Cyberbullying and problematic social media use: an insight into the positive role of social support in adolescents-data from the Health Behaviour in School-aged Children study in Italy.

OBJECTIVES: The global spread of electronic devices has made cyberbullying and problematic social media use (PSMU) emerging public health concerns. This study aimed to investigate the prevalence of cyberbullying and PMSU among adolescents in northwestern Italy. We also explored the association between cyberbullying and PSMU and whether this association was moderated by social support. STUDY DESIGN: Data were collected as part of the Italian 2018 Health Behaviour in School-aged Children (HBSC) study in the Piedmont region; 186 school classes participated, comprising 3022 children aged 11, 13 and 15 years. The prevalence of cyberbullying and PSMU were estimated in subgroups of age and gender. Multivariate logistic regression was used to investigate the association between cyberbullying and PSMU, before and after taking into account social support. RESULTS: Girls reported higher cyber-victimisation and PSMU than boys (9.1% vs 6.0% and 10.2% vs 6.1%, respectively), and the risk of cyber-victimisation was higher in the presence of PSMU. This risk was attenuated in the presence of social support. CONCLUSIONS: PSMU is an important driver of cyberbullying, although social support can mediate these behaviours. Public health interventions are needed to guide adolescents how to use social media appropriately and to prevent cyberbullying and the mental health problems they can provoke.

Physical activity as a key issue for promoting human health on a local and global scale: evidences and perspectives.

Physical inactivity represents the fourth leading risk factor with the highest epidemiological impact on population health worldwide, as estimated by the epidemiological measures used in global surveillance systems as the Global Burden of Disease Study. Scientific research has provided compelling evidence to establish and clarify the causal relationships and to devise effective intervention strategies, including the development of both national and international recommendations and the planning of whole-of-system and integrated actions. Over the last few years, new paradigms have been identified, such as the distinction between physical inactivity and sedentary behaviour, the different methods to integrate enough levels of physical activity in daily life, and the relevance of sleep in normal lifestyle activities. The experience in programs planning and in their assessments has led to the definition of a whole-of-system and global approach for the promotion of an active lifestyle, specifically the Global Action Plan on Physical Activity 2018 - 2030 by the World Health Organization, with the definition of overlapping areas with further objectives of public health as established by the 2030 Agenda for Sustainable Development. Thus, the action plan aims to ensure access to inclusive and equitable opportunities for people to be physically active in their daily life (with reference to more socially disadvantaged groups, such as women, people with disabilities, people of low socioeconomic status) and to improve planetary health.

Self-reported recurrent pain and medicine use among 15-year-olds: results from the HBSC Italian study.

BACKGROUND: The prevalence of adolescent pain varies considerably across epidemiological studies, and little information is available on pain-related behaviours among adolescents, including medicine use. The aims of this study were: [1] to examine the prevalence of recurrent pain among 15-year-old adolescents in Italy; [2] to investigate the association between recurrent pain and medicine use among boys and girls; and [3] to evaluate the consistency of these associations across Regions. METHODS: The World Health Organization (WHO) collaborative International Health Behaviour in School-aged Children 2013/2014 study collected self-reported data on pain and medicine use from 13611 15-year-old adolescents in 21 Italian Regions. We used multi-level multivariate logistic regression, stratified by gender, to analyse the association between recurrent pain and medicine use for headache, stomachache, nervousness and difficulties in getting to sleep. RESULTS: On average, across all Regions, almost 45% of adolescents reported recurrent headache, more than 30% reported recurrent backache and approximately 30% reported recurrent stomachache. Although the prevalence of both pain and medicine use was much higher among girls, the association between pain and medicine use was similarly strong in adolescents of both genders. Adolescents with recurrent pain proved more likely to use medicines also for non-corresponding pain, nervousness and difficulties in getting to sleep. The association between recurrent pain and medicine use was consistent across Regions despite large inter-regional differences in the prevalence of both phenomena. CONCLUSIONS: Recurrent pain in adolescence is common nationwide. Adolescents with recurrent pain are more likely to use medicines in general. Recurrent pain and medicine use should be addressed by adolescent health policies.

The contribution of club participation to adolescent health: evidence from six countries.

BACKGROUND: Social networks have been recognised as an important factor for enhancing the health of people and communities. Bridging social capital, characterised by numerous and varied weak ties, exemplifies a particular type of network that can help people reach their goals and improve their health. This study seeks to contribute to the evidence base on the use of positive social networks for young people's health by exploring the importance of club participation in predicting the health and health-related behaviours of 15-year-old girls and boys across Europe and North America. METHODS: Data are derived from a 2005-6 World Health Organization collaborative study, to establish the relationships between different types of club and a range of health outcomes (self-perceived health, wellbeing and symptoms) and health-related behaviours (smoking, drinking). Multi-level logistic regression was used to assess the independent effects of club participation by controlling for gender and socioeconomic position. Data were compared across six countries. RESULTS: All the considered outcomes, both in terms of perceived health and wellbeing and health behaviours were associated with participation in formal associations. The associations are in the expected direction (participation corresponding to better health) except for some particular association types. CONCLUSIONS: Participation in formal associations seems supportive for good health and health behaviours in adolescence, and should be promoted in this age group.

School-based prevention for illicit drugs' use.

BACKGROUND: Drug addiction is a chronic, relapsing disease. Primary interventions should be aimed to reduce first use, or prevent the transition from experimental use to addiction. School is the appropriate setting for preventive interventions. OBJECTIVES: To evaluate the effectiveness of school-based interventions in improving knowledge, developing skills, promoting change, and preventing or reducing drug use versus usual curricular activities or a different school-based intervention . SEARCH STRATEGY: MEDLINE , EMBASE, ERIC, PSYCHINFO, Cochrane Library, ACP Journal Club, Cochrane Drug and Alcohol Group Register, updated to February 2004, were searched. Bibliography of papers was checked and personal contacts were made to identify other relevant studies. SELECTION CRITERIA: RCTs, CCTs or Controlled Prospective Studies (CPS) evaluating school-based interventions designed to prevent substance use. DATA COLLECTION AND ANALYSIS: Data were selected and extracted independently by two reviewers. Quality was assessed with the CDAG checklist. Interventions were classified as skills, affective, knowledge-focused and other characteristics were also studied (teaching, follow-up implementation, context activation). MAIN RESULTS: 32 studies (29 RCTs and 3 CPSs) were included. 28 were conducted in the USA; most were focused on 6th-7th grade students, and based on post-test assessment. RCTs: (1) Knowledge vs usual curricula: Knowledge focused programs improve drug knowledge (SMD=0.91; 95% CI: 0.42, 1.39).(2) Skills vs usual curricula: Skills based interventions increase drug knowledge (WMD=2.60; 95% CI: 1.17-4.03), decision making skills (SMD=0.78; CI95%: 0.46-1.09), self-esteem (SMD=0.22; CI95%: 0.03-0.40), peer pressure resistance (RR=2.05; CI95%: 1.24-3.42), drug use (RR=0.81; CI95%: 0.64, 1.02), marijuana use (RR=0.82; CI95%: 0.73, 0.92) and hard drug use (RR=0.45; CI95%: 0.24-0.85). (3) Skills vs knowledge: No differences are evident.(4) Skills vs affective: Skills-based interventions are only better than affective ones in self-efficacy (WMD=1.90; CI95%: 0.25, 3.55). (5) Affective vs usual curricula: Affective interventions improve drug knowledge (SMD=1.88; CI95%: 1.27, 2.50) and decision making skills (SMD=1.35; CI95%: 0.79, 1.9). (6) Affective vs knowledge: Affective interventions improve drug knowledge (SMD=0.60; CI95%: 0.18,1.03), and decision making skills (SMD=1.22; CI95%: 0.33, 2.12). Results from CPSs: No statistically significant results emerge from CPSs. AUTHORS' CONCLUSIONS: Skills based programs appear to be effective in deterring early-stage drug use. The replication of results with well designed, long term randomised trials, and the evaluation of single components of intervention (peer, parents, booster sessions) are the priorities for research. All new studies should control for cluster effect.

Methadone maintenance at different dosages for opioid dependence.

BACKGROUND: Methadone maintenance treatment (MMT) is a long term opioid replacement therapy, recognised as effective in the management of opioid dependence. Even if MMT at high dosage is recommended as therapy for reducing illicit opioid use and promoting longer retention in treatment, at present day "the organisation and regulation of the methadone maintenance treatment varies widely". OBJECTIVES: To evaluate the efficacy of different dosages of MMT for opioid dependence in modifying health and social outcomes and in promoting patients' familial, occupational and relational functioning. SEARCH STRATEGY: The following sources were scanned: - MEDLINE (OVID 1966-2001)- EMBASE (1988-2001)- ERIC (1988-2001)- Psychinfo (1947-2001)- Cochrane Controlled Trials Register (CCTR) (1947-2001)- Register of the Cochrane Drug and Alcohol Group (CDAG) (1947-2001)The CDAG search strategy was applied together with a specific MESH strategy. Further studies were searched through: letters to the authors of selected trials or to experts in order to obtain unpublished data. check of references of relevant reviews. SELECTION CRITERIA: Randomised Controlled Trials (RCT) and Controlled Prospective Studies (CPS) evaluating methadone maintenance at different dosages in the management of opioid dependence were included in the review. Non-randomised trials were included when proper adjustment for confounding factors was performed at the analysis stage. DATA COLLECTION AND ANALYSIS: Extraction of data was performed separately by two reviewers. Discrepancies were resolved by a third reviewer. RevMan software was used for analysis. Quality assessments of the methodology of studies were carried out using CDAG checklist. MAIN RESULTS: 22 studies were excluded from the review. 21 studies were included; of them, 11 were RCTs with 2279 people randomised and 10 were CPSs with 3715 people followed-up. OUTCOMES: Retention rate - RCTs: High vs low doses at shorter follow-ups: RR=1.36 [1.13,1.63], and at longer ones: RR=1.62 [0.95,2.77]. Opioid use (self reported), times/w - RCTs: high vs low doses WMD= -2.00 [-4.77,0.77] high vs middle doses WMD= -1.89[-3.43, -0.35] Opioid abstinence, (urine based) at >3-4 w - RCTs: high vs low ones: RR=1.59 [1.16,2.18] high vs middle doses RR=1.51[0.63,3.61] Cocaine abstinence (urine based) at >3-4 w - RCTs: high vs low doses RR=1.81 [1.15,2.85]Overdose mortality - CPSs: high dose vs low dose at 6 years follow up: RR=0.29 [0.02-5.34] high dose vs middle dose at 6 years follow up: RR=0.38 [0.02-9.34] middle dose vs low dose at 6 years follow up: RR=0.57 [0.06-5.06] REVIEWER'S CONCLUSIONS: Methadone dosages ranging from 60 to 100 mg/day are more effective than lower dosages in retaining patients and in reducing use of heroin and cocaine during treatment. To find the optimal dose is a clinical ability, but clinician must consider these conclusions in treatment strategies.

Decennial trends of social differentials in smoking habits in Italy.

OBJECTIVE: To present social trends of smoking habits in Italy during the period 1980-1994. METHODS: Data from five national health surveys (1980, 1983, 1986-1987, 1990-1991, 1994) were analyzed in order to calculate smoking prevalences. Education attained was used as social class indicator. MAIN MEASURES: SDPs (prevalence rate standardized on the 1981 Italian population) and PRs (prevalence ratios primary school/degree). Confidence intervals and p-values were calculated as indicators of statistical significance. RESULTS: Among men SDP decreased from 59.5% in 1980 to 37.3% in 1994 and PRs for social classes varied from 1.21 in 1980 to 1.47 in 1994. Corresponding results for women were 17.9% to 20.0% and 0.36 to 0.73. CONCLUSIONS: Lower-educated men smoke more than those in higher social categories, and data collected during 1980-1994 in Italy show a tendency to increase such differentials. Among women this pattern was the opposite in 1980, with a tendency to reduce differences over time. Therefore, for both genders data show a progressive disadvantage for the low-educated categories. The greater compliance of better-educated groups with anti-smoking interventions must be taken into account, and should suggest "unequal" interventions that can be more effective among disadvantaged social groups.

Cancer mortality by educational level in Italy.

Social differences in health concern both ethics and science. From a public health point-of-view, one must assess actual differences and then try to find explanations. This was made possible for the first time for cancer in Italy via nationwide record-linkage between the 1981 census and the national death index. Over the subsequent six months after census, the study-base included 31,000 deaths for cancer and 18 million person-years at risk. Rate ratio (RR) were estimated through a Poisson regression model adjusted by age and geographic area of residence. Educational level was used as social level indicator. Profound social differences were evident for buccal cavity (RR = 3.10 for lowest cf highest educational level), esophagus (RR = 3.00), stomach (RR = 3.43), and larynx (RR = 3.30) among men, and for stomach (RR = 2.25) and uterus (RR = 1.76) among women. Colon (RR = 0.62) and pancreas cancers (RR = 0.65) presented an inverse relationship among men, as did colon (RR = 0.37), breast (RR = 0.56), ovary (RR = 0.45), and melanoma (RR = 0.62) among women. In conclusion, the Italian population at the beginning of the 1980s had large social differences in the risk of dying from cancer, confirming the patterns commonly found in such other countries as Great Britain, France, and New Zealand. Some dissimilarities, useful for hypothesis generation on the mechanisms of inequality, were evident, such as the generally highest social differences found among northern Italian men and among southern Italian women.

[Health problems of foreign immigrants in Italy: the answer from the institutions]. / I problemi di salute degli stranieri immigrati in Italia: la risposta delle istituzioni.

The possibility and the result of the meeting between immigrant's health problems and the health services system are conditioned by legal bonds and by the ability of the system to meet different cultures and values. In the present work we outline the Italian legislation about immigration to search those critical points that may help to understand some features of immigration in Italy. We describe the foreigner's health problems, according the present documentary evidence, and we outline adequate answers.

[The health of the foreign immigrants in Turin in the current informative systems]. / La salute degli stranieri immigrati a Torino nei sistemi informativi correnti.

The rising phenomenon of immigration to Italy makes necessary to be equipped with basic tools allowing to work out a health pattern of the immigrated foreigners useful to develop programs for their health protection. We describe the image of the health pattern of foreigners immigrated to Turin obtained using the current socio-sanitary informative systems and the record of some outpatient's department. The resulting health condition is similar to that of the general population, with a few epidemiological peculiarities of the origin countries (a larger diffusion of tubercolosys and intestinal parasitosis) and with acute problems typical of populations with high mobility (traumatology, respiratory diseases). Besides, these sources suggest to examine carefully health problems pregnancy and work related. Completeness and quality limits of the informative systems used are then discussed.

[Social differences in infant mortality in a longitudinal Turin study]. / Differenze sociali nella mortalità infantile nello studio longitudinale torinese.

The Turin longitudinal study enables to study the one-year survival of children born to any member of the study population and to relate the still-born and infant mortality to the parents' census characteristics. In this paper 25,108 children, born between 1981 and 1985 of parents residents in Turin at the 1981 population census, were followed up with respect to one-year survival. The numbers of infant deaths have been observed according to parents' education, housing ownership, occupational status and professional position. Only parents' education showed consistent differential in the still-born and infant mortality risks, adjusted for maternal age.