Barriers and recommendations for parent-child conversations about pornography.

Introduction: Parents consistently report being worried about the impact of online pornography on their adolescent and pre-adolescent children's development. Yet, most parents do not discuss pornography as part of parent-child conversations about sexuality. The current study sought to identify the barriers to parent-child conversations about pornography. Methods: We present two studies. The first study employed one-to-one interviews to explore parents' (n = 14) beliefs about their role in their child's pornography education. The second study involved the quantitative assessment of Study 1 findings in a sample of parents of pre-adolescent and adolescent children (n = 408). Results: Findings indicate that three overarching themes prevent parents from addressing pornography with their adolescent children, parents' practical ability to discuss pornography, their attitudes toward discussing pornography, and the perceived positive impact of addressing pornography with their adolescent children. Practical ability was most often reported as the greatest barrier to parents engaging in parent-child conversations about pornography. Most notably, parents reported hesitancy in discussing pornography because they did not know how to define pornography or how to address pornography in an age-appropriate way. Fathers were also significantly less likely to believe that talking about pornography was socially acceptable. Discussion: We discuss the implications of these findings and present recommendations for developing a parents' pornography education resource.

The determinants of the nutritional quality of food provided to the homeless population: a mixed methods systematic review protocol.

BACKGROUND: Studies assessing the nutritional quality of food provided to the homeless population show deficiencies in micronutrients and excess fat, sugar, and salt. The availability of cheap, energy-dense and nutrient-poor food has changed the profile of people living with homelessness from primarily underweight to obese in western countries. Many factors influence the nutritional quality of food provided to the homeless population such as budget and time constraints, food donations and limited equipment. Nutrient intakes in this population are unlikely to be met outside of charitable meal programmes, making the nutritional quality of these meals crucial. This review will synthesise mixed methods literature with the overarching aim of understanding the determinants of the nutritional quality of food provided to the homeless population. METHODS: This mixed methods systematic review will include English language empirical research studies from Europe, North America and Oceania. The following electronic databases have been chosen for this review: SCOPUS, EMBASE, PsycINFO, EBSCOHost SocIndex and CINAHL. The grey literature databases OpenGrey and ProQuest will also be searched. Quality appraisal will be conducted using the Mixed-Methods Appraisal Tool. Two independent reviewers will be included in study selection, data extraction and quality appraisal. A third reviewer will resolve conflicts. Thematic synthesis will be employed. DISCUSSION: Results will be organised based on a determinants of health model, to highlight areas where change may be effective, thereby making it more likely to be useful to practitioners and researchers. The iterative steps in the systematic review process will be the focus of this article. Findings from this review will be used to develop best-practice guidelines for stakeholders such as policy makers and service providers to improve the nutritional quality of food provided in the homeless sector. SYSTEMATIC REVIEW REGISTRATION: This mixed methods systematic review protocol has been registered with the International Prospective Register of Systematic Reviews (PROSPERO): CRD42021289063.

Mapping the capacity of health promotion interventions for non-communicable diseases in Oman.

Non-communicable diseases (NCDs) are chronic medical conditions that are, by definition, non-infectious, and non-transmissible among people and caused by a combination of genetic, physiological, environmental and behavioral factors. Affecting all age groups, regions and countries, NCDs cause 72% of deaths in Oman. Health promotion (HP) capacity development is considered fundamental to strengthening and sustaining action against NCDs. This study aimed to map the existing HP capacity for NCDs in Oman by assessing existing knowledge, skills, commitment, structure, systems and leadership and identifying gaps where further capacity is required. The current study used an adapted version of the World Health Organization capacity mapping tool for HP to assess the stage of development across eight HP capacity domains. Quantitative data were collected from 306 geographically dispersed participants across Oman via an online cross-sectional survey. Analyses revealed low scores in policies and plans, collaboration, partnership and professional development domains and even lower scores in the domains of program delivery, information systems and financing. We recommend Oman build and develop more capacity in all domains. The implications of findings are discussed in the context of the current HP policy and practice in Oman.

Perceptions of participation in school and association with health and wellbeing: comparison among Nigerian and Irish pupils.

School participation among pupils is considered a key value of the health promoting school approach. However, few studies have documented the relationship between the school participation of pupils and health and wellbeing outcomes in different geographical contexts, especially looking at developing and developed country contexts. This study investigated the perceptions of Nigerian and Irish pupils on participation in school and reported health and wellbeing. Data was collected using self-completed questionnaires among 333 and 231 primary school pupils in 4th, 5th and 6th classes across 17 schools in Nigeria and Ireland. Logistic regression analysis was used to analyse the data from both countries. There was no statistically significant difference in the mean scores for participation in school activities (NIG mean = 22.8, SD 3.5; IRE mean = 22.3, SD 3.4) and school events (NIG mean = 18.8, SD 3.7; IRE mean = 17.1, SD 3.6). However, participation in school decisions and rules (NIG mean = 17.3, SD 4.7; IRE mean = 15.8, SD 3.6) and health and wellbeing (NIG mean = 16.9, SD 1.7; IRE mean = 15.3, SD 2.4) scores were significantly higher among Nigerian pupils, while positive perception of school participation (NIG mean = 24.2, SD 4.1; IRE mean = 26.2, SD 3.4) was significantly higher among Irish pupils. The findings suggest that Irish and Nigerian pupils have positive perceptions of their schools irrespective of their location and levels of development. However, further research using qualitative approaches might be needed to better clarify dimensions of pupils' perceptions of school life and school participation among Nigerian pupils in order to substantiate these claims.

'It's Hard to Make Good Choices and It Costs More': Adolescents' Perception of the External School Food Environment.

Research on the impact of school and community food environments on adolescent food choice is heavily reliant on objective rather than subjective measures of food outlets around schools and homes. Gaining the perspective of adolescents and how they perceive and use food environments is needed. The aim of this study was to explore adolescent's perception and use of the food environment surrounding their schools. Purposive sampling was used to recruit schools. Mapping exercises and discussion groups were facilitated with 95 adolescents from six schools. Thematic analysis showed that adolescents are not loyal to particular shops but are attracted to outlets with price discounts, those with 'deli' counters and sweets. Cost, convenience and choice are key factors influencing preference for food outlets and foods. Quality, variety and health were important factors for adolescents but these features, especially affordable healthy food, were hard to find. Social factors such as spending time with friends is also an important feature of food environments that deserves further attention. Adolescents' perceptions of their food environment provide insights into features that can be manipulated to enable healthy choices.

Love and Dating Patterns for Same- and Both-Gender Attracted Adolescents Across Europe.

Sexual orientation is a multidimensional phenomenon, which includes identity, behavior, and attraction. The attraction component, however, is less studied than the other two. In this article, we present the development of a two-item measure to identify adolescents who prefer same- and both-gender partners for love and dating. The questions were administered to nationally representative samples of 15-year-old adolescents in eight European countries and regions participating in the Health Behaviour in School-aged Children (HBSC) cross-national study. The distribution of attraction, as operationalized by preference for the gender of love and dating partners, was similar across countries. These questions offer an alternative or supplementary approach to identify same- and both-gender attracted youth, without administering questions related to sexual identity.

Sexual Health questions included in the Health Behaviour in School-aged Children (HBSC) Study: an international methodological pilot investigation.

BACKGROUND: This paper describes the methodological developments of the sexual health items included in the Health Behaviour in School-aged Children (HBSC) study since their mandatory inclusion in the study in 2002. The current methodological, ethical and pedagogical challenges in measuring young people's sexual health behaviours are discussed along with the issues associated with the sexual health items introduced to the HBSC study in 2002. The development and piloting of new cross-national items for use in the 2013/14 HBSC data collection are presented and discussed. METHODS: An international pilot study was undertaken to determine the impact of these proposed changes. Questionnaires and classroom discussion groups were conducted in five pilot countries in 2012/2013 (France, Hungary, Ireland, Portugal and Romania) with a total of 612 school-aged children (age M = 15.55 years, SD = 0.95). RESULTS: The majority of participants in each country provided positive feedback about the appropriateness of the questions. Some small cross-national differences were found in the self-reported quantitative data relating to the appropriateness of the questions (χ2 = 22.831, df = 9, p = .007, V = .117). Qualitative feedback suggests that for the vast majority of students the phrasing and age-targeting of the questions were considered appropriate. With the exception of a small number of respondents who commented on the clarity and/or personal nature of the content, no specific issues with the questions were identified. CONCLUSIONS: These findings provide guidance on the answerability (including the extent of missing and inconsistent data), understandability, acceptability (including in different cultures) and relevance of questions to potential participants. The findings from the pilot study suggest that in general, the questions are understandable, acceptable, and of a high priority to the target population, and that the simplification has significantly reduced the proportion of missing data. The new developments thus enhance the capacity of the questions to measure cross-nationally, sensitive aspects of young people's sexual behaviour. These questions were included in the 2013/2014 round of the HBSC survey and will continue to be used to monitor trends in adolescent sexual health and behaviours, and to inform and influence health services and health education policy and practice at local, national and international levels.

Weight concerns among adolescent boys.

OBJECTIVE: To investigate weight concerns among adolescent boys and relationships with health indicators and family factors. DESIGN: Analysis of the 2010 Health Behaviour in School-aged Children survey of 10-17-year-olds. SETTING: Schools in the Republic of Ireland. RESULTS: Among 6187 boys, 25.1% reported a desire to lose weight (weight 'loss' concern) and 7.7% reported a desire to gain weight (weight 'gain' concern). Both types of weight concerns were associated with poor self-rated health, life satisfaction and happiness, and with more frequent emotional and physical symptoms. Family factors were associated with boys' weight concerns. In adjusted analyses, the risk of weight 'loss' concerns decreased with daily family breakfasts (OR=0.80; 95% CI 0.66, 0.97). The risk of weight 'gain' concerns decreased with frequent family evening meals (OR=0.77; 95% CI 0.60, 0.99). Ease of communication with mother was associated with a decreased risk of weight 'loss' and weight 'gain' concerns among boys (OR=0.74; 95% CI 0.60, 0.90 and OR=0.61; 95% CI 0.44, 0.82, respectively). An open father-son relationship and having a father present in the home decreased the risk of weight 'loss' concerns (OR=0.69; 95% CI 0.57, 0.82 and OR=0.81; 95% CI 0.67, 0.98, respectively). CONCLUSIONS: Body weight concerns were reported by a sizeable minority of boys and were associated with negative health outcomes. The findings support the need to promote frequent family meals and facilitate open communication in families.

Gendered trends in early and very early sex and condom use in 20 European countries from 2002 to 2010.

BACKGROUND: Sexual activity is often initiated during the adolescent period, and previous research suggests that the age of first sexual intercourse and condom use are crucial determinants of later sexual health. This study examined trends in adolescent sexual behaviours from 2002 to 2010 in 20 countries across four geographical regions of Europe. METHODS: Data were collected by self-report questionnaires from 15-year-olds in classrooms during 2002, 2006 and 2010. Linear time trends were determined through logistic regression models, stratified for gender. RESULTS: No linear trend over time was documented for most countries for sexual intercourse at the age of 13 or younger. Increased initiation among girls in Eastern Europe and decreased very early initiation among girls in Northern Europe emerged, along with a general increase in condom use in boys and most notably in girls. CONCLUSION: Overall prevalence of early and very early sexual intercourse initiation was quite stable in Europe between 2002 and 2010, while condom use increased. More detailed research and policy attention to the antecedents of non-condom use among young people is warranted; and further study of the relationships between age of sexual initiation and condom or pill use would be particularly valuable.

Adolescents' medicine use for headache: secular trends in 20 countries from 1986 to 2010.

BACKGROUND: This study reports secular trends in medicine use for headache among adolescents in 20 countries from 1986 to 2010. METHODS: The international Health Behaviour in School-aged Children (HBSC) survey includes self-reported data about medicine use for headaches among nationally representative samples of 11-, 13- and 15-year-olds. We included 20 countries with data from at least three data collection waves, with a total of 380 129 participants. RESULTS: The prevalence of medicine use for headaches varied from 16.5% among Hungarian boys in 1994 to 62.9% among girls in Wales in 1998. The prevalence was higher among girls than boys in every country and data collection year. The prevalence of medicine use for headaches increased in 12 of 20 countries, most notably in the Czech Republic, Poland, Russia, Sweden and Wales. CONCLUSION: The prevalence of medicine use for headaches among adolescents is high and increasing in many countries. As some medicines are toxic this may constitute a public health problem.

Macro-level determinants of young people's subjective health and health inequalities: a multilevel analysis in 27 welfare states.

OBJECTIVES: Cross-national studies have rarely focused on young people. The aim of this study is to investigate whether macro-level determinants are associated with health and socioeconomic inequalities in young people's health. STUDY DESIGN: Data were collected from the Health Behaviour in School-aged Children (HBSC) study in 2006, which included 11- to 15-year old adolescents from 27 European and North American countries (n=134,632). This study includes national income, health expenditure, income inequality, and welfare regime dummy-variables as macro-level determinants, using hierarchical regression modelling. MAIN OUTCOME MEASURE: Psychosomatic health complaints and socioeconomic inequalities in psychosomatic health complaints. RESULTS: Adolescents in countries with higher income inequality and with liberal welfare tradition were associated with more health complaints and a stronger relationship between socioeconomic status and macro-level determinants compared to adolescents from countries with lower income inequality or the Social Democratic regime. National income and health expenditure were not related to health complaints. Countries with higher national income, public health expenditure and income inequality showed stronger associations between socioeconomic status and psychosomatic health complaints. CONCLUSION: Results showed that macro-level characteristics are relevant determinants of health and health inequalities in adolescence.

Drinking motives mediate cultural differences but not gender differences in adolescent alcohol use.

PURPOSE: To test whether differences in alcohol use between boys and girls and between northern and southern/central Europe are mediated by social, enhancement, coping, and conformity motives. METHODS: Cross-sectional school-based surveys were conducted among 33,813 alcohol-using 11- to 19-year-olds from northern Europe (Denmark, Estonia, Finland, Ireland, Poland, Scotland, and Wales) and southern/central Europe (Belgium, Hungary, Italy, Portugal, Slovakia, and Switzerland). RESULTS: Particularly in late adolescence and early adulthood, boys drank more frequently and were more often drunk than girls. Instead of mediation, gender-specific motive paths were found; 14- to 16-year-old girls drank more because of higher levels of coping motives and lower levels of conformity motives, whereas 14- to 19-year-old boys drank more because of higher levels of social and enhancement motives. Geographical analyses confirmed that adolescents from southern/central European countries drank more frequently, but those from northern Europe reported being drunk more often. The strong indirect effects demonstrate that some of the cultural differences in drinking are because of higher levels of social, enhancement, and coping motives in northern than in southern/central Europe. CONCLUSIONS: The results from the largest drinking motive study conducted to date suggest that gender-specific prevention should take differences in the motivational pathways toward (heavy) drinking into account, that is, positive reinforcement seems to be more important for boys and negative reinforcement for girls. Preventive action targeting social and enhancement motives and taking drinking circumstances into account could contribute to tackling underage drinking in northern Europe.

Drinking motives and links to alcohol use in 13 European countries.

OBJECTIVE: The purpose of this study was to test the structure and endorsement of drinking motives and their links to alcohol use among 11- to 19-year-olds from 13 European countries. METHOD: Confirmatory factor analysis, latent growth curves, and multiple regression models were conducted, based on a sample of 33,813 alcohol-using students from Belgium, Denmark, Estonia, Finland, Hungary, Ireland, Italy, Poland, Portugal, Scotland, Slovakia, Switzerland, and Wales who completed the Drinking Motives Questionnaire Revised Short Form (DMQ-R SF). RESULTS: The findings confirmed the hypothesized fourdimensional factor structure. Social motives for drinking were most frequently indicated, followed by enhancement, coping, and conformity motives, in that order, in all age groups in all countries except Finland. This rank order was clearest among older adolescents and those from northern European countries. The results confirmed that, across countries, social motives were strongly positively related to drinking frequency, enhancement motives were strongly positively related to frequency of drunkenness, and conformity motives were negatively related to both alcohol outcomes. Against our expectations, social motives were more closely related to drunkenness than were coping motives, particularly among younger adolescents. CONCLUSIONS: The findings reveal striking cross-cultural consistency. Health promotion efforts that are based on, or incorporate, drinking motives are likely to be applicable across Europe. As social motives were particularly closely linked to drunkenness among young adolescents, measures to impede the modeling of alcohol use and skills to resist peer pressure are particularly important in this age group.

Peer victimization and subjective health among students reporting disability or chronic illness in 11 Western countries.

BACKGROUND: To compare the strength of the association between peer victimization at school and subjective health according to the disability or chronic illness (D/CI) status of students across countries. METHODS: This study used data from 55 030 students aged 11, 13 and 15 years from 11 countries participating in the 2005-06 Health Behaviour in School-aged Children survey. Self-completed questionnaires were administered in classrooms. Multivariate models of logistic regression (controlled for confounding factors and countries) were used to investigate differences in the association between peer victimization and poor subjective health according to the D/CI status. RESULTS: Overall, 13.5% of the students reported having been bullied at least two or three times a month. The percentage of victims was significantly higher among those reporting D/CI than among others in all countries studied. Victims of bullying were more likely to report poor self-rated health, low life satisfaction and multiple health complaints. However, there were no differences in the associations between peer victimization and subjective health indicators according to the D/CI status. CONCLUSIONS: In all countries studied, students reporting D/CI were more likely to report being victims of bullying. Victims of bullying reported more negative subjective health outcomes regardless of their D/CI status. Although inclusive education is currently a major topic of educational policies in most countries, additional efforts should be made to improve the quality of the integration of students with D/CI.

Parents' support and knowledge of their daughters' lives, and females' early sexual initiation in nine European countries.

CONTEXT: Associations between early sexual initiation and parental support and knowledge have not been uniformly tested in multiple European population-based samples. Understanding such associations is important in efforts to discourage females' early sex. METHODS: Data were compiled for 7,466 females aged 14-16 who participated in the 2005-2006 Health Behaviors in School-Aged Children survey in nine countries (Austria, Finland, Greece, Hungary, Iceland, Lithuania, Romania, Spain and Ukraine). Univariate, bivariate and multivariable analyses were run with standard error corrections and weights to assess how sexual initiation before age 16 was related to maternal and paternal support and knowledge of daily activities. RESULTS: Prevalence of early sexual initiation ranged from 7% (in Romania) to 35% (in Iceland). In bivariate analyses, maternal and paternal support were significantly negatively related to adolescent females' early sexual initiation in most countries. In models with demographic controls, parental support was negatively associated with early sexual initiation (odds ratio, 0.8 for maternal and 0.7 for paternal). After parental knowledge was added, early sexual initiation was no longer associated with parental support, but was negatively associated with maternal and paternal knowledge (0.7 for each). These patterns held across countries. CONCLUSIONS: Parental knowledge largely explained negative associations between parental support and early initiation, suggesting either that knowledge is more important than support or that knowledge mediates the association between support and early sex.

Dance is the new metal: adolescent music preferences and substance use across Europe.

This study examined relationships between music preferences and substance use (tobacco, alcohol, cannabis) among 18,103 fifteen-year-olds from 10 European countries. In 2005-2006, across Europe, preferences for mainstream Pop (pop chart music) and Highbrow (classical music and jazz) were negatively associated with substance use, while preferences for Dance (house/trance and techno/hardhouse) were associated positively with substance use. In three countries, links were identified between liking Rock (rock, heavy metal punk/hardcore, and gothic) and substance use; associations between Urban (hip-hop and R&B) and substance use were mixed. No substantial gender differences emerged in these patterns, and controlling for relevant covariates did not attenuate the predictive value of substance use. The findings are consistent with the conclusion that music is a robust marker of adolescent substance use.

Peer victimization among school-aged children with chronic conditions.

Peer victimization is a common problem among school-aged children, and those with chronic conditions are at an increased risk. A systematic review of the literature was carried out to explore the increased risk of peer victimization among children with chronic conditions compared with others, considering a variety of chronic conditions; and to assess intervention programs designed to reduce negative attitudes or peer victimization at school toward children with chronic conditions. Various data sources were used (PubMed, ERIC, PsycINFO, Web of Science), and 59 studies published between 1991 and 2011 and mainly carried out in North American and European countries were included in the review. A higher level of peer victimization among children with chronic conditions was shown for each type of condition explored in this review (psychiatric diagnoses, learning difficulties, physical and motor impairments, chronic illnesses, and overweight). Despite a substantial number of studies having shown a significant association between chronic conditions and peer victimization, intervention studies aiming to reduce bullying among these children were rarely evaluated. The findings of this review suggest a growing need to develop and implement specific interventions targeted at reducing peer victimization among children with chronic conditions.

The medicine use and corresponding subjective health complaints among adolescents, a cross-national survey.

BACKGROUND: Medicine use among children and young people is under-researched. Studies that investigated cross-national patterns in adolescents' medicine use practice are rare. This study aims to investigate adolescents' medicine use for corresponding health complaints in Europe and USA. METHODS: Nationally representative samples of adolescents from 19 countries and regions in Europe and USA completed an anonymous, standardised questionnaire as part of the Health Behaviour in School-aged Children 2005/2006 survey. The prevalence of health complaints and medicine use were determined. The influence of the frequency of medicine use, age, gender and country of residence, on the likelihood of medicine use was assessed using multilevel multivariate logistic regression, with separate analyses for boys and girls. RESULTS: Both health complaints and medicine use were common among adolescents. Medicine use was strongly associated with the frequency of health complaints. The prevalence of both medicine use and health complaints was higher among girls than boys. Boys and girls with weekly health complaints were both similarly likely to report elevated rates of medicine use. CONCLUSIONS: The findings indicated that adolescents who report more frequent recurrent health complaints are also more likely to report more frequent medicine use for their health complaints. Adolescent boys with weekly health complaints have the same risk of medicine use as girls with weekly health complaints. The importance of educating school-aged children to interpret their bodily feelings and complaints and to use medicines appropriately is of high priority.