (ST; i.e., television [TV] and computer [PC] time) from early adolescence to early adulthood and to identify social ecological predictors of weekday and weekend ST among boys and girls separately. METHODS: Data were retrieved from elementary schools (n = 59) in Flanders (Belgium). At baseline, 1,957 children (age, 9.9 ± .43 years) and one of the parents filled out a questionnaire on sedentary behavior and individual, social, and environmental variables. After a 10-year follow-up period, six hundred fifty-five 20-year-olds (age, 19.9 ± .43 years) filled out an adapted questionnaire on sedentary behavior, of which 593 contained full data at baseline and follow-up. Multiple regressions were performed to examine predictors (baseline) of ST (follow-up), and logistic regressions were used to analyze tracking of ST. RESULTS: For boys, a consistent positive predictor of weekday and weekend TV and PC time at follow-up was ST at baseline (p < .01). For girls, drinking more soda at baseline predicted more weekday and weekend TV and PC time at follow-up (p ≤ .02). Some other individual variables also predicted ST in both boys and girls. Tracking was only found among boys; those exceeding the ST guideline at baseline were three to five times more likely to exceed this guideline at follow-up (p ≤ .001). Tracking was not present among girls. CONCLUSIONS: To minimize TV and PC time during early adulthood, interventions for adolescent boys should focus on minimizing ST. For girls, focus should be on healthy eating. However, more research is warranted to confirm these conclusions.

The influence of parental drinking on offspring's drinking motives and drinking: a mediation analysis on 9 year follow-up data.

BACKGROUND AND AIMS: The influence of parental drinking on offspring's drinking is well-documented. However, longitudinal evidence on the mediating role of drinking motives in this relationship is lacking. This study longitudinally investigates the mediating role of drinking motives in the relationship between parental and offspring's drinking. METHODS: Using a prospective design, 587 Flemish children (response 30.0%) were followed for 9 years. Parental drinking was documented during the offspring's late childhood (10 and 11 years old) through paper-and-pencil questionnaires distributed by schools. The offspring's drinking habits and -motives were documented in early adulthood (18 and 19 year old) through a web-based questionnaire; invitations were sent by letter. Motives were measured using the Drinking Motives Questionnaire Revised Short-form, and mediation analyses were conducted with the product of coefficient test using bootstrapping. RESULTS: Half the offspring were female (53.8%) and the mean age was 19.35 (SD = 0.52) years. A significant direct effect of maternal drinking during childhood on offspring drinking nine years later was found (ß = 0.091, t = 2.071, p = 0.039). However, the association turned non-significant after stratifying the model for boys and girls. No direct effect was found for paternal drinking on offspring's drinking. Nevertheless, paternal drinking indirectly affected offspring's drinking through offspring's enhancement motives (ß = 0.041, 95%CI[0.004, 0.082]) and maternal drinking indirectly affected male offspring's drinking through offspring's social motives (ß = 0.067, 95%CI[0.007, 0.148]). CONCLUSION: These results show that parental drinking during late childhood relates to a high level of those drinking motives among young adults that are known risk factors for heavy drinking in early adulthood.

Drinking motives mediate cultural differences but not gender differences in adolescent alcohol use.

PURPOSE: To test whether differences in alcohol use between boys and girls and between northern and southern/central Europe are mediated by social, enhancement, coping, and conformity motives. METHODS: Cross-sectional school-based surveys were conducted among 33,813 alcohol-using 11- to 19-year-olds from northern Europe (Denmark, Estonia, Finland, Ireland, Poland, Scotland, and Wales) and southern/central Europe (Belgium, Hungary, Italy, Portugal, Slovakia, and Switzerland). RESULTS: Particularly in late adolescence and early adulthood, boys drank more frequently and were more often drunk than girls. Instead of mediation, gender-specific motive paths were found; 14- to 16-year-old girls drank more because of higher levels of coping motives and lower levels of conformity motives, whereas 14- to 19-year-old boys drank more because of higher levels of social and enhancement motives. Geographical analyses confirmed that adolescents from southern/central European countries drank more frequently, but those from northern Europe reported being drunk more often. The strong indirect effects demonstrate that some of the cultural differences in drinking are because of higher levels of social, enhancement, and coping motives in northern than in southern/central Europe. CONCLUSIONS: The results from the largest drinking motive study conducted to date suggest that gender-specific prevention should take differences in the motivational pathways toward (heavy) drinking into account, that is, positive reinforcement seems to be more important for boys and negative reinforcement for girls. Preventive action targeting social and enhancement motives and taking drinking circumstances into account could contribute to tackling underage drinking in northern Europe.

The association between family affluence and smoking among 15-year-old adolescents in 33 European countries, Israel and Canada: the role of national wealth.

AIMS: To examine the role of national wealth in the association between family affluence and adolescent weekly smoking, early smoking behaviour and weekly smoking among former experimenters. DESIGN AND PARTICIPANTS: Data were used from the Health Behaviour in School-aged Children (HBSC) study conducted in 2005/2006 in 35 countries from Europe and North America that comprises 60 490 students aged 15 years. Multi-level logistic regression was conducted using Markov chain Monte Carlo methods (MCMC) to explore whether associations between family affluence and smoking outcomes were dependent upon national wealth. MEASUREMENT: Family Affluence Scale (FAS) as an indicator for the socio-economic position of students. Current weekly smoking behaviour is defined as at least weekly smoking (dichotomous). Early smoking behaviour is measured by smoking more than a first puff before age 13 years (dichotomous). Weekly smoking among former experimenters is restricted to those who had tried a first puff in the past. FINDINGS: The logistic multi-level models indicated an association of family affluence with current weekly smoking [odds ratio (OR) = 1.088; 95% credible interval (CrI) = 1.055-1.121, P < 0.001], early smoking behaviour (OR = 1.066; CrI = 1.028-1.104, P < 0.001) and smoking among former experimenters (OR = 1.100; CrI = 1.071-1.130; P < 0.001). Gross domestic product (GDP) per capita was associated positively and significantly with the relationship between family affluence and current weekly smoking (OR = 1.005; CrI = 1.003-1.007; P < 0.001), early smoking behaviour (OR = 1.003; CrI = 1.000-1.005; P = 0.012) and smoking among former experimenters (OR = 1.004; CrI = 1.002-1.006; P < 0.001). The association of family affluence and smoking outcomes was significantly stronger for girls. CONCLUSIONS: The difference in smoking prevalence between rich and poor is greater in more affluent countries.

Social capital and adolescent smoking in schools and communities: a cross-classified multilevel analysis.

We sought to determine whether social capital at the individual-, school- and community-level can explain variance in adolescent smoking and accounts for social inequalities in smoking. We collected data as part of the 2005/6 Health Behavior in School-aged Children survey, a nationally representative survey of the health and well-being of high school pupils in Belgium (Flanders). Social capital was assessed by structural and cognitive components of family social capital, a four-factor school social capital scale and a cognitive community social capital scale. We fitted non-hierarchical multilevel models to the data, with 8453 adolescents nested within a cross-classification of 167 schools and 570 communities. Significant variation in adolescent regular smoking was found between schools, but not between communities. Only structural family social capital and cognitive school social capital variables negatively related to regular smoking. No interactions between socio-economic status and social capital variables were found. Our findings suggest that previously observed community-level associations with adolescent smoking may be a consequence of unmeasured confounding. Distinguishing nested contexts of social capital is important because their associations with smoking differ.

Adolescent alcohol use: a reflection of national drinking patterns and policy?

AIMS: To analyse how adolescent drunkenness and frequency of drinking were associated with adult drinking patterns and alcohol control policies. DESIGN, SETTING AND PARTICIPANTS: Cross-sectional survey data on 13- and 15-year-olds in 37 countries who participated in the Health Behaviour in School-Aged Children (HBSC) Study in 2010 (n = 144 788) were linked to national-level indicators on alcohol control policies and adult drinking patterns. MEASUREMENTS: Outcome measures were self-reported weekly drinking and life-time drunkenness (drunk once or more). Data were analysed using multi-level logistic regression models. FINDINGS: In the mutually adjusted models, adolescent drunkenness was associated significantly with high adult alcohol consumption [odds ratio (OR) = 3.15 among boys, 95% confidence interval (CI) = 2.13-4.64, OR girls = 2.44, CI = 1.57-3.80] and risky drinking patterns in the adult population (OR boys = 2.02, CI = 1.33-3.05, OR girls = 1.61, CI = 1.18-2.18). The level of abstainers in the adult population was also associated significantly with girls' drunkenness; a 10% increase in the number of abstainers in a country reduced the odds of drunkenness with 21% (OR = 0.79, CI = 0.68-0.90). Weekly drinking was associated significantly with weak restrictions on availability (OR boys = 2.82, CI = 1.74-4.54, OR girls = 2.00, CI = 1.15-3.46) and advertising (OR boys = 1.56, CI = 1.02-2.40, OR girls = 1.79, CI = 1.10-2.94). CONCLUSIONS: Comparing data cross-nationally, high levels of adult alcohol consumption and limited alcohol control policies are associated with high levels of alcohol use among adolescents.

Drinking motives and links to alcohol use in 13 European countries.

OBJECTIVE: The purpose of this study was to test the structure and endorsement of drinking motives and their links to alcohol use among 11- to 19-year-olds from 13 European countries. METHOD: Confirmatory factor analysis, latent growth curves, and multiple regression models were conducted, based on a sample of 33,813 alcohol-using students from Belgium, Denmark, Estonia, Finland, Hungary, Ireland, Italy, Poland, Portugal, Scotland, Slovakia, Switzerland, and Wales who completed the Drinking Motives Questionnaire Revised Short Form (DMQ-R SF). RESULTS: The findings confirmed the hypothesized fourdimensional factor structure. Social motives for drinking were most frequently indicated, followed by enhancement, coping, and conformity motives, in that order, in all age groups in all countries except Finland. This rank order was clearest among older adolescents and those from northern European countries. The results confirmed that, across countries, social motives were strongly positively related to drinking frequency, enhancement motives were strongly positively related to frequency of drunkenness, and conformity motives were negatively related to both alcohol outcomes. Against our expectations, social motives were more closely related to drunkenness than were coping motives, particularly among younger adolescents. CONCLUSIONS: The findings reveal striking cross-cultural consistency. Health promotion efforts that are based on, or incorporate, drinking motives are likely to be applicable across Europe. As social motives were particularly closely linked to drunkenness among young adolescents, measures to impede the modeling of alcohol use and skills to resist peer pressure are particularly important in this age group.

Traditional and cyberbullying victimization as correlates of psychosocial distress and barriers to a healthy lifestyle among severely obese adolescents--a matched case-control study on prevalence and results from a cross-sectional study.

BACKGROUND: Obese youth are at increased risk for peer victimization, which may heighten their risk of psychosocial problems and physical activity avoidance, and lower the effectiveness of professional and lifestyle weight-loss initiatives. Little is known about obese adolescents' risk for victimization from cyber-bullying and how this relates to psychosocial functioning and healthy lifestyle barriers. The purpose of the study was to assess traditional and cyber-victimization among adolescents with severe obesity and its relation to psychosocial distress and barriers to healthy lifestyles. METHODS: A sample of 102 obese adolescents (mean age=15.32±1.71) in residential treatment was matched with 102 normal-weight youngsters from the Health Behavior in School-aged Children (HBSC) study (mean age=15.30±1.73). RESULTS: Adolescents with obesity were significantly more often cyber-victimized than normal-weight peers. Obese youth victimized by traditional bullying experienced lower quality of life, lower motivation for physical activity and higher avoidance and emotional coping towards healthy lifestyles than those non-victimized. Obese cyber-victims experienced significantly higher suicidal ideation. CONCLUSIONS: Traditional and cyber-victimization may hinder treatment effectiveness and healthy lifestyle change in adolescents with obesity. Health professionals should pro-actively address peer victimization and psychosocial functioning during multidisciplinary obesity treatment. Schools could contribute to a better physical and psychosocial health of obese youth by implementing multi-behavioral health-promotion programs.

Severity of pediatric pain in relation to school-related functioning and teacher support: an epidemiological study among school-aged children and adolescents.

The current cross-sectional study examined child and adolescent pain severity in relation to various domains of school functioning and, in line with self-determination theory, the potentially protective role of perceived teacher support of child/adolescent autonomy and competence. Data from a large representative sample of Flemish school children and adolescents (N=10650; 50.8% boys; age range 10-21years; mean age=14.33) was collected as part of the World Health Organization (WHO) collaborative Health Behaviour in School-Aged Children (HBSC) survey. Child/adolescent pain severity was graded based on a pediatric pain classification system adapted from that of Von Korff et al. The current study thus provided insight regarding the prevalence of pain among Flemish children/adolescents and, extending the limitations of existing literature, examined the specific role of pain severity across various domains of school functioning. Findings indicated that a sizeable proportion of children reported moderate to severe pain problems (ie, about 14% of children and adolescents were classified in the highest pain grades: ie, grade III or IV). Furthermore, higher pain grades were associated with poorer outcomes across all indices of school functioning (ie, school absenteeism, school-related pressure and satisfaction, and bullying experiences), with the exception of academic performance. However, the association between pain grade and school absenteeism was less pronounced when children perceived their teachers to be highly supportive of competence and autonomy. Furthermore, teacher support of competence appeared to buffer against the harmful effects of severe pain upon instances of bullying experiences at school. Future research directions and implications for school-based interventions are discussed.

Do societal wealth, family affluence and gender account for trends in adolescent cannabis use? A 30 country cross-national study.

AIMS: To examine cross-national changes in frequent adolescent cannabis use (40+ times consumed over life-time at age 15) over time and relate these trends to societal wealth, family affluence and gender. DESIGN: Data from three cycles (2002, 2006, 2010) of the Health Behaviour in School-aged Children (HBSC) Study were used for cross-sectional and trend analyses of adolescent cannabis use. SETTING: Representative surveys in 30 European and North American countries. PARTICIPANTS: A total of 160 606 15-year-old students. MEASUREMENTS: Respondents' life-time cannabis use, demographics, family affluence (FAS) and frequency of peer contacts were measured individually. Indicators of wealth (gross domestic product per capita, GDP) and perceived availability of cannabis were obtained from national public data bases. FINDINGS: The frequency of life-time cannabis use decreased over time among adolescents in Europe and North America, particularly in western European countries and the United States (relative risk (RR) = 0.86: confidence interval (CI) 0.79-0.93). This trend was not observed consistently in rapidly developing countries in eastern, central and southern Europe. Over time (2002-10), cannabis use became: (i) less characteristic of high GDP countries in contrast to lower GDP countries (RR = 0.74: CI 0.57-0.95); (ii) less characteristic of youth from high FAS families in contrast to youth from low FAS families (RR = 0.83: CI 0.72-0.96); and (iii) characterized by an increasing gender gap, i.e. consumption was higher among males (RR 1.26: CI 1.04-1.53). Perceived availability of cannabis and peer contacts remained strong predictors of frequent cannabis use. CONCLUSIONS: Among 30 European and North American countries, cannabis use appears to have 'trickled down' over time, with developing countries taking on the former (heavier) use pattern of richer countries, and less affluent youth taking on the former (heavier) use pattern of more affluent youth. Cannabis use continues to be more common among adolescent males than females.