Review: Can digital mental health interventions bridge the 'digital divide' for socioeconomically and digitally marginalised youth? A systematic review.

BACKGROUND: Digital mental health interventions (DMHIs) have the potential to improve the efficiency, accessibility and effectiveness of mental health services for young people, with the potential to reach socioeconomically and digitally marginalised young people with mental health needs who would otherwise not seek help in person. This review aims to investigate the characteristics, acceptability and efficacy of DMHIs specifically developed for socioeconomically and digitally marginalised youth. METHOD: Key databases were searched widely and systematically (EMBASE, MEDLINE, PsycINFO, OpenGrey). Final inclusion in this review required studies to evaluate DMHIs specifically targeting socioeconomically and digitally marginalised children and young people through a broad range of research designs. RESULTS: Ten studies, describing seven DHMIs, were included in this review. Studies varied in terms of methodology, population, intervention, outcome measures, technologies used and methodological quality. Qualitative and quantitative results are synthesised across three key phenomena of interest: effectiveness, acceptability and feasibility. Findings suggest that there is moderate but limited evidence supporting DMHIs for improving mental health outcomes among these populations. CONCLUSIONS: While there is moderate evidence suggesting that digitally delivered interventions can be effective in improving mental health outcomes among socioeconomically and digitally marginalised youth, more high-quality research is needed in order to determine whether DMHIs can fully bridge the so-called 'digital divide'.

Exploring the economics of public health intervention scale-up: a case study of the Supporting Healthy Image, Nutrition and Exercise (SHINE) cluster randomised controlled trial.

BACKGROUND: The costs and benefits of an intervention within the intervention testing phase may differ from those experienced when that intervention is implemented and delivered at scale. Yet limited empirical work has been undertaken to explore how economic constructs related to implementation and scale-up might have an impact on intervention cost. The aim of this study was to explore the potential economic impacts of implementation and scale-up on a healthy weight and body image intervention tested in a Type II translational research trial. METHODS: The Supporting Healthy Image, Nutrition and Exercise (SHINE) study is a cluster randomised controlled trial, aiming to deliver universal education about healthy nutrition, physical activity and wellbeing behaviours to adolescents in Australian secondary schools. Data on the cost of the intervention were collected alongside the trial using standard micro-costing techniques. Semi-structured interviews were conducted with key intervention stakeholders to explore the potential economic impacts of implementation and scale-up. Thematic content analysis was undertaken by two authors. RESULTS: Fifteen intervention group schools participated in the 8-week online intervention targeting students in 2019 (99 Grade 7 classes; 2,240 students). Booster sessions were delivered during one class session in Grades 8 and 9, in 2020 and 2021 respectively. Time costs of intervention delivery and co-ordination comprised the majority (90%) of intervention cost as per the trial, along with costs associated with travel for intervention training and equipment. Themes related to the benefit of the intervention emerged from interviews with six intervention stakeholders, including the potential for economies of scale afforded by online delivery. Contextual themes that may have an impact on intervention implementation and scale included acceptability across all school sectors, availability and reliability of IT infrastructure for intervention delivery and variations in population characteristics. A number of key alterations to the intervention program emerged as important in supporting and sustaining intervention scale-up. In addition, significant implementation costs were identified if the intervention was to be successfully implemented at scale. CONCLUSIONS: The findings from this study provide important information relevant to decisions on progression to a Type III implementation trial, including budget allocation, and will inform modelled economic evaluation.

Measurement invariance of the Multidimensional Depression Assessment Scale (MDAS) across gender and ethnic groups of Asian, Caucasian, Black, and Hispanic.

BACKGROUND: Major Depressive Disorder is a severe and highly disabling mental illness. Almost all self-reported questionnaires have overlooked the interpersonal symptoms of depression which are important across gender and culture. The Multidimensional Depression Assessment Scale (MDAS) developed by Cheung and Power (2012) entails comprehensive emotional, cognitive, somatic, and interpersonal subscales. It addresses the criticism that existing self-report depression scales might not cover sufficient phenomenological heterogeneity of depression. The current study aimed to evaluate the psychometric properties of the MDAS across gender and four major ethnic groups of Caucasian, Black, Asian and Hispanic, including reliability and concurrent validity against the Centre for Epidemiological Studies Depression Scale (CESD) and Patients Health Questionnaire (PHQ-9). It also aimed to establish a stable factor structure across gender and ethnic groups and test the measurement invariance to enhance its potential for clinical use. METHODS: A community sample of 3499 participants from four ethnic groups were recruited via online crowdsourcing sites of Qualtrics and Amazon M Turk. Each individual completed a demographic questionnaire, the MDAS, CESD and PHQ-9. RESULTS: There was good internal consistency (Cronbach's alpha >0.90) and concurrent reliability across gender and ethnic groups. Strict measurement invariance was established for MDAS over a four-factor factor structure corresponding to the four subscales. CONCLUSIONS: The MDAS showed good psychometric properties and measurement invariance of a four-factor structure, suggesting its potential to be used in clinical settings across gender and ethnic groups. LIMITATIONS: Participants all answered the questionnaires in English, which could hinder cultural variations in their expression of symptoms.

Barriers and enablers of contraceptive use among adolescent girls and women under 30 years of age in Cambodia: a qualitative study.

OBJECTIVE: Unintended pregnancy and an unmet need for modern contraception remain high among adolescent girls and women in Cambodia. Qualitative descriptive research was conducted to explore the barriers to contraceptive use among young women in urban Cambodia. METHODS: Semi-structured interviews were conducted among 30 adolescent girls and women aged 16-27 years, using purposive and snowball sampling strategies until data saturation was achieved. The audio-recorded interviews were transcribed verbatim and quality-checked. Inductive thematic data analysis was conducted. The results are presented using Bronfenbrenner's theoretical social ecological model. RESULTS: The emerging major and minor themes indicate misconceptions about hormonal contraception as well as women's preference for using oral contraceptive pills for family planning after an unintended pregnancy. Women had low autonomy in choosing a contraceptive method, as their partners or husbands tended to prefer the withdrawal method. Young women faced cultural and supply chain barriers in accessing short- and long-acting reversible modern contraceptive methods at health centres. CONCLUSION: Cambodian women aged 16-27 years are a vulnerable group who have low autonomy and sexual and reproductive health literacy and also face gender inequality.

Factors influencing unmet need for contraception amongst adolescent girls and women in Cambodia.

BACKGROUND: Unmet need is the gap between women's need and their practice of using contraception. Unmet need for contraception in female adolescents and women in Cambodia is a public health concern which may lead to unintended pregnancies or abortions that can contribute to maternal morbidity and mortality. METHODS: Bronfenbrenner's Social Ecological Model was used as a theoretical framework to analyze data from the 2014 Cambodian Demographic and Health Survey to ascertain demographic and social factors potentially associated with unmet need for contraception. Bivariate and weighted multiple logistic regression analyses with adjusted odds ratios (AOR) were conducted for 4,823 Cambodian, sexually active females aged 15-29 years. RESULTS: The percentage of unmet need for contraception was 11.7%. At the individual level of the Social Ecological Model, there was an increased likelihood of unmet need in adolescent girls 15-19 years and women 20-24 years. Unmet need was decreased in currently employed women. At the microenvironment level, there was an increased likelihood of unmet need with the husband's desire for more children and when the decision for a woman's access to healthcare was made by someone else in the household. At the macroenvironment level, unmet need was decreased in women who could access a health facility near their residence to obtain medical care. There were no urban rural differences found in the Cambodian sample population. CONCLUSION: Unmet need for contraception in Cambodian females adolescents and women is associated with younger age, unemployment and low personal autonomy for accessing healthcare but not with education or wealth status. There is a need to implement culturally appropriate reproductive and sexual health literacy programs to increase access to modern contraception and to raise women's autonomy.

Protocol for economic evaluation alongside the SHINE (Supporting Healthy Image, Nutrition and Exercise) cluster randomised controlled trial.

INTRODUCTION: Limited evidence exists on the cost-effectiveness of interventions to prevent obesity and promote healthy body image in adolescents. The SHINE (Supporting Healthy Image, Nutrition and Exercise) study is a cluster randomised control trial (cRCT) aiming to deliver universal education about healthy nutrition and physical activity to adolescents, as well as targeted advice to young people with body image concerns who are at risk of developing disordered eating behaviours. This paper describes the methods for the economic evaluation of the SHINE cRCT, to determine whether the intervention is cost-effective as an obesity prevention measure. METHODS AND ANALYSIS: A public payer perspective will be adopted, with intervention costs collected prospectively. Within-trial cost-effectiveness analysis (CEA) and cost-utility analysis (CUA) will quantify the incremental costs and health gains of the intervention as compared with usual practice (ie, teacher-delivered curriculum). CEA will present results as cost per body mass index unit saved. CUA will present results as cost per quality-adjusted life year gained. A modelled CUA will extend the target population, time horizon and decision context to provide valuable information to policymakers on the potential for incremental cost offsets attributable to disease prevention arising from intervention. Intervention costs and effects will be extrapolated to the population of Australian adolescents in Grade 7 of secondary school (approximate age 13 years) and modelled over the cohort's lifetime. Modelled CUA results will be presented as health-adjusted life years saved and healthcare cost-savings of diseases averted. Incremental cost-effectiveness ratios will be calculated as the difference in costs between the intervention and comparator divided by the difference in benefit. Semi-structured interviews with key intervention stakeholders will explore the potential impact of scalability on cost-effectiveness. These data will be thematically analysed to inform sensitivity analysis of the base case economic evaluation, such that cost-effectiveness evidence is reflective of the potential for scalability. ETHICS AND DISSEMINATION: Ethics approval was obtained from the Deakin University Human Research Ethics Committee (#2017-269) and the Victorian Department of Education and Training (#2018_003630). Study findings will be disseminated through peer-reviewed academic papers and participating schools will receive annual reports over the 3 years of data collection. TRIAL REGISTRATION NUMBER: ACTRN 12618000330246; Pre-results.

Burden of diabetes and oral cancer in India.

Oral cancer and diabetes are highly prevalent among the Indian population and are part of the top four non-communicable diseases responsible for mortality and morbidity. Their numbers are so great that they pose a unique burden to the socioeconomic growth of the country. In recent years, there has been an increase in the number of studies examining the role of diabetes in oral cancer reporting co-existence of diabetes and cancer. There is also growing evidence of a higher risk for developing a number of cancers among individuals with diabetes, including pancreatic, liver, gynecologic, colorectal, oral and breast cancer, and consequently 'diabetic oncopathy' is emerging as one of the complications of diabetes. Diabetes may lead to the development of cancer through oxidative damage leading to accumulation of DNA mutations and/or through immune dysfunction, which predisposes to viral infection. Cancer and diabetes may co-occur due to shared risk factors such as increased insulin-like growth factor-1 and obesity, but there is no clear biologic link between the two disorders. This literature review aims to review the evidence showing the current burden of two non-communicable diseases, diabetes and oral cancer and their potential association, with particular reference to India.

Validation of Chinese Multidimensional Depression Assessment Scale (MDAS) in Inner Mongolia pregnant women and risk factors of antenatal depression in Inner Mongolia in the era of one-child policy.

BACKGROUND: Pregnancy involves physiological changes in reproductive and endocrine systems, and social role changes that can increase the risk of mental health problems. In China, greater emphasis has been given to postpartum depression and its negative impact on infant development. This study examined depression in pregnant women in Inner Mongolia, who are under the influence of cultural values of collectivism and social factors specific to China. Chinese society adheres firmly to traditional values, while market reform, birth-control policy, together with high parental investment in childcare and rearing construct a unique and sometimes unfavorable environment for Chinese women that may influence their depression expression. THE AIMS OF THIS STUDY ARE TWOFOLD: First, it validated the Chinese Multidimensional Depression Assessment Scale (MDAS), a holistic self-report questionnaire measuring depression severity in four domains of depression-emotional, somatic, cognitive and interpersonal in pregnant women in Inner Mongolia; second, it examined the influences of demographic characteristics (including age, education and employment), pregnancy characteristics (week of gestation, first pregnancy), self-esteem, social support, social activity, work stress, and work-family balance on depression. METHODS: A total of 234 pregnant women, mostly in their third trimester, were recruited in an antenatal hospital in Inner Mongolia and self-reported questionnaires were completed. RESULTS: Using Confirmatory factor analysis (CFA), MDAS gave rise to a best-fit four-factor model corresponding to each subscale when it was first developed. MDAS also reported high Cronbach's alpha (0.96) and good convergent validity. Using hierarchical multiple linear regressions with significant demographic variables controlled for, self-esteem, work-family conflict, and social support were found to be significant predictors for depression. CONCLUSIONS: MDAS is a valid scale to be used with Chinese pregnant women, especially in more collectivistic geographical areas. Risk factors specific to the Chinese context add insights to the experience of antenatal depression in China and contribute to understanding depression in from a global mental health perspective.

A qualitative exploration of the sexual and reproductive health knowledge of adolescent mothers from indigenous populations in Ratanak Kiri Province, Cambodia.

INTRODUCTION: Adolescents from indigenous populations in Ratanak Kiri Province in Cambodia experience worse sexual and reproductive health (SRH) outcomes when compared to their urban counterparts. However, few qualitative studies have been conducted to identify factors that may explain the poor SRH outcomes experienced by this population group. METHODS: The socioecological model was used as the analytical lens to explore the SRH knowledge and sources of SRH information of adolescent mothers (aged 15-19 years) from indigenous populations in north-eastern Cambodia. Adolescent mothers from the Tompoun and Jarai indigenous population groups (n=22) were purposively recruited from seven villages in two districts of Ratanak Kiri Province. All adolescent mothers engaged in a combined body mapping exercise and semi-structured interview; this approach was considered the most appropriate qualitative data collection method to use in this context as it reduced language, cultural and social barriers that have previously restricted qualitative exploration of sensitive issues among this population group. The body maps and semi-structured interview transcripts were analysed using thematic analysis. RESULTS: Adolescent mothers demonstrated limited SRH knowledge including that pertaining to the anatomy of the female reproductive body, the physiology of human reproduction, fertility and pregnancy. Adolescents' primary source of SRH information was interaction with female family members and friends within their community. Adolescents' limited SRH knowledge was influenced by factors on individual (eg educational attainment, child marriage), relationship (eg social interaction with female family members and friends), community (eg access to educational and healthcare services) and societal (eg barriers to accessing national SRH programs and initiatives) levels. CONCLUSION: The%u202Ffindings support the need for SRH education in the primary and secondary school curriculum. In 2018 the Cambodia Ministry of Education, Youth and Sports introduced a Comprehensive Sexuality Education (CSE) program into the government primary and secondary school curriculum. The CSE, which is delivered in the Khmer language, provides Cambodian youth with an avenue to access accurate SRH information that will aid their SRH decision-making. However, indigenous girls face numerous social, cultural, economic and language barriers that restrict or prevent their access to formal education. Therefore, additional SRH materials and resources that are culturally and linguistically appropriate need to be developed for indigenous students attending primary and secondary schools in Ratanak Kiri Province and for young people who have ceased formal education. Educating village chiefs to deliver non-formal, community-based education programs is proposed as a means of increasing SRH knowledge and reducing health inequalities faced by this population group while ensuring that accurate information is delivered in a culturally appropriate manner.

Factors Influencing Unintended Pregnancies amongst Adolescent Girls and Young Women in Cambodia.

Background: Unintended pregnancies in Cambodian youth are a major reproductive health concern with detrimental personal and socioeconomic consequences. A social ecological model was used to identify sociodemographic factors potentially associated with unintended pregnancies, and an analysis of data from the 2014 Cambodian Demographic and Health Survey was used to determine associations. Methods: Weighted data were analysed using multiple logistic regression analyses for 3406 Cambodian sexually active single, in union or married females aged 15-29 years. Results: The prevalence of unintended pregnancy was 12.3%. Unintended pregnancy was significantly associated with younger age groups (15-24 years), multiparity, history of abortion, and current use of modern contraceptive methods. All women had an increased likelihood of unintended pregnancy when the husband alone or someone else in the household made decisions about their access to healthcare. Conclusion: The burden of unintended pregnancies is associated with young age, multiparity, history of abortions, unemployment, and low autonomy for accessing healthcare. Multi-pronged, holistic reproductive and sexual health program interventions are needed to increase literacy and accessibility to modern contraception and to raise awareness about women's health and status in Cambodia.

Social marketing and community mobilisation to reduce underage alcohol consumption in Australia: A cluster randomised community trial.

BACKGROUND AND AIMS: In many countries adolescent alcohol use is a major health problem. To supplement national policies, it is important to trial community interventions as a potential strategy to prevent adolescent alcohol use. METHODS: This study evaluated a multicomponent community intervention that included community mobilisation, social marketing, and the monitoring of alcohol sales to minors. Evaluation was a clustered randomised trial design with 14 intervention and 14 control communities. Prior to randomisation, communities were matched on socioeconomic status and location. Intervention communities were not blinded. PARTICIPANTS: 3545 Year 8 students (M = 12 years) were surveyed at baseline from 75 schools; 3377 students were surveyed post intervention in 2013 from 54 schools. OUTCOMES: It was hypothesised that the primary outcome, individual alcohol consumption in last 30 days, after the intervention would be 15% lower in intervention communities. Secondary outcomes were consumption in the past year and intention not to drink before age 18. RESULTS: The intervention communities showed larger relative reductions compared to the controls in last 30-day consumption and past year (10%), but not significantly different. A significantly lower proportion of participants in the intervention community (63%), compared to the controls (71%), reported intending to drink before 18 years old. Subgroup analysis identified regional and state differences for some secondary measures. CONCLUSIONS: Intervention assignment was associated with lower adolescent intention to drink before the age of 18. However, more intensive and longer-term intervention may be required to measure significant differences in behaviour change. TRIAL REGISTRATION: ACTRN12612000384853. PROTOCOL: Rowland B, Toumbourou JW, Osborn A, et al. BMJ Open 2013;3:e002423. doi:10.1136/bmjopen-2012-002423.

Risky dieting amongst adolescent girls: Associations with family relationship problems and depressed mood.

OBJECTIVE: This study examined the association of risky dieting amongst adolescent girls with depressed mood, family conflict, and parent-child emotional closeness. METHOD: Grade 6 and 8 females (aged 11-14years, N=4031) were recruited from 231 schools in 30 communities, across three Australian States (Queensland, Victoria, and Western Australia). Key measures were based on the Adolescent Dieting Scale, Short Mood and Feelings Questionnaire, and widely used short measures of family relationship quality. Controls included age, early pubertal onset, and socioeconomic status. RESULTS: Risky dieting was significantly related to family conflict and depressed mood, depressed mood mediated the association of family conflict and risky dieting, and these associations remained significant with controls in the model. CONCLUSION: Family conflict and adolescent depressed mood are associated with risky dieting. IMPLICATIONS: Prevention programs may benefit from a broadening of behavioural targets to include depressed mood and family problems.

The Australian longitudinal study on male health-methods.

BACKGROUND: The Australian Longitudinal Study on Male Health (Ten to Men) was established in 2011 to build the evidence base on male health to inform policy and program development. METHODS: Ten to Men is a national longitudinal study with a stratified multi-stage cluster random sample design and oversampling in rural and regional areas. Household recruitment was conducted from October 2013 to July 2014. Males who were aged 10 to 55 years residing in private dwellings were eligible to participate. Data were collected via self-completion paper questionnaires (participants aged 15 to 55) and by computer-assisted personal interview (boys aged 10 to 14). Household and proxy health data for boys were collected from a parent via a self-completion paper-based questionnaire. Questions covered socio-demographics, health status, mental health and wellbeing, health behaviours, social determinants, and health knowledge and service use. RESULTS: A cohort of 15,988 males aged between 10 and 55 years was recruited representing a response fraction of 35 %. CONCLUSION: Ten to Men is a unique resource for investigating male health and wellbeing. Wave 1 data are available for approved research projects.

Healthy weight regulation and eating disorder prevention in high school students: a universal and targeted Web-based intervention.

BACKGROUND: Given the rising rates of obesity in children and adolescents, developing evidence-based weight loss or weight maintenance interventions that can be widely disseminated, well implemented, and are highly scalable is a public health necessity. Such interventions should ensure that adolescents establish healthy weight regulation practices while also reducing eating disorder risk. OBJECTIVE: This study describes an online program, StayingFit, which has two tracks for universal and targeted delivery and was designed to enhance healthy living skills, encourage healthy weight regulation, and improve weight/shape concerns among high school adolescents. METHODS: Ninth grade students in two high schools in the San Francisco Bay area and in St Louis were invited to participate. Students who were overweight (body mass index [BMI] >85th percentile) were offered the weight management track of StayingFit; students who were normal weight were offered the healthy habits track. The 12-session program included a monitored discussion group and interactive self-monitoring logs. Measures completed pre- and post-intervention included self-report height and weight, used to calculate BMI percentile for age and sex and standardized BMI (zBMI), Youth Risk Behavior Survey (YRBS) nutrition data, the Weight Concerns Scale, and the Center for Epidemiological Studies Depression Scale. RESULTS: A total of 336 students provided informed consent and were included in the analyses. The racial breakdown of the sample was as follows: 46.7% (157/336) multiracial/other, 31.0% (104/336) Caucasian, 16.7% (56/336) African American, and 5.7% (19/336) did not specify; 43.5% (146/336) of students identified as Hispanic/Latino. BMI percentile and zBMI significantly decreased among students in the weight management track. BMI percentile and zBMI did not significantly change among students in the healthy habits track, demonstrating that these students maintained their weight. Weight/shape concerns significantly decreased among participants in both tracks who had elevated weight/shape concerns at baseline. Fruit and vegetable consumption increased for both tracks. Physical activity increased among participants in the weight management track, while soda consumption and television time decreased. CONCLUSIONS: Results suggest that an Internet-based, universally delivered, targeted intervention may support healthy weight regulation, improve weight/shape concerns among participants with eating disorders risk, and increase physical activity in high school students. Tailored content and interactive features to encourage behavior change may lead to sustainable improvements in adolescent health.

Prevalence and community variation in harmful levels of family conflict witnessed by children: implications for prevention.

Children's reports of high family conflict consistently predict poor outcomes. The study identified criteria for high family conflict based on prospective prediction of increased risk for childhood depression. These criteria were subsequently used to establish the prevalence of high family conflict in Australian communities and to identify community correlates suitable for targeting prevention programs. Study 1 utilised a longitudinal design. Grade 6 and 8 students completed a family conflict scale (from the widely used Communities That Care survey) in 2003 and depression symptomotology were evaluated at a 1-year follow-up (International Youth Development Study, N = 1,798). Receiver-operating characteristic analysis yielded a cut-off point on a family conflict score with depression symptomatology as a criterion variable. A cut-off score of 2.5 or more (on a scale of 1 to 4) correctly identified 69 % with depression symptomology, with a specificity of 77.2 % and sensitivity at 44.3 %. Study 2 used data from an Australian national survey of Grade 6 and 8 children (Healthy Neighbourhoods Study, N = 8,256). Prevalence estimates were calculated, and multivariate logistic regression with multi-level modelling was used to establish factors associated with community variation in family conflict levels. Thirty-three percent of Australian children in 2006 were exposed to levels of family conflict that are likely to increase their future risk for depression. Significant community correlates for elevated family conflict included Indigenous Australian identification, socioeconomic disadvantage, urban and state location, maternal absence and paternal unemployment. The analysis provides indicators for targeting family-level mental health promotion programs.

Community variation in adolescent alcohol use in Australia and the Netherlands.

To investigate the cross-national relevance of community health promotion, this paper compared community variation in alcohol use and risk and protective factors for adolescents in Australia (State of Victoria, 2009) and the Netherlands (2007/2008). Multi-level analyses examined community variation in heavy episodic (binge) alcohol use [≥5 drinks in a session ≥once in the prior fortnight (>63 ml of ethanol)] and associations with predictors. Representative community samples of adolescents (12-17 years) were recruited. The participants were 7812 students from 36 Australian communities and 15 082 adolescents from 124 Dutch communities. Predictors included adolescent reports of family, school, peer and neighbourhood environments and community predictors (rural, disadvantage). The overall prevalence of alcohol use prevalence was similar in both nations. Australia had higher use at younger ages and no difference between genders. In the Netherlands older adolescents and males used alcohol at significantly higher rates. Although individual predictors were mostly similar, binge drinking was more strongly associated with poor family management, friends' use of drugs and community disorganization in Australia. Significant community variation in adolescent heavy alcohol use was observed in both countries, but was higher in the Netherlands [inter class correlation 6.1%, (95% CI: 4.5-8.3%)] than Australia (ICC 2.4%, 1.3-4.5%). Youth from rural areas drank at a higher level, especially in the Netherlands. Targeting community level adolescent alcohol use appears feasible in both countries. Although behavioural patterns and risk and protective influences are similar in the Netherlands and Australia, important differences should be taken into account in tailoring community interventions.

Family relationship quality and early alcohol use: evidence for gender-specific risk processes.

OBJECTIVE: Family characteristics (relationship quality, parental behaviors, and attitudes relating to alcohol use) are known to influence alcohol use in the mid-teen years, and there is evidence that family characteristics have different influences on mid-teen girls versus boys. This study examined child gender differences in the association of family relationship quality, parental disapproval of children's alcohol use, and parental alcohol use with early adolescent alcohol use. METHOD: Grade 6 and 8 students (modal age 11 and 13, respectively; N = 6,837; 52.6% female) were recruited from 231 schools across three Australian states. Hypotheses were tested using two-level ordinal logistic regression (individuals nested within schools). The main dependent measure was lifetime frequency of early adolescent alcohol consumption. Independent variables included mother's/father's alcohol use, closeness, conflict, and disapproval of adolescent alcohol use. Control variables included sensation seeking, peer alcohol use, and socioeconomic disadvantage. RESULTS: The key findings were that for the young age group (Grade 6), emotional closeness to the parent of the opposite sex was protective. Family conflict was associated with females' drinking in both age groups but not males' drinking. CONCLUSIONS: There was evidence of gender differences in the epidemiology of family relationship quality and early alcohol use. Social developmental models may need revision to account for these child gender differences. Gender-specific family dynamics may be an important consideration for family-oriented prevention strategy.

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.

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.

How do school-day activity patterns differ with age and gender across adolescence?

PURPOSE: A knowledge of how young people use their time could be instrumental in informing health interventions, modeling consumer behaviors, and planning service delivery. The aim of the present study was to describe age- and gender-related patterns in the self-reported use of time on school days in a large sample of Australian children and adolescents aged between 10 and 18 years. METHODS: A single, detailed use-of-time diary for a school day was collected from 6024 Australians aged 10-18 from several state and regional surveys conducted in the states of South Australia (SA) and Victoria between 2001 and 2006. Time-use profiles were analyzed for a range of active and sedentary state behaviors. RESULTS: Boys reported higher physical activity levels (PALs), moderate-to-vigorous physical activity (MVPA), and sports than girls. There were no differences in free play, and girls used more active transport. All activity-related variables decreased with age, except active transport, which peaked at 14-15 years. Boys exhibited higher levels of screen time, whereas girls had higher levels of passive transport. Screen time and its components (television, videogames, and computer use) peaked in the peripubertal years. CONCLUSION: Age- and gender-related patterns of time use vary greatly within adolescence. This may reflect a mix of biological and social factors.