Adolescent smoking prevention--primary health care in cooperation with local schools. A controlled intervention study.

OBJECTIVE: To evaluate a secondary school smoking prevention program in a small rural Norwegian municipality. DESIGN: The project applied grade specific intervention strategies to all students grades 6-9 and comprised a total of 32 lessons over a period of 3 years, with high student activity. A non-randomised control group was constituted by all 6th-9th grade students in municipalities of similar characteristics in the same county. Results were recorded in annual class-based surveys. SUBJECTS: The intervention group totalled 187 and the control group 364 students. MAIN OUTCOME MEASURES: Prevalence of daily and occasional smoking and number of cigarettes smoked, during the intervention period. RESULTS: An 80% lower rate of daily smoking and 50% fewer cigarettes smoked by daily smokers. Lower rates of smoking in 9th grade occurred mostly among girls. CONCLUSION: The project resulted in a lower recruitment of daily smokers up to grade 9, as well as fewer cigarettes smoked by daily smokers. The intervention was more successful among girls than boys.

[Affective disorders. Drug treatment and electroconvulsive therapy]. / Affektive lidelser. Medikamentell behandling og elektrokonvulsiv terapi.

Optimal treatment of mood disorders and prevention of suicide requires biological and psychosocial methods, therapeutic alliance and psycho-education. In moderate unipolar depression an antidepressant may be sufficient, if necessary potentiated by another antidepressant or triiodothyronine. In moderate bipolar depression lithium or carbamazepine are preferred. In severe unipolar and bipolar depression the combination of an antidepressant and lithium (or carbamazepine) or electroconvulsive therapy (ECT) is indicated, in psychotic depression neuroleptics, too. Non-selective monoamine oxidase inhibitors (MAOIs) are the most potent antidepressants. Moderate acute mania and mixed state may respond to lithium, carbamazepine or valproate only. In severe cases a neuroleptic and lithium are combined, or these drugs may be combined with carbamazepine or valproate. Electroconvulsive therapy is preferable in acute mixed states with marked confusion or depression. In chronic mixed state and rapid cycling, withdrawal of antidepressants and neuroleptics should be tried. Most patients will need a combination of lithium and carbamazepine or valproate. Added to these drugs, antidepressants are less risky. Adding thyroxin may stabilize rapid cycling. The combination of lithium and an antidepressant is the most potent prophylaxis in unipolar disorder and bipolar disorder dominated by depression.

[Intoxication with tricyclic antidepressive agents in therapeutic doses. Benefits of routine blood level measurements]. / Intoksikasjon med tricykliske antidepressiva i terapeutiske doser. Nytten av rutinemessig måling av serumnivå.

Measurement of the level of tricyclic antidepressants in the blood is useful in the treatment of affective disorders. We describe four patients, all of whom became intoxicated by the recommended therapeutic doses of tricyclic antidepressants. The only obvious sign of such gradual intoxication may be worsening of the depressive syndrome. Therefore, to enable administration of high enough doses without intoxication we recommend routine blood level measurements. We present therapeutic ranges and intoxication levels, based on the international literature.

[Smoking of crushed tobacco tablets. An epidemic among young people in a distant municipality in Nordland]. / Røyking av knuste tablettar. Epidemi blant ungdom i ein utkantkommune i Nordland.

Smoking of crushed pills mixed with tobacco, a form of drug abuse not previously reported in Norway, occurred during the winter of 1988/89 in a rural coastal municipality in northern Norway. All pupils aged 12 to 17 years (N = 356) were included in a study use of alcohol, drugs and tobacco. The overall response rate was 94%. The number who had smoked pills at least once was 16 (eight of each sex). Use of all three substances was significantly higher among pill smokers than among the rest of the sample. Use of illegal drugs was practically non-existent. Only two subjects had tried smoking cannabis. Pill smokers had less contact with parents and other adults, but reported close relationships with peers. The attitudes of parents towards alcohol and smoking, as perceived by the adolescents themselves, were more permissive among pill smokers (31% believed that their parents accepted occasional drunkenness, 69% believed that they accepted smoking) than among the rest of the sample (9% as regards drunkenness and 16% as regards smoking). Interviews with two pill smokers revealed that the phenomenon of combining crushed pills with tobacco was of local origin.

[Smoking and use of snuff among young people in 2 municipalities in Nordland]. / Røyking og snusbruk blant ungdom i to nordlandskommuner.

A survey of the entire youth population (grades 6 to 9) in two coastal municipalities of northern Norway (N = 356, response rate 94%) showed that the percentage of smokers increased from 6% (with no daily smokers) in 6th grade to 30% (25% daily smokers) in 9th grade, and was higher among girls in all grades. Smoking among young people does not seem to have declined in this country since 1985. 4% of the boys and 2% of the girls used smokeless tobacco regularly, whereas common percentages in nation-wide studies are 10% among boys and 0 to 1% among girls. Smoking and use of smokeless tobacco were strongly correlated with use of intoxicants. The strongest social predictor of smoking was the attitude of parents towards smoking, as perceived by the adolescents themselves, followed by degree of closeness to parents.

[Use of alcohol and snuff among young people in 2 municipalities in Nordland]. / Alkoholbruk og sniffing blant ungdom i to nordlandskommuner.

Among 356 pupils in grades 6 to 9 (response rate 94%), the percentage who had tried drinking alcohol increased from 40% in grade 6 to 82% in grade 9. Alcohol consumption and inhalation of solvents were strongly interrelated, and both covaried with smoking and having sometime tried smokeless tobacco. 35% believed that a young person who did not drink alcohol would feel that he/she would be regarded by others as somewhat childish, cowardly or stupid. In fact, only 10% reported that they would look upon an abstainer in this way. This finding indicates that many young people exaggerate the risk of losing status among their peers because they abstain from drinking. Parental tolerance towards drunkenness and lack of a trustful relationship with parents were strong predictors both of alcohol use and intoxication from inhalants.