Association between caregiver and household alcohol use and child behavior problems in KwaZulu Natal, South Africa.

We explored the association between household alcohol use and behavior problems among South-African children, using data from the Asenze study, a population-based cohort of South African children and their caregivers. Household alcohol use and child behavior were assessed when children were 6-8 years old. To examine the association, we performed linear regressions. The sample included 1383 children with complete data under the care of 1251 adults. Children living in a household where self-reported caregiver alcohol use was scored as hazardous (4.6%) had higher levels of problem behavior (ß = 1.94, 95% CI 0.06-3.82). There were no statistically significant associations between reported hazardous alcohol use by another member of the household (14.5%) and child problem behavior. Hazardous household alcohol use was associated with child problem behavior and this effect appeared to be mainly driven by primary caregiver use.

Trends in gender and socioeconomic inequalities in adolescent health over 16 years (2002-2018): findings from the Canadian Health Behaviour in School-aged Children study. / Évolution des inégalités en santé chez les adolescents selon le genre et le statut socioéconomique sur 16 ans (2002 à 2018) : résultats de l'Enquête sur les comportements de santé des jeunes d'âge scolaire.

INTRODUCTION: Monitoring health inequalities in adolescents informs policy approaches to reducing these inequalities early in the life course. The purpose of this study was to investigate trends in gender and socioeconomic inequalities in six health domains. METHODS: Data were from five quadrennial survey cycles of the Health Behaviour in School-aged Children (HBSC) study in Canada (pooled n = 94 887 participants). Differences in health between socioeconomic groups (based on material deprivation) and between genders were assessed using slope and relative indices of inequality in six health domains: daily physical activity, excess body weight, frequent physical symptoms, frequent psychological symptoms, low life satisfaction, and fair or poor self-rated health. RESULTS: Over a 16-year period, adolescents in Canada reported progressively worse health in four health domains, with those at the lowest socioeconomic position showing the steepest declines. Socioeconomic differences increased in excess body weight, physical symptoms, low life satisfaction, and fair or poor health. Gender differences also increased. Females showed poorer health than males in all domains except excess body weight, and gender differences increased over time in physical symptoms, psychological symptoms and low life satisfaction. CONCLUSION: Socioeconomic and gender inequalities in health are persistent and widening among adolescents in Canada. Policies that address material and social factors that contribute to health disparities in adolescence are warranted.

Shielding children from food insecurity and its association with mental health and well-being in Canadian households.

OBJECTIVE: Adults in food-insecure households will often sacrifice their own nutritional needs so that children are fed first. This shielding may protect children from malnutrition, but its links to mental health and well-being have not been closely examined. The aim of this study is to explore these links. METHODS: We used data from three cycles of the Canadian Community Health Survey (n = 28,871 youth, 74,416 adults) to identify shielded children (those who reported not being food insecure but lived in food-insecure households). Using Poisson regression, we examined youth and adult mental health and well-being (mood disorder, anxiety disorder, fair/poor mental health, fair/poor health, and low life satisfaction) in shielding households compared to food-secure households and food-insecure households where children were not shielded. RESULTS: About one in six (15.3%) households with children was food insecure. One third of these (6.3%) included children who were shielded from experiencing food insecurity. Shielded youth did not differ significantly from food-secure youth in three of the five outcomes examined. However, unshielded youth, compared to food-secure youth, showed increased risks of every health outcome we investigated. Adults in food-insecure households also reported worse mental health than food-secure adults but better mental health if children were shielded. CONCLUSION: Shielding is associated with reduced risk of common psychiatric outcomes and poor mental health in youth and adults, possibly because it is associated with milder forms of food insecurity. The inability to protect children from having inadequate access to food may compound the psychological strain of food insecurity on mental health and well-being among adults.

RéSUMé: OBJECTIF: Les adultes d'un ménage en insécurité alimentaire sacrifient souvent leurs propres besoins nutritionnels afin que les enfants soient nourris en priorité. Cette protection peut préserver les enfants de la malnutrition, mais ses liens avec la santé mentale et le bien-être n'ont pas été spécifiquement examinés. L'objectif de cette étude est d'explorer ces liens. MéTHODE: Nous avons utilisé les données de trois cycles de l'Enquête sur la santé dans les collectivités canadiennes (n = 28 871 jeunes, 74 416 adultes) dans le but d'identifier les ménages en insécurité alimentaire dans lesquels les enfants ne se trouvaient pas en insécurité alimentaire ( « protégés ¼). Afin de comparer la santé mentale et le bien-être des jeunes et adultes vivant au sein d'un ménage en insécurité alimentaire « protégé ¼ par rapport aux individus vivant au sein d'un ménage en sécurité alimentaire et d'un ménage en insécurité alimentaire où les enfants n'étaient pas protégés de cette insécurité, nous avons utilisé la régression de Poisson. RéSULTATS: Environ un ménage avec des enfants sur six (15,3 %) était en insécurité alimentaire. Un tiers de ces enfants (6,3 %) étaient protégés de l'insécurité alimentaire. Les enfants « protégés ¼ ne différaient pas significativement des enfants vivant au sein d'un ménage en sécurité alimentaire pour la plupart des résultats concernant la santé mentale. Les enfants « non protégés ¼ ont montré des risques accrus pour chaque indicateur étudié (trouble de l'humeur, trouble de l'anxiété, santé mentale moyenne/ mauvaise, santé moyenne/ mauvaise, faible satisfaction de la vie). Les adultes vivant dans un ménage en insécurité alimentaire ont également déclaré une plus mauvaise santé mentale que les adultes vivant dans un ménage en sécurité alimentaire, mais une meilleure santé mentale lorsque les enfants du ménage étaient protégés de l'insécurité alimentaire. CONCLUSION: La protection des enfants au sein d'un ménage en insécurité alimentaire est associé à une réduction du risque de problèmes psychiatriques communs et de mauvaise santé mentale chez les jeunes et les adultes, possiblement parce que les ménages dans lesquels les enfants sont protégés font face à des formes plus légères d'insécurité alimentaire. L'incapacité de protéger les enfants et l'accès inadéquat à la nourriture peut aggraver la pression psychologique de l'insécurité alimentaire sur la santé mentale et le bien-être des adultes.

Relative food insecurity, mental health and wellbeing in 160 countries.

Food insecurity contributes to various stress-related health problems and previous research found that its association with mental illness is stronger in more affluent countries. We hypothesised that this pattern is a function of relative deprivation whereby the severity of individual food insecurity relative to others in a reference group determines its associations with mental health and wellbeing after differences in absolute food insecurity are controlled for. Using survey data from the Gallup World Poll collected in 160 countries and a measure of relative deprivation (Yitzhaki index), we found that relative food insecurity-based on national or regional reference groups-related to more mental health symptoms, lower positive wellbeing and lower life satisfaction after controlling for absolute food insecurity, household income, and country differences. Our analysis also found that relative food insecurity was more strongly related to mental health and wellbeing where the prevalence of food insecurity was lower. The findings underscore the negative health consequences of material deprivation and unfavourable social comparisons. Consistent with relative deprivation theory, individuals who live with constant worries about not getting enough food, have to skip meals, or face chronic hunger are deprived of material and social resources that support mental health and wellbeing, especially in settings where food insecurity is less common and potentially more stigmatised. The implications of these findings for global food policy and surveillance efforts are discussed.

Mutual Influences on Bullying Perpetration and Substance Use Among Adolescents in the United States.

PURPOSE: Identifying temporal pattern of associations between bullying perpetration and substance use among youth is useful for optimal targeting of intervention and prevention. We examined the mutual influences on bullying perpetration and substance use and test the cumulative effects of bullying perpetration and substance use over time. METHODS: We used data from the Population Assessment of Tobacco and Health cohort study, a nationally representative sample of youth, on bullying perpetration and substance use at three points in time over 3 years. We analyzed the associations of bullying perpetration with alcohol, cannabis and cigarette use using binary logistic regressions. The 13,068 youths aged 12-17 years at baseline (2013-2014) were included in the analytical sample. RESULTS: Cross-sectional associations between bullying perpetration and substance use were found at baseline (odds ratio [OR]alcohol = 1.62, 95% confidence interval [CI] 1.33-1.97; ORmarijuana = 1.28, 95% CI .99-1.66; ORcigarette = 1.86, 95% CI 1.44-2.39). Cumulative episodic and frequent bullying perpetration over three data waves predicted an increased likelihood of substance use at follow-up (ORs between 1.18, 95% CI 1.02-1.36 and 2.13, 95% CI 1.66-2.74). Conversely, both episodic and frequent substance use predicted an increased probability of bullying others at follow-up (ORs between 1.50, 95% CI 1.20-1.86, and 2.10, 95% CI 1.69-2.61). CONCLUSIONS: Associations between bullying perpetration and substance use appears to be bidirectional. In addition, episodic bullying perpetrators displayed intermediate levels of risk, suggesting a graded association between bullying perpetration pattern and substance use.

Bidirectional Association Between Bullying Perpetration and Internalizing Problems Among Youth.

PURPOSE: Identification of the temporal pattern of associations between bullying perpetration and mental health problems among youth is needed for the optimal targeting of intervention and prevention. We examined the bidirectional association between bullying perpetration and internalizing problems among youth in the U.S. METHODS: We used data from the prospective cohort study of the Population Assessment of Tobacco and Health waves 1 (September 12, 2013, to December 14, 2014) and 2 (October 23, 2014, to October 30, 2015), a nationally representative sample of youth. We analyzed the associations of bullying perpetration with internalizing problems using binary and multinomial logistic regressions. The 13,200 youths aged 12-17 years were included in the analytic sample. RESULTS: There was a cross-sectional association between bullying perpetration and moderate/high lifetime internalizing problems (ORmoderate vs. no/low = 3.13, 95% CI 2.67-3.65; and ORhigh vs. no/low = 8.77, 95% CI 7.53-10.20). In the prospective analyses, bullying perpetration was associated with increased likelihood of moderate/high internalizing problems at follow-up (ORmoderate vs. no/low = 1.49, 95% CI 1.15-1.94; and ORhigh vs. no/low = 1.71, 95% CI 1.23-2.38), and youth with moderate/high internalizing problems had higher odds of bullying perpetration at follow-up (ORmoderate = 1.95, 95% CI 1.65-2.31; and ORhigh = 3.21, 95% CI 2.74-3.76). CONCLUSIONS: The association between bullying perpetration and internalizing problems appears to be bidirectional. Bullying behaviors prevention and intervention strategies among youth should consider how to take into account and handle negative feelings and mental health problems.

Does liberalisation of cannabis policy influence levels of use in adolescents and young adults? A systematic review and meta-analysis.

OBJECTIVES: To examine the effect of cannabis policy liberalisation (decriminalisation and legalisation) levels of use in adolescents and young adults. DESIGN: Systematic review and meta-analysis. INCLUSION CRITERIA: Included studies were conducted among individuals younger than 25 years and quantitatively assessing consequences of cannabis policy change. We excluded articles: (A) exclusively based on participants older than 25 years; (B) only reporting changes in perceptions of cannabis use; (C) not including at least two measures of cannabis use; (D) not including quantitative data; and (E) reviews, letters, opinions and policy papers. PubMed, PsycINFO, Embase and Web of Science were searched through 1 March 2018. DATA EXTRACTION AND SYNTHESIS: Two independent readers reviewed the eligibility of titles and abstracts and read eligible articles, and four authors assessed the risk of bias (Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies). Extracted data were meta-analysed. The protocol was registered with PROSPERO. RESULTS: 3438 records were identified via search terms and four via citation lists; 2312 were retained after removal of duplicates, 99 were assessed for eligibility and 41 were included in our systematic review. 13 articles examined cannabis decriminalisation, 20 examined legalisation for medical purposes and 8 examined legalisation for recreational purposes. Findings regarding the consequences of cannabis decriminalisation or legalisation for medical purposes were too heterogeneous to be meta-analysed. Our systematic review and meta-analysis suggest a small increase in cannabis use among adolescents and young adults following legalisation of cannabis for recreational purposes (standardised mean difference of 0.03, 95% CI -0.01 to -0.07). Nevertheless, studies characterised by a very low/low risk of bias showed no evidence of changes in cannabis use following policy modifications. CONCLUSIONS: Cannabis policy liberalisation does not appear to result in significant changes in youths' use, with the possible exception of legalisation for recreational purposes that requires monitoring. TRIAL REGISTRATION NUMBER: CRD42018083950.

Long-term occupational trajectories and suicide: a 22-year follow-up of the GAZEL cohort study.

Objective Most suicides occur among individuals of working age. Risk is elevated in some occupational groups, however relations between long-term occupational trajectories and suicide are not well known. We describe career-long occupational trajectories and examine their influence on suicide. Methods Data come from GAZEL, a French cohort study set among employees of a large national utilities company. Occupational grade was obtained from company records from the time of hiring (1953‒1988). Group-based trajectory models were used to define occupational trajectories over a mean time period of 25.0 (standard deviation 6.5) years. Causes of mortality, coded using the International Classification of Diseases, were recorded from 1993‒2014 and studied using Cox regression models. Results Of the 20 452 participants included in the study, 73 died by suicide between 1993‒2014. Results suggested an increased risk of suicide [hazard ratio (HR) 2.57, 95% confidence interval (CI) 1.08-6.15] among participants with persistently low occupational grade compared to those with higher occupational grade and career development. After adjustment for all covariates, especially psychological factors, this association was reduced and no longer statistically significant (HR 2.02, 95% CI 0.82-4.95). Conclusions Persistently low occupational grade could be related to an elevated risk of suicide. This association partly reflects psychological and health characteristics, which can influence occupational trajectories and be reinforced by unfavorable work conditions.

Longitudinal association of antidepressant medication use with metabolic syndrome: Results of a 9-year follow-up of the D.E.S.I.R. cohort study.

OBJECTIVE: To examine longitudinal associations between antidepressant medication use and the metabolic syndrome (MetS). METHODS: 5014 participants (49.8% were men) from the D.E.S.I.R. cohort study, aged 30-65 years at baseline in 1994-1996, were followed over 9 years at 3-yearly intervals (1997-1999, 2000-2002, and 2003-2005). Antidepressant use and MetS, defined by the National Cholesterol Education Program Adult Treatment Panel III criteria (NCEP-ATP III) and the American Heart Association and the National Heart, Lung and Blood Institute (AHA/NHLBI) criteria, were assessed concurrently at four medical examinations. RESULTS: In fully-adjusted longitudinal logistic regression analyses based on generalized estimating equations, antidepressant users had a 9% (p=0.011) and a 6% (p=0.036) greater annual increase in the odds of having the MetS defined by NCEP-ATP III and AHA/NHLBI criteria respectively. Sex-specific analyses showed that this association was confined to men only. When the different types of antidepressant were considered, men who used selective serotonin reuptake inhibitors (SSRIs), imipramine type antidepressants or "other" antidepressants had a 52% (p=0.028), 31% (p=0.011), and 16% (p=0.016) greater annual increase in the odds of having the MetS over time compared to non-users, respectively. These associations depended on the definition of the MetS. CONCLUSIONS: Our longitudinal data showed that antidepressant use was associated with an increased odds of having the MetS in men but not in women and this was mainly for SSRIs, imipramine type and "other" antidepressants. People on antidepressants may need to be checked regularly for the elements of the metabolic syndrome treatable by change in diet, physical activity and/or by medication therapy.

Antidepressant medication use and trajectories of fasting plasma glucose, glycated haemoglobin, ß-cell function and insulin sensitivity: a 9-year longitudinal study of the D.E.S.I.R. cohort.

BACKGROUND: Use of antidepressants is seen to be a risk factor for type 2 diabetes, even though the underlying mechanisms remain unclear. We examined whether antidepressant use was associated with change in fasting plasma glucose, glycated haemoglobin (HbA1c), ß-cell function (HOMA2-%B) and insulin sensitivity (HOMA2-%S) over time. METHODS: Participants in the French D.E.S.I.R. cohort study included over 4700 men (48.1%) and women, free of diabetes, aged 30-65 years at baseline in 1994-96 (D.E.S.I.R. 0), who were followed for 9 years at 3-yearly intervals (D.E.S.I.R. 3, 1997-99; 6, 2000-02; 9, 2003-05). Antidepressant use, fasting plasma glucose, HbA1c, HOMA2-%B and HOMA2-%S were assessed concurrently at four medical examinations. Linear mixed models were used to examine the cross-sectional and longitudinal associations of time-dependent antidepressant use with changes in these four biological parameters. RESULTS: Mean fasting plasma glucose and HbA1c increased whereas HOMA2-%B and HOMA2-%S decreased over the follow-up. In a fully adjusted model, there were no differences in: mean fasting plasma glucose (ß = 0.01 mmol/l, P = 0.702); HbA1c (ß = 0.01 %, P = 0.738); HOMA2-%B (ß = 0.00, P = 0.812); or HOMA2-%S (ß =-0.01, P = 0.791) at baseline (1994-96) between antidepressant users and non-users. The interaction term with time also suggested no differences in the annual change in: fasting plasma glucose (ß = 0.00 mmol/l, P = 0.322); HbA1c (ß = 0.00 %, P = 0.496); HOMA2-%B (ß = 0.00, P = 0.609); or HOMA2-%S (ß = 0.00, P = 0.332) between antidepressant users and non-users. Similar associations were observed in analyses of type and cumulative use of antidepressants over follow-up. CONCLUSION: Our longitudinal data show that use of antidepressants is not associated with altered glucose metabolism, suggesting that the association between antidepressant use and diabetes reported by previous studies may not be causal. Detection bias or clinical ascertainment bias may account for much of this apparent association.

Sleep duration and sleep disturbances partly explain the association between depressive symptoms and cardiovascular mortality: the Whitehall II cohort study.

Depressive symptoms are associated with an increased risk of death, but most of this association remains unexplained. Our aim was to explore the contribution of sleep duration and disturbances to the association between depressive symptoms, all-cause and cardiovascular disease mortality. A total of 5813 (4220 men and 1593 women) aged 50-74 years at baseline, participants of the British Whitehall II prospective cohort study, were included. Depressive symptoms, sleep duration and disturbances were assessed in 2003-04. Mortality was ascertained through linkage to the national mortality register until August 2012, with a mean follow-up of 8.8 years. Depressive symptoms were associated with an increased risk of mortality from all causes [hazard ratio (HR) = 1.51; 95% confidence interval (CI): 1.16-1.97)] and cardiovascular diseases (HR = 1.63; 95% CI: 1.01-2.64) after adjustment for sociodemographic characteristics. Further adjustment for sleep duration and disturbances reduced the association between depressive symptoms and cardiovascular mortality by 21% (HR = 1.53; 95% CI: 0.91-2.57). Sleep seems to have a role, as a mediator or confounder, in explaining the association between depressive symptoms and cardiovascular mortality. These findings need replication in larger studies with longer follow-up.

Bidirectional association between physical activity and symptoms of anxiety and depression: the Whitehall II study.

Although it has been hypothesized that the association of physical activity with depressive and anxiety symptoms is bidirectional, few studies have examined this issue in a prospective setting. We studied this bidirectional association using data on physical activity and symptoms of anxiety and depression at three points in time over 8 years. A total of 9,309 participants of the British Whitehall II prospective cohort study provided data on physical activity, anxiety and depression symptoms and 10 covariates at baseline in 1985. We analysed the associations of physical activity with anxiety and/or depression symptoms using multinomial logistic regression (with anxiety and depression symptoms as dependent variables) and binary logistic regression (with physical activity as the dependent variable). There was a cross-sectional inverse association between physical activity and anxiety and/or depressive symptoms at baseline (ORs between 0.63 and 0.72). In cumulative analyses, regular physical activity across all three data waves, but not irregular physical activity, was associated with reduced likelihood of depressive symptoms at follow-up (OR = 0.71, 95 % CI 0.54, 0.99). In a converse analysis, participants with anxiety and depression symptoms at baseline had higher odds of not meeting the recommended levels of physical activity at follow-up (OR = 1.79, 95 % CI 1.17, 2.74). This was also the case in individuals with anxiety and/or depression symptoms at both baseline and follow-up (OR = 1.70, 95 % CI 1.10, 2.63). The association between physical activity and symptoms of anxiety and/or depression appears to be bidirectional.