The association between socioeconomic position and vigorous physical activity among adolescents: a cross-sectional study in six European cities.

BACKGROUND: The relationship between socioeconomic position (SEP) and adolescent physical activity is uncertain, as most evidence is limited to specific settings and a restricted number of SEP indicators. This study aimed to assess the magnitude of socioeconomic differences in adolescent vigorous physical activity (VPA) across various European countries using a wide range of SEP indicators, including family-based (education, family affluence, perceived social standing, parents' employment, housing tenure) and adolescent-based (academic performance and pocket money) ones. METHODS: We used data from a survey among 10,510 students aged 14-17 from 50 schools in six European cities: Namur (BE), Tampere (FI), Hannover (DE), Latina (IT), Amersfoort (NL), Coimbra (PT). The questionnaire included socio-demographic characteristics and the amount of time spent in VPA. RESULTS: The mean time spent practicing VPA was 60.4 min per day, with lower values for Namur (BE) and Latina (IT), and higher values for Amersfoort (NL). In the multivariable analysis, both categories of SEP indicators (family-based and adolescent based indicators) were independently associated with VPA. For each SEP indicator, lower levels of VPA were recorded in lower socioeconomic groups. In the total sample, each additional category of low SEP was associated with a decrease in mean VPA of about 4 min per day. CONCLUSIONS: This study showed that across European cities adolescent VPA is positively related to both family-based SEP and adolescents' own SEP. When analysing socioeconomic differences in adolescent VPA, one should consider the use of multiple indicators of SEP.

Do maternal knowledge and paternal knowledge of children's whereabouts buffer differently against alcohol use? A longitudinal study among Finnish boys and girls.

BACKGROUND: Previous research suggests that parental knowledge of the child's activities and whereabouts prevents adolescents' alcohol use. However, evidence on whether the positive effects of maternal and paternal knowledge are distinctive for boys' and girls' alcohol use is inconclusive. We examined whether perceived parental knowledge at age 13 prevents alcohol use at age 16, whether the effect of maternal and paternal knowledge was the same for both genders, and whether paternal knowledge had as strong an effect as maternal knowledge. METHOD: Adolescents answered a school survey in 2011 (age 13) and 2014 (age 16) in Finland (N = 5742). Perceived maternal and paternal knowledge was measured separately using a Parents' Monitoring Scale. The data were analysed via moderation regression modelling using Bayesian estimation. RESULTS: Perceived maternal and paternal knowledge at age 13 predicted boys' and girls' lower alcohol use at age 16. For those who had not used alcohol at age 13, parental knowledge protected against an increase of alcohol use at age 16. Both maternal and paternal knowledge had a shielding effect against the increase of boys' and girls' alcohol use, but maternal knowledge had a stronger shielding effect than paternal knowledge. CONCLUSIONS: Both maternal and paternal perceived knowledge at age 13 buffers against the adverse development of alcohol use at age 16 for both genders. Underlining the importance of parent-child communication and knowledge about the child's activities should be a part of family health counselling and school health services.

Nicotine dependence among adolescents in the European Union: How many and who are affected?

BACKGROUND: Nicotine dependence during adolescence increases the risk of continuing smoking into adulthood. The magnitude of nicotine dependence among adolescents in the European Union (EU) has not been established. We aimed to estimate the number of nicotine dependent 15-year-old adolescents in the EU, and identify high-risk groups. METHODS: The number of nicotine dependent 15-year-olds in the EU was derived combining: (i) total number of 15-year-olds in the EU (2013 Eurostat), (ii) smoking prevalence among 15-year-olds (2013/2014 HBSC survey) and (iii) proportion of nicotine dependent 15-year-olds in six EU countries (2013 SILNE survey). Logistic regression analyses identified high-risk groups in the SILNE dataset. RESULTS: We estimated 172 636 15-year-olds were moderately to highly nicotine dependent (3.2% of all 15 years old; 35.3% of daily smokers). In the total population, risk of nicotine dependence was higher in males, adolescents with poor academic achievement, and those with smoking parents or friends. Among daily smokers, only lower academic achievement and younger age of smoking onset were associated with nicotine dependence. CONCLUSION: According to our conservative estimates, more than 172 000 15-year-old EU adolescents were nicotine dependent in 2013. Prevention of smoking initiation, especially among adolescents with poor academic performance, is necessary to prevent a similar number of adolescents getting addicted to nicotine each consecutive year.

Tobacco use and exposure to tobacco promoting and restraining factors among adolescents in a developing country.

OBJECTIVE: With a long history of tobacco cultivation, adolescents in Ghana are at relatively high risk of the emerging tobacco epidemic in developing countries. This study explored exposure to tobacco promoting/restraining factors and their associations with smoking and tawa (traditional smokeless tobacco) use among 13-18-year-old Ghanaians. METHODS: School-based representative data were collected in 2008 (n = 1165). RESULTS: Prevalence rates of tobacco use, smoking and tawa use were 9.1% (11.5% boys and 6.4% girls), 6.6% (8.0% boys and 4.7% girls) and 5.7% (7.3% boys and 3.9% girls), respectively. Four percent of the respondents attended schools without a smoking ban, 66% had been taught about the harmful effects of smoking in the current school year, and 53% had been exposed to tobacco advertising. Fifty-three percent of adolescents who had tried to purchase tobacco products were not refused because of their age. Multivariate analyses found that attendance at a school where smoking was allowed, not having been taught about the harmful effects of smoking, exposure to tobacco advertising and parental smoking were positively associated with tobacco use, and knowledge that smoking is harmful to health and difficult to quit were negatively associated with tobacco use. CONCLUSIONS: Both smoking and tawa use were relatively low among Ghanaian adolescents. Exposure to tobacco advertising was high. There is no tobacco legislation in Ghana, but societal norms or cultural values seem to restrict smoking in schools and access to tobacco products.

Questionnaire-assessed moderate to vigorous physical activity of the Finnish youth in 1979-2005.

The purpose of the study was to investigate the time trend of questionnaire-assessed moderate to vigorous physical activity (MVPA) among 12-18-year-old Finnish boys and girls from 1979 to 2005. The MVPA was defined as "at least moderately breathtaking and sweating in leisure time physical activities more than 3 times week." Data were based on the Adolescent Health and Lifestyle Survey, which is a biannual, nation-wide survey on adolescent health and health-related lifestyle in Finland. The nationally representative samples were drawn from the Finnish Population Register Centre. The numbers of participants varied from 2832 to 8390 and the response rates from 91% (girls, 1981) to 58% (boys, 2005). The main results showed that the participation rate in MVPA increased during the study period. The increase was not continuous, but showed an upward trend during the years 2001-2005. The study also revealed that boys participated in MVPA more than girls. However, the gender difference decreased during the study period. Age differences in MVPA were rather small and they decreased during the study period. However, perceived intensity of physical activity was higher among older than younger groups, whereas participation in MVPA was more frequent in younger than older groups. The results supported the findings of some previous studies that reported that especially in Finland the vigorous physical activity among young people had consistently increased. This study gave more information about this phenomenon because the study period was longer, 26 years, and the sample also included older, 16- and 18-year-old boys and girls.

Anabolic-androgenic steroid use among young Finnish males.

The aim of the present study was to describe the lifetime occurrence and associated factors of anabolic-androgenic steroids (AAS) among young Finnish males. Of the 10 829 male conscripts (median age 19), 10 396 (96%) answered a questionnaire during the first days of their conscription in the years 2001-2007. The main outcome was lifetime AAS use. We also studied associations between 13 socioeconomic, health, and health behavioral background variables and AAS use by logistic regression. Eighty-nine (0.9%) respondents reported having used AAS. In addition, 26 (0.3%) respondents reported that they would use AAS if they could obtain them. In multivariate analysis, which included all significant variables and age, the strongest associated factors were weight training at fitness centers more than three times a week [odds ratio (OR) 11.8; 95% confidence interval (CI): 7.1-19.6], low educational status (OR 3.7; 95% CI: 2.0-7.0), and weekly drunkenness as drinking style (OR 2.4; 95% CI: 1.4-4.5). Sports other than weight training were not associated with AAS in our sample. The use of AAS is relatively uncommon among Finnish males. It is strongly associated with weight training at fitness centers but also with lower educational status and a drunkenness-oriented lifestyle. Prevention should be targeted at those males participating in weight training.

Participation in sports clubs is a strong predictor of injury hospitalization: a prospective cohort study.

The aim of this prospective cohort study was to investigate the nature and risk factors of injuries leading to hospitalization. A cohort of 57 407 Finns aged 14-18 years was followed in the Hospital Discharge Register for an average of 10.6 years, totaling 608 990 person-years. We identified 5889 respondents (10.3%) with injury hospitalization. The most common anatomical location was the knee and shin (23.9%), followed by the head and neck (17.8%), and the ankle and foot (16.7%). Fractures (30.4%) and distortions (25.4%) were the most common injury types. The strongest risk factor for injury hospitalization was frequent participation in sports clubs [hazard ratio (HR) in males 1.8; 95% confidence interval (CI): 1.7-2.0 and in females 2.3; 95% CI: 1.9-2.7], followed by recurring drunkenness (HR 1.6; 95% CI: 1.4-2.7 in males and 1.4; 95% CI: 1.2-1.6 in females) and daily smoking (HR 1.4; 95% CI: 1.3-1.5 in males and 1.43 95% CI: 1.2-1.5 in females). The association between injuries and sports clubs participation remained after adjusting for sociodemographic background, health, and health behaviors. Health behavior in adolescence, particularly sports club activity, predicted injury hospitalization. Preventive interventions directed toward adolescents who participate in sports clubs may decrease injury occurrence.

The risk for a cruciate ligament injury of the knee in adolescents and young adults: a population-based cohort study of 46 500 people with a 9 year follow-up.

OBJECTIVES: The knee joint is the most common site for injury among younger people, the injury often resulting in expensive (surgical) treatment, long-term rehabilitation and permanent functional impairment and disability. METHODS: We investigated the incidence and risk factors for a major knee-ligament injury in an adolescent Finnish population. A population-based cohort of 46 472 adolescents was followed for an average of 9 years. All patients hospitalised with the diagnosis of anterior or posterior cruciate ligament injury (ACL or PCL injury) were included in the analysis. RESULTS: 265 (0.6%) people (194 male and 71 female subjects) from the total cohort of 46 472 were treated for a cruciate ligament injury of the knee during the follow-up period, giving an injury incidence of 60.9 (95% CI 53.6 to 68.2) per 100 000 person-years. When the socioeconomic, health and lifestyle background variables were taken into account, the adjusted hazard ratio for a cruciate ligament injury of the knee was 8.5 (95% CI 4.3 to 16.4) for female and 4.0 (95% CI 2.7 to 6.1) for male subjects who participated in organised sports > or =4 times/week. CONCLUSIONS: The general risk for a cruciate ligament injury of the knee is relatively low among adolescents and young adults, but participation in organised sports increases the risk significantly. The risk is especially high in active young women. Preventive measures should be adopted to decrease the short-term and long-term burden of these severe injuries.

Are the desks and chairs at school appropriate?

The aim of the current study was to find out how the measures of chairs and desks match with the anthropometrics of schoolchildren and how schoolchildren sit during a lesson in their classroom. This paper reports the baseline measurements of an intervention study. Participants of this study were 6th and 8th grade (12 and 14 year old) schoolchildren from two comprehensive schools in Finland (N = 101, 57 girls and 44 boys). The main outcome measures were the differences between desk height and elbow-floor height, and chair height and popliteal height. Forty-three participants were randomized for sitting posture analysis by video recordings. The study showed that desks were on average 13 cm above elbow-floor height and chairs 2 cm below popliteal height. For 56% of time participants sat with their backs flexed >20 degrees and/or rotated >45 degrees . For 70% of time they sat with their necks flexed >20 degrees or rotated >45 degrees. The results indicate that there is a mismatch between school furniture and the anthropometrics of schoolchildren. Schoolchildren sit in disadvantaged postures for a substantial part of school lessons.

Health inequality in adolescence. Does stratification occur by familial social background, family affluence, or personal social position?

BACKGROUND: Two new sets of stratification indicators--family's material affluence and adolescent's personal social position- were compared with traditional indicators of familial social position based on parental occupation and education for their ability to detect health inequality among adolescents. METHODS: Survey data were collected in the Adolescent Health and Lifestyle Survey in 2003 from nationally representative samples of 12-, 14- and 16-year-old Finns (number of respondents 5394, response rate 71%). Indicators of the familial social position were father's socio-economic status, parents' education, parents' labour market position. Indicators of material affluence were number of cars, vacation travels, and computers in the family, own room and amount of weekly spending money. Adolescent's personal social position was measured as school performance. Measures of health were long-standing illness, overweight, use of mental health services, poor self-rated health and number of weekly health complaints. Ordinal logistic regression analysis was applied to study the associations between stratification indicators and health variables. RESULTS: All three groups of indicators of social stratification showed inequality in health, but the strongest associations were observed with the adolescent's personal social position. Health inequality was only partly identifiable by the traditional indicators of familial social position. The direction of the inequality was as expected when using the traditional indicators or personal social position: adolescents from higher social positions were healthier than those from lower positions. The indicators of family's material affluence showed mainly weak or no association with health and some of the indicators were inversely associated, although weakly. CONCLUSION: In addition to traditional indicators describing the socio-structural influences on the distribution of health among adolescents, indicators of family's material affluence should be further developed. Adolescents' personal social position should be included in the studies of health inequalities.

Use of information and communication technology and prevalence of overweight and obesity among adolescents.

BACKGROUND: The prevalence of overweight and obesity has increased among children and adolescents, as well as among adults, and television viewing has been suggested as one cause. Playing digital games (video, computer and console games), or using computer may be other sedentary behaviors related to the development of overweight and obesity. OBJECTIVE: To study the relationships of times spent on viewing television, playing digital games and using computer to overweight among Finnish adolescents. DESIGN: Mailed cross-sectional survey. SUBJECTS: Nationally representative samples of 14-, 16-, and 18-y-old (N=6515, response rate 70%) in 2001. METHODS: Overweight and obesity were assessed by body mass index (BMI). The respondents reported times spent daily on viewing television, playing digital games (video, computer and console games) and using computer (for e-mail, writing and surfing). Data on timing of biological maturation, intensity of weekly physical activity and family's socio economic status were taken into account in the statistical analyses. RESULTS: Increased times spent on viewing television and using computer were associated with increased prevalence of overweight (obesity inclusive) among girls: compared to girls viewing television <1 h daily, the adjusted odds ratio (OR) for being overweight was 1.4 when spending 1-3 h, and 2.0 when spending > or =4 h daily on viewing television. In girls using computer > or =1 h daily, the OR for being overweight was 1.5 compared to girls using computer <1 h daily. The results were similar in boys, although not statistically significant. Time spent on playing digital games was not associated with overweight. CONCLUSION: Overweight was associated with using information and communication technology (ICT), but only with certain forms of ICT. Increased use of ICT may be one factor explaining the increased prevalence of overweight and obesity at the population level, at least in girls. Playing digital games was not related to overweight, perhaps by virtue of game playing being less sedentary or related to a different lifestyle than viewing television and using computer.

Pubertal timing and educational careers: a longitudinal study.

BACKGROUND: Pubertal timing is related to several dimensions of adolescent development. No studies concern its associations with educational careers. AIM: To investigate whether pubertal timing predicts attained educational level and how school achievement, educational track and sociodemographic background in adolescence mediate this relationship. SUBJECTS AND METHODS: Survey data (1981, 1983, 1985) from samples of 12-16-year-old Finns (n = 7674) were linked with the respondents' attained education in 1998 (ages 27-33). Ages of menarche and of first ejaculation were indicators of pubertal timing. RESULTS: Among boys who by age 16 had experienced early, average or late pubertal timing, 13%, 12%, and 6% reached upper tertiary educational level, respectively. Boys with early or average puberty often came from high social strata and selected educational tracks with good prospects. In girls, sociodemographic factors rather than pubertal timing predicted attained educational level. CONCLUSIONS: Early or average onset of puberty plays a role in dividing boys into educational tracks after compulsory schooling. Support should be given to boys, whose delayed pubertal development makes them immature to making appropriate educational decisions and to boys who may have experienced early puberty but fail to exploit educational opportunities available for them.

The effectiveness of tobacco sales ban to minors: the case of Finland.

OBJECTIVE: To evaluate the effects of the 1977 and 1995 tobacco sales bans on tobacco acquisition of minors. DESIGN: Biennial nationwide postal surveys (adolescent health and lifestyle survey, AHLS) in 1977-2003; annual classroom surveys (school health promotion survey, SHPS) in 1996-2003. SETTING AND PARTICIPANTS: Entire Finland-12, 14, 16, and 18 year olds (AHLS, n = 80 282); eighth and ninth graders (14-16 year olds) (SHPS, n = 226 681). MAIN OUTCOME MEASURES: Purchase of tobacco from commercial sources during the past month, purchase from different commercial (shop, kiosk, other outlet) and social sources, ease of buying tobacco, overall acquisition of tobacco products, daily smoking, tobacco experimenting. RESULTS: Decrease in tobacco purchase from commercial sources was small and short term after 1977 but large and permanent after 1995: purchase rate among 14 year old smokers diminished from 90% to 67% in 2003, 16 year olds from 94% to 62%. Purchases in shops decreased most (14 year olds: from 39% to 14%; 16 year olds: from 76% to 27%); purchases in kiosks less. An increase was observed in obtaining tobacco from other outlets and friends (social sources). Only 2-3% of 14-16 year old smokers used commercial sources exclusively when obtaining tobacco. Daily smoking began to decrease after 2001, following an earlier decrease in those experimenting. No changes were observed among age groups not targeted by the ban. CONCLUSIONS: Legislation appears to have permanently changed tobacco sales practices and decreased purchases from commercial sources. Social sources need to be taken into account when controlling access to tobacco. Sales bans should be accompanied by other health promotion measures.

Toothbrushing as part of the adolescent lifestyle predicts education level.

Socio-economic differences in health and health behavior are well-known. Our hypothesis was that toothbrushing frequency in adolescents predicts their education level in adulthood. The aim was also to study the role of toothbrushing in adolescents' health-related lifestyle. Data from nationally representative samples of 12- to 16-year-olds (N = 11,149) were linked with register data on the highest level of education attained at age 27-33 years. Adolescents with a low toothbrushing frequency reached only the lowest education levels. School achievement or sociodemographic background only partly accounted for the association. Exploratory factor analysis found four dimensions of health behaviors. At age 12, a low toothbrushing frequency was loaded highly with "street-oriented" behaviors, concentrated around smoking and alcohol use. At ages 14 and 16, it was associated with a "traditional" lifestyle of the less-well-educated. Altogether, a low toothbrushing frequency indicated selection into the less-well-educated stratum of society. This is likely to be reflected in socio-economic health differences in adulthood.

Sociodemographic differences in the occurrence of teenage pregnancies in Finland in 1987-1998: a follow up study.

STUDY OBJECTIVE: To analyse sociodemographic differences in the occurrence of pregnancies to 14 to 19 year olds and changes in these differences from 1987 to 1998. DESIGN: Follow up of adolescent survey respondents using registers. SETTING AND SUBJECTS: The dataset includes information on all registered pregnancies (abortions, births, and miscarriages, n=2743) of the female respondents (n=28 914) to the Adolescent Health and Lifestyle Survey (AHLS) from 1987 to 1998. In the AHLS, self administered questionnaires were mailed every second year to independent samples of 12, 14, 16, and 18 year olds representative for Finland. MAIN OUTCOME MEASURE: Relative risk (hazard) of becoming pregnant at teenage. MAIN RESULTS: Girls from lower socioeconomic background had a higher pregnancy risk. Girls who did not live with both parents at the baseline survey had higher pregnancy risk than those who did, and girls who lived in a stepfamily had a higher risk than those who lived in a one parent family. Swedish speaking girls had a lower pregnancy risk than the Finnish speaking girls. There was no systematic change from 1987 to 1998 in most sociodemographic differentials in the teenage pregnancy risk, however, there was some increase in the differences by family structure. Changes in the sociodemographic structure did not explain the levelling off of the downward trend in teenage pregnancy risk, nor did the regional socioeconomic differences explain regional differentials in teenage pregnancy risk. CONCLUSION: Although the reduction of socioeconomic and regional differences has been a general objective in Finnish social and health policies, the relative differences in teenage pregnancies have not decreased.

Secular trends in overweight and obesity among Finnish adolescents in 1977-1999.

OBJECTIVE: To study the trends in overweight and obesity among Finnish adolescents in 1977-1999. DESIGN: Mailed surveys every other year. SUBJECTS: Nationally representative samples of 12, 14, 16 and 18-y-olds (n = 64,147, response rate 78.9%). METHODS: Overweight and obesity were measured by body mass index (BMI) and relative weight (RW) based on self-reported height and weight. BMI > or = the 85th percentile cut-off point for BMI in each age- and sex-specific group in the entire data set was considered as overweight, and BMI > or = 95th percentile cut-off point as obesity. RW > or = 110% and > or = 120%, calculated as the individual's weight divided by the mean weight in each age- and sex-specific height percentile group in the entire data set, were considered as overweight and obesity, respectively. The trends in overweight and obesity are described by the change in the 85th and 95th percentile cut-off points of BMI over time. The prevalence of overweight and obesity is also reported using BMI reference values recommended for international comparisons. Because of the similarity of the BMI and the RW criteria in classifying adolescents as overweight and obese, only results based on BMI are presented. RESULTS: Overweight and obesity increased linearly in all sex and age groups from 1977 to 1999. Depending on the age group, the average increase in the 85th percentile cut-off point of the BMI per 10 y was 0.6-1.1 kg/m2 in boys and 0.3-0.7 kg/m2 in girls. The 95th percentile cut-off point of the BMI for boys and girls increased by 1.1-1.6 kg/m2 and by 0.6-1.0 kg/m2 per 10 y, respectively. In boys, the increase in overweight and obesity was largest in the two youngest age groups. In girls, the increase in overweight was largest in the oldest age group, and that of obesity both in the 14 and 18-y-olds. Overweight and obesity increased more in boys than in girls in all age groups except in the 18-y-olds among whom the increase was similar in both sexes. Examination of the entire BMI distribution showed that there was little or no change over time at the lower (5th, 15th) and middle (50th) percentiles, but increasing differences at the upper end of the distribution, the increases in the 95th percentile being even more marked than those in the 85th percentile curves. According to international reference values, the age-standardized prevalence of overweight increased in boys from 7.2 to 16.7%, and in girls from 4.0 to 9.8%, between 1977 and 1999. The prevalence of obesity in boys was 1.1% in 1977 and 2.7% in 1999, and in girls 0.4 and 1.4%, respectively. CONCLUSION: Overweight and obesity increased remarkably among Finnish adolescents from 1977 to 1999. The changes concentrated at the upper end of the BMI distribution, suggesting that factors behind this development have influenced only a part of the adolescent population.

Public health training in Europe. Development of European masters degrees in public health.

BACKGROUND: Changing political and economic relations in Europe mean that there are new challenges for public health and public health training. There have been several attempts to develop training at the master's level in public health which is focused on meeting the new needs. These have failed due to being too inflexible to allow participation by schools of public health. METHODS: A project funded by the European Union involving public health trainers has developed a new approach which allows participating schools to retain their national differences and work within local rules and traditions, but which aims to introduce the European dimension into public health training. This paper reports the conclusions of this project. CONCLUSIONS: A network of schools wishing to develop European Master's degrees is being established and other schools offering good quality programmes will be able to join.

Health behavior-based selection into educational tracks starts in early adolescence.

Health behaviors and educational tracks of an individual are here presumed to have a strengthening influence on each other during the developmental process, through which individuals gradually reach their adult health and social position. This longitudinal study of a Finnish nationally representative sample of 12 year olds born in 1970 (N = 1009) examined the associations of health behaviors at ages 12 and 14 with educational track at age 16. The dependent variable, educational track, classified the respondents into five successive categories, thought to predict their adult social position. Selection into different educational tracks according to health behaviors was obvious already at age 12, when frequency of tooth brushing, consumption of sweets, coffee drinking and level of participation in physical exercise predicted educational track independently of sociodemographic background. At age 14, the independent predictors were smoking, frequency of tooth brushing and coffee drinking. At both ages, sociodemographic factors had independent associations with educational track. It seems that certain health-related behaviors in early adolescence are indicators of a person's possibilities to benefit from a country's educational supply. Both sociodemographic background and health-related behaviors influence the process of selection into educational tracks leading to social position and health in adulthood.

Depression, drinking, and substance use among 14- to 16-year-old Finnish adolescents.

Our aim was to assess the relationship between self-reported depression, alcohol consumption, and substance use among 14- to 16-year-olds. A school survey was conducted of 16,464 14- to 16-year-olds in two regions of Finland. Alcohol and other substance use were found to be significantly associated with depression. Of girls (boys) who reported drinking weekly, 24% (13%) scored as depressed, compared with 7% (4%) of those not drinking. Of girls (boys) who reported having experimented with substances five times or more, 37% (28%) scored as depressed compared with 8% (5%) of those who reported never having experimented with substances. These associations persisted in multivariate analyses controlling for sociodemographic background. In conclusion, frequent drinking and experimenting with substances indicate a risk for adolescent depressive disorders, and depressive adolescents are at risk for substance use. Health services should pay attention to the identified depressive adolescents to prevent the possibly subsequent substance use problems among them and also pay attention to frequently drinking adolescents and substance experimenters, to increase identification of depressive disorder and possibilities for early interventions.

The trend and risk factors of perceived toothache among Finnish adolescents from 1977 to 1997.

Toothache is a subjective oral health indicator that should become uncommon when oral health is improving. The aim of this study was to assess changes in perceived toothache between 1977 and 1997 among Finnish adolescents. In the Adolescent Health and Lifestyle Survey, a self-administered questionnaire was mailed to a representative sample of 12-, 14-, 16-, and 18-year-old Finns every second year. The sample sizes in the surveys varied from 2422 to 11,105, making a total of 35,349 subjects in the entire study. The incidence of toothache during the previous 2 years was requested in 1977, 1985, 1991, 1995, and 1997, and the prevalences were 31%, 25%, 28%, 29%, and 37%, respectively. The increase between 1995 and 1997 was highest among 16- and 18-year-olds. There was no tendency for perceived toothache to decline over the study period, despite the decrease in caries experience. Toothache varied by age, socioeconomic status (SES), place of residence, and toothbrushing frequency. The increase in the incidence of toothache reported after 1995 could be a warning signal that economic recession in Finland has caused changes in the dental care system.