Development of a Measure to Assess What Young Heterosexual Adults Say They Learn About Sex from Pornography.

This study involved the development of two new measures to assess what some young heterosexual-identifying adults report learning about sex from pornography. Inventory items were generated from an extensive literature review and six qualitative focus group sessions with young adults (N = 54) aged 18-29 which explored how pornography could be used as a source of sexual information. A total of 135 items pertaining to sexual learning from pornography were produced, reviewed and categorized by a sample of young adults (n = 9), and finally reviewed for item and construct relevance by a panel of pornography, sex education and scale development experts (n = 6). Inventory items were administered to a sample of young adult university students (n = 1306). Two separate exploratory factor analyses were conducted for the female and male datasets. The final factors were reviewed by a panel of young adults = 8) to identify the theme of each factor. Both the SIPI-F and SIPI-M yielded three factors: (1) How to be a good sexual partner, (2) Body aesthetic, and (3) Sexual exploration. Results show that pornography provides information about a range of sex-related topics. Findings also show that more frequent female pornography users reported learning more about how to be a good sexual partner and body aesthetic than less frequent pornography users. The SIPI-F and SIPI-M can be useful for examining a variety of questions regarding the use of pornography as an informal source of sexual information and its correlates.

Sexual intercourse, age of initiation and contraception among adolescents in Ireland: findings from the Health Behaviour in School-aged Children (HBSC) Ireland study.

BACKGROUND: The need to tackle sexual health problems and promote positive sexual health has been acknowledged in Irish health policy. Young people's sexual behaviour however remains under-researched with limited national data available. METHODS: This study presents the first nationally representative and internationally comparable data on young people's sexual health behaviours in Ireland. Self-complete questionnaire data were collected from 4494 schoolchildren aged 15-18 years as part of a broader examination of health behaviour and their context. The prevalence of sexual initiation, very early sexual initiation (< 14 years) and non-condom use at last intercourse are reported and used as outcomes in separate multilevel logistic regression models examining associations between sociodemographic characteristics, lifestyle characteristics and young people's sexual behaviours. RESULTS: Overall, 25.7% of boys and 21.2% of girls were sexually initiated. Older age was consistently predictive of initiation for both boys and girls, as were alcohol, tobacco and cannabis involvement, living in poorer neighbourhoods and having good communication with friends. Involvement in music and drama was protective. Very early sexual initiation (< 14 years) was reported by 22.8% of sexually initiated boys and 13.4% of sexually initiated girls, and was consistently associated with rural living, cannabis involvement and bullying others for both. Boys' very early initiation was predicted by alcohol involvement, receiving unhealthy food from parents and taking medication for psychological symptoms, whereas better communication with friends and more experience of negative health symptoms were protective. Girls' very early initiation was predicted by being bullied and belonging to a non-Traveller community, whereas taking medication for physical symptoms and attending regular health checks was protective. Condom use was reported by 80% of sexually initiated students at last intercourse. Boys' condom use was associated with older age, higher family affluence, bullying others, more frequent physical activity and health protective behaviours. For girls, condom use was predicted by belonging to a non-Traveller community, healthy food consumption, higher quality of life and being bullied, whereas taking medication for physical and psychological symptoms was associated with non-condom use. CONCLUSIONS: These nationally representative research findings highlight the importance of focusing on young people as a distinct population subgroup with unique influences on their sexual health requiring targeted interventions and policy.

Physical activity, screen time and the risk of subjective health complaints in school-aged children.

Internationally, subjective health complaints have become increasingly prevalent in children. Thus, a comprehensive understanding of the determinants of health complaints is needed to inform effective policies and strategies. This study explores if meeting physical activity and total screen time (TST) recommendations are associated with the risk of reporting health complaints weekly or more. The 2014 Irish Health Behaviour in School-aged Children study collected questionnaire data from 10,474 10-17year olds. Children reported how often they experienced eight health complaints as less than weekly or weekly or more. Children who met moderate-to-vigorous physical activity recommendations were active for 60min/day in the past seven days. Three types of screen based activity were categorised to reflect if children met TST recommendations of ≤2h/day. Poisson regression examined the association between meeting recommendations and the risk of health complaints. The prevalence of individual health complaints ranged from 20.4-44.3% in girls and from 10.1-35.4% in boys. Overall, 5.1% (4.5-5.6%) of girls and 8.7% (7.8-9.5%) of boys met both (physical activity and TST) recommendations, while two thirds of girls (67.3%, 66.1-68.5%) and over half of boys (55.0%, 53.5-56.6%) met neither recommendation. Not meeting TST recommendations was significantly associated with the risk of reporting health complaints while associations with physical activity were less apparent. Children who did not meet either recommendation had a significantly increased risk for six of the health complaints when compared to those who met both recommendations. As health complaints and poor lifestyle behaviours were common in children, population level measures are warranted.

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.

Children's participation in school: a cross-sectional study of the relationship between school environments, participation and health and well-being outcomes.

BACKGROUND: Schools are a key setting for health promotion and improvement activities and the psycho-social environment of the school is an important dimension for promoting the health and well-being of children. The development of Health Promoting Schools (HPS) draws on the settings-based approach to health promotion and includes child participation as one of its basic values. This paper investigates the relationships between child participation, the school environment and child outcomes. METHODS: Study participants were recruited from nine primary schools, three of which were designated as Health Promoting Schools (HPS). Each HPS was matched with two non-HPS (NHPS) with similar characteristics. Two hundred and thirty-one pupils in the 4th-6th class groups completed self-report questionnaires to document their perspectives on the school socio-ecological environment, how they take part in school life, school processes and their health and well-being. RESULTS: School participation was measured with four scales: participation in school decisions and rules, school activities, school events and positive perception of school participation. The differences in the reported mean score for three of the four scales were marginal and not statistically significant. However, the mean score for reported positive perception of school participation was significantly lower (χ2 = 5.13, df =1, p < 0.05) among pupils in HPS (mean = 26.03; SD 3.37) compared to NHPS (mean = 26.30; SD 3.36). Participation in school decisions and rules (OR 1.22, 95% CI 1.12-1.33), participating in school activities (OR 1.20, 95% CI 1.10-1.31), participating in school events (OR 1.19, 95% CI 1.10-1.29) and reported positive perception of school participation (OR 1.26, 95% CI 1.15-1.39) were all positively associated with health and well-being outcomes for all pupils. Logistic regression analyses indicated positive associations between school participation and school socio-ecological environment. CONCLUSIONS: These findings suggest that school participation is important for children in schools and is relevant for improved school environment, relationships and positive health and well-being outcomes. The positive associations between school participation and school socio-ecological environment and health and well-being outcomes suggests that pupil health and well-being and school relationships could be improved or sustained by providing or supporting an environment that encourages pupil participation in school life.

Perceived Discrimination Among Adolescents in Ireland.

Adolescents belonging to minority or marginalized groups often experience discrimination, which may negatively affect their mental and physical health. Using the dataset of the 2018 Health Behaviour in School-Aged Children (HBSC) study, we analyzed perceived discrimination based on various grounds in four minority groups of schoolchildren in Ireland: sexual minority youth, youth living with a disability or chronic condition, immigrant youth, and youth belonging to the Traveller community. To minimize the potential confounding effect of psycho-social contextual factors, we used a case-control matching approach, comparing minority groups with their non-minority peers matched by gender, age group, and social class. Minority groups were significantly more likely than their matched non-minority counterparts to report discrimination, not only on the basis of their minority status but also on other grounds. These associations varied in their effect size. We discuss educational and policy implications of the findings for reducing discrimination and structural stigma in school settings.

Welfare state regimes, health and health inequalities in adolescence: a multilevel study in 32 countries.

Comparative research on health and health inequalities has recently started to establish a welfare regime perspective. The objective of this study was to determine whether different welfare regimes are associated with health and health inequalities among adolescents. Data were collected from the 'Health Behaviour in School-aged Children' study in 2006, including 11- to 15-year-old students from 32 countries (N = 141,091). Prevalence rates and multilevel logistic regression models were calculated for self-rated health (SRH) and health complaints. The results show that between 4 per cent and 7 per cent of the variation in both health outcomes is attributable to differences between countries. Compared to the Scandinavian regime, the Southern regime had lower odds ratios for SRH, while for health complaints the Southern and Eastern regime showed high odds ratios. The association between subjective health and welfare regime was largely unaffected by adjusting for individual socioeconomic position. After adjustment for the welfare regime typology, the country-level variations were reduced to 4.6 per cent for SRH and to 2.9 per cent for health complaints. Regarding cross-level interaction effects between welfare regimes and socioeconomic position, no clear regime-specific pattern was found. Consistent with research on adults this study shows that welfare regimes are important in explaining variations in adolescent health across countries.

Sunburn, Sun Safety and Indoor Tanning Among Schoolchildren in Ireland.

Objectives: We present patterns of sunburn, sun safety behaviors and indoor tanning bed use in a nationally representative sample of schoolchildren aged 10-17. These behaviors were explored across gender, age, and social class groups. Methods: Within the Health Behaviour in School-aged Children (HBSC) Ireland study, 10,271 young people (aged 13.54 ± 1.92, percentage girls 53.3%) reported frequency of sun safety behaviors, sunburn, and frequency and circumstances of indoor tanning bed use. Results: Children frequently experienced sunburn (90% lifetime, 74% last year), and 3% reported never using any sun protection. Applying sunscreen and wearing sunglasses were the most commonly used sun safety measures; other ways of sun protection were less popular. Indoor tanning bed use was reported by around 5%, and a large proportion of users were not advised of any indoor tanning safety measures. Sun safety behaviors varied by age and gender, with some socio-economic differences in tanning bed use. An association was found between frequency of family holidays abroad and sunburn. Conclusion: Targeted interventions are needed to increase sun safety behaviors and eliminate tanning bed use among children in Ireland.

Transport to School and Mental Well-Being of Schoolchildren in Ireland.

Objectives: We explored whether modes of transport (cycling, walking, public transport or private vehicle) between home and school are associated with mental well-being in children aged 10-17 years, participating in the Irish Health Behaviour in School-aged Children (HBSC) study. Methods: Scores on the World Health Organization Well-being Index and the Mental Health Inventory five-item versions, self-reported life satisfaction, happiness with self, body satisfaction, excellent self-rated health, and multiple health complaints of 9,077 schoolchildren (mean age: 13.99 ± 1.91 years, percentage girls: 52.2%) were compared across modes of transport, unadjusted and adjusted for gender, age, family affluence and area of residence. Results: Those who reported using public transport reported poorer mental well-being than those using other means of transport, but adjusting for sociodemographic variables obscured these differences. The only exception was excellent health, where children who cycled outperformed the other three groups, even after adjustment for sociodemographic variables. Conclusions: Cycling can improve well-being in children. However, in promotion of cycling, social and environmental determinants and inequalities which influence adolescents' and their parents' decisions on modes of transport, need to be considered.

Connected, Respected and Contributing to Their World: The Case of Sexual Minority and Non-Minority Young People in Ireland.

Outcome 5 of the Irish Better Outcomes, Brighter Futures national youth policy framework ("Connected, respected, and contributing to their world") offers a suitable way to study psychosocial determinants of adolescent health. The present study (1) provides nationally representative data on how 15- to 17-year-olds score on these indicators; (2) compares sexual minority (same- and both-gender attracted youth) with their non-minority peers. We analyzed data from 3354 young people (aged 15.78 ± 0.78 years) participating in the Health Behaviour in School-aged Children (HBSC) study in Ireland. Age and social class were associated with the indicators only to a small extent, but girls were more likely than boys to report discrimination based on gender and age. Frequency of positive answers ranged from 67% (feeling comfortable with friends) to 12% (being involved in volunteer work). Sexual minority youth were more likely to feel discriminated based on sexual orientation, age, and gender. Both-gender attracted youth were less likely than the other groups to report positive outcomes. Same-gender attracted youth were twice as likely as non-minority youth to volunteer. The results indicate the importance of a comprehensive approach to psycho-social factors in youth health, and the need for inclusivity of sexual minority (especially bisexual) youth.

Patterns in weight reduction behaviour by weight status in schoolchildren.

OBJECTIVE: To investigate the relationships between weight reduction behaviour among non-overweight schoolchildren and dietary habits, perception of health, well-being and health complaints. DESIGN: Analysis of the 2006 Health Behaviour in School-aged Children survey, a cross-sectional study involving schoolchildren aged 10-17 years. SETTING: Schools in the Republic of Ireland. RESULTS: The proportion of children (n 3599) engaged in weight reduction behaviour ('dieting' among non-overweight students) was 10.3 %. Older children, females and those from higher social classes (SC) were more likely to report such behaviour. Non-overweight schoolchildren who reported weight reduction behaviour were less likely than those not engaged in such behaviour to frequently consume sweets, soft drinks, crisps and chips/fried potatoes (OR from 0.39 (95 % CI 0.17, 0.89) to 0.72 (95 % CI 0.53, 0.99)); were more likely to consume diet soft drinks (OR 1.50 (95 % CI 1.03, 2.18); and were more likely to miss breakfast during the week (OR 0.62 (95 % CI 0.48, 0.80). The risk of subjective health complaints increased (OR from 1.47 (95 % CI 1.13, 1.91) to 1.92 (95 % CI 1.48, 2.49)); as did body dissatisfaction (OR 9.17 (95 % CI 6.99, 12.02)), while perception of health and well-being decreased (OR 0.47 (95 % CI 0.36, 0.61)) to 0.54 (95 % CI 0.41, 0.70)). All analyses were controlled for age, gender and SC. CONCLUSIONS: Weight reduction behaviour among non-overweight schoolchildren is associated with considerable risk to physical health and emotional well-being. Since the risks associated with such behaviour varies by weight status, health professionals and researchers need to consider these issues in parallel.

Is it the music? Peer substance use as a mediator of the link between music preferences and adolescent substance use.

Both music preferences and the substance use behavior of peers are important elements in explaining adolescent substance use. The extent to which music preference and peer use overlap in explaining adolescent substance use remains to be determined. A nationally representative sample of 7324 Dutch school-going adolescents (aged 12-16) provided data on music preferences, substance use behaviors and perceived number of peers using substances. Factor analyses showed that preferences for eight music genres factored into four styles: Pop (chart music, Dutch pop), Adult (classical music, jazz), Urban (rap/hiphop, soul/R&B) and Hard (punk/hardcore, techno/hardhouse); substance use was indicated by smoking, drinking, and cannabis use. Structural equation modeling revealed that the relationship between music preference and substance use was either wholly or partially mediated by perceived peer use. Music can model substance use and fans of different types of music may select friends with use patterns that reinforce their own substance use inclinations.

Early adolescent sexual initiation and physical/psychological symptoms: a comparative analysis of five nations.

Although most people in developed countries experience sexual initiation during adolescence, little is known about inter-country variability in the psychosocial correlates of early initiation. Population-based samples of 15-year-olds (n = 6,111, 52% female) who participated in the Health Behaviors in School-Aged Children Study (Finland, Scotland, France and Poland, 1997/1998) or the National Longitudinal Study of Adolescent Health (United States, 1996) self-reported sexual intercourse experience and physical (headaches, trouble sleeping) or psychological (unhappiness, loneliness, sadness, moodiness) symptoms. Analyses were conducted stratified by gender. Sexual initiation prevalence and symptoms scores varied significantly across nations. In adjusted models, sexual initiation was not related to symptoms among boys in any nation, but significantly positively related to symptoms among girls in Poland and the US. Results support variability by gender and nation in the relationship between adolescents' sexual initiation and physical/psychological symptoms. Empirically investigating specific features of national contexts that generate these differences should be explored further.

Toward a Model of Porn Literacy: Core Concepts, Rationales, and Approaches.

Although some positive outcomes for pornography engagement have been highlighted, researchers and educators have also expressed concerns about youth pornography engagement and have called for porn literacy education to be incorporated into sex education programs. As yet, there is lack of agreement regarding intervention development. This study aimed to engage participants in the identification of relevant curriculum content. Participatory methods of data collection were used with 54 young adults aged 18 to 29 to generate core concepts for porn literacy education, and these concepts were subsequently explored in group interviews. Findings suggest that the proposed learning outcomes should focus on reducing shame regarding pornography engagement and improving critical thinking skills regarding the following sexual health topics: body image comparisons and dissatisfaction; sexual and gender-based violence; fetishising of gay and transgender communities; and setting unrealistic standards for sex. Methods of engagement for porn literacy, gendered differences, and important findings that are specific to lesbian, gay, bisexual, transgender, plus (LGBT+) persons are discussed, and recommendations regarding future research and intervention development are outlined.

Self-Reported Health and Patterns of Romantic Love in Adolescents from Eight European Countries and Regions.

Purpose: Sexual minority youth (SMY) are at increased risk of poor health, but it remains unclear whether this phenomenon is universal. In this study, nationally representative samples of 15-year olds from eight European countries and regions were investigated to test if adolescents who have been in love with same- or both-gender partners report poorer health than those exclusively in love with opposite-gender partners or who have never been in love. Methods: A subsample of 13,674 adolescents participating in the 2014 Health Behaviour in School-aged Children (HBSC) study was used. We conducted binary logistic regression, adjusted for gender, region, and relative family affluence, to analyze associations between self-reported romantic love, multiple psychosomatic symptoms, and poor self-rated health. Results: Adolescents reporting same-gender love (adjusted odds ratio [aOR] = 1.50, 95% confidence interval [CI]: 1.11-2.02) and both-gender love (aOR = 3.57, 95% CI: 2.65-4.83) had significantly higher odds for multiple psychosomatic symptoms than those who reported opposite-gender love. Similarly, both SMY groups had higher odds of poor self-rated health (aOR = 2.95, 95% CI: 1.64-5.31 and aOR = 3.08, 95% CI: 1.79-5.31, respectively). Those who reported that they have never been in love had significantly lower odds for multiple symptoms. Adjustment for sociodemographic variables and stratifying by gender did not substantially change the odds ratios. Conclusion: Adolescents in love with same- and both-gender partners reported poorer subjective health outcomes than those in love with opposite-gender partners or who reported never being in love, suggesting that SMY health inequalities are found across various European countries and regions.

Romantic Attraction and Substance Use in 15-Year-Old Adolescents from Eight European Countries.

Sexual minority youth are at higher risk of substance use than heterosexual youth. However, most evidence in this area is from North America, and it is unclear whether the findings can be generalized to other cultures and countries. In this investigation, we used data from the 2014 Health Behaviour in School-aged Children (HBSC) study to compare substance use in same- and both-gender attracted 15-year-old adolescents from eight European countries (n = 14,545) to that of their peers who reported opposite-gender attraction or have not been romantically attracted to anyone. Both-gender attracted, and to a lesser extent, same-gender attracted adolescents were significantly more likely to smoke cigarettes, consume alcohol, get drunk and use cannabis, or be involved in multiple substance use in the last 30 days compared to their opposite-gender attracted peers. Those adolescents who have not been in love had significantly lower odds for substance use than all other youth. The pattern of results remained the same after adjusting for country, gender and family affluence. These findings are compatible with the minority stress and romantic stress theories. They suggest that sexual minority stigma (and love on its own) may contribute to higher substance use among adolescents in European countries.

Socio-Demographic, Health and Lifestyle Factors Influencing Age of Sexual Initiation among Adolescents.

Behavioural and developmental factors mean that adolescents who initiate sexual intercourse early may be at an increased risk of adverse sexual health outcomes at the time of first sex and later in life. In an Irish context, there is insufficient knowledge about the specific correlates of early sexual initiation. This research explores relationships between contextual socio-demographic, health and lifestyle factors and the timing of first sexual intercourse among 15⁻17-year-olds in Ireland. Multiple regression analysis was carried out in conjunction with Multiple Imputation using data collected through the 2014 Health Behaviour in School-Aged Children Ireland study on a sample of 879 sexually active adolescents. The socio-demographic and lifestyle factors measured were a stronger predictor of age of sexual initiation among girls than boys. Risk behaviour initiation was significantly related to age of sexual initiation for adolescents, while alcohol use/drunkenness and unhealthy food consumption was significant among girls only. Family support and number of male friends were significant predictors for boys only. The study highlights the need for holistic approaches to sexual health promotion and provides a foundation for the development of alternative strategies and policies aimed at reducing negative health, well-being, educational and economic outcomes.

The relationship between parental socio-economic status and episodes of drunkenness among adolescents: findings from a cross-national survey.

BACKGROUND: Behavioral factors such as (excessive) alcohol consumption play a major role in the explanation of social inequalities in health. The unequal distribution of health risk behaviors among socio-economic groups has important consequences for both the current and future health status of the younger generation. However, little is known about socio-economic differences in unhealthy lifestyles during adolescence. The purpose of the present study is to investigate socio-economic differences in adolescent drinking behaviour among 11-15 year old adolescents in Europe and North America. METHODS: Data was obtained from the Health Behaviour in School-aged Children (HBSC) study 2001/02, a cross-national survey conducted in collaboration with the World Health Organization. The present analysis is based on 69249 male and 73619 female students from 28 countries. The effect of parental occupation and family affluence on episodes of drunkenness was assessed using separate logistic regression models controlling for age. RESULTS: Socio-economic circumstances of the family had only a limited effect on repeated drunkenness in adolescence. For girls only in one out of 28 countries a significant association between family affluence and repeated drunkenness was observed, while boys from low and/or medium affluent families in nine countries faced a lower risk of drunkenness than boys from more affluent families. Regarding parental occupation, significant differences in episodes of drunkenness were found in nine countries for boys and in six countries for girls. Compared to family affluence, which was positively related to risk of drunkenness, a decreasing occupational status predicted an increasing risk of drunkenness. This pattern was identified within a number of countries, most noticeably for boys. CONCLUSION: Parental socio-economic status is only of limited importance for episodes of drunkenness in early adolescence, and this very limited role seems to apply for girls more than for boys and for parental occupation more than family affluence. For future studies it might be important to look at the effects of socio-economic status within the context of other peer, family and school related factors in order to assess to what extent those factors might mediate the effects of social class background.

Macro-level age norms for the timing of sexual initiation and adolescents' early sexual initiation in 17 European countries.

PURPOSE: To examine the relationship between country-level age norms for sexual initiation timing and early sexual initiation (ESI) among adolescent boys and girls. METHODS: Nationally representative data from 17 countries that participated in the 2006/2007 European Social Survey (ESS-3, n = 33,092) and the 2005/2006 Health Behaviour in School-Aged Children Study (HBSC, n = 27,702) were analyzed. Age norms were measured as the average country-level response to an item asking the age at which ESS respondents believed someone is too young to have sexual intercourse. HBSC respondents (aged 14-16 years) self-reported age at sexual initiation, which we defined as early (<15 years) or not early (≥15 years or no initiation). Control variables included age, family affluence, perceived socioeconomic status, family living arrangement, substance use, school attachment, and country-level legal age of consent. Multivariable three-level logistic models with random intercepts were run separately by sex. RESULTS: In multivariable analyses, higher overall age norms were associated with reduced likelihood of ESI among girls (AOR .60, 95% CI .45-.79); associations with ESI were stronger for parent cohort (ages 31-65 years) norms (AOR .37, 95% CI .23-.58) than for peer cohort (ages 15-20 years) norms (AOR .60, 95% CI .49-.74). For boys, overall norms were also significantly negatively associated with ESI (AOR .68, 95% CI .46-.99), as were parent cohort norms (AOR .66, 95% CI .45-.96). Peer cohort norms were not significantly related to boys' ESI. CONCLUSION: Macrolevel cultural norms may impact adolescents' sexual initiation timing. Research exploring the sexual health outcomes of early initiators in countries with contrasting age norms is warranted.

Comparing the clinical-effectiveness and cost-effectiveness of an internet-delivered Acceptance and Commitment Therapy (ACT) intervention with a waiting list control among adults with chronic pain: study protocol for a randomised controlled trial.

INTRODUCTION: Internet-delivered psychological interventions among people with chronic pain have the potential to overcome environmental and economic barriers to the provision of evidence-based psychological treatment in the Irish health service context. While the use of internet-delivered cognitive-behavioural therapy programmes has been consistently shown to have small-to-moderate effects in the management of chronic pain, there is a paucity in the research regarding the effectiveness of an internet-delivered Acceptance and Commitment Therapy (ACT) programme among people with chronic pain. The current study will compare the clinical-effectiveness and cost-effectiveness of an online ACT intervention with a waitlist control condition in terms of the management of pain-related functional interference among people with chronic pain. METHODS AND ANALYSIS: Participants with non-malignant pain that persists for at least 3 months will be randomised to one of two study conditions. The experimental group will undergo an eight-session internet-delivered ACT programme over an 8-week period. The control group will be a waiting list group and will be offered the ACT intervention after the 3-month follow-up period. Participants will be assessed preintervention, postintervention and at a 3-month follow-up. The primary outcome will be pain-related functional interference. Secondary outcomes will include: pain intensity, depression, global impression of change, acceptance of chronic pain and quality of life. A qualitative evaluation of the perspectives of the participants regarding the ACT intervention will be completed after the trial. ETHICS AND DISSEMINATION: The study will be performed in agreement with the Declaration of Helsinki and is approved by the National University of Ireland Galway Research Ethics Committee (12/05/05). The results of the trial will be published according to the CONSORT statement and will be presented at conferences and reported in peer-reviewed journals. TRIAL REGISTRATION NUMBER: ISRCTN18166896.