An Examination of Gender Differences in the Association of Adolescent Substance use with Eating and Weight Loss Attitudes.

OBJECTIVE: To assess gender differences in the relationship between eating and weight loss attitudes (EWAs), and 30-day tobacco and alcohol use among adolescents, while controlling for potential confounds (age, country of birth, psychological distress, pubertal development, peer alcohol and tobacco use, and sexual activity). METHODS: School students aged between 11 and 17 years (N = 10,273) from high schools in the State of Victoria (Australia) completed surveys in class under conditions of anonymity and confidentiality. RESULTS: The interaction between EWAs and gender was significant for tobacco use but not for alcohol use, indicating that the effect of EWAs on tobacco use, but not alcohol use, vary by gender. CONCLUSIONS: Tobacco use was related to EWAs in adolescent females but not males, and this is consistent with the possibility that females use tobacco in an instrumental fashion to control weight. Implications and Contribution: Female adolescents high in eating and weight loss attitudes were more likely to engage in tobacco use. In contrast, eating and weight loss attitudes were not related to male tobacco use. These results point to the potential importance of developing gender-specific approaches towards addressing problematic behaviors in adolescent populations.

Linking eating and weight control attitudes to relationship experiences: A large-scale survey of adolescent females.

OBJECTIVE: To examine the extent to which family conflict, peer bullying and psychological distress account for eating and weight loss attitudes in adolescent females. This study examined the degree to which psychological distress mediated the association between family conflict and eating and weight loss attitudes, and the association of bullying and eating and weight loss attitudes. METHOD: Females aged between 11 and 17 years (N = 5125) were recruited from schools in the State of Victoria (Australia). Key measures included psychological distress, family conflict, and bullying victimisation. RESULTS: A structural model showed good fit, and all predictors were significant. Psychological distress mediated the association between eating and weight loss attitudes, and family problems and bullying. CONCLUSION: Family conflict and peer bullying were associated with eating and weight loss attitudes and this association may occur via psychological distress. Early intervention programs may benefit from a focus on family and peer relationships.

Social Development Measures Associated with Problem Behaviours and Weight Status in Australian Adolescents.

During the adolescent years, substance use, anti-social behaviours and overweight/obesity are amongst the major public health concerns. We investigate if risk and protective factors associated with adolescent problem behaviours and substance use are also associated with weight status in young Australian adolescents. Data comes from the 2006 Healthy Neighbourhoods study, a cross-sectional survey of students attending primary (grade 6, mean age 11) and secondary (grade 8, mean age 12) schools in 30 communities across Australia. Adolescents were classified as not overweight, overweight or obese according to international definitions. Logistic and linear regression analyses, adjusted for age, gender and socio-economic disadvantage quartile, were used to quantify associations between weight status (or BMI z-score) and the cumulative number of problem behaviour risk and protective factors. Prevalence of overweight and obesity was 22.6 % (95 % confidence interval (CI), 21.2-24.0 %) and 7.2 % (CI, 6.3-8.3 %). Average number of risk and protective factors present was 4.0 (CI, 3.7-4.2) and 6.2 (CI, 6.1-6.3). Independently, total number of risk factors present was positively associated with likelihood of overweight and obesity, while number of protective factors present was inversely associated with the likelihood of being above a healthy weight. When both risk and protective factors were included in a regression model, only risk factors were associated with the likelihood of being overweight or obese. Average BMI z-score increased by 0.03 units with each additional risk factor present. Prevention programmes targeting developmental risk and protective factors in adolescents that reduce substance use and problem behaviours may also benefit physical health.

Associations between diet quality and depressed mood in adolescents: results from the Australian Healthy Neighbourhoods Study.

OBJECTIVE: Adolescence frequently coincides with the onset of psychiatric illness and depression is commonly observed in adolescents. Recent data suggest a role for diet quality in adult depression. Given the importance of adequate nutrition for brain development, it is of interest to examine whether diet quality is also related to depression in adolescents. METHODS: The study examined 7114 adolescents, aged 10-14 years, who participated in the Australian Healthy Neighbourhoods Study. Healthy and unhealthy diet quality scores were derived from a dietary questionnaire. The Short Mood and Feelings Questionnaire for adolescents measured depression. Adjustments were made for age, gender, socioeconomic status, parental education, parental work status, family conflict, poor family management, dieting behaviours, body mass index, physical activity, and smoking. RESULTS: Compared to the lowest category of the healthy diet score, the adjusted odds ratios (95% confidence interval) for symptomatic depression across categories (C) was: C2 = 0.61 (0.45-0.84); C3 = 0.58 (0.43-0.79); C4 = 0.47 (0.35-0.64); and C5 = 0.55 (0.40-0.77). Compared to the lowest quintile, the adjusted odds ratios (95% confidence interval) for symptomatic depression across increasing quintiles of the unhealthy diet score were: Q2 = 1.03 (0.87-1.22); Q3 = 1.22 (1.03-1.44); Q4 = 1.29 (1.12-1.50); and Q5 = 1.79 (1.52-2.11). CONCLUSIONS: Our results demonstrate an association between diet quality and adolescent depression that exists over and above the influence of socioeconomic, family, and other potential confounding factors.

Are rates of school suspension higher in socially disadvantaged neighbourhoods? An Australian study.

ISSUE ADDRESSED: Health promotion with adolescents spans many contexts including schools. Income and its distribution, education and social exclusion are key social determinants of health. Exclusionary school policies such as school suspension contribute to exclusion, increase the likelihood of school dropout (reducing educational and subsequent employment opportunities), and negatively impact on student wellbeing. Often excluded students are from socio-economically disadvantaged areas. This paper examines associations between area level socio-economic status (SES) and school suspension in Australian students. METHODS: Students (8,028) in years 6 (n = 4393) and 8 (n = 3635) completed a comprehensive social development survey administered in schools in 30 socio-economically stratified communities in 2006. RESULTS: Associations between area level SES and school suspension were found. Relative to students in the lowest SES quartile communities, students in mid level and high SES had lower suspension rates. These effects remained after controlling for antisocial behaviour, gender, age and the established risk factors of poor family management, interaction with antisocial peers and academic failure. CONCLUSIONS: Students living in low SES areas are exposed to higher rates of school suspension, at similar levels of adjustment problems. Assisting schools, particularly those with disadvantaged students, to foster school engagement is essential for schools committed to health promotion.

Challenges in profiling Australian scuba divers through surveys.

INTRODUCTION: This study aimed to compare the results from three Australian scuba diver surveys. As the surveys differed in recruitment methods, the expectation was that respondents would differ in some important characteristics. METHODOLOGY: Anonymous, online, cross-sectional surveys of the demographics, health, diving practices and outcomes were distributed to: (1) Divers Alert Network Asia-Pacific (DAN AP) members; (2) Professional Association of Diving Instructors (PADI) Asia-Pacific members; and (3) divers who had received any PADI non-leadership certification within the previous four years. Only data from divers resident in Australia were analysed. RESULTS: A total of 2,275 responses were received from current Australian residents, comprising 1,119 of 4,235 (26.4%) DAN members; 350 of 2,600 (13.5%) PADI members; and 806 of 37,000 (2.2%) PADI divers. DAN and PADI members had similar diving careers (medians 14 and 15 years, respectively). PADI members had undertaken more dives (median 800) than DAN members (330) and PADI divers (28). A total of 692 respondents reported suffering from diabetes or a cardiovascular, respiratory, neurological or psychological condition and included 34% of the DAN members and 28% of each of the PADI cohorts. Eighty-four divers had been treated for decompression illness (approximately 5% of DAN and PADI member groups and 1% of the PADI divers). Eighty-seven of 1,156 (7.5%) PADI respondents reported a perceived life-threatening incident while diving. CONCLUSIONS: Despite low response rates, this study indicates clear differences in the characteristics of the divers in the three cohorts. Therefore, a survey of a single cohort may represent that diving population alone and the findings may be misleading. This bias needs to be clearly understood and any survey findings interpreted accordingly.

Student survey trends in reported alcohol use and influencing factors in Australia.

INTRODUCTION AND AIMS: There is a need to explain reported trends of reduced alcohol and drug (substance) use in school-aged children in Australia. This study used student survey data collected in the states of Victoria, Western Australia and Queensland to examine trends in substance use and associated influencing factors. DESIGN AND METHODS: Youth self-reports were examined from 11 cross-sectional surveys completed by 41 328 adolescents (average age 13.5 years, 52.5% female) across 109 Australian communities between 1999 and 2015. Multi-level modelling was used to identify trends in adolescent reports of lifetime alcohol, tobacco and cannabis use, adjusted for age, gender, social disadvantage and minority status. Trends in influencing factors were also examined that included: individual attitudes, and family, school and community environments. Multivariate analyses estimated the main contributors to alcohol use trends. RESULTS: Alcohol, tobacco and cannabis use all fell significantly from 1999 to 2015. Higher levels of use were observed in Victoria compared to Western Australia or Queensland. Multivariate analyses identified reductions in favourable parent attitudes and lower availability of substances as direct contributors to reducing alcohol use trends. Indicators of school and family adjustment did not show similar trend reductions. DISCUSSION AND CONCLUSIONS: Reductions in adolescent alcohol, tobacco and cannabis use from 1999 to 2015 were associated with similar reductions in parent favourable attitudes and availability of substances. It is plausible that a reduced tendency for parents and other adults to supply adolescent alcohol are implicated in the reductions in adolescent alcohol use observed across Australia.

Peer drug use and adolescent polysubstance use: Do parenting and school factors moderate this association?

AIMS: This study examined the association between peer drug use and adolescent polysubstance use, and investigated if this association was moderated by parenting and/or school factors. METHODS: The sample consisted of 9966 participants (mean age=14.3; 49.34% males) randomly selected from secondary schools in Victoria, Australia. Three 30-day polysubstance use profiles were derived from latent class analysis - no drug use (47.7%), mainly alcohol use (44.1%) and polysubstance use (8.2%). These profiles were then regressed on peer's drug use, family conflict, parental monitoring, parental disapproval of drug use, school commitment, reward for prosocial involvement in school and academic failure, and the interactions between peer's drug use and each of the parenting and school variables. RESULTS: Relative to non-users, peer's drug use was strongly associated with polysubstance use (OR=30.91, p<0.001), and this association was moderated by parental disapproval of drug use (OR=0.46, p<0.001). This indicated that high level of parental disapproval may mitigate the negative influence of drug using peers. School commitment and parental monitoring were significantly associated with reduced likelihood of polysubstance use (p<0.05), but they did not moderate the relationship between peer drug use and adolescent polysubstance use. All analyses were adjusted for key demographic factors such as age, gender, areas of residence, birth place and family affluence. CONCLUSION: Reinforcing parent disapproval of drug use may be an important strategy in reducing adolescent substance use. Parents may need to be more integrated into mainstream prevention programs.

Does gender moderate the relationship between polydrug use and sexual risk-taking among Australian secondary school students under 16 years of age?

INTRODUCTION AND AIMS: This study examines the association of alcohol and polydrug use with risky sexual behaviour in adolescents under 16 years of age and if this association differs by gender. DESIGN AND METHODS: The sample consisted of 5412 secondary school students under 16 years of age from Victoria, Australia. Participants completed an anonymous and confidential survey during class time. The key measures were having had sex before legal age of consent (16 years), unprotected sex before 16 (no condom) and latent-class derived alcohol and polydrug use variables based on alcohol, tobacco, cannabis, inhalants and other illegal drug use in the past month. RESULTS: There were 7.52% and 2.55% of adolescents who reported having sex and having unprotected sex before 16 years of age, respectively. After adjusting for antisocial behaviours, peers' drug use and family and school risk factors, girls were less likely to have unprotected sex (odds ratio = 0.31, P = 0.003). However, the interaction of being female and polydrug use (odds ratio = 4.52, P = 0.004) was significant, indicating that girls who engaged in polydrug use were at higher risk of having unprotected sex. For boys, the effect of polydrug use was non-significant (odds ratio = 1.44, P = 0.310). Discussion and Conclusions For girls, polydrug use was significantly associated with unprotected sex after adjusting for a range of risk factors, and this relationship was non-significant for boys. Future prevention programs for adolescent risky sexual behaviour and polydrug use might benefit from a tailored approach to gender differences. [Chan GCK, Kelly AB, Hides L, Quinn C, Williams JW. Does gender moderate the relationship between polydrug use and sexual risk-taking among Australian secondary school students under 16 years of age? Drug Alcohol Rev 2016;35:750-754].

Individual, school-related and family characteristics distinguish co-occurrence of drinking and depressive symptoms in very young adolescents.

INTRODUCTION AND AIMS: Alcohol misuse and depressed mood are common during early adolescence, and comorbidity of these conditions in adulthood is associated with poorer health and social outcomes, yet little research has examined the co-occurrence of these problems at early adolescence. This study assessed risky and protective characteristics of pre-teens with concurrent depressed mood/early alcohol use in a large school-based sample. DESIGN AND METHODS: School children aged 10-14 years (n = 7289) from late primary and early secondary school classes in government, Catholic and independent sectors participated with parental consent in the cross-sectional Healthy Neighbourhoods Study. Key measures included depressed mood, recent alcohol use, school mobility, family relationship quality, school engagement and coping style. Multinomial logistic regression analyses were used to identify school and family-related factors that distinguished those with co-occurring drinking and depressive symptoms from those with either single condition. Gender and school-level interactions for each factor were evaluated. RESULTS: Co-occurring conditions were reported by 5.7% of students [confidence interval (CI)95 5.19, 6.19]. Recent drinkers were more likely than non-drinkers to have symptoms consistent with depression (odds ratio 1.80; CI95 1.58, 2.03). Low school commitment was associated with co-occurring drinking/depressive symptoms (odds ratio 2.86; CI95 2.25, 3.65 compared with null condition). This association appeared to be weaker in the presence of adaptive stress-coping skills (odds ratio 0.18; CI95 0.14, 0.23). CONCLUSIONS: We have identified factors that distinguish pre-teens with very early co-occurrence of drinking and depressed mood, and protective factors with potential utility for school-based prevention programmes targeting these conditions. [Salom CL, Kelly AB, Alati R, Williams GM, Patton GC, Williams JW. Individual, school-related and family characteristics distinguish co-occurrence of drinking and depressive symptoms in very young adolescents. Drug Alcohol Rev 2016;35:387-396].

Does parental monitoring and disapproval explain variations in alcohol use among adolescents from different countries of birth?

INTRODUCTION AND AIMS: This study investigated the extent to which parental monitoring and parental disapproval of alcohol use account for the association between country of birth and adolescent alcohol use. DESIGN AND METHODS: The sample consisted of 10 273 adolescents from grades 7 (Mean age = 12.5 years), 9 (14.5 years) and 11 (16.4 years) in Victoria, Australia. Participants completed a questionnaire during class time. Mediation analyses were performed to examine the extent to which parental monitoring and parental disapproval of alcohol use accounted for variations in past 30 day alcohol use between Australian-born and immigrant adolescents. RESULTS: Alcohol use in the past 30 days ranged from 8.0% to 44.4% for participants from different countries/regions of birth. Those born in Asia (odds ratio 0.20-0.51, P < 0.05) and Africa (odds ratio 0.45, P < 0.01) were much less likely to have consumed alcohol compared to those born in Australia. Adolescents from these two regions (except for Western Asia) reported higher levels of parental monitoring and parental disapproval of alcohol use (P < 0.05). Higher levels of parental monitoring and parental disapproval of alcohol use partially mediated the association between birth place and alcohol use (P < 0.05). DISCUSSION AND CONCLUSIONS: There were large variations in alcohol use between Australian-born and immigrant adolescents from different countries/regions. Adolescents from Asia or Africa were much less likely to consume alcohol, and this protective effect was partially accounted for by parental monitoring and disapproval of alcohol use.[Chan GCK, Kelly AB, Connor JP, Hall WD, Young RM, Williams JW. Does parental monitoring and disapproval explain variations in alcohol use among adolescents from different countries of birth? Drug Alcohol Rev 2016;35:741-749].

The relationship between psychological distress and adolescent polydrug use.

Polydrug use is relatively common among adolescents. Psychological distress is associated with the use of specific drugs, and may be uniquely associated with polydrug use. The purpose of this study was to test the association of psychological distress with polydrug use using a large adolescent sample. The sample consisted of 10,273 students aged 12-17 years from the State of Victoria, Australia. Participants completed frequency measures of tobacco, alcohol, cannabis, inhalant, and other drug use in the past 30 days, and psychological distress. Control variables included age, gender, family socioeconomic status, school suspensions, academic failure, cultural background, and peer drug use. Drug-use classes were derived using latent-class analysis, then the association of psychological distress and controls with drug-use classes was modeled using multinomial ordinal regression. There were 3 distinct classes of drug use: no drug use (47.7%), mainly alcohol use (44.1%), and polydrug use (8.2%). Independent of all controls, psychological distress was higher in polydrug users and alcohol users, relative to nondrug users, and polydrug users reported more psychological distress than alcohol users. Psychological distress was most characteristic of polydrug users, and targeted prevention outcomes may be enhanced by a collateral focus on polydrug use and depression and/or anxiety.

The association of puberty and young adolescent alcohol use: do parents have a moderating role?

PURPOSE: To explore the extent to which parent-adolescent emotional closeness, family conflict, and parental permissiveness moderate the association of puberty and alcohol use in adolescents (aged 10-14). METHODS: Cross-sectional survey of 7631 adolescents from 231 Australian schools. Measures included pubertal status, recent (30day) alcohol use, parent-adolescent emotional closeness, family conflict, parental permissiveness of alcohol use and peer alcohol use. The analysis was based on a two-level (individuals nested within schools) logistic regression model, with main effects entered first, and interaction terms added second. RESULTS: The interaction of family factors and pubertal stage did not improve the fit of the model, so a main effect model of family factors and pubertal stage was adopted. There were significant main effects for pubertal stage with boys in middle puberty at increased odds of alcohol use, and girls in advanced puberty at increased odds of alcohol use. CONCLUSIONS: Puberty and family factors were strong predictors of adolescent alcohol use, but family factors did not account for variation in the association of pubertal stage and alcohol use.

Changes in body mass index and health related quality of life from childhood to adolescence.

OBJECTIVE: To determine longitudinal relationships between body mass index (BMI) and health-related quality of life (HRQoL) in an adolescent population sample. Design. Data collected in 2000 and 2005 within the Health of Young Victorians longitudinal cohort study. SETTING: Originally a community sample of elementary school students in Victoria, Australia. Follow-up occurred in either secondary schools or individuals homes. PARTICIPANTS: Cohort recruited in 1997 via a random sampling design from Victorian elementary schools. Originally comprising 1 943 children, 1 569 (80.8%) participated in 2000 (wave 2, 8-13 years) and 851 (54%) in 2005 (wave 3, 13-19 years). Main outcome measures. In both waves participants and their parents completed the PedsQL, a 23-item child HRQoL measure, and BMI z-scores and status (non-overweight, overweight or obese) were calculated from measured height and weight. Associations were tested cross-sectionally and longitudinally (linear regression, adjusted for baseline values) RESULTS: A total of 81.6% remained in the same BMI category, while 11.4% and 7.0% moved to higher and lower categories, respectively. Cross-sectional inverse associations between lower PedsQL and higher BMI categories were similar to those for elementary school children. Wave 2 BMI strongly predicted wave 3 BMI and wave 2 PedsQL strongly predicted wave 3 PedsQL. Only parent-reported Total PedsQL score predicted higher subsequent BMI, though this effect was small. Wave 2 BMI did not predict wave 3 PedsQL. CONCLUSIONS: This novel study confirmed previous cross-sectional associations, but did not provide convincing evidence that BMI is causally associated with falling HRQoL or vice versa across the transition from childhood to adolescence.

Gender differences in personal, social and environmental influences on active travel to and from school for Australian adolescents.

Active travel (walking or cycling for transport) is an important contributor to adolescents overall physical activity (PA). This study examines associations between personal, social and environmental variables and active travel to and from school using data from a large observational study to examine active travel in 2961 year 6 and 8 students (48.7% male), aged 10-14 years (M=11.4, SD=0.8yrs) from 231 schools. Participants completed an on-line survey and all reported living within 2km of school. Data collected included mode of travel to and from school, self-reported health, and PA variables. Social environmental variables included having playgrounds, parks or gyms close by, feeling safe to walk alone, barriers to walking in the neighbourhood (e.g. traffic, no footpaths), peer and family support for PA, existence of sports teams/scout groups, community disorder and perceived neighbourhood safety. Results showed that while more girls (44.3%) than boys (37.4%) walked to school, lower proportions rode bikes (8.3% vs 22.4%) and hence fewer were active travellers overall. Logistic regression models, adjusted for age, location and socio-economic status were conducted for active travel to/from school, separately for boys and girls. Predictors for boys and girls being 'active travellers' to/from school included recreational facilities close to home, higher perceived safety of the neighbourhood and higher community disorder. For boys, social support from friends, scout groups available and higher enjoyment of physical activity was also important. These findings suggest areas for future research and may be used to guide strategies to increase active travel to and from school.

BMD in population-based adult women is associated with socioeconomic status.

With few exceptions, an inverse relationship exists between social disadvantage and disease. However, there are conflicting data for the relationship between socioeconomic status (SES) and BMD. The aim of this study was to assess the association between SES and lifestyle exposures in relation to BMD. In a cross-sectional study conducted using 1494 randomly selected population-based adult women, we assessed the association between SES and lifestyle exposures in relation to BMD. BMD was measured at multiple anatomical sites by DXA. SES was determined by cross-referencing residential addresses with Australian Bureau of Statistics 1996 census data for the study region and categorized in quintiles. Lifestyle variables were collected by self-report. Regression models used to assess the relationship between SES and BMD were adjusted for age, height, weight, dietary calcium, smoking, alcohol consumption, physical activity, hormone therapy, and calcium/vitamin D supplements. Unadjusted BMD differed across SES quintiles (p < 0.05). At each skeletal site and SES index, a consistent peak in adjusted BMD was observed in the mid-quintiles. Differences in adjusted BMD were observed between SES quintiles 1 and 4 (3-7%) and between quintiles 5 and 4 (2-7%). At the spine, the maximum difference was observed (7.5%). In a subset of women, serum 25(OH)D explained a proportion of the association between SES and BMD (difference remained up to 4.2%). Observed differences in BMD across SES quintiles, consistent across both SES indices, suggest that low BMD may be evident for both the most disadvantaged and most advantaged.