Changes in co-use of alcohol and cannabis among Nordic adolescents in the 21st century: Results from the European School Survey Project on Alcohol and Other Drugs study.

INTRODUCTION: In the 21st century, there has been a decline in alcohol use among adolescents in most Nordic countries, while trends of cannabis use have diverged. We explore how alcohol and cannabis use, respectively, and co-use of the two substances, have changed among Nordic adolescents. Three hypotheses are used to frame the study: (i) cannabis use has substituted alcohol use; (ii) there has been a parallel decline in both substances; and/or (iii) there has been a 'hardening' of users, implying that alcohol users increasingly use cannabis. METHODS: Data from the European School Survey Project on Alcohol and Other Drugs, conducted among 15- to 16-year-olds in Denmark, Finland, Iceland, Norway and Sweden (N = 74,700, 49% boys), were used to explore trends of past-year alcohol and cannabis use in the period 2003-2019. RESULTS: The proportion of adolescents reporting alcohol use decreased significantly in all Nordic countries except Denmark. The proportion of those using cannabis only was low (0.0%-0.7%) and stable in all countries. The total number of substance use occasions declined among all adolescents in all countries but Denmark. Among alcohol users, cannabis use became increasingly prevalent in all countries but Denmark. DISCUSSION AND CONCLUSIONS: We found no support for the 'parallel decline hypothesis' in alcohol and cannabis use among Nordic adolescents. Partially in line with the 'substitution hypothesis', cannabis use accounted for an increasing proportion of all substance use occasions. Our results suggests that the co-use of alcohol and cannabis has become more common, thus also providing support to the 'hardening' hypothesis.

Nordic adolescents responding to demanding survey scales in boring contexts: Examining straightlining.

INTRODUCTION: Straightlining, or identical responses across all items within a multi-item scale, is often taken as an indication that responses to all items in a questionnaire are of poor quality. The purpose of this study was to examine straightlining on two scales: The Sense of Unity Scale (SUS) and the short version of the Warwick-Edinburgh Mental Well-being Scale (SWEMWBS). METHODS: Data stem from the 2017-2018 data collections in four Nordic countries of the Health Behaviour in School-children study (HBSC) (15-year-old students only; 50.9% girls; n = 5928). Data were weighted to adjust for oversampling of Swedish-speaking Finnish students and to equalize sample size across countries. The main analyses were done with general linear modeling with adjustments for cluster effects (school classes). RESULTS: The proportion with straightlining on SUS was 22.8%, varying from 5.8% among Swedish girls to 46.4% among Finnish boys. The proportion with straightlining on SWEMWBS was 18.4%, varying from 5.2% among Norwegian girls to 46.0% among Finnish boys. Straightlining on one of the scales correlated with straightlining on the other one. Straightlining tended to inflate Cronbach's α values and reduce number of factors in factor analyses. Associations between the two scales and external variables tended to be lower among straightlining students. Associations between external variables (other than SUS/SWEMWBS) are on average slightly weaker among straightliners. Straightlining students obtained more favorable scores on several resource-related variables. CONCLUSION: Although some problems have been identified, straightlining does not serve well as a general indicator of poor data quality.

Sexual orientation and migration intentions among rural, exurban and urban adolescents in Iceland.

Rural areas have often been assumed to be somewhat hostile territory for sexual minorities. As a result, moving to an urban area may be an integral part of "coming out" for those living in a rural area. However, surprisingly few quantitative studies have examined the level of rural-to-urban migration intent among sexual minorities. In this study, we examined the migration expectations of adolescents in Iceland, a country characterised by a heavy urban concentration and a scattered rural population, strong international ties and comparatively high levels of formal rights and public acceptance of sexual minorities. Based on a population sample of 2,858 students aged 15-16 years, we found no evidence of greater overall migration expectations among rural or exurban lesbian, gay, bisexual and questioning (LGBQ) youth than their urban counterparts. However, while urban LGBQ youth were more likely to move abroad, young people in other areas are more likely to move domestically. The results are discussed in the context of prior studies of sexual minorities in rural areas and migration expectations among rural youth.

Cyberbullying and traditional bullying among Nordic adolescents and their impact on life satisfaction.

Aims: The aim of this study was to investigate the prevalence of cybervictimization in the six Nordic countries and to assess its overlap with traditional bullying. A further aim was to examine potential associations between life satisfaction, on the one hand, and traditional bullying and cyberbullying on the other. Methods: Analyses were based on data from the 2013/2014 Health Behaviour in School-aged Children study. It included 32,210 boys and girls, aged 11, 13, and 15, living in the six Nordic countries. Results: The prevalence of cyberbullying by both pictures and by messages was around 2% in all the Nordic countries except Greenland. There it was considerably higher. The prevalence of being bullied in a traditional manner varied widely by country. For boys, this type of bullying was most frequent in the youngest age group and then decreased steadily in the older age groups. Girls were on average more likely to be cyberbullied. Cyberbullying was more common among 13- and 15-year-olds than 11-year-olds. Higher family affluence was unrelated to the risk of cyberbullying. However, it was related to traditional bullying and combined forms of bullying. Compared with intact families, cybervictimization was commoner among single-parent families and stepfamilies. Adjusting for age, gender, family affluence, and family structure, those subjected to cyberbullying had lower life satisfaction than those who were not bullied. Conclusions: We found relatively little overlap between cyberbullying and traditional bullying, indicating that the two may be separate phenomena stemming from different mechanisms, at least in the Nordic context.

The Effects of Gender and Family Wealth on Sexual Abuse of Adolescents.

Background: Sexual abuse and sexual assaults against adolescents are among the most significant threats to their health and well-being. Some studies have found poverty to be a risk factor for sexual abuse. The present study investigates the effects of gender and family affluence on the prevalence of sexual abuse of 15-year-old Icelanders in the 10th grade. Methods: The study is based on data collected for the Icelandic part of the Health Behaviour in School-aged Children study in 2014. Standardized questionnaires were sent to all students in the 10th grade in Iceland, of which 3618 participated (85% of all registered students in this grade). Results: Girls were more than twice as likely to be sexually abused as boys (20.2% versus 9.1%). Adolescents perceiving their families to be less well off than others were twice as likely to report sexual abuse as those of ample or medium family affluence. However, family affluence had more effect on the prevalence of abuse in girls than in boys. Conclusion: Female gender and low socioeconomic status may independently contribute to the risk of sexual abuse.

The Problem with Low-Prevalence of Bullying.

This paper tests the hypothesis of whether being bullied in an environment where bullying is infrequent decreases adolescents' life satisfaction. Analyses were based on the international standard questionnaire from the 2005/2006 Health Behaviour in School-aged Children study (HBSC). The sample included answers from 183,736 children in 35 Western, industrialized countries. Our results show that the negative effects of being bullied on the life satisfaction of individuals are stronger in schools and countries where bullying is less frequent. We therefore conclude that the prevalence of bullying in the students' surroundings may act as a mediating variable explaining the relationship between bullying and life satisfaction.

Adolescent alcohol and cannabis use in Iceland 1995-2015.

INTRODUCTION: Over the past two decades, alcohol consumption of Icelandic adolescents has decreased dramatically. The aim of this study was to quantify the extent of this reduction and compare it with the trend in cannabis use over a 20 year period and to identify possible explanations. METHODS: We used data from the Icelandic participants to the European School Survey Project on Alcohol and Other Drugs study (collected via paper-and-pencil questionnaires in classrooms). The sample included all students in the 10th grade (54-89% response rate). RESULTS: The percentage of participants who had never used alcohol during their lifetime rose from 20.8% in 1995 to 65.5% in 2015. Similarly, there was a decline in the proportion of students who had consumed alcohol 40 times or more, from 13.7% to 2.8%. During the same period, the number of students who had never used cannabis rose from 90.2% to 92.0%. In contrast, we found a small, but statistically significant, increase in the prevalence of those who had used cannabis 40 times or more, from 0.7% in 1995 to 2.3% in 2015. Parental monitoring increased markedly between 1995 and 2015, but availability of alcohol decreased. Perceived access to cannabis and youth attitudes towards substance use remained unchanged. DISCUSSION: Although Iceland has enjoyed success in lowering alcohol use among adolescents over the past decades, and somewhat fewer claim to have ever tried cannabis, there has been a threefold increase among heavy users of cannabis. Increased parental monitoring and decreased availability of alcohol explain some of the changes seen.

Social inequalities in self-rated health: A comparative cross-national study among 32,560 Nordic adolescents.

AIMS: We aimed to estimate the magnitude of socioeconomic inequality in self-rated health among Nordic adolescents (aged 11, 13 and 15 years) using the Family Affluence Scale (a composite measure of material assets) and perceived family wealth as indicators of socioeconomic status. METHODS: Data were collected from the Health Behaviour in School-aged Children (HBSC) survey in 2013-2014. A sample of 32,560 adolescents from Denmark, Norway, Finland, Iceland, Greenland and Sweden was included in the study. Age-adjusted regression analyses were used to estimate associations between fair or poor self-rated health and the ridit scores for family affluence and perceived wealth. RESULTS: The pooled relative index of inequality of 2.10 indicates that the risk of fair or poor health was about twice as high for young people with the lowest family affluence relative to those with the highest family affluence. The relative index of inequality for observed family affluence was highest in Denmark and lowest in Norway. For perceived family wealth, the pooled relative index of inequality of 3.99 indicates that the risk of fair or poor health was about four times as high for young people with the lowest perceived family wealth relative to those with the highest perceived family wealth. The relative index of inequality for perceived family wealth was highest in Iceland and lowest in Greenland. CONCLUSIONS: Social inequality in self-rated health among adolescents was found to be robust across subjective and objective indicators of family affluence in the Nordic welfare states.

[The diversion of prescribed stimulant medications of 10th graders in Iceland].

INTRODUCTION: ADHD is a neurodevelopmental disorder that usually surfaces before seven years of age. Stimulants are commonly used medications for the treatment of this disorder in Iceland, but they carry with them a significant risk of both abuse and diversion - i.e. when it is used by an individual other than it was prescribed for by a physician. The purpose of this study was to estimate the prevalence of diversion amongst Icelandic adolescents. MATERIAL AND METHODS: This study is based on data collected in the Icelandic portion of the European School Survey Project on Alcohol and Other Drugs (ESPAD) focused on the drug and alcohol use of 10th graders in Europe. RESULTS: Of the 2,306 students that participated in the study 91% (2,098) claimed they had never been prescribed stimulant medications while 9% (208) claimed they had. Boys were twice as likely to get a stimulant prescription compared to girls. Almost 18% of the participants that had been prescribed simulants said they had at some point in time diverted their stimulant medication. CONCLUSION: The diversion of stimulants by 10th graders in Iceland is quite common compared to studies from other countries where the prevalence is closer to 5-10%. These findings demonstrate the importance of carefully overseeing stimulant use of adolescents, for the benefit of both those who divert as well as those diverted to.

Sexual orientation among Icelandic year 10 adolescents: Changes in health and life satisfaction from 2006 to 2014.

Minority sexual orientation may add additional stresses to the period of adolescence thus affecting mental health and wellbeing. The whole population of year 10 students in 2006, 2010, and 2014 in Iceland were surveyed as part of the Health Behaviour in School-aged Children Survey. Sexual orientation could be identified in 1,994 participants from 2006 (43.8% of population; 988 girls), 3,777 from 2010 (78.6%; 1,863 girls) and 3,526 in 2014 (80.1%; 1,731 girls). About 3.1%, 3.6%, and 4.4% were identified as lesbian, gay, or bisexual (LGB) in 2006, 2010, and 2014, respectively. Given the sampling proportions, the results reflect parameters (population values) rather than statistics (sample values). LGB adolescents were worse off across most of the psychosocial measures across the three surveys as compared with adolescents of unknown sexual orientation (USO). However, the gap between LGB and USO adolescents appears to be closing, at least for the 2010 to 2014 change, suggesting that outcomes for LGB adolescents have improved compared to four years earlier. Social support, liking school and one's classmates, being bullied, and physical and mental health all seem to play an important part in life satisfaction and general wellbeing. While advances have been made for LGB adolescents, gaps between LGB and USO adolescents still exist and need to be closed through evidence-based school and society-wide programs.

Transplanting embryonic stem cells onto damaged human corneal endothelium.

AIM: To investigate whether human embryonic stem cells (hESCs) could be made to attach, grow and differentiate on a human Descemet's membrane (DM). METHODS: Spontaneously differentiated hESCs were transferred onto a human corneal button with the endothelial layer removed using ocular sticks. The cells were cultured on a DM for up to 15 d. The genetically engineered hESC line expressed green fluorescent protein, which facilitated identification during the culture experiments, tissue preparation, and analysis. To detect any differentiation into human corneal endothelial-like cells, we analysed the transplanted cells by immunohistochemistry using specific antibodies. RESULTS: We found transplanted cells form a single layer of cells with a hexagonal shape in the periphery of the DM. The majority of the cells were negative for octamer-binding transcription factor 4 but positive for paired box 6 protein, sodium potassium adenosine triphosphatase (NaKATPase), and Zona Occludens protein 1. In four of the 18 trials, the transplanted cells were found to express CK3, which indicates that the stem cells differentiated into corneal epithelial cells in these cases. CONCLUSION: It is possible to get cells originating from hESCs to become established on a human DM, where they grow and differentiate into corneal endothelial-like cells in vitro.

[The prevalence of sexual abuse and sexual assault against icelandic adolescents].

INTRODUCTION: Sexual abuse and sexual assaults against children and adolescents is one of the most significant threats to their health. The aim of the current study was to investigate its prevalence and effects on Icelandic teenagers in the 10th grade. MATERIAL AND METHODS: The study is based on data collected for the Icelandic part of the HBSC-project (Health and behaviour of school- aged children). Standardized questionnaires were sent to all students in 10th grade in Iceland of which 3,618 participated. The students experience of sexual abuse or assaults was assessed by asking them how often they had been against their will a) touched in a sexual way, b) made to touch someone else in a sexual way, c) the subject of an attempted rape or d) subjected to rape. RESULTS: The results showed that 14.6% (527) participants had experienced sexual abuse or assault. Of these, 4.5% (162) had one such experience but 10.1% had either suffered certain type of abuse or assault more than once, or had experienced more than one kind. About 1% of participants (35) said that they had suffered many times from many forms of abuse and assaults. The prevalence of poor mental well-being and risk behaviour was much higher amongst those that had experienced sexual abuse or assault. CONCLUSION: Although the results show that the prevalence of sexual abuse and assault against Icelandic adolescents is similar to other Western countries, we find it to be higher than a previous study a decade ago. KEY WORDS: Sexual abuse, sexual assault, adolescents. Correspondence: Arsaell Mar Arnarsson, aarnarsson@unak.is.

Suicidal risk and sexual orientation in adolescence: a population-based study in Iceland.

AIM: Suicidality is an important public health problem, particularly among lesbian, gay, and bisexual (LGB) adolescents and young adults. The purpose of the present study is to compare the rate of suicide ideations and attempts among LGB adolescent to that of non-LGB adolescents in a population-based sample, and to identify important protective factors as well as risk factors Method: We used the Icelandic data set from the 2009/2010 Health Behaviour in School-aged Children (HBSC) study. The sample consisted of 3813 grade 10 Icelandic adolescents; 1876 girls and 1937 boys. The participants were asked about attraction and/or activity, as well as about suicidal ideation and/or attempts. The questionnaire also included various other items regarding health and lifestyle. RESULTS: LGB adolescents were five to six times more likely to have had frequent suicidal ideations. Factors that were associated with less suicide ideations and fewer attempts were easy communication and liking school. The LGB girls were six times more likely to have had frequent suicide attempts, whilst the LGB boys were 17 times more likely to have attempted suicide that often. No specific protective or risk factors were identified for suicidality in LGB adolescents other than bullying. CONCLUSIONS: Adolescents that had engaged in heterosexual activity and those that had LGB attraction had similarly heightened risk for suicidality, but sexually active LGB adolescents were far more likely to have suicidal ideations or to have attempted suicide.

[Physical activity and its relation to metabolic and cardiovascular risk factors among three professions]. / Hreyfing þriggja starfsstétta og tengsl hennar við ahættuthætti efnaskiptasjúkdóma og hjarta- og æðasjúkdóma.

INTRODUCTION: The relation between objectively measured physical activity (PA) and metabolic and cardiovascular risk factors has not been studied in Iceland. This study aimed to investigate PA and metabolic and cardiovascular risk factors among three professions: manual laborers, office workers, and farmers. MATERIAL AND METHODS: The participants (73 males, 89 females) underwent anthropometric measurements. Total PA and time spent in moderate-to-vigorous PA (MVPA) was assessed with activity monitors. Blood pressure was measured and fasting blood samples analyzed for total cholesterol, low- and high-density lipoprotein cholesterol, triglycerides, glucose, insulin and homeostatic model assessment. RESULTS: Male manual laborers and farmers were more physically active than office workers (p<0.01), but no difference was found among females. Nevertheless, female farmers spent less time in MVPA than other professions (p%lt;0.05). Low proportion (18.4%) of all participants and none of the male office workers met the guidelines of the Directorate of Health for daily PA. Farmers had lower levels of triglycerides (p=0.01) and glucose (p<0.01), and greater fat-free mass (p<0.03) than other professions. They also had the highest levels of high-density lipoprotein cholesterol, followed by manual laborers, and then office workers (p<0.02). Total PA was significantly related to a greater number of metabolic risk factors than time spent in MVPA. CONCLUSION: Farmers have the most favorable metabolic and cardiovascular risk factors in the blood and their PA and fat-free mass are a likely explanation. Regardless, their PA is low, and only one-fifth of all participants meet the guidelines for daily PA. Total PA appears more important for the metabolic and cardiovascular risk factors than time spent in MVPA.

Gender differences in development of mental well-being from adolescence to young adulthood: an eight-year follow-up study.

BACKGROUND: The transition from adolescence to young adulthood is marked by many changes. Mental well-being plays an important role in how individuals deal with these changes and how they develop their lifestyle. The goal of this study was to examine gender differences in the long-term development of self-esteem and other mental well-being variables from the age of 15 to the age of 23. METHODS: A baseline measurement was performed in a nationwide sample of 385 Icelandic adolescents aged 15, and a follow-up measurement was conducted eight years later, when participants had reached the age of 23. Standardized questionnaires were used to measure self-reports of self-esteem, life satisfaction, body image, anxiety, depression and somatic complaints. RESULTS: Women improved their self-esteem significantly more than men from the age of 15 to 23 (p=0.004). Women were more satisfied with their life than men at the age of 23 (p=0.009). Men had a better body image, less anxiety, less depression and fewer somatic complaints than women, independent of age. Across gender, anxiety declined and somatic complaints became fewer (p<0.05). CONCLUSIONS These findings suggest that gender differences in mental well-being factors, favouring men, found in adolescents, are not as long-lasting as previously thought. Women improve their mental well-being from adolescence to young adulthood while men's mental well-being does not change.

[Public attitudes towards presumed consent in organ donation in Iceland]. / Viðhorf Íslendinga til ætlaðs samþykkis við líffæragjafir.

INTRODUCTION: Organ transplant is often the only viable treatment for patients with end-stage organ failure. Until now, Icelandic legislation has required informed consent for organ donors, but a new parliamentary bill has been put forth to change the laws to presumed consent. The goal of this study was to investigate the attitude of the Icelandic population towards legislative changes to presumed consent. MATERIALS AND METHODS: Descriptive cross-sectional study using a questionnaire. The study population included all Icelanders, 18 years and older. The sample involved 1400 persons randomly selected from a Capacent Gallup mailing-list. The response rate was 63% or 880 answers. RESULTS: The majority of Icelanders are in favour of the proposed legislative change (more than 80%). Women were more likely to support presumed consent than men, 85% versus 76% respectively. Younger participants were more likely to be positive towards the new law, but no significant difference was found in attitude by family income, demographics or education. Persons who knew someone close to them that had received a transplanted organ were 50% more likely to be in complete agreement with the proposed legislation. Only 5% of participants were currently registered organ donors - 29 women and 15 men. CONCLUSION: Icelanders are very positive towards changing the law to include presumed consent in organ donation. Women and younger people tended to be more in favour and similarly those who know someone that has received donated organs. A majority of responders are willing to donate their organs, but very few are registered as donors.

[Visual impairment and blindness in Icelanders aged 50 years and older - the Reykjavík Eye Study]. / Sjónskerding og blinda Reykvíkinga 50 ára og eldri. Reykjavíkuraugnrannsóknin.

INTRODUCTION: The purpose of this study was to examine the cause-specific prevalence and 5-year incidence of visual impairment and blindness among middle-aged and older citizens of Reykjavík. MATERIAL AND METHODS: A random sample of 1045 persons aged 50 years or older underwent a detailed eye examination in 1996 and 846 of the survivors participated in a follow-up examination in 2001. Visual impairment was defined according to World Health Organization definitions as a best-corrected visual acuity of <6/18 but no worse than 3/60, or visual field of ≥5° and <10° around a fixation point in the better eye. Best-corrected visual acuity of <3/60 in the better eye was defined as blindness. The causes of visual impairment or blindness were determined for all eyes with visual loss. RESULTS: The prevalence of bilateral visual impairment and blindness was 1.0% (95% CI 0.4-1.6) and 0.6% (95% CI 0.1-1.0), respectively and the 5-year incidence was 1.1% (95% CI 0.4-1.8) and 0.4% (95% CI 0.0-0.8), respectively. The prevalence of visual impairment among 60-69 year old participants was 0.6%, but among those aged 80 years or older the prevalence was 7.9%. The major cause of bilateral visual impairment and blindness both at baseline and follow-up was age-related macular degeneration. Cataract accounted for less severe visual loss. The two most common causes of unilateral visual impairment at baseline were amblyopia and cataract. Cataract was the main cause of unilateral visual impairment at 5-year follow-up. CONCLUSION: Prevalence and 5-year incidence of both uni- and bilateral visual impairment and blindness increases with age. Age-related macular degeneration was the leading cause of severe visual loss in this population of middle-aged and older Icelanders.

The 7-year cumulative incidence of cornea guttata and morphological changes in the corneal endothelium in the Reykjavik Eye Study.

PURPOSE: To examine the corneal endothelium and establish the 7-year cumulative incidence of cornea guttata (CG). METHODS: Population-based prospective cohort study with 573 participants (third wave of the Reykjavik Eye Study (RES) in 2008). Four hundred and thirty-seven subjects had either right or left eyes available for analysis after excluding confounding eye conditions. The baseline for eyes at risk for developing CG is the second wave of the RES in 2001. Participants underwent specular microscopy and a standardized eye examination. RESULTS: The cumulative 7-year incidence of CG in either eye was estimated as a 95% confidence interval for the expected value for both genders combined (15-23%), for males (8-18%) and for females (19-29%). In right eye only, the 7-year cumulative incidence for both genders combined was estimated to be 6-11%. For genders combined and for males only, the data indicated no correlation between 7-year cumulated incidence and age at baseline. In women, however, the change of 7-year incidence for CG in at least one eye appeared to be correlated to age at baseline. Reduction of endothelial cell density for corneas with CG at baseline was found [CI (0.95)-132 ± 94]. CONCLUSION: The cumulative 7-year incidence of primary central CG for a middle-aged and older Caucasian population without history of potentially confounding eye disease has been established. Women tend to have higher incidence if onset occurs at middle age. If CG is present, the cell density and the cell size variation decrease within a 7-year period.

Twelve-year Incidence of Exfoliation Syndrome in the Reykjavik Eye Study.

PURPOSE: To examine the 12-year incidence of exfoliation syndrome (XFS) in persons aged 50-79 years at baseline and also to monitor changes in related ophthalmologic variables, to identify possible risk factors for incidence and to estimate the reliability of our diagnostic criteria. METHODS: Baseline examination was performed in 1996 on a random sample of 1045 participants from the population of Reykjavik, 50 years and older. Five years later, in 2001, 88.2% of survivors returned for a follow-up. In 2008, 12 years after the baseline examination, a total of 573 participants returned for the third examination (71.5% of survivors). On all three occasions, the participants underwent a thorough eye examination including slitlamp examination specifically looking for XFS and answered a comprehensive questionnaire. RESULTS: A total of 8.0% of participants developed XFS during the follow-up period in at least one eye, with women being more commonly affected than men, 9.2% versus 6.6%. The overall 12-year incidence for either eye increased with increasing age, from 6.5% in those participants aged 50-59 years at baseline to 10.6% in those that were 70-79 years at baseline; 71% of clinically unilateral cases had converted to bilateral over 12 years. CONCLUSIONS: Twelve-year incidence of XFS is higher in women than in men and higher in older age groups than in younger ones. Most persons deemed on the slitlamp to be unilaterally affected have converted to bilateral over 12 years. Eyes with XFS at baseline were 3-4 times more likely to have cataract surgery during the 12 years. Our definition of definite XFS generally holds, while our definition of probable XFS is of no prognostic value over 12 years.