Medical use, nonmedical use of prescription medication and risk behaviour among Croatian adolescents.

BACKGROUND: At the drug scene some major shifts were observed, more and more reports highlighted the abuse of prescription medication. Despite the importance of controlled medication in treatment child and adolescent disorders, this increase may be a factor which influence misuse and nonmedical use of prescribed drugs among adolescents. SUBJECT AND METHODS: Croatian data from ESPAD survey in 2003, 2007 and 2011 were used, and variables selected from the international ESPAD questionnaire. Dependent variable was taking tranquilizers or sedatives prescribed by doctor in the past 12 months. Independent variables were nonmedical use of tranquilizers/sedatives, use of other psychoactive substances, school performance, truancy, delinquent behaviour, satisfaction with relationships with parents, friends, health, self-perception, financial situation and symptoms of depression. The respondents were 8849 students (4393 boys and 4456 girls) in three consecutive ESPAD surveys (2003, 2007 and 2011). RESULTS: In multivariate analysis for all three survey years the strongest predictor for prescription medication use was use of sedatives/tranquilizers without prescription (OR 6.14; CI 4.08-9.23; OR 8.16; CI4.65-14.32; OR 9.77; CI5.92-15.13). Frequent drinking and excessive drinking or drunkenness also predicted prescription medication use, (OR 1.85; CI1.10-3.10; OR 2.01: CI 1.20-3.39). Among other problem behaviours lower school performance (OR 2.92; CI 1.41-6.05; OR 2.56; CI 1.12-5.87), missed school days OR 1.59; OR1.01-2.51; OR1.72; CI 1.03-2.87), aggressive behaviour (OR 1.532; CI 1.01-2.28; OR1.65; CI 1.04-2.62), depressive symptoms (OR 2.19; CI 1.24-3.85) and poorer financial situation were connected with prescription medication use. CONCLUSION: Prescription use of tranquilizers/sedatives was predicted by nonmedical tranquilizers/sedatives use, alcohol abuse, symptoms of depression and variables indicating maladjusted behaviour. Although there is sufficient evidence that prescription medication abuse might went unobserved, the further analysis which could better explain its' role and impact is still needed.

School health services in the City of Zagreb - do we meet adolescents' needs?

BACKGROUND: School health services (SHS) have in Croatia long tradition, established organizational structure, defined program and educated staff. The program is limited to the preventive activities. The aim of the study was to investigate the satisfaction of the children, school staff and parents with existing school health services in the City of Zagreb. SUBJECT AND METHODS: The structured questionnaire was sent to the primary and secondary schools in the City of Zagreb, which were selected using random sample method. The questionnaires were anonymous and filled in supervised by class masters. In the secondary schools the structure of schooling was respected. Questionnaires were filled by 448 pupils from primary, 551 from secondary schools, by 596 parents and 595 teachers. RESULTS: In primary schools pupils rated SHS more available and accessible, staff complaisant and responsible, counselling being useful and justified, confidentiality respected higher than pupils from secondary schools (p<0.001). Teachers from primary and secondary schools perceived SHS as valuable school partners (88.9% and 82.3%). Teachers from primary and secondary schools (88.9% and 88.1%) and parents (78.3% and 67.5%) stated that SHS could not be replaced by GPs or paediatricians. Primary school pupils felt that most common problems were injuries and vocational counselling, secondary school pupils assessed behavioural and sexual related problems as mostly challenging. Satisfaction with the SHS response to the most challenging problems was rated higher by teachers from primary schools (p<0.001 for learning difficulties, chronic diseases, bullying and vocational counselling), by parents for learning difficulties and vocational counselling, but no significance was found for pupils' satisfactions. CONCLUSION: SHS in Zagreb are recognized as vital and necessary partners for schools, available and accessible for pupils, teachers and parents, especially for primary schools. Counselling is highly rated by all respondents, confidentiality considered as respected, and the problem of the most common challenges as successfully solved.

Inequalities in Croatian pupils' risk behaviors associated to socioeconomic environment at school and area level: a multilevel approach.

The socioeconomic inequality in pupils' risk behaviors has been the topic of many studies with quite contradictory findings. Furthermore, the role of socioeconomic environment has been analyzed much less often than the role of individual socioeconomic status (SES). This study examined the association between school/area-level socioeconomic environment and Croatian pupils' risk behaviors (tobacco use, drunkenness, cannabis use, early sexual initiation and fighting). Data from the WHO-Collaborative 'Health Behavior in School-aged Children' study conducted in Croatia in 2006 (1601 secondary schools' pupils, aged 15) and census data were used. Multilevel logistic regression analyses, adjusted by gender, were performed. The individual level of SES explained the majority of differences in all risk behaviors among adolescents. Differences in tobacco use, early sexual initiation and fighting were more closely attributed to school level than area level, which was more closely associated with differences in adolescent drunkenness and cannabis use. At the individual level, high individual SES was associated with higher probability for tobacco use and drunkenness compared to low individual SES. Furthermore, school heterogeneity (compared to school homogeneity) and medium school-level SES (compared to low school-level SES) were associated with higher probability for cannabis use. Compared to the most advanced schools (gymnasiums), attending the least advanced schools (industrial and crafts schools) was associated with higher probability for fighting. Compared to low area-level SES, medium area-level SES was associated with higher probability for cannabis use and fighting. Conclusively, it was found that low SES at individual, school and area levels, school homogeneity and advanced school attendance play a protective role against risk behaviors. To reduce inequalities in pupils' risk behaviors, there is a need for community and school-based programs that take into consideration not only individual SES but also school- and area-level socioeconomic circumstances.

Impact of environmental factors on marijuana use in 11 European countries.

AIM: To investigate the association between environmental factors (perceived availability of marijuana, perceived use among friends and siblings, use of alcohol and tobacco, family structure, parental control, school performance) and lifetime prevalence and frequent and early marijuana use in high school students. METHODS: We used self-reported data from 15-16 years old participants of the 2003 European School Survey Project on Alcohol and Other Drugs (ESPAD) conducted in 11 countries: Denmark, Estonia, Norway, Croatia, Slovenia, Germany, Switzerland, Bulgaria, Czech Republic, Russian Federation, and Ukraine. Multivariate logistic regression was used for data analysis. RESULTS: Countries varied according to lifetime prevalence (8.7%-47.8%) and frequent (8.7%-23.9%) and early (3.0%-13.0%) marijuana use. Daily tobacco smoking was most strongly associated with lifetime marijuana use for boys in 7 and for girls in 5 countries, with highest odds ratio (OR, 95% and confidence interval - CI) for boys in Denmark (OR, 13.52; 95% CI, 8.16-22.4), and for girls in the Czech Republic (OR, 21.21; 95% CI, 12.99-34.62). Perceived marijuana availability was most strongly associated with frequent marijuana use for boys in 4 countries (highest in Slovenia: OR, 19.28; 95% CI, 6.52-57.02) and girls in 5 (highest in Slovenia: OR, 19.05; 95% CI, 5.18-70.04). Perceived use of marijuana among friends was most strongly associated with frequent marijuana use in 5 countries, both for boys (highest in Norway: OR, 23.91; 95% CI, 4.16-137.48) and girls (highest in Denmark: OR, 75.42; 95% CI, 13.11-433.90). Perceived use of marijuana among friends was most strongly associated with early marijuana use in 8 countries for boys (highest in Norway: OR, 54.03; 95% CI, 3.34-875.19) and 3 countries for girls (highest in Denmark: OR, 7.29; 95%CI, 1.77-30.12). CONCLUSION: In each country, marijuana use was associated with similar factors, regardless of marijuana use prevalence in that country.The influence of peer group and perceived availability of marijuana seemed more important than parental control and family structure.

Inequalities in Croatian pupils' unhealthy behaviours and health outcomes: role of school, peers and family affluence.

BACKGROUND: To examine the influence of family affluence (measure of socioeconomic status), school environment (liking school, school pressure, academic achievement and classmates support) and peer group (size of the peer group and frequency of peer contact) on unhealthy behaviours (smoking, drunkenness, physical inactivity, irregular breakfast and soft drink consumption) and health outcomes (self-rated health, multiple health complaints and life satisfaction) in Croatian pupils. METHODS: The Croatian data from Health Behaviour in School-aged Children 2005/06 (HBSC) were used (1666 11-year-olds, and 1630 15-year-olds). Binary logistic regression analysis was conducted (95% confidence intervals, P < 0.05 and P < 0.01). RESULTS: School environment and peer group were connected to more unhealthy behaviours along with greater differences in those behaviours than family affluence. The only exception was physical inactivity at age 11 (compared to high family affluence, low family affluence increased 80% odds for physical inactivity, whereas, compared to favourable school environment, poor school environment increased 50% odds). Compared to favourable school environment, poor school environment was the most consistent and strongest predictor of poor health outcomes (all three measures). No influence of peer group to health outcomes was found. Compared to high-affluent families, low-affluent families were associated to higher odds for poor self-rated health and life dissatisfaction, and, for 11-year-olds, medium-affluent families to lower odds for multiple health complaints. Gender differences in unhealthy behaviours and health outcomes were also found. CONCLUSIONS: Compared to socioeconomic inequalities, greater inequalities in unhealthy behaviours were connected to school environment and peer group, and in health outcomes to school environment.

[Child in contemporary Croatian society]. / Dijete u suvremenome hrvatskom drustvu.

The symposium on the topic "Child in contemporary Croatian society", organized by Croatian Pediatric Society, Croatian Academy of Sciences and Arts, Ministry of health and social welfare and UNICEF Croatia Office, was held in Zagreb on December 12, 2009. The lecturers have shown important information on difficulties the children in Croatia are exposed to. Namely, diseases of the so called "new morbidity", which are becoming more and more frequent in the contemporary world, demand a new approach of work from all who participate in healthcare for children, including additional education. These diseases are not part of a practitioner's routine activity. Due to variety of problems children are exposed to, the approach can be only multidisciplinary. Basic national interest of every country (basic interest of every human society) should be to direct more attention and financial resources to the healthcare of children, which would ensure the existence and healthy future of the society. This approach requires a national consensus and clear political decision of all responsible official services.

Body image and weight control among adolescents in Lithuania, Croatia, and the United States in the context of global obesity.

AIM: To compare body image and weight control behavior among adolescents in Lithuania, Croatia, and the United States (US), the countries with striking contrasts in the prevalence of overweight among adolescents. METHOD: The study was carried out according to the methodology of the Health Behavior in School-aged Children collaborative survey. Nationally-representative samples of students, aged 13 and 15, were surveyed in Lithuania (3778 respondents), Croatia (2946 respondents), and the US (3546 respondents) in the 2001/2002 school year. RESULTS: In all three countries, girls perceived themselves as being "too fat" more frequently than boys (37.0% vs 19.7%, P<0.001, z test). The prevalence of this perception increased with age among girls (32.7% vs 41.1%, P<0.001, z test) and decreased among boys (21.4% vs 17.9%, P=0.005, z test). Lithuanian adolescents were least likely to perceive themselves as "too fat;" this perception was significantly more frequent in Croatia and the US (24.2%, 27.5%, and 34.3%, respectively; P<0.001, chi(2) test). With the exception of 15-year-old Lithuanian boys, in all respondents the proportion of adolescents with body mass index (BMI) > or =85th percentile who perceived themselves as "too fat" was significantly higher (up to 3.13 times among 15-year-old US girls) than the proportion of adolescents with BMI < or =15th percentile who perceived themselves as "too thin." The highest proportion of overweight boys and girls on a diet or doing something else to lose weight was found in the US. Boys in Lithuania were most likely to be satisfied with their weight regardless of their weight status. CONCLUSION: Perceived body image and weight control behavior differ among adolescents in Lithuania, Croatia, and the US. Cross-cultural, age, and sex influences moderate body image and weight control behavior in underweight and overweight adolescents.

Early sexual intercourse and risk factors in Croatian adolescents.

Sexual behaviour in adolescence is a sensitive issue and has possible immediate and long term medical and psychical consequences. The aim of the study was to examine whether early sexual intercourse varies by gender and how is associated with unhealthy behaviour and factors of psycho-social well-being. 773 boys and 857 girls of 15.5 years old, included in a representative national school-based survey, conducted in Croatia in 2006, were invited to fill in anonymous questionnaires. Sexual experience before the age of 16 years was reported by 28.6% of the boys and 16.5% of the girls. Early sexual experience in boys was associated with smoking, drinking of alcohol, marijuana taking, physical fighting, and bullying other The odds ratio was highest for smoking. (OR:8. 1; CI:5.4-12. 1). For girls the same variables were associated with the early sexual intercourse, marijuana use being the strongest independent predictor (OR:8.0; CI:5.0-12.6). While controlled for other behaviours, daily smoking remained the strongest predictor for both genders. Girls who had early sexual experience were more prone to be dissatisfied with their health (OR:2.9; CI:2.0-4.2), with their life (OR:2.1; CI:1.4-3.0), communication with father and mother (OR:1.9; CI:1.2-2.8 and OR:1. 7; CI:1.1-2.6) and reported more psychosomatic symptoms (OR:2.9; CI:2.0-4.3). For both genders odds were higher if they had good communication with the friend of the opposite gender. Evenings spent out with friends were associated to early sexual experience in boys and girls as well as poorer school achievement. Early menarche was associated with the probability of being engaged in the early sexual intercourse and with smoking, marijuana use and psychosomatic symptoms. Early sexual intercourse is associated with unhealthy behaviour such as smoking, substance abuse, aggressiveness and lower psychosocial well-being. Preventive educational programmes should follow multi-facet approaches and recognize differences between boys and girls. Human papillomavirus (HPV) vaccination could be part of a comprehensive approach and is not to be viewed as an isolated activity.

Psychosocial correlates of substance use in adolescence: a cross-national study in six European countries.

AIMS: To examine the psychosocial correlates of substance use among adolescents in six European countries. DESIGN: Cross-sectional school population survey (ESPAD) based on standardized methodological procedures. SETTING: High schools in six European countries: Bulgaria, Croatia, Greece, Romania, Slovenia and UK. PARTICIPANTS: Representative samples of a total sample of 16,445 high school students whose 16th birthday fell in the year of data collection. MEASUREMENTS: Anonymous self-administered questionnaire. Self-reported substance use was measured by core items on tobacco, alcohol, marijuana and any illegal drug use. Psychosocial correlates included scales of self-esteem, depression, anomie and antisocial behavior, and items pertaining to family, school and peers. FINDINGS: Logistic regression analyses for each potential correlate adjusted for country, taking into account the clustered sample, showed statistically significant associations with each substance use variable separately, in almost every case. Particularly strong associations were found between smoking and going out most evenings and having many friends who smoke, while cannabis and illegal drugs were strongly correlated with having friends or older siblings who used these substances. The self-esteem scale score was not correlated with substance use. Anomie and antisocial behavior were more strongly associated than depression with substance use. In the case of depression, anomie and most of the other items examined, associations were stronger for girls than for boys. CONCLUSION: The present cross-national study identified correlates of legal and illegal substance use which extend outside specific countries, providing grounds to believe that they can be generalized. They provide evidence for the need to address both the use of the gateway drugs and deviant behavior in conjunction with environmental risk factors when designing and implementing preventive interventions in schools.

Further investigation of psychological and environmental correlates of substance use in adolescence in six European countries.

AIM: To study the multifactorial correlates of adolescents' use of legal and illegal substances in six European countries and to assess whether a common pattern of factors exists irrespective of the countries' different sociocultural backgrounds. DESIGN: Cross-sectional European school population survey (ESPAD) following standardized methodology. PARTICIPANTS: National probability samples of 16-year-old high school students from Bulgaria, Croatia, Greece, Romania, Slovenia and the UK. Total sample 16,445. MEASUREMENTS: Anonymous questionnaire self-administered in the classroom. Self-reported use of tobacco, alcohol, marijuana and other illegal drugs. Correlates examined: environmental, such as peer culture and family-related; behavior-related such as antisocial behavior, truancy and anomie; and psychological factors such as self-esteem and depressive mood. FINDINGS: Separate logistic regressions for the two genders produced a set of psychosocial correlates common to the use of all legal and illegal substances. The strongest were peer and older sibling models of use, and peer-oriented lifestyle, followed by patterns of antisocial behavior and truancy. Family-related variables such as not living with both parents, parental monitoring and relationships with parents were less significant. Self-esteem and depressive mood were not significant. Girls' use of substances, especially illegal ones, showed stronger associations than boys' with a deviant behavior pattern. Few interactions between country and other correlates were significant. CONCLUSIONS: Common correlates can be identified across countries. Older siblings' and peers' substance have a strong impact on adolescents' use. Preventive interventions should include all substances with addictive potential.

[Register of treated psychoactive drug addicts]. / Registar osoba lijecenih zbog zlouporabe psihoaktivnih droga.

In the order to accomplish data collection for the Treated Psychoactive Drug Addicts Registry, the Drug Abuse Registration Program has been developed according to the adapted Council of Europe Pompidou group questionnaire. The main goals of the system are: introduction of a local database, implementation of standard data consistency control algorithm, personal data protection and connection to public health network. Paper forms are being gradually discarded. The procedure of registration proposed will improve data quality, increase promptness of data entry, and enable feedback from the central registry toward registration institutions. The introduction of the system will gradually modify the operation while strictly respecting personal data confidentiality.

[Demographic and educational characteristics of physicians in the health care system in Croatia: overview] ]. / Demografske i izobrazbene znacajke lijecnika zaposlenih u sustavu zdravstva Hrvatske: opci pregled.

The structure of 10,146 physicians working in Croatia's health system in 1990 and that of 11,103 working in 1999 are compared in terms of age, sex and level of training (intern, unspecialized doctor, resident, and specialist). Comparison of the same 5-year groups with reference to 1990 uncovered a reduction in the share of the two youngest 5-year physician groups (ages 25-29 and 30-34 years) in the total physician population working in 1999. Between 1990 and 1999, the average age of working physicians increased from 44.2 to 46.5 years and from 39.2 to 42.4 years in male and female doctors, respectively. In the same period the lady doctors' share of the physician total increased from 50.8 to 55.6%. By the criterion of the number of physicians per 100,000 population in 1980-99, Croatia was below selected group averages of the European countries. From 1991 to 1995 the generally rising trend of the number of physicians was interrupted due to the war in Croatia. Because of unequal numbers of physicians at individual years of age, we emphasized the need for demographic approach both in the planning of physician employment and advanced medical training. This necessity was reinforced by the fact that in 1999, at 35-44 years of age 1,147 (29%) physicians neither possessed a specialty degree nor started on any such course.