Educational intervention for increasing knowledge of human papillomavirus and vaccination amongst parents of first year high school students in Croatia.

BACKGROUND: In Croatia, the human papillomavirus (HPV) vaccine became available through a publicly funded national programme during the 2015/2016 school year among boys and girls in the first year high school. Improved parental awareness of HPV and vaccination could help increase the uptake of the vaccination. The primary aim of this study is to establish the importance of educating parents for a greater response to the voluntary vaccination. METHODS: Parents of students in the first year of high school evaluated the educational lessons in the spring of 2016 in 11 counties coordinated by the Croatian Institute of Public Health: total of 36 doctors from 11 counties. Statistical significance was tested using chi-squared test. RESULTS: In total, 3350 evaluations were submitted (82.7%). Parents with a positive attitude towards vaccination following the education more often stated the lesson contributed to this attitude than parents with a negative attitude (P < 0.001). Results show that counties with highest attendance had highest rates of vaccination (Sisacko-moslovacka 1.74 highest and Dubrovacko-Neretvanska 0.03 lowest). CONCLUSION: Our study shows that parents have the impression an educational lesson can contribute to the development of their positive attitude towards vaccination. Further research should be aimed at disparities and how to target these with appropriate interventions.

Characteristics of Persons Registrated Due to Cannabinoid Abuse in Croatia - Do We Have enough Effective Intervention?

BACKGROUND: It is known that cannabis increases mood, decreases anxiety and causes mild euphoria, but also it can cause serious mental diseases. Previous studies showed harmful effects of cannabis and the aim of this study is to show characteristics of persons registrated because of cannabinoids abuse in Croatia in the period 2008-2018 and show effectiveness of interventions using statistic methods. SUBJECTS AND METHODS: Research data were collected based on the national Registry of Treated Psychoactive Drug Abusers in period 2008 to 2018 and included 10 533 registrated persons. Statistical analysis was performed by chi-square test and binary logistic regression. RESULTS: Results showed that men and very young people took cannabinoids more often than women and older people. There was a changing trend of registrated people in a ten-year period. The most commonly used intervention of obligatory healthcare treatment is consultation, but the difference between apstinents and people with unchanged status isn't statistically significant. The most people are referred by repressive mechanism and they are more likely to have apstinent status compared to unrepressive source of referral, with one exception - referred by the family. The highest probability of abstinence have those referred by the center for social welfare. CONCLUSIONS: Registrated people were mostly referred by repressive way, which makes question of its efficiency and prevention of long term addiction, because system like that more likely stigmatizes and punishes young people, opposite to giving support and help.

Program for Dental Health Advancement in Children "Dental Passport".

OBJECTIVE: The need for improving oral health in the Republic of Croatia was based on health indicators and poor oral health status and resulted in the implementation of measures to improve the use of dental health care for schoolchildren through the national program called "Dental Passport", which began in the 2017/2018 school year. PURPOSE: The aim of this study was to present the content and results of its implementation and to analyse them with emphasis on the sustainability and inclusion of the program and its implementation in preventive activities and procedures. MATERIAL AND METHODS: The data were collected from the completed "Dental Passport" forms from September 2017 to August 2018. The dental examinations and diagnostic-therapeutic procedures were recorded in The Central Health Information System of Croatia. RESULTS: In the school year 2017/2018, 24,729 6th grade elementary school students visited a dentist. The response rate in the Republic of Croatia was 68%. According to the CEZIH data, in the period from September 1 to December 31 2017, an increase in the number of first examinations and diagnostic-therapeutic procedures was observed in children aged 12 years, compared to the same period in 2015. The least reported preventive procedures in preschool children and 6th grade students were fissure sealing and sealing restorations, while motivating and instructing children on oral hygiene were the most common reported procedures. CONCLUSION: Good organization of work in school medicine provides the basis for the implementation of dental programs involving schoolchildren. However, greater motivation of the dental health care provider in the implementation of preventive procedures and motivation of parents and patients for a more active involvement in the "Dental Passport" program are important determinants in further implementation and improvement of oral health in children.

HEADACHES IN ADOLESCENTS - FREQUENCY, RISK FACTORS AND OTHER HEALTH COMPLAINTS: A CROSS-SECTIONAL STUDY IN CROATIA.

- Headaches are very common in school population. The aim of this study was to determine epidemiological data on headaches among Croatian schoolchildren and their connection to risk factors and other health complaints. In the study, we used the Croatian database of the international research entitled Health Behavior in School-aged Children for 2013/2014. It is a cross-sectional study conducted every four years in 44 countries among children aged 11-16. The students were interviewed using an anonymous standardized questionnaire. The Croatian sample consisted of 5741 students, of which 2857(49.8%) girls and 2884 (50.2%) boys. The response rate was 85.9%. Headaches were reported to be often (once a week to daily) by 23.5% of students and were more often in girls and in higher school grades. They were positively linked to cigarette smoking and health complaints such as back pain and stomachache, bad mood, nervousness, irritability, difficulties with sleeping and dizziness. Headaches are associated to many health problems and can cause difficulties in student functioning. This could be a serious problem. This study pointed to connection of headaches with cigarette smoking and importance to underpin the smoking prevention programs.

Inequalities in Croatian pupils' risk behaviors associated to socioeconomic environment at school and area level: a multilevel approach.

The socioeconomic inequality in pupils' risk behaviors has been the topic of many studies with quite contradictory findings. Furthermore, the role of socioeconomic environment has been analyzed much less often than the role of individual socioeconomic status (SES). This study examined the association between school/area-level socioeconomic environment and Croatian pupils' risk behaviors (tobacco use, drunkenness, cannabis use, early sexual initiation and fighting). Data from the WHO-Collaborative 'Health Behavior in School-aged Children' study conducted in Croatia in 2006 (1601 secondary schools' pupils, aged 15) and census data were used. Multilevel logistic regression analyses, adjusted by gender, were performed. The individual level of SES explained the majority of differences in all risk behaviors among adolescents. Differences in tobacco use, early sexual initiation and fighting were more closely attributed to school level than area level, which was more closely associated with differences in adolescent drunkenness and cannabis use. At the individual level, high individual SES was associated with higher probability for tobacco use and drunkenness compared to low individual SES. Furthermore, school heterogeneity (compared to school homogeneity) and medium school-level SES (compared to low school-level SES) were associated with higher probability for cannabis use. Compared to the most advanced schools (gymnasiums), attending the least advanced schools (industrial and crafts schools) was associated with higher probability for fighting. Compared to low area-level SES, medium area-level SES was associated with higher probability for cannabis use and fighting. Conclusively, it was found that low SES at individual, school and area levels, school homogeneity and advanced school attendance play a protective role against risk behaviors. To reduce inequalities in pupils' risk behaviors, there is a need for community and school-based programs that take into consideration not only individual SES but also school- and area-level socioeconomic circumstances.

Family history and parental recognition of overweight in Croatian children.

UNLABELLED: The aim of this study was to evaluate the perception of parents on the weight status of their offspring, particularly in relation to a family history of obesity and obesity-related illnesses. A cross-sectional study of 1,068 child-parent dyads sampled at school entry health examination was conducted (median age of the child 6.75 years, range 5.7-8.3 years, 50.3 % males). The parental perception of the weight status of their child was compared to the body mass index (BMI, kilogram per square meter), calculated from measured weight and height. Weight status (underweight, normal, overweight, and obese) was defined using the United States Centers for Disease Control and Prevention BMI for age reference charts. Backward multiple linear regression analysis was used to determine possible predictors of parental misclassification of overweight/obese children. Among this cohort of children, 12 % were overweight, 10.2 % obese, and 8.1 % were underweight. Only 24.8 % of obese children and 2.2 % of overweight children were considered "overweight" by their parents. A positive family history was not significantly associated with parental recognition of overweight. Parental misperception of overweight/obese children as being normal was related to the child BMI z-score (odds ratio (OR) 0.036; 0.012-0.111) and diabetes in family history (OR 3.187; 1.207-8.413). CONCLUSION: The majority of parents did not perceive their overweight/obese children as overweight. As having an obese family member or one who has suffered from an obesity-related illness does not increase the parental ability to recognize overweight in their children, strategies to increase public awareness about the importance of one's family medical history are needed.

Impact of environmental factors on marijuana use in 11 European countries.

AIM: To investigate the association between environmental factors (perceived availability of marijuana, perceived use among friends and siblings, use of alcohol and tobacco, family structure, parental control, school performance) and lifetime prevalence and frequent and early marijuana use in high school students. METHODS: We used self-reported data from 15-16 years old participants of the 2003 European School Survey Project on Alcohol and Other Drugs (ESPAD) conducted in 11 countries: Denmark, Estonia, Norway, Croatia, Slovenia, Germany, Switzerland, Bulgaria, Czech Republic, Russian Federation, and Ukraine. Multivariate logistic regression was used for data analysis. RESULTS: Countries varied according to lifetime prevalence (8.7%-47.8%) and frequent (8.7%-23.9%) and early (3.0%-13.0%) marijuana use. Daily tobacco smoking was most strongly associated with lifetime marijuana use for boys in 7 and for girls in 5 countries, with highest odds ratio (OR, 95% and confidence interval - CI) for boys in Denmark (OR, 13.52; 95% CI, 8.16-22.4), and for girls in the Czech Republic (OR, 21.21; 95% CI, 12.99-34.62). Perceived marijuana availability was most strongly associated with frequent marijuana use for boys in 4 countries (highest in Slovenia: OR, 19.28; 95% CI, 6.52-57.02) and girls in 5 (highest in Slovenia: OR, 19.05; 95% CI, 5.18-70.04). Perceived use of marijuana among friends was most strongly associated with frequent marijuana use in 5 countries, both for boys (highest in Norway: OR, 23.91; 95% CI, 4.16-137.48) and girls (highest in Denmark: OR, 75.42; 95% CI, 13.11-433.90). Perceived use of marijuana among friends was most strongly associated with early marijuana use in 8 countries for boys (highest in Norway: OR, 54.03; 95% CI, 3.34-875.19) and 3 countries for girls (highest in Denmark: OR, 7.29; 95%CI, 1.77-30.12). CONCLUSION: In each country, marijuana use was associated with similar factors, regardless of marijuana use prevalence in that country.The influence of peer group and perceived availability of marijuana seemed more important than parental control and family structure.

Comparative study on self-perceived health of parents of children with autism spectrum disorders and parents of non-disabled children in Croatia.

AIM: To assess self-perceived health of parents of children with autism spectrum disorders (ASD) in comparison with those of parents of non-disabled children. METHODS: A total of 350 parents participated in the study: 178 parents of children with ASD (71% response rate) and 172 parents of non-disabled children matched by age, education, and place of living. Parents' self-perceived health was assessed using the Croatian version of the health status questionnaire SF-36, while socio-demographic information, chronic medical conditions, and needs were assessed by a general questionnaire. RESULTS: For all dimensions of health, except physical health, parents of children with ASD had significantly poorer self-perceived health and reported significantly more deteriorated health in the last year than the control group (P<0.001). They also reported more psychological disorders (11% vs 4.3%), which was the largest difference in specified chronic medical conditions. Hundred twenty six (71%) parents of children with ASD thought that enhancing different policy measures (economic, social, educational) could advance their and their children's health and well-being. CONCLUSION: Parents of children with ASD had poorer health than the control group in all components, except physical health. Because parents are the main providers of support for children with ASD, preserving parents' good health and well-being is a precondition for an optimal care for children. Therefore, current system for treating children with ASD in Croatia should also include permanent improvement of parents' health and well-being.