Measuring adolescent mental health around the globe: psychometric properties of the self-report Strengths and Difficulties Questionnaire in South Africa, and comparison with UK, Australian and Chinese data.

AIMS: This study evaluated the psychometric properties of the Strengths and Difficulties Questionnaire Self-Report (SDQ-S) in South African adolescents, and compared findings with data from the UK, Australia and China. METHODS: A sample of 3451 South African adolescents in grade 8, the first year of secondary school (Mage = 13.7 years), completed the SDQ-S in Afrikaans, English or isiXhosa. Means, group differences and internal consistency were analysed using SPSS V22, and confirmatory factor analyses were conducted using MPlus V7. RESULTS: In the South African sample, significant gender differences were found for four of the five sub-scale means and for total difficulties, but gender differences of alpha scores were negligible. The internal consistency for the total difficulties, prosocial behaviour and emotional symptoms sub-scales were fair. UK cut-off values for caseness (set to identify the top 10% of scores in a UK sample) led to a higher proportion of South African adolescents classified in the 'abnormal' range on emotional and peer difficulties and a lower proportion classified in the 'abnormal' range for hyperactivity. South African cut-offs were therefore generated. The cross-country comparison with UK, Australian and Chinese data showed that South African adolescent boys and girls had the highest mean scores on total difficulties as well as on the subscales of emotional symptoms and conduct problems. In contrast, South African boys and girls had the lowest mean scores for hyperactivity/inattention. The UK boys and girls had the highest mean scores for hyperactivity/inattention, while the Australian sample had the highest scores for prosocial behaviours. The Chinese boys had the highest peer problem mean scores and Chinese boys and girls had the lowest means on prosocial behaviours. Confirmatory factor analyses showed significant item loadings with loadings higher than 0.40 for the emotional and prosocial behaviour sub-scales on the five-factor model, but not for all relevant items on the other three domains. CONCLUSIONS: Findings support the potential usefulness of the SDQ-S in a South African setting, but suggest that the SDQ-S should not be used with UK cut-off values, and indicate the need for further validation and standardisation work in South African adolescents. We recommend that in-country cut-offs for 'caseness' should be used for clinical purposes in South Africa, that cross-country comparisons should be made with caution, and that further examination of naturalistic clusters and factors of the SDQ should be performed in culturally and contextually diverse settings.

Changes from 1986 to 2006 in reasons for liking leisure-time physical activity among adolescents.

Reasons for participating in physical activity (PA) may have changed in accordance with the general modernization of society. The aim is to examine changes in self-reported reasons for liking leisure-time physical activity (LTPA) and their association with self-reported LTPA over a 20-year period. Data were collected among nationally representative samples of 13-year-olds in Finland, Norway, and Wales in 1986 and 2006 (N = 9252) as part of the WHO cross-national Health Behaviour in School-aged Children (HBSC) study. Univariate ANOVAs to establish differences according to gender, year, and country were conducted. In all countries, 13-year-olds in 2006 tended to report higher importance in terms of achievement and social reasons than their counterparts in 1986, while changes in health reasons were minor. These reasons were associated with LTPA in a similar way at both time points. Health reasons for liking LTPA were considered most important, and were the strongest predictor of LTPA. The findings seem robust as they were consistent across countries and genders. Health education constitutes the most viable strategy for promoting adolescents' motivation for PA, and interventions and educational efforts could be improved by an increased focus on LTPA and sport as a social activity.

Co-occurring development of early childhood communication and motor skills: results from a population-based longitudinal study.

BACKGROUND: Communicative and motor development is frequently found to be associated. In the current study we investigate to what extent communication and motor skills at 1½ years predict skills in the same domains at 3 years of age. METHODS: This study is based on the Norwegian Mother and Child Cohort Study (MoBa) conducted by the Norwegian Institute of Public Heath. Data stem from 62,944 children and their mothers. Mothers completed questionnaires on their child's communication and motor skills at ages 1½ and 3. Associations between communication and motor skills were estimated in a cross-lagged model with latent variables. RESULTS: Early communication skills were correlated with early motor skills (0.72). Stability was high (0.81) across time points for motor skills and somewhat lower (0.40) for communication skills. Early motor skills predicted later communication skills (0.38) whereas early communication skills negatively predicted later motor skills (-0.14). CONCLUSION: Our findings provide support for the hypothesis that these two difficulties are not symptoms of separate disorders, but might rather be different manifestations of a common underlying neurodevelopmental weakness. However, there also seem to be specific developmental pathways for each domain. Besides theoretical interest, more knowledge about the relationship between these early skills might shed light upon early intervention strategies and preventive efforts commonly used with children with problems in these areas. Our findings suggest that the relationship between language and motor skills is not likely to be simple and directional but rather to be complex and multifaceted.

Effects of the SATZ teacher-led school HIV prevention programmes on adolescent sexual behaviour: cluster randomised controlled trials in three sub-Saharan African sites.

In this study, the effects on young adolescent sexual risk behaviour of teacher-led school HIV prevention programmes were examined in two sites in South Africa (Cape Town and Mankweng) and one site in Tanzania (Dar es Salaam). In Cape Town, Dar es Salaam and Mankweng, 26, 24 and 30 schools, respectively, were randomly allocated to intervention or comparison groups. Primary outcomes were delayed sexual debut and condom use among adolescents aged 12-14 years (grade 8 in South Africa and grades 5 and 6 in Tanzania). In total, 5352, 4197 and 2590 students participated at baseline in 2004 in Cape Town, Dar es Salaam and Mankweng, respectively, and 73% (n = 3926), 88% (n = 3693) and 83% (n = 2142) were retained 12-15 months later. At baseline, 13% (n = 224), 5% (n = 100) and 17% (n = 164) had had their sexual debut, and 44% (n = 122), 20% (n = 17) and 37% (n = 57) of these used a condom at last sex, respectively. In Dar es Salaam, students in the intervention were less likely to have their sexual debut during the study (OR 0.65, 95% CI 0.48-0.87). In Cape Town and Mankweng, the intervention had no impact. The current interventions were effective at delaying sexual debut in Dar es Salaam but not in South Africa, where they need to be supplemented with programmes to change the environment in which adolescents make decisions about sexual behaviour.

Subjective attractiveness and perceived trendiness in smoking and snus use: a study among young Norwegians.

In Norway, there has been a decline in smoking among adults and young people, but there has also been an increase in the use of snus, particularly among young males. Among females, snus use is less common. This study examines to what extent subjective attractiveness (SA) (the individual's personal opinion regarding how attractive a person who smokes/uses snus is) and perceived trendiness (PT) (the individual's impressions of how popular smoking/use of snus is) may contribute to explaining current trends in smoking and snus use among young people in Norway. Data were collected from a national representative sample of 2400 young people (age 16-20) by telephone interviews. Among males, regular smokers were also likely to be regular snus users and vice versa. SA and PT were significant predictors of their respective behaviours (smoking and snus use) and in some cases of the other behaviour. Smoking and snus use were perceived as unattractive, while snus use was perceived to be trendier than smoking. Males, more than females, perceived snus use to be attractive and trendy. This pattern is partly consistent with current changes in tobacco use in the Norwegian population.

Relative harm of snus and cigarettes: what do Norwegian adolescents say?

BACKGROUND: The public receives mixed messages about the harmfulness of alternative tobacco products to cigarettes, and little is known about what present and potential users of these products actually think about their relative harmfulness. METHODS: In a nationally representative survey of 2415 Norwegian adolescents aged 16-20 years, participants were asked to rate the harmfulness of various available tobacco products and their own use of snus and cigarettes. A study was undertaken to examine how adolescents rate the relative harm of tobacco products in general, and snus and cigarettes in particular, and how this varies with age, gender and their own use of snus and smoking. RESULTS: Cigarettes were generally rated as more harmful than snus, but 41% still rated snus as equally or more harmful than cigarettes. Male participants reported lower harm from all products than females. Being a snus user was associated with lower ratings of harm for snus, but being a smoker was not associated with reporting of harm for cigarettes. CONCLUSIONS: Compared with the current scientific consensus, the participants overrated the harmfulness of snus and, as such, our results suggest a potential for changing peoples' perceptions of the relative health risks of various tobacco products. To the extent that health information affects consumption, accurate information on relative risks may lead more people to choose snus over cigarettes.

Decline in respiratory symptoms in service workers five months after a public smoking ban.

OBJECTIVE: To evaluate the effect of a total ban on smoking indoors in restaurants and other hospitality business premises in Norway, on respiratory symptoms among workers in the industry. METHODS: Phone interviews with 1525 employees in the hospitality business were conducted immediately before the enacting of the law. In a follow-up study five months later, 906 of the workers from the baseline sample participated. Questions were asked on demographic variables, passive smoking exposure, personal smoking, attitudes towards the law, and five respiratory symptoms. Change in symptom prevalence was analysed with McNemar's test and with analysis of variance (ANOVA) for repeated measures. RESULTS: The prevalence of all five symptoms declined after the ban; for morning cough from 20.6% to 16.2% (p < 0.01); for daytime cough from 23.2% to 20.9%; for phlegm cough from 15.3% to 11.8% (p < 0.05); for dyspnoea from 19.2% to 13.0% (p < 0.01); and for wheezing from 9.0% to 7.8%. ANOVA showed that the largest decline in symptom prevalence was seen among workers who themselves gave up smoking, and subjects with a positive attitude towards the law before it took effect. CONCLUSION: A significant decrease in respiratory symptoms among service industry workers was found five months after the enacting of a public smoking ban.

[Psychological and somatic complaints among adolescents]. / Psykiske og somatiske plager blant ungdom.

BACKGROUND: Health promotion and disease prevention among adolescents should include efforts to reduce the burden of health complaints. In order to develop systematic preventive approaches, epidemiological research is needed. This study focuses on prevalence, gender differences, and intercorrelations among such complaints. MATERIAL AND METHODS: The data were drawn from a nationwide (Norwegian) survey among pupils in compulsory school grades 6, 8, and 10 (age 11, 13, and 15); response rate 79%. RESULTS: Among 15-year-olds, most health complaints were more prevalent among girls than among boys. A principal components analysis revealed a dimension from primarily psychological to primarily somatic complaints. Among 15-year-olds, 18% reported at least one daily psychological complaint and 14% reported at least one daily somatic complaint. Sum-scores for psychological and somatic complaints were constructed, the intercorrelation being 0.56 among 15-year-olds. Girls scored significantly higher than boys on both sum-scores. Among girls there was a marked increase in scores with age (particularly for somatic complaints). INTERPRETATION: The high prevalence of complaints among both genders and the increase with age among girls implies that preventive action is needed. The intercorrelations among complaints indicate common etiological processes.

Tobacco use by early adolescents in Norway.

BACKGROUND: This study examined trends in the prevalence of smoking and snuff use among Norwegian adolescents in lower secondary school (ages 13-15 years) from a national survey conducted every 5 years between 1975 and 1995. METHODS: Pupils completed a brief written questionnaire on tobacco use and related information. Local school administrators coordinated data collection and forwarded a sample of completed questionnaires to the National Council on Tobacco and Health for compilation and analysis. Effects for age, gender and survey year were examined using logistic regression analysis. Overall, 24,127 pupils in five different cohorts were included. RESULTS: Smoking was highest in 1975 when 45.5% of youth reported smoking either daily or occasionally (figures adjusted for age and gender). Smoking declined each year thereafter through to 1990 (23.6%) but increased in 1995 (26.0%), primarily due to an increase in occasional smoking. Like smoking, snuff use declined between 1985 and 1990 but increased in 1995. All changes across survey years were statistically significant. Smoking was higher among girls than boys, while snuff use was much higher among boys. CONCLUSION: Several hypotheses that might account for the recent increase were examined with the most likely factor being Norway's low allocation of resources for educational interventions and public information campaigns during the years studied. However, in the past 2 years Norway has undertaken a number of new tobacco control initiatives that may result in reversal of the most recent trends.

Injury registration in a developing country. A study based on patients' records from four hospitals in Dar es Salaam, Tanzania.

BACKGROUND: A recent study conducted in some parts of Tanzania has revealed that injuries rank as the third major leading cause of death among the adult population only after tuberculosis and HIV/AIDS. Critical to any injury prevention activities is a reliable surveillance system. Such a system may for instance be based on hospital registration of injuries. OBJECTIVES: The aim of this study was to evaluate available hospital records for the purpose of describing the epidemiology of injuries among inpatients in four hospitals in Dar es Salaam, Tanzania. METHODS: The study utilized patients' medical records for the year 1998. The final sample included 1098 cases from four hospitals. Data handling and analysis was performed using statistical software SPSS for windows version 10.0. Cross tabulations with Chi-square testing for independence, t-test for difference between means (independent groups) and one way analysis of variance was used. RESULTS: The age group 21 to 30 years formed the largest proportion of injury-related admissions. The male to female ratio was 2.3 to 1. The largest categories of injuries were road traffic injuries (43.7%), violence and assaults (23.5%), and falls (13.8%). Burns accounted for 6.5% of the cases. The following variables were routinely recorded in case notes: gender (100%), nature of injury/principal diagnosis (99.6%), body part injured (99.4%), and age (96.4%). CONCLUSIONS: There is a need for improving the way injuries are recorded in hospitals. Hospitals' records could provide a useful tool for monitoring injury preventive activities in developing countries like Tanzania.

Effects of a school-based smoking prevention program among subgroups of adolescents.

In autumn 1995 The Norwegian Cancer Society in cooperation with The Research Center for Health Promotion, University of Bergen started a study of school-based interventions aiming at preventing smoking among pupils in Norwegian secondary schools. The study comprised a nationwide sample of 4441 students at 99 schools (195 classes). This panel of students is followed through annual data collections till they graduate in spring 1997. Written consensus from students and parents was obtained from 95%. Schools were systematically allocated to one of four groups: Group A, control; Group B, intervention, containing classroom program, involvement of parents and teacher courses; Group C, like B, but without teacher courses; Group D, like B, but without parental involvement. Baseline data were collected by questionnaires administered in class in November 1994 and the first follow-up survey was carried out in May 1995. At follow-up the proportion of smokers had increased by 8.3 percentage points in Group A (control) and by 1.9 percentage points in Group B (most extensive intervention). As expected, the recruitment of smokers was higher in Groups C and D than in the ideal intervention, but lower than in the control group. Effects of the most extensive program among subgroups of students were examined by comparing Groups A and B. Students are categorized as high risk or low risk based on scores on scales measuring sensation seeking, physical maturity, antisocial behavior and parental smoking. The effect of the program on recruitment of smokers seems to have been at least as strong or even stronger among 'high-risk' students than among other students.

Evaluation of the Norwegian campaign against the illegal spirits trade.

In 1993, a 21m NOK (3m US$) national campaign against trade with illegal spirits (homebrewed or smuggled) was launched in Norway. This article reports results of its evaluation study. Surveys covering the age range 16-80 were carried out just before the campaign started and 1 year later. Half of those responding at baseline as well as a new sample were surveyed after 1 year. While at baseline 48% reported to have drunk and 16% to have bought illegal spirits during the last 12 months, the corresponding figures after 1 year were 42 and 14%. Significant associations between being exposed to the campaign and reduced use and buying of illegal spirits were found. Further, use and buying of illegal spirits at baseline, and stopping to use and buy illegal spirits from baseline to follow-up were analyzed in bivariate and multivariate logistic regression analyses. In the multivariate prediction of stopping to use illegal spirits, only behavioral norms and significant others' opinions (both measured at baseline) obtained significance.

Effectiveness of postal smoking cessation advice: a randomized controlled trial in young men with reduced FEV1 and asbestos exposure.

There have been few community-based randomized, controlled intervention trials for cessation in high-risk smokers. In such a trial we evaluated the effects of postal smoking cessation advice in smokers with asbestos exposure and/or reduced forced expiratory volume in one second (FEV1). All men aged 30-45 yrs (n=22,392) living in 34 municipalities in western Norway were invited to a cross-sectional community survey. Information on smoking habits and occupational asbestos exposure were obtained from self-administered questionnaires and measurements of FEV1 were performed with dry-wedge bellow spirometers. Among 16,393 participants we identified a group of 2,610 smokers with previous occupational asbestos exposure and/or adjusted FEV1 in the lowest quartile. A random half (n=1,300) received a mailed personal letter from a respiratory physician with a person-specific health advice to quit smoking and a pamphlet on smoking cessation. The remaining smokers (n=1,310) acted as controls and did not receive any information. Twelve months after the intervention, information on smoking habits was re-examined using a postal questionnaire. Among the respondents (n=2,282), smoking cessation was reported altogether by 13.7% in the intervention group versus 9.9% in the control group (p<0.01). The 1 yr sustained quit rate (no smoking at all during the last year) was 5.6 versus 35% (p<0.05), respectively. Measurements of carbon monoxide in expired air (with < or = 10 parts per million) confirmed self-reported nonsmoking in samples of the two groups. In a community this simple postal smoking cessation advice from a respiratory physician based on person-specific risk factors improved the 1 yr sustained success rate by 60% in identified high-risk smokers.

Provocative appeals in anti-smoking mass media campaigns targeting adolescents--the accumulated effect of multiple exposures.

This paper reports findings from a longitudinal study that evaluated the accumulated effect of three consecutive mass media campaigns using provocative and dissonance arousing appeals to prevent cigarette smoking by adolescents. In the spring of 1992, all eligible adolescents aged 14 and 15 in one intervention county (N = 4898) and one control county (N = 5439) in Norway were included in the study, and were followed until they were 17 and 18 years of age in 1995. Only students who completed questionnaires both in 1992 and 1995 were included in the analyses. Among the non-smokers at baseline, a significantly lower proportion of adolescents of both genders had started to smoke in the intervention county compared to the proportion in the control county. Among those who were smokers at baseline, significantly more girls in the intervention county had stopped smoking than in the control county, while no significant difference between the counties was detected among boys. Our findings suggest that provocative and dissonance arousing appeals that create affective reactions and lead to interpersonal communication should be given more attention in campaigns designed to influence adolescent smoking. However, such appeals may easily produce negative reactions and the normative context should be thoroughly considered when using such appeals in future interventions.

Predicting adolescents' intentions to drink alcohol: outcome expectancies and self-efficacy.

OBJECTIVE: This article examines the relationship between intention to drink alcohol, alcohol outcome expectancies and alcohol-related self-efficacy among Norwegian adolescents. The relationship of expectancies, intention and self-efficacy was assessed for respondents of different ages and different drinking experience. METHOD: Data were collected from all seventh and ninth graders in 12 randomly selected schools in Norway. The self-administered questionnaire contained a short version of the Alcohol Expectancy Questionnaire for Adolescents and measures of intentions to drink in the next 12 months, current alcohol use and alcohol-related self-efficacy (e.g., ability to refuse alcohol). RESULTS: Results showed that both alcohol outcome expectancies and previous experience with alcohol were related to intentions to drink alcohol in the near future. Drinking experience had a larger impact than a 2-year age difference on the associations between alcohol outcome expectancies, alcohol-related self-efficacy and intention to drink. A significantly higher proportion of adolescents with drinking experience reported positive alcohol expectancies, poor alcohol-related self-efficacy and strong intention to drink alcohol than did those adolescents without drinking experience. CONCLUSIONS: Personal drinking experience was a stronger predictor of drinking intentions than was age. Still, both alcohol outcome expectancies and alcohol-related self-efficacy are significant predictors of intention to drink among both seventh and ninth graders, independent of previous drinking experience. This study indicates that postponing the onset of alcohol experimentation could be a major goal in primary alcohol prevention among adolescents, although longitudinal confirmation of these results is needed.

Pregnancy--a golden opportunity for promoting the cessation of smoking?

OBJECTIVE: To investigate whether daily-smoking pregnant women are more motivated to reduce their cigarette consumption than daily-smoking non-pregnant women. DESIGN: Prospective study with self-administered questionnaires at inclusion and 18 months later. SETTING: 116 general practitioners in western Norway. SUBJECTS: 83 pregnant and 107 non-pregnant women. MAIN OUTCOME MEASURES: Non-anonymous questionnaires focusing on smoking habits and attitudes to smoking cessation. RESULTS: Pregnant women were more often encouraged to stop smoking by their partners than non-pregnant women (p < 0.01). More pregnant than non-pregnant women totally agreed that their GP should try to motivate their patients to stop smoking (p < 0.001). Pregnant women also predicted that they would be non-smokers in five years more often than non-pregnant women (p < 0.001). Eighteen months later no such difference was found. A reduced cigarette consumption, verified by serum thiocyanate, was found among women early in pregnancy. The reduced consumption found later in pregnancy and the first year after delivery may be explained to some extent by systematic underreporting. At the end of the study eight per cent of both pregnant and non-pregnant women had stopped smoking. CONCLUSION: We need to develop strategies for utilizing the unique opportunity which pregnancy provides for the motivation of cessation of smoking.

Is smoking intervention in general practice more successful among pregnant than non-pregnant women?

The objective of this study was to evaluate the effect of a simple smoking intervention programme, carried out by a large number of general practitioners (GPs) among pregnant and non-pregnant women. Four groups of women were defined by the dichotomies pregnant versus non-pregnant and intervention versus control. The intervention was semistructured, using a flip-over and a booklet, and it was implemented in an ordinary sequence of consultations. The study involved 187 GPs in western Norway. The subjects were 350 daily smoking pregnant women and 274 daily smoking non-pregnant women, 18-34 years of age. The point prevalence abstinence rate at 18 months was 15 and 20% for pregnant and non-pregnant women, respectively, in the intervention groups, and 7% in the control groups (Ppregnant = 0.06, Pnon-pregnant = 0.006). Twenty-five per cent of the pregnant women and 34% of the non-pregnant women reported that they had reduced their cigarette consumption, but had not stopped smoking entirely. If we include all drop-outs as smokers, the continuous abstinence rate during 15 months was 6%/0% among pregnant women (intervention/control) and 5%/1% among non-pregnant women. Stopping smoking was associated with having a non-smoking partner (P = 0.001), and being encouraged to do so by their partner (P = 0.004). The prevalence of both pregnant and non-pregnant women who stopped smoking was higher in the intervention than in the control groups. Pregnant women stopped smoking as frequently as non-pregnant individuals.(ABSTRACT TRUNCATED AT 250 WORDS)