Lower levels of physical activity volume are beneficial, and it's never too late to start: Results from the HUNT Study, Norway.

AIMS: We aimed to explore (a) how different patterns of physical activity (PA) over time (36 years) were associated with all-cause and cause-specific mortality, (b) if the association was similar for males and females and for different body mass levels and (c) how change in PA was associated with mortality for subjects who started out as physically inactive. METHODS: The study is based on the prospective population-based cohort Trøndelag Health Study (HUNT) from 1984 to 2020, across four study waves. Data were linked to the Norwegian Cause of Death Registry. There were 123,005 participants, divided into three groups: persistently active, persistently inactive and mixed, with two cut-offs for PA: 60 and 150 minutes per week. The results are reported as cumulative incidence and hazard ratios (HRs). RESULTS: At 60 minutes of PA per week, 8% of participants were persistently inactive, 15% were persistently active and 77% had a mixed pattern. At 150 minutes, the corresponding numbers were 32%, 2% and 65%. Compared to the persistently inactive group, for the 60-minute cut-off, the mixed group had an all-cause mortality HR of 0.83 (95% confidence interval (CI) 0.70-0.98), and the persistently active group had an HR of 0.51 (95% CI 0.40-0.65). For the 150-minute cut-off, the corresponding HRs were 0.84 (95% CI 0.75-0.94) and 0.48 (95% CI 0.26-0.88). The patterns were similar for males and females and across body mass index levels. Initially inactive participants had lower mortality if they ended up physically active, regardless of their activity level at an intermediate time point. CONCLUSIONS: At least 60 minutes of PA per week was associated with a marked reduction in mortality when this was a lasting habit over three decades. Given that six times as many people reach this less ambitious goal, it is vital to encourage all levels of PA in public health promotion. Any increase in PA during the lifespan is beneficial.

Family factors predicting self-rated health during early adolescence.

BACKGROUND: Health impairments in adolescents associated with divorce and loss of parental contact are frequently reported. However, other family factors more likely to promote health are less researched. We examined the impact of several family factors on self-rated health (SRH). METHODS: A longitudinal cohort study of 1225 students in high school aged 11 and 13 years in 2011. The students were surveyed at onset and after 2 years with SRH as the outcome measure. We adjusted for sex, age and self-rated socioeconomic status in temporal causal analyses, and adjusted for SRH at onset in residual change analyses, applying an ordinal logistic method. Adjusted analyses with each factor and multivariable models with backward exclusion were performed. We reported the predictive associations with odds ratios and 95% confidence limits. RESULTS: The most decisive factors predicting future positive SRH were linked to confidence in communicating with both parents about bothersome issues, and the experience of parental support with school work. Furthermore, the experience of opinions being taken seriously in the family and the absence of excessive parental expectations predicted SRH positively after 2 years. Divorce had a modest impact on SRH and was mediated by the other factors. Only the absence of contact with fathers moderated the effect that divorce experience had on SRH. We ascertained the causal relationships through residual change analyses. CONCLUSIONS: As SRH in adolescence has an impact on later health and is amendable, it is important, from a public health perspective, to preserve and improve relationships and confidence between children and both parents.

How body concerns, body mass, self-rated health and self-esteem are mutually impacted in early adolescence: a longitudinal cohort study.

BACKGROUND: Impaired self-rated health (SRH) and self-esteem (SE) in adolescents are associated with increased body mass index (BMI). These associations are often studied using cross-sectional designs; we performed a longitudinal cohort survey to examine them. METHODS: A longitudinal cohort study of 1225 Norwegian high school students, with SRH, SE and BMI as primary outcomes. We reported the results from temporal causal and residual change analyses separately, with odds ratios (ORs) and standardised regression coefficients (b) and 95% confidence limits. RESULTS: Body and weight concerns had unfavourable effects on SRH and SE, which both had favourable effects on each other. Increased BMI had unfavourable effects on SRH, but less so on SE. Body and weight concerns impacted SE change only among girls. Paradoxically, the intention of becoming thinner was associated with an increase in BMI, and the intention of becoming fatter predicted a decrease in BMI during the 2 years. SE and SRH were associated with a leaner body after 2 years. CONCLUSIONS: This study confirms that body concerns had unfavourable effects on subjective health, and that positive self-concepts predicted a leaner body. Health promotion strategies built on body acceptance should be increasingly emphasised in clinical and public health practice.

Divorce and conversational difficulties with parents: Impact on adolescent health and self-esteem.

Background: Divorce experience (DE) may cause health and self-conceptual problems, but these consequences might also be caused by conflicts and lack of conversational confidence (CC) with one or both parents. We investigated how DE impacted CC and how DE and CC impacted health complaints and self-esteem in a two-year longitudinal cohort study. Methods: The study was performed between 2011 and 2013 among 1225 students in junior high school (aged 11 and 13 years in 2011). We used binary logistic analyses to account for how DE impacted CC, and linear regression analyses to examine how DE and CC impacted on subjective health and self-esteem in 2013. Results: The study revealed that former and recent DEs impacted CC with fathers only. The impact was most evident for the more severe forms of conversational difficulties. DE in itself predicted only self-esteem, and CC with parents mediated this association. CC with both mothers and fathers had strong temporal causal associations with the outcomes two years later. Only CC with fathers impacted changes of the health complaints and self-esteem in full-model residual change analyses. Conclusions: The study proves a sex-specific effect on loss of CC between fathers and children after divorce. The impairment of CC has predictive repercussions on the health and self-conception of adolescents in their middle teenage years. From a public-health perspective, preserving the relation and the confidence between children and their fathers after divorce seems an important task.

Helicopter emergency medical service (HEMS) activity after increased distance to out-of-hours services: an observational study from Norway.

BACKGROUND: Organizational changes in out-of-hour (OOH) services may have unintended consequences for other prehospital services. Reports indicate an increased use of helicopter emergency medical services (HEMS) after changes in OOH services in Norway due to greater geographical distances for the on-call doctors. We investigated whether HEMS dispatches increased when nine municipalities in Sogn og Fjordane County merged into one large inter-municipal OOH district. METHODS: All primary dispatches of the HEMS in the county between 2004 and 2013 were included. We applied interrupted time series regression to monthly aggregated data to evaluate the impact of the organizational change 1 April 2009. The nine target municipalities were compared to the rest of the municipalities in the county, which served as a control group. A quasipoisson model adjusted for seasonality was found to be most applicable. RESULTS: We included 8,751 dispatches, 5,009 (57.2%) of which were completed with a patient encounter. Overall, we found no alteration in requests for HEMS after 2009 (p = 0.251). Separate analyses of the target municipalities and control group revealed no significant increase after 2009 (p = 0.400 and p = 0.056, respectively). When categorizing the municipalities into urban or rural, we found a general increase in HEMS dispatches for the rural group over the 10-year span (p = 0.045) but no added increase after 2009 (p = 0.502). The urban subgroup showed no change. Distance from the OOH service in regards to travel increased within the nine municipalities after 2009, median [quartiles] (5.0[3.0, 6.2] km vs 26.5[5.0, 62.2] km, p < 0.001). CONCLUSION: After relocating nine local OOH services into one large inter-municipal OOH district, we found no increase in requests for HEMS.

Loss of life years due to unavailable helicopter emergency medical service: a single base study from a rural area of Norway.

Background: Despite the potential benefits of physician-staffed Helicopter Emergency Medical Service (HEMS), many dispatches to primary HEMS missions in Norway are cancelled before patient encounter. Information is sparse regarding the health consequences when medically indicated HEMS missions are cancelled and the patients are treated by a GP and ambulance staff only. We aimed to estimate the potential loss of life years for patients in these situations. Method: We included all HEMS requests in the period 2010-2013 from Sogn and Fjordane County that were medically indicated but subsequently cancelled. This provided a selection of patients, with the purpose of studying cancellations independently of the patient's medical status A multidisciplinary expert panel retrospectively assessed each patient's potential loss of life years due to the lack of helicopter transport and intervention by a HEMS physician. Results: The study included 184 patients from 176 missions. Because of unavailable HEMS, seven patients (4%) were anticipated to have lost a total of 18 life years. Three patients suffered from myocardial infarction, three from stroke and one from abdominal haemorrhage. The main contribution from HEMS care in these seven cases might have been rapid transport to definitive care. The probability of a patient losing life years when in need of HEMS evacuation was found to be 0.2%. Conclusion: During the four years period seven patients lost 18 life years. Lack of rapid transport seems to be the primary cause of lost life years in this specific geographical area. Key Points Knowledge about to what extent HEMS contributes to an increased survival and a better outcome for patients is limited. Compared to similar studies on life years gained the estimated loss of life years was minor when HEMS evacuation was unavailable in this rural area. The findings indicates that lack of rapid HEMS transport was the primary cause of the estimated loss of life years.

Treatment, transport, and primary care involvement when helicopter emergency medical services are inaccessible: a retrospective study.

OBJECTIVE: To examine handling of cancelled helicopter emergency medical services (HEMS) missions with a persisting medical indication. DESIGN: Retrospective observational study. SETTING AND SUBJECTS: Cancelled HEMS missions with persisting medical indication within Sogn og Fjordane county in Norway during the period of 2010-2013. Both primary and secondary missions were included. MAIN OUTCOME MEASURES: Primary care involvement, treatment and cooperation within the prehospital system. RESULTS: Our analysis included 172 missions with 180 patients. Two-thirds of the patients (118/180) were from primary missions. In 95% (112/118) of primary missions, GPs were alerted, and they examined 62% (70/112) of these patients. Among the patients examined by a GP, 30% (21/70) were accompanied by a GP during transport to hospital. GP involvement did not differ according to time of day (p = 0.601), diagnostic group (p = 0.309), or patient's age (p = 0.409). In 41% of primary missions, the patients received no treatment or oxygen only during transport. Among the secondary missions, 10% (6/62) of patients were intubated or received non-invasive ventilation and were accompanied by a physician or nurse anaesthetist during transport. CONCLUSIONS: Ambulance workers and GPs have an important role when HEMS is unavailable. Our findings indicated good collaboration among the prehospital personnel. Many of the patients were provided minimal or no treatment, and treatment did not differ according to GP involvement. Key Points Knowledge about handling and involvement of prehospital services in cancelled helicopter emergency medical services (HEMS) missions are scarce. Ambulance workers and general practitioners have an important role when HEMS is unavailable Minimal or no treatment was given to a large amount of the patients, regardless of which health personnel who encountered the patient.

Impact of divorce and loss of parental contact on health complaints among adolescents.

BACKGROUND: Mental health consequences related to divorce have been documented, but might be caused by concomitant factors such as conflicts and loss of parental contact (PC). We investigated these relationships and mental health among adolescents. METHODS: The study was based on data from four cross-sectional surveys carried out between 1997 and 2009 among tertiary school students in Førde, Norway. We established two groups according to divorce experience (DE) with or without loss of PC. Frequencies of DEs were calculated with 95% confidence intervals. The group with no DE was used as reference group in all the analyses. RESULTS: The divorce rate increased by 34% (6.8% absolute increase) between 1997 and 2009, but no sign of attenuated effects on emotional health was observed. Mental complaints were not attenuated as time since divorce increased. A majority of those losing contact with parents had no contact with their fathers. The study revealed only a modest increase of health complaints if PC was preserved, but a marked increase when the adolescents experienced loss of PC following the divorce. Interaction analyses showed no gender differences, and parental support and confidence in parent(s) did not mediate the associations between divorce and distress. CONCLUSIONS: Emotional distress after divorce is not attenuated as divorce prevalence increases, but the deleterious effects of divorce on the well-being of adolescents seem to be confined to those experiencing a concomitant loss of PC. Efforts aiming at reducing parental hostility and improving mutual parental responsibility and care therefore seem important.

PSA measurement and prostate cancer--overdiagnosis and overtreatment?

BACKGROUND: Growing attention is being paid to PSA testing and the risk of overdiagnosis of prostate cancer. This paper investigates how the number of PSA tests has developed over time in Norwegian counties, and relates this development to the incidence of cancer in the various counties and the rates of prostate cancer surgery. METHOD: Data on incidence, survival and mortality were obtained from public registers. The numbers of PSA tests carried out were acquired from Norwegian laboratories. The PSA testing rates per county and correlation with prostate cancer incidence rates and surgery rates were surveyed. Developments in Sogn og Fjordane, which has the highest incidence of prostate cancer in Norway, were examined separately. A net-based survey of primary doctors' attitudes and practice was carried out. RESULTS: The number of PSA tests increased substantially in the period 1999-2011 and in 2011 corresponded to testing of 45% of the total male population aged over 40 in Norway. The number of PSA tests in 2011 correlated with the incidence by county of prostate cancer in the previous period (Pearson's r = 0.41). The correlation between the incidence of cancer and surgical procedures was 0.66. In Sogn og Fjordane, the prostate cancer incidence and survival are rising steeply, while mortality is at the same level as in Norway generally. Primary doctors often comply with their patients' wish for PSA testing and find it difficult not to refer them to specialists if values are elevated. INTERPRETATION: There is probably a correlation between the increased incidence of prostate cancer and the amount of PSA testing. Compliance with the guidelines for testing should be better and clinicians could practice more watchful waiting with regard to further treatment in cases of elevated PSA values.

Effect of Optimal Alcohol-Based Hand Rub among Nurse Students Compared with Everyday Practice among Random Adults; Can Water-Based Hand Rub Combined with a Hand Dryer Machine Be an Alternative to Remove E. coli Contamination from Hands?

Efficient hand hygiene is essential for preventing the transmission of microorganisms. Alcohol-based hand rub (ABHR) is a recommended method. We compared health personnel (skilled nurse students) with random adults to study the effect of an ABHR procedure. A water-based hand rub (WBHR) procedure, using running tap water and a hand-drying machine, was also investigated. The study included 27 nurse students and 26 random adults. Hands were contaminated with Escherichia coli, and concentrations of colony forming units (CFU/mL) were determined before and after ABHR or WBHR. Concentrations after ABHR were 1537 CFU/mL (nurse students) and 13,508 CFU/mL (random adults) (p < 0.001). One-third of participants reported skin irritation from daily ABHR. Concentrations after WBHR were 41 CFU/mL (nurse students) and 115 CFU/mL (random adults) (p < 0.011). The majority of participants (88.5%) preferred the WBHR method. Results from 50 air samples from filtered air from the hand dryer outlet showed no CFU in 47 samples. A significant difference between the two groups was shown for the ABHR method, indicating that training skills are important for efficient hand hygiene. Surprisingly, the WBHR method seemed to have a significant effect in largely removing transient bacteria from hands.

[Do differences in referral rates threaten the goal of equity in health care?]. / Truar skilnadene i tilvisingsratar målet om likeverdige helsetenester?

BACKGROUND: In comparison with the national average, and particularly in comparison with the region Helse Vest, which it forms part of, Sogn og Fjordane county has a high level of specialist health care utilization. Apart from the fact that it has two small community hospitals, little is known that could explain this county's high expenditure, and especially whether contrasts exist between its municipalities. MATERIALS AND METHODS: Based on data from the National Patient Registry and the administrative hospital registry DIPS for the year 2009, age and sex-adjusted utilization rates are compared at municipality level and at the level of the primary health care doctor. RESULTS: Marked contrasts between the municipalities were observed, both with respect to contact and DRG point rates. A further comparison of three comparable municipalities with different utilization rates revealed high and concurrent differences in referral rates between primary health doctors in the three municipalities. INTERPRETATION: The high and diverse utilization rates of specialist health care between municipalities in Sogn og Fjordane seem to be associated with correspondingly high and even more pronounced differences in referral rates from primary health care doctors.

Emotional, self-conceptual, and relational characteristics of bullies and the bullied.

AIMS: To clarify distributions of emotional and somatic symptoms among different groups involved in bullying behaviour during early adolescence; to explore differences in social integration and self-perceptions; to explore how different cut-off limits for bullying behaviour may affect the impact of these measures; and to interpret our findings in the light of theories of identity that may suggest directions for interventions against bullying in schools. METHODS: A cross-sectional study, based on self-completion questionnaire, of 1237 pupils aged 11-15 years in autumn 2000 in Alesund, Norway. RESULTS: Bullies and their victims reported similar and greater emotional impairments and psychosomatic complaints, lack of self-confidence, and pessimism than students not involved in bullying. With increasing involvement, bullies differed from non-involved students only in regard to depressive complaints and pessimism. The bullied group reported more depressive, somatic and anxiety complaints, and self-reproach with increasing victimisation. Both bullies and the bullied reported problems relating to school, parents, and teachers. Bullies enjoyed friendships to the same degree or better than their peers not involved in bullying, whereas the bullied group reported impaired peer relations and increasing problems with more serious involvement. Bullies, the bullied, and bully-victims reported diminishing peer support in their class with increasing involvement. CONCLUSIONS: Both the bullied and bullies share relational, emotional, and self-conceptual problems, but they also differ in whether they succeed in social arenas and to what extent they are affected by different emotional and self-conceptual problems. They are, however, fellow sufferers in many aspects.

[Unwanted sexual experiences and health complaints among adolescents]. / Uønskede seksuelle erfaringer og helseplager blant ungdom.

BACKGROUND: Strong indicators support a causal relationship between sexual assaults and impaired emotional health. The aim of this study was to investigate the prevalence of unwanted sexual experiences among adolescents and potential associations between such experiences and other health problems. MATERIAL AND METHODS: The study is based on a survey among senior high school students in Førde in 2001. Linear regression analyses were used to examine the association between negative sexual experiences and emotional and somatic impairment. RESULTS: 837 students participated, representing 93 % of the student mass. 7.5 % of the girls and 1.4 % of the boys had experienced a sexual assault. Students with such experiences reported earlier sexual debut and more alcohol intoxication in association with their sexual debut than students without negative experiences. They also had more depression, anxiety and somatic complaints than students without a sexual debut (beta values 0.15-0.18, p < 0.001 in the multivariable analyses). The associations were partly mediated by reduced parental support and lack of self-confidence. INTERPRETATION: Health impairment is associated with earlier unwanted sexual experiences. The study indicates that such experiences may be prevented by consumption of less alcohol in association with the sexual debut, sexual debut at a higher age, and that the health consequences can be alleviated by parental support and the promotion of self-confidence.

Self-rated health during adolescence: stability and predictors of change (Young-HUNT study, Norway).

BACKGROUND: Self-rated health (SRH) is an important single-item variable used in many health surveys. It is a predictor for later mortality, morbidity and health service attendance. Therefore, it is important to study how SRH is influenced during adolescence. The present study examined the stability of SRH over a 4-year period in adolescence, and the factors predicting change in it. METHODS: Analyses were based on 4-year longitudinal data from the Young-HUNT studies in Norway among adolescents aged 13-19 years. A total of 2800 students (81%) participated in the follow-up study, and 2399 of these were eligible for data analysis. Cross-tables for SRH at the start of the study (between 1995 and 1997) and 4 years later were used to estimate the stability over the period. Proportional odds logistic regression analyses of SRH during 2000-01 were carried out, controlling for initial SRH, independent variables at the start of the study and changes in the same independent variables over 4 years as covariates. RESULTS: In 59% of the respondents, SRH remained unchanged through the 4-year observation period during adolescence. Fewer than 4% changed their ratings of SRH by two steps or more on a four-level scale. The self-assessed general well-being, health behaviour variables, being disabled in any way, and body dissatisfaction at the start of the study and the change of these predictors influenced SRH significantly during the 4-year observation. Being diagnosed with a medical condition, or specific mental or somatic health symptoms was of less importance for later SRH. Adolescents with more health service contacts at the start of the study, or who increase their attendance rate during the 4 years, report deterioration of SRH. CONCLUSION: SRH is a relatively stable construct during adolescence, and deteriorates consistently with a lack of general well-being, disability, healthcare attendance and health-compromising behaviour.

Self-rated health (SRH) in young people and causes of death and mortality in young adulthood. A prospective registry-based Norwegian HUNT-study.

BACKGROUND: Self-rated health (SRH), which is frequently used in epidemiological research, has consistently been shown to be a strong predictor of morbidity and mortality, even after controlling for demographic, social and medical risk factors. However, less is known about the relationship between SRH and all-cause and cause-specific mortality in young adulthood. OBJECTIVE: To investigate SRH in young people (13-35 years-old) as a predictor of all-cause mortality in young adulthood (deaths before age 54) and examine the associated causes of death. METHODS: We used data from two large population-based cohort studies (N = 23,679): Young-HUNT1 (1995-1997, persons 13 to 20 years old, participation rate = 90%) and HUNT2 (1995-1997, persons 20 to 35 years old, participation rate = 70%). These data were linked to the Norwegian Cause of Death Registry up to 2014, and 247 deaths were identified. Other predictors we examined included age, gender, baseline smoking, physical activity and physical and mental disability. RESULTS: Participants reporting 'not so good'/'poor' SRH had approximately twice the risk of death compared to those reporting 'good' or 'very good' SRH at baseline. The association between low SRH and risk of death was attenuated when the models were adjusted for other predictors, but remained statistically significant. The causes of death differed somewhat between SRH levels. Most of the deaths for people reporting 'very good' SRH at baseline were mostly due to neoplasms (34%) and other external causes (30%). The causes of death were more varied for people reporting 'not so good'/'poor' SRH, with suicide (23%), other external causes (21%) and other/unknown causes of death (17%) being the most frequent causes. CONCLUSION: SRH predicts all-cause mortality in young adulthood, with poor SRH being associated with death in young adulthood. The findings also indicate different causes of death for different SRH. This knowledge is important for identifying groups at risk for later disease, which can potentially be used to prevent morbidity in the adult population.

Is self-rated health in adolescence a predictor of prescribed medication in adulthood? Findings from the Nord Trøndelag Health Study and the Norwegian Prescription Database.

Self-rated health (SRH) is a commonly used health indicator predicting morbidity and mortality in a range of populations. However, the relationship between SRH and medication is not well established. The aim of this study was to examine adolescent SRH as a predictor for prescribed medication later in young adulthood. Eighteen years' prospective data from the Nord-Trøndelag Health Study (HUNT) and the Norwegian Prescription Database (NorPD) were analyzed. Baseline data, gathered from 8982 adolescents (mean age 16.0 years) in the Young-HUNT I survey (1995-1997), were linked to individual data from NorPD, including information on all medications prescribed in 2013-2014. Gender-stratified negative binomial regression models were used to investigate the association between SRH and medication, also adjusted for age, baseline self-reported medicine use, physical and mental disability, smoking, and physical activity. Based on the Anatomical Therapeutic Chemical (ATC) Classification System, total consumption and consumption related to various ATC groups were examined. The adjusted analyses showed a dose-response relationship for females, with poorer SRH predicting higher average medication for both total consumption and for the ATC groups "Musculoskeletal system" (M), "Nervous system" (N; Analgesics (N02), Opioids (N02A)) and "Respiratiory system" (R). The predictive power of SRH, as well as the role of the adjustment factors, varies by gender and drug groups. This knowledge is important in order to identify risks for later disease and to capture pathological changes before and beyond the disease diagnosis, potentially preventing morbidity in the adult population.

[Adolescent sexuality in rural Norway 1997-2001]. / Ungdom og seksualitet i Utkant-Norge 1997-2001.

BACKGROUND: In order to understand and prevent unwanted health consequences related to sexual behaviour, we need to know the status and changes of sexual behaviour in adolescence. MATERIAL AND METHOD: In 1997 and 2001, surveys were conducted including a total of 1665 adolescents and young adults aged 15 to 24 (response rate > 90%) in secondary schools in a small town in a rural district in Norway. We analysed frequencies for boys and girls and estimated the change in median age of first intercourse. Logistic regression analyses of median age and other health-related parameters were performed. RESULTS: A greater proportion of the respondents reported sexual experience in 2001 than in 1997. Girls have their first intercourse at a younger age than boys, often with older partners. 21% of the girls had experienced unwanted sexual situations. Use of contraception has increased, though insignificantly. Still, 11% of sexually active girls had had unwanted pregnancies. First intercourse during adolescence is clearly associated with other forms of behaviour that compromise health. However, a great and stable majority report a stable partner during adolescence. CONCLUSIONS: In accordance with other studies we find changes in sexual behaviour over a short period of time among adolescents in rural Norway. Stable sexual relations may still be a protective factor.

[Teenagers with piercing and tattooing]. / Tenåringer med piercing og tatovering.

BACKGROUND: The search for social identity seems important to young people's efforts at finding a social practice that fulfills their own needs. "Body art", i.e. tattoos and piercing, could be understood as a way of demonstrating a personal identity, though it is doubtful whether this practice over time could fill such needs in a modern society. This study addresses the question of whether young people that acquire tattoos or piercings have special characteristics in terms of social integration and behaviour. MATERIAL AND METHOD: A cross-sectional questionnaire was administered to junior high school students (6th, 8th and 10th grade, age 11-15) in a Norwegian town (population: 40,000). A total of 1237 students filled in the questionnaire. The social integration and health-impacting behaviour of those with body art was compared to those without. Adjustments were made for age and sex through linear and logistic regression analysis. RESULTS: Teenagers with body art are just as active in their spare time as their peers without such decorations and they are just as close to and trusting of their friends (relational quality), but they are more integrated with their friends in terms of time spent with them (relational quantity). Teenagers with body art see themselves as less well integrated in school than their peers. Moreover, they assess the support they get from their parents and their closeness to them lower than do those without body art. Having body art is strongly associated with health-compromising behaviour. INTERPRETATION: Health-promoting efforts in schools would benefit from recognition of young people's need for expressing their personal identity and that so-called risk behaviour may be an expression of personal identity. A focus on mastering experiences and inter-generational dialogue could be as fruitful as a focus on risk behaviour.

Is self-rated health a stable and predictive factor for allostatic load in early adulthood? Findings from the Nord Trøndelag Health Study (HUNT).

Self-rated health (SRH) is a widely used health indicator predicting morbidity and mortality in a wide range of populations. However, little is known about the stability and biological basis of SRH. The aim of this study was to map the stability of SRH from adolescence to early adulthood, and to examine the relationships between SRH and biological dysregulation, in terms of allostatic load (AL). The AL score comprises the eleven biomarkers systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate (HR), cholesterol, high-density lipoprotein cholesterol (HDL), triglycerides, waist-hip ratio (WHR), diabetes risk profile, glucose, C-reactive protein (CRP) and body mass index (BMI). Eleven years prospective data from the Nord-Trøndelag Health Study (HUNT), Norway, were utilised. Baseline data were gathered from 9141 adolescents (mean age 15.9 years) in the Young-HUNT I survey (1995-1997) and follow-up data were gathered from the adult HUNT3 survey (2006-2008). Altogether, 1906 respondents completed both questionnaires and clinical measurements in both studies. Cross-tables for SRH at baseline and follow-up showed that SRH remained unchanged in 57% of the respondents. Only 3% of the respondents changed their ratings by two steps or more on a four-level scale. Further, linear regression analyses adjusted for age and gender revealed that SRH in adolescence predicted AL in young adulthood. Similar patterns were found for most of the individual biomarkers. The consistency found in SRH from adolescence to young adulthood, and its association with AL across time, indicate that routines for dealing with SRH early in life may be a central strategy to prevent morbidity in the adult population.