Longitudinal associations between asthma and general and abdominal weight status among Norwegian adolescents and young adults: the HUNT Study.

BACKGROUND: In adolescents the temporal directionality to the asthma and adiposity association remains unclear. Asthma may be a consequence of obesity; however, asthma may increase adiposity. OBJECTIVES: This study aimed to assess the associations between (i) baseline weight status and subsequent asthma and (ii) baseline asthma and subsequent weight status after 4 and 11 years of follow-up (N = 1543 and N = 1596, respectively) using data from three, sequentially enrolled population-based surveys of Norwegians aged 12-30 years from 1995 to 2008. METHODS: Weight status was defined as general (body mass index) or abdominal (waist circumference) underweight, normal weight, overweight or obesity. Self-report physician-diagnosed asthma defined asthma status. RESULTS: Over the longitudinal 11-year follow-up, baseline generally overweight or abdominally obese adolescents had increased risk of asthma. Likewise, baseline asthmatics had increased risk of general overweight or abdominal obesity. After sex stratification, these associations were stronger in males. Generally (odds ratio [OR] 1.90; 95% confidence interval [CI] 1.32, 2.73) or abdominally (OR 1.66; 95% CI 1.13, 2.44) overweight males were at increased risk of asthma. Baseline asthmatic males were also at increased risk of general (OR 2.14; 95% CI 1.54, 2.98) and abdominal (OR 1.77; 95% CI 1.27, 2.47) overweight. CONCLUSIONS: Among Norwegian adolescents, a bidirectional association of asthma and adiposity was observed in males. Each baseline condition increased the risk of the other condition over time. No association was observed in females.

Trends in overweight and obesity over 22 years in a large adult population: the HUNT Study, Norway.

Some reports indicate that the obesity epidemic may be slowing down or halting. We followed body mass index (BMI) and waist circumference (WC) in a large adult population in Norway (n = 90 000) from 1984-1986 (HUNT1) through 1995-1997 (HUNT2) to 2006-2008 (HUNT3) to study whether this is occurring in Norway. Height and weight were measured with standardized and identical methods in all three surveys; WC was also measured in HUNT2 and HUNT3. In the three surveys, mean BMI increased from 25.3 to 26.5 and 27.5 kg m-2 in men and from 25.1 to 26.2 and 26.9 kg m-2 in women. Increase in prevalence of obesity (BMI ≥ 30 kg m-2) was greater in men (from 7.7 to 14.4 and 22.1%) compared with women (from 13.3 to 18.3 and 23.1%). In contrast, women had a greater increase in abdominal obesity (WC ≥ 102 cm for men and WC ≥ 88 cm for women). There was a continuous shift in the distribution curve of BMI and WC to the right, demonstrating that the increase in body weight was occurring in all weight groups, but the increase of obesity was greatest in the youngest age groups. Our data showed no signs of a halt in the increase of obesity in this representative Norwegian population.

Sex-specific effects of weight-affecting gene variants in a life course perspective--The HUNT Study, Norway.

OBJECTIVE: The impact of previously identified genetic variants directly or indirectly associated with obesity, were investigated at birth, adolescence and adulthood to provide knowledge concerning timing and mechanisms of obesity susceptibility with focus on sex differences. DESIGN: Twenty four previously identified obesity- and eating disorder susceptibility loci were tested for association with adiposity traits at birth (ponderal index (PI)), adolescence and young adulthood (body mass index (BMI), waist circumference (WC) and waist-hip ratio (WHR)) in 1782 individuals from the HUNT study. Single-nucleotide polymorphism (SNPs) were evaluated individually and by haplotype sliding-window approach for windows50 kb (near-MC4R, FTO and near-BDNF). The analyses were performed on the total and sex stratified samples. RESULTS: The most substantial effect on BMI was observed for the near-MC4R variants at adolescence and adulthood (adjusted P-values in adolescence: 0.002 and 0.003 for rs17782313 and rs571312, respectively). The same variants showed inverse association with PI in males (adjusted P-values: 0.019-0.036). Furthermore, significant effects were observed at adolescence with BMI for the near-KCTD15 variant (rs11084753) (adjusted P=0.038) in the combined sample. The near-INSIG2 (rs7566605) was significantly associated to WHR in males and near-BDNF (rs925946) in the combined sample (adjusted P=0.027 and P=0.033, respectively). The OPRD1 locus was associated to BMI and WC in males both at adolescence and adulthood with highest effect in adults (adjusted P=0.058). Interaction with sex was identified for near-MC4R, OPRD1, COMT, near-BDNF and DRD2. CONCLUSIONS: Most obesity susceptibility variants show stronger effect at adolescence than at birth and adulthood with a clear sex-specific effect at some loci. The near-MC4R locus exhibit inverse effect on weight at birth in boys compared with findings at adolescence and adulthood. Some variants less known for obesity-susceptibility such as OPRD1 were found to be associated to weight with strongest effects in males.

Cohort Profile: the HUNT Study, Norway.

The HUNT Study includes large total population-based cohorts from the 1980ies, covering 125 000 Norwegian participants; HUNT1 (1984-86), HUNT2 (1995-97) and HUNT3 (2006-08). The study was primarily set up to address arterial hypertension, diabetes, screening of tuberculosis, and quality of life. However, the scope has expanded over time. In the latest survey a state of the art biobank was established, with availability of biomaterial for decades ahead. The three population based surveys now contribute to important knowledge regarding health related lifestyle, prevalence and incidence of somatic and mental illness and disease, health determinants, and associations between disease phenotypes and genotypes. Every citizen of Nord-Trøndelag County in Norway being 20 years or older, have been invited to all the surveys for adults. Participants may be linked in families and followed up longitudinally between the surveys and in several national health- and other registers covering the total population. The HUNT Study includes data from questionnaires, interviews, clinical measurements and biological samples (blood and urine). The questionnaires included questions on socioeconomic conditions, health related behaviours, symptoms, illnesses and diseases. Data from the HUNT Study are available for researchers who satisfy some basic requirements (www.ntnu.edu/hunt), whether affiliated in Norway or abroad.

The association of parental fatal and non-fatal suicidal behaviour with offspring suicidal behaviour and depression: a systematic review and meta-analysis.

BACKGROUND: Children whose parents die by, or attempt, suicide are believed to be at greater risk of suicidal behaviours and affective disorders. We systematically reviewed the literature on these associations and, using meta-analysis, estimated the strength of associations as well as investigated potential effect modifiers (parental and offspring gender, offspring age). METHOD: We comprehensively searched the literature (Medline, PsycINFO, EMBASE, Web of Science), finding 28 articles that met our inclusion criteria, 14 of which contributed to the meta-analysis. Crude odds ratio and adjusted odds ratio (aOR) were pooled using fixed-effects models. RESULTS: Controlling for relevant confounders, offspring whose parents died by suicide were more likely than offspring of two living parents to die by suicide [aOR 1.94, 95% confidence interval (CI) 1.54-2.45] but there were heterogeneous findings in the two studies investigating the impact on offspring suicide attempt (aOR 1.31, 95% CI 0.73-2.35). Children whose parents attempted suicide were at increased risk of attempted suicide (aOR 1.95, 95% CI 1.48-2.57). Limited evidence indicated that exposure to parental death by suicide is associated with subsequent risk of affective disorders. Maternal suicidal behaviour and younger age at exposure were associated with larger effect estimates but there was no evidence that the association differed in sons versus daughters. CONCLUSIONS: Parental suicidal behaviour is associated with increased risk of offspring suicidal behaviour. Findings suggest that maternal suicidal behaviour is a more potent risk factor than paternal, and that children are more vulnerable than adolescents and adults. However, there is no evidence of a stronger association in either male or female offspring.

Increased headache prevalence in female adolescents and adult women with early menarche. The Head-HUNT Studies.

BACKGROUND: Age at menarche is associated with cardiovascular events and lifestyle factors such as body mass index (BMI), certain women's diseases like breast cancer and endometriosis and with occurrence of certain physical symptoms during puberty. It is unclear whether age at menarche is an independent determinant of headache. OBJECTIVES: The aim of the study was to explore age of menarche in relation to headache prevalence in a large population-based study of both adolescents and adult women (HUNT). METHODS: In the Nord-Trøndelag Health Study in Norway 1995-97 (HUNT 2), a total of 26,636 (57%) of 46,506 invited women responded to questions regarding menarche and headache (Head-HUNT). In the youth part of HUNT 2, 3196 female students were interviewed about their headache complaints and 2766 (87%) responded to questions regarding menarche. All the final analyses were adjusted for age, use of oral contraceptives and BMI, and for adults also for educational level. RESULTS: Headache was more prevalent amongst females with menarche ≤ 12 years, both amongst adolescents (OR=1.3, 95% CI=1.1-1.5) and adults (OR=1.1, 95% CI=1.1-1.2), evident for migraine and non-migrainous headache. CONCLUSION: Headache, both migraine and non-migrainous headache, was more prevalent amongst both adolescents and adult females with early menarche. Early menarche may increase headache susceptibility, or be a consequence of a common pathogenetic factor, e.g., sensitivity to estrogens.

An unfavorable lifestyle and recurrent headaches among adolescents: the HUNT study.

OBJECTIVES: To examine the relationship between recurrent headache disorders (i.e., migraine and tension-type headache) and lifestyle factors (overweight, low physical activity, and smoking) in an unselected population study among adolescents. METHODS: In this cross-sectional study from Norway, a total of 5,847 students were interviewed about headache complaints and completed a comprehensive questionnaire including items concerning physical activity and smoking. In addition, they underwent a clinical examination with height and weight measurements. Adolescents with high physical activity who were not current smokers and not overweight were classified as having a good lifestyle status. These students were compared to those with 1 or more of the negative lifestyle factors present in regard to headache diagnosis and headache frequency. RESULTS: In adjusted multivariate analyses, recurrent headache was associated with overweight (odds ratio [OR] = 1.4, 95% confidence interval [CI] 1.2-1.6, p < 0.0001), low physical activity (OR = 1.2, 95% CI 1.1-1.4, p = 0.002), and smoking (OR = 1.5, 95% CI 1.3-1.7, p < 0.0001). The prevalence of OR increased with more than 1 negative lifestyle factor present, evident for headache diagnoses and frequency. CONCLUSION: The results from the present study show that overweight, smoking, or low physical activity are independently and in combination associated with recurrent headache among adolescents. The associations observed and the additive effect of these negative lifestyle factors on the prevalence of recurrent headache indicates possible targets for preventive measures.

Atopic dermatitis in adolescent boys is associated with greater psychological morbidity compared with girls of the same age: the Young-HUNT study.

BACKGROUND: Having atopic dermatitis (AD) as well as other chronic diseases is often associated with reduced mental health. Adolescents with AD are thought to be especially vulnerable, but few studies have included an ample number of young people. OBJECTIVES: To study self-reported mental distress among boys and girls 13-19 years of age with AD compared with mental distress among healthy adolescents as well as mental distress among adolescents with other chronic diseases or complaints, such as headache, neck or shoulder pain, asthma, allergy and rhinitis. METHODS: The Young-HUNT study was conducted as a cross-sectional, population-based survey in 1995-97. All students in Nord-Trondelag County, Norway, aged 13-19 years were invited, and some 89% participated. A questionnaire on mental and somatic health, life-style and social conditions was completed during one school hour. RESULTS: A total of 4384 girls and 4433 boys participated. The prevalence of mental distress was higher among older teenagers, and more than every fourth girl aged 17-19 reported mental distress. Although more girls than boys reported mental distress, AD, headache and neck or shoulder pain, the odds for reporting both AD and mental distress were higher for boys [odds ratio (OR) = 2.1 (1.6-2.9)] compared with girls [OR = 1.3 (1.1-1.6)]. A corresponding sex difference in reporting mental distress was also seen for some other chronic diseases or complaints. CONCLUSIONS: In adolescents aged 13-19 years there was a strong and significant association between self-reported mental distress and AD as well as headache and neck or shoulder pain for both sexes. Although boys reported fewer complaints as AD, they perceived the complaints a heavier burden than did the girls.

Change in height, weight and body mass index: Longitudinal data from the HUNT Study in Norway.

OBJECTIVE: The aim of this study was to analyse changes in body weight and height, and the changes in the prevalence of overweight and obesity. DESIGN: Prospective population based study with 11-year follow-up. SUBJECTS: Norwegian men (n=21565) and women (n=24337) aged 20 years or more who participated in two health surveys, the first in 1984-1986 and the other in 1995-1997. MEASUREMENTS: Height and weight were measured by using standardised procedures at both surveys, and we computed body mass index (BMI) as weight in kilo divided by the squared value of height in meters. RESULTS: Participants who were younger than 50 years at the first survey showed a large increase in body weight, and men and women aged 20-29 years increased their weight with an average of 7.9 kg and 7.3 kg, respectively. Contradictory, participants who were 70 years or older had on average a weight loss. The prevalence of overweight (BMI=25.0-29.9 kg/m(2)) and obesity (BMI>/=30 kg/m(2)) increased between the surveys, especially in the youngest age groups. Overall, the proportion classified as obese increased from 6.7 to 15.5% among men and from 11.0 to 21.0% among women. Some of this increase was due to a reduction in height, which was most pronounced in the oldest age groups. CONCLUSION: During approximately 10 years, body weight increased in all age groups below 70 years, and the prevalence of overweight and obese persons was approximately 20% higher at the second survey compared with the first survey.

The prevalence of migraine and tension-type headaches among adolescents in Norway. The Nord-Trøndelag Health Study (Head-HUNT-Youth), a large population-based epidemiological study.

The aim of this study was to examine the prevalence of headache and primary headache disorders like migraine and tension-type headaches among adolescents, and to explore the differences in headache prevalence and frequency by gender and age. This cross-sectional study was conducted in Nord-Trøndelag county, Norway, during the years 1995-97. In total, 8984 (88%) out of 10 202 invited adolescents aged 12-19 years participated in the youth part of the Nord-Trøndelag Health Study [Helseundersøkelsen i Nord-Trøndelag (HUNT)]. The total study population in this study consisted of 8255 individuals after exclusion of invalid questionnaires and students outside the target range of 13-18 years of age. The students completed a comprehensive questionnaire, and one of the questions was whether the students had experienced any headaches during the last 12 months. In addition, 5847 of these students were also subject to an interview in which they were asked whether they had experienced recurring headaches during the last year and, if so, were they classified as migraine (MI), tension-type headache (TTH) or non-classifiable headache. In the total questionnaire-based population, 76.8% reported having had headaches during the last 12 months (69.4% boys and 84.2% girls). Among those who also were interviewed, 29.1% reported having recurrent headaches (21.0% boys and 36.5% girls). The overall 1-year prevalence of migraine was 7%, of tension-type headache 18%, and of non-classifiable headache 4.8%. Higher prevalence rates were found for girls in all age groups and for all headache categories. The overall frequency of recurrent headaches did not vary significantly with age, but girls had significantly more frequent headaches than boys. We concluded that headache in general, and recurrent primary headache disorders like migraine and tension-type headaches, are common somatic complaints among Norwegian adolescents, especially among girls.

Sex differences in lung vulnerability to tobacco smoking.

Studies have indicated that females are more vulnerable to the deleterious effect of tobacco smoking than males. The current study aimed to investigate the associations between tobacco smoking and reported respiratory symptoms, self-rated health, and lung function by sex. In 1995-1997 65,225 subjects aged > or = 20 yrs (71% of invited) attended for screening within the Nord-Trøndelag Health Study. Among these, 10,941 subjects selected randomly or because they reported having asthma or asthma-related symptoms, participated in the Bronchial Obstruction in Nord-Trøndelag study consisting of spirometry and a personal interview. Tobacco smoking was associated with increased prevalence of respiratory symptoms, reduced lung function, and lower score on global self-rated health (SRH). Adjusted for smoking burden and lung function, females had a higher risk for reporting respiratory symptoms and lower SRH compared with males. Further, smoking burden was associated with a larger relative reduction in expiratory lung function in females than in males. Females reported more symptoms and lower self-rated health compared with males with similar smoking burden. Even if smoking in females was associated with a larger reduction in per cent predicted lung function compared with males, this does not fully explain the higher symptom prevalence in females.

Gender differences in asthma prevalence may depend on how asthma is defined.

BACKGROUND: Asthma may be defined either as wheeze within the previous 12 months (current wheeze) doctor-diagnosed asthma (DDA), or current wheeze plus confirmed airway hyperresponsiveness (AHR). AIMS: We wanted to estimate asthma prevalence in randomly selected adolescents based on different criteria for asthma diagnosis, study gender differences in reported asthma-like symptoms vs DDA, and relate our findings to measurements of AHR, levels of exhaled nitric oxide (ENO) and total IgE. METHODS: As part of the health survey of North-Trøndelag (HUNT), 8571 adolescents aged 13-19 years were investigated with an interview on allergic and respiratory symptoms (phase I study). Of these, 401 subjects who reported wheeze within the previous 12 months (current wheeze) and 213 non-symptomatic controls were randomly selected and investigated with allergy screening, methacholine bronchoprovocation test and measurements of ENO (phase II study). RESULTS: In the phase I study prevalence of current wheeze was 26% (30% in girls and 23% in boys, P < 0.01). Prevalence of DDA was 10.8% (10.5% in girls and 11% in boys). Among subjects with current wheeze, the likelihood of having DDA was reduced in girls compared to boys, odds ratio (95% CI) 0.82 (0.68-0.98) which was partly explained by a longer history of wheeze among boys. In the phase II study, although more girls than boys with current wheeze had AHR (62% versus 50%, P < 0.02) more boys than girls reported DDA (44% vs. 32%, P < 0.02). Of the objective parameters, increased levels of ENO most strongly increased the risk of having DDA. CONCLUSIONS: When asthma is defined as DDA, there is a risk of underestimating the prevalence of asthma, especially among girls.

The validity of 'recognition-based' headache diagnoses in adolescents. Data from the Nord-Trøndelag Health Study 1995-97, Head-HUNT-Youth.

The aim of this study was to evaluate the validity of the headache diagnoses (migraine and tension-type headache) obtained from short interviews by nurses, where the subjects were asked to identify their headache(s) based on recognition of typical headache descriptions. All students in junior high schools and high schools aged 12-19 years in Nord-Trøndelag county, Norway, were invited to participate in the youth part of the Nord-Trøndelag Health Study ('Helseundersøkelsen i Nord-Trøndelag'-HUNT), 1995-1997. In this cross-sectional study a total of 8984 students (88%) completed a comprehensive questionnaire with different health-related items. Of these, 6149 were also interviewed by nurses about their headache complaints by giving them two alternative headache descriptions in accordance with either migraine or tension-type headache (Head-HUNT-Youth). The headache diagnoses obtained from nurse interviews were validated in a stratified random sample enriched with headache subjects from the interviewed population. Out of 159 invited individuals, 112 (70%) participated in extensive semistructured interviews by neurologists. The overall chance-corrected agreement (kappa) was 0.76 (confidence interval (CI) 0.66-0.86), which is considered good. For migraine, the positive and negative predictive values were 89% and 90%, respectively, and the chance-corrected agreement (kappa) was 0.72 (CI 0.58-0.87). For tension-type headache, positive and negative predictive values were 83% and 91%, respectively, and chance-corrected agreement (kappa) was 0.74 (CI 0.62-0.87). There was good agreement between the headache diagnoses obtained from the short interviews by nurses and the extensive interviews by neurologists. Short interviews based on recognition of typical headache descriptions seem to be an alternative and efficient way to identify migraine and tension-type headache sufferers among adolescents. The method can be useful in epidemiological research, e.g. in estimation of headache prevalence.

Gender differences in the impact of adolescent smoking on lung function and respiratory symptoms. the Nord-Trøndelag Health Study, Norway, 1995-1997.

Girls take up smoking at least as frequently as boys. Few studies have focused on gender differences in the impact of adolescent smoking. We evaluated the sex-specific effect of adolescent smoking on respiratory symptoms and lung function. All students in junior high and high schools in Nord-Trøndelag County Norway, 1995-97, were invited to participate in a cross-sectional study. Information on smoking habits and respiratory symptoms was obtained by self-administered questionnaires. Spirometry was performed in accordance with ATS standards. Eight-thousand-three-hundred and five students (83%) completed both questionnaire and spirometry. Among 6811 students aged 13-18 years (50.3% girls) with no history of asthma, 2993 (43.9%) reported never smoking, 665 (98%) reported occasional smoking, and 667 (9.9%) reported daily smoking (mean initiation age: 13.9 years). More boys than girls were heavy smokers. In all smoking categories, smokers reported a higher prevalence of respiratory symptoms than nonsmokers; symptoms increased with smoke burden. Girls reported more symptoms compared to boys with comparable smoke burden. A dose-response relation between smoking and reduced lung function was found only in girls. Girls were more vulnerable than boys to the impact of smoking on respiratory symptoms and lung function.

Physical exercise, sports, and lung function in smoking versus nonsmoking adolescents.

Associations between adolescent smoking habits and exercise, particularly participation in sports and lung function were studied. All students aged 13-19 yrs in Nord-Trøndelag County, Norway, 1995-1997, were invited to join a cross-sectional study. Information on smoking habits and exercise was obtained by self-administered questionnaire. Spirometry was performed in accordance with American Thoracic Society standards. Of the 6,811 students (aged 13-18 yrs, without asthma), 2,993 (44%) reported never-smoking, and 1,342 (20%) reported current smoking (90% daily). Frequency of physical exercise was inversely associated with smoking, but participants in individual sports with lesser endurance, especially body-building and fighting sports, were more likely to be daily smokers than nonparticipants. Both daily (53%) and occasional smokers (43%) were more likely to have quit sports than never-smokers (26%)). Never-smokers showed a positive dose-response between physical exercise and lung function (forced vital capacity and forced expiratory volume in one second, adjusted for age and height). No similar significant association was observed in daily smokers. These data suggest that smoking habits in different sports should be considered when promoting physical activity as smoking prevention, and sports organizations should include smoking prevention programmes. Adolescents with better lung function may self-select into sports; this possibility needs to be studied in a longitudinal design.

Sensitization and exposure to pet allergens in asthmatics versus non-asthmatics with allergic rhinitis.

In sensitized subjects with allergic rhinitis (AR) or asthma, allergen exposure provokes symptoms. Among non-asthmatics with AR, an association between allergen sensitization, pollen season and lower airway inflammation has been demonstrated. Our aims were to compare AR and asthma with regard to patterns of allergen sensitization, the degree of airway hyperresponsiveness (AHR) and levels of exhaled nitric oxide (ENO). Finally, we wanted to relate our findings to previous or current exposure to household pets. Four hundred and thirty-one adolescents with different clinical phenotypes were randomly selected from a large-scale epidemiological survey. They were investigated with allergy screening, measurements of ENO and a methacholine bronchoprovocation test. Sensitization to pet allergens (cat, dog and horse) was associated with increased AHR and ENO both in asthmatics and non-asthmatics with AR. The risk of being sensitized to cat allergens was significantly reduced in those who had kept cats vs. those who had never kept them. Keeping dogs or horses did not influence the risk of being sensitized to the respective allergens. Only in steroid-naive, non-smoking asthmatics, a trend towards increased ENO in those sensitized and exposed to cat or dog allergens was seen. Although sensitization towards pet allergens was associated with inflammation in the lower airways irrespective of clinical phenotype, keeping pets did not increase the risk of being sensitized to pet allergens.

Forced spirometry reference values for Norwegian adults: the Bronchial Obstruction in Nord-Trøndelag Study.

The purpose of this study was to develop new prediction equations for flow/volume spirometry parameters in asymptomatic, never-smoking adults in Norway, and to assess any differences of these parameters when applying the new and most commonly used equation sets. Flow/volume spirometry was measured according to the American Thoracic Society criteria in 2,792 subjects aged > or = 20 yrs, randomly selected from participants in the Nord-Trøndelag Health Study. Ever-smokers and subjects with respiratory symptoms and/or diseases reported in this questionnaire were excluded. A total of 546 females and 362 males met the inclusion criteria and were included in the analyses. Most lung function variables were nonlinear by age and had to be transformed. After a plateau in younger adults, the variables declined by age. The reference values for forced expiratory volume in one second and forced vital capacity from the present study, were higher than those given by prediction equations from the European Community for Coal and Steel, but in closer agreement with later studies from Europe, Australia and the USA. Healthcare providers should be encouraged to reconsider their choice of prediction equations of spirometry in order to improve management of obstructive lung diseases.

[Treatment of children with asthma--ideals and reality]. / Behandling av barn med astma--idealer og virkelighet.

Children with bronchial asthma are the largest group of children with chronic disease in general practice. The aim of this study was to obtain information on morbidity, examination, and treatment in children with bronchial asthma. 102 children with current asthma, aged 7-15 years, participated in this study, which used a questionnaire, flow volume spirometry with beta2-agonist reversibility test, and two weeks of registrations of peak flow and symptom score. Most children had mild to moderate asthma; 60% had acceptable asthma control defined by a morbidity index. 64 children used either inhaled steroids or dinatriumcromoglycate prophylactic. 76 children had been examined by a paediatrician. Lung function measurements had been performed in 57 of 69 children with follow-up in general practice during the last 12 months. Allergy tests had been taken of 87 children. With respect to allergen exposure at home, only 30 children reported having an optimal home environment. Despite the extensive follow-up of children with asthma, our study indicates that the asthma control is not up to the standard set by current guidelines. By use of written treatment plans, and increasing knowledge of the disease, triggers and of the treatment of children and their parents, we probably would exploit the potential better. The recommendations and goals of the guidelines should, however, also be evaluated.

Health problems in teenage daily smokers versus nonsmokers, Norway, 1995-1997: the Nord-Trøndelag Health Study.

Increased morbidity among teenage smokers has been reported, but specific current health problems and medication use other than of alcohol and narcotics have received less attention. The aim of this study was to examine the association between health problems and daily smoking in teenagers. Ninety percent of all teenagers attending junior high or high schools participated in a cross-sectional study conducted in Nord-Trøndelag County, Norway, 1995-1997; included were 8,040 students aged 13-18 years. Information on smoking habits, health problems, medication use, and use of health services was obtained in schools by self-administered questionnaire and by interview. Fifty-five percent of boys and 57% of girls had tried smoking, and 9% and 11%, respectively, reported current daily smoking. When compared with boys and girls who had never smoked, daily smoking among both sexes and all age groups was associated with significantly poorer perceived health, respiratory symptoms, headache, neck and shoulder pain, stomachache, nausea, frequent heartbeats, nervousness/restlessness, and sleep problems. Daily smokers used more medications and health services. Daily smoking by adolescents is already associated with multiple somatic health problems. Whether or not the association is causal, daily smoking identifies a group of adolescents with health problems for whom preventive strategies should also include medical and social support.

Adolescent occasional smokers, a target group for smoking cessation? the Nord-Trøndelag Health Study, Norway, 1995-1997.

BACKGROUND: Adolescent smokers are often unsuccessful in quitting and difficult to retain in cessation programs. In health promotion, focusing on the right target groups is essential. Aim. The aim was to examine if adolescent occasional smokers differ from daily smokers, and if possible differences could be useful for targeted smoking cessation programs. METHODS: Ninety-one percent of all teenagers attending junior high or high schools participated in a cross-sectional study, conducted in Nord-Trøndelag County, Norway, 1995-1997, including 8,460 students 13-18 years old. Information on smoking habits, education, after school activities, and parents was obtained by self-administered questionnaires. RESULTS: Fifty-four percent of boys and 57% of girls had tried at least one cigarette. Of these, 36% of boys and 41% of girls were current smokers, half of whom reported occasional smoking. Students who had quit smoking had more often been occasional than daily smokers. Compared to daily smokers, occasional smokers participated in higher academic courses, were more engaged in organized activities and sports, had been drunk less often, and had better family role models. CONCLUSION: Differences support potential utility of focusing on occasional smokers as a special target group in smoking cessation programs.