Depressive symptoms and clustering of risk behaviours among adolescents and young adults attending vocational education: a cross-sectional study.

BACKGROUND: Depressive symptoms and risk behaviours often do not occur in isolation among adolescents and young adults. In order to improve intervention programmes, more research is needed to elucidate the clustering of risk behaviours, the association with depressive symptoms, and demographic variables. Therefore, this study examined the clustering of risk behaviours, the association with depressive symptoms, and demographic variables among adolescents and young adults in vocational education. Furthermore, the prevalence of depressive symptoms and risk behaviours was examined. METHODS: This study included 584 students (mean age 18.3 years) attending vocational education in the Netherlands. Depressive symptoms and risk behaviours (binge drinking, cannabis use, smoking, delinquency and incurring debts) were assessed with self-report questionnaires. Truancy was monitored via the school registration system. Principal Components Analysis (PCA) was conducted to assess the factor structure of the risk behaviours (i.e. clustering). Linear regression analyses with a bootstrapping method were performed to assess the associations. RESULTS: Binge drinking was reported by 50.5% and cannabis use by 14.2% of the students (both in the past 4 weeks), whereas 37.7% reported currently being a smoker. More than 10% reported having been questioned at a police station in the past year. Furthermore, 82.2% had been truanting in the first two months of education, 21.0% reported having debts and 29.2% reported clinically-relevant depressive symptoms. The PCA indicated two clusters. The 'substance use' cluster consisted of the risk behaviours: binge drinking, cannabis use and smoking. The 'problem behaviours' cluster consisted of the risk behaviours: delinquency, truancy and incurring debts. Both clusters were associated with depressive symptoms. Various demographic variables were associated with both clusters. CONCLUSIONS: Risk behaviours formed two clusters, both of which were associated with depressive symptoms. These findings underscore the importance of screening adolescents and young adults at lower educational levels for multiple risk behaviours and depressive symptoms and of focusing on multiple risk behaviours in interventions simultaneously.

A longitudinal study of children's outside play using family environment and perceived physical environment as predictors.

BACKGROUND: A natural and cheap way of increasing children's physical activity is stimulating unstructured outside play. PURPOSE: This study examined whether characteristics of the family and perceived physical environment were associated with the duration of children's outside play. METHODS: Parents participating in the "Be Active, Eat Right" cluster RCT control group (N = 2007) provided information on potential predictors of outside play (i.e. family and perceived physical environment) of their 5-year-old child by questionnaire. Child outside play was assessed by parental reports both at five and seven years. Linear regression analyses, adjusted for seasonality, were performed to evaluate associations between potential predictors and child outside play. Linear mixed models were fitted to evaluate the relationship between potential predictors and the development of outside play over two years, with season entered as a random factor. RESULTS: Family environment was the strongest construct predicting child outside play, while parent perceived physical environment had no significant association with child outside play. Parental habit strength and the presence of rules were the strongest predictors of increased outside play. Parent perceived difficulty in improving child outside play was the strongest predictor of decreased outside play. CONCLUSION: Family environment predicted child outside play and not perceived physical environment. Parental rules and habit strength regarding improving outside play were associated with an improvement of child's engagement in outside play.

Longitudinal investigation of the role of temperament and stressful life events in childhood anxiety.

The current study investigated the longitudinal relationships among behavioral inhibition (BI), life events, and anxiety in a sample of 102 BI children and 100 behaviorally uninhibited (BUI) children aged 3 to 4 years. Children's parents completed questionnaires on BI, stressful life events, and anxiety symptoms, and were administered a diagnostic interview three times in a 5-year period. In line with our hypotheses, negative life events, particularly negative behavior-dependent life events (i.e., life events that are related to the children's own behaviors), and the impact of negative life events were predictive of increases in subsequent anxiety symptoms, the likelihood of having an anxiety disorder, and increased number of anxiety diagnoses over the 5-year follow-up period. Experiencing more positive, behavior-independent life events decreased the risk of being diagnosed with an anxiety disorder. Furthermore, differences were found in life events between BI and BUI children. That is, BI children experienced fewer positive and specifically positive behavior-dependent life events, and the impact of these positive life events was also lower in BI children than in BUI children. However, BI did not interact with life events in the prediction of anxiety problems as hypothesized. Therefore, this study seems to indicate that BI and life events act as additive risk factors in the development of anxiety problems.

Your health, an intervention at senior vocational schools to promote adolescents' health and health behaviors.

UNLABELLED: This study evaluates the appreciation, application and effects of an intervention (Your Health), in which adolescents received a consultation with the school nurse. A cluster randomized controlled trial with an intervention and control group (care-as-usual) was conducted among first-grade senior vocational students. Adolescents (n = 418) completed a questionnaire at baseline and 6-month follow-up assessing health and health behaviors. School absenteeism was monitored via the school registration system. After the consultation, adolescents and nurses evaluated the consultation by questionnaire. Adolescents appreciated being invited for the consultation and gave the consultation a positive mean rating of 8.78 on a 10-point scale. Adolescents rated the other nine items on the appreciation of the consultation also high. In 36.8% of the adolescents, nurses suspected problems. Most often these adolescents were given tailored advice (59.3%) or they were referred to another professional (40.7%). No statistically significant effects of the intervention were found on the health and health behaviors of adolescents. This study supports the use of Your Health as a promising intervention to reach senior vocational students. Future research is needed to evaluate long-term effects and the effects and appreciation of the subsequent help that is offered. TRIAL REGISTRATION: www.trialregister.nl, NTR3545.

Effectiveness of a Web-based tailored intervention (E-health4Uth) and consultation to promote adolescents' health: randomized controlled trial.

BACKGROUND: To promote well-being and health behaviors among adolescents, 2 interventions were implemented at 12 secondary schools. Adolescents in the E-health4Uth group received Web-based tailored messages focused on their health behaviors and well-being. Adolescents in the E-health4Uth and consultation group received the same tailored messages, but were subsequently referred to a school nurse for a consultation if they were at risk of mental health problems. OBJECTIVE: This study evaluated the effect of E-health4Uth and E-health4Uth and consultation on well-being (ie, mental health status and health-related quality of life) and health behaviors (ie, alcohol and drug use, smoking, safe sex). METHODS: A cluster randomized controlled trial was conducted among third- and fourth-year secondary school students (mean age 15.9, SD 0.69). School classes (clusters) were randomly assigned to (1) E-health4Uth group, (2) E-health4Uth and consultation group, or (3) control group (ie, care as usual). Adolescents completed a questionnaire at baseline and at 4-month follow-up assessing alcohol consumption, smoking, drug use, condom use, mental health via the Strengths and Difficulties Questionnaire (SDQ) and the Youth Self Report (YSR; only measured at follow-up), and health-related quality of life. Multilevel logistic, ordinal, and linear regression analyses were used to reveal differences in health behavior and well-being between the intervention groups and the control group at follow-up. Subsequently, it was explored whether demographics moderated the effects. RESULTS: Data from 1256 adolescents were analyzed. Compared to the control intervention, the E-health4Uth intervention, as a standalone intervention, showed minor positive results in health-related quality of life (B=2.79, 95% CI 0.72-4.87) and condom use during intercourse among adolescents of Dutch ethnicity (OR 3.59, 95% CI 1.71-7.55) not replicated in the E-health4Uth and consultation group. The E-health4Uth and consultation intervention showed minor positive results in the mental health status of adolescents (SDQ: B=-0.60, 95% CI -1.17 to -0.04), but a negative effect on drug use among boys (OR 0.36, 95% CI 0.13-0.96). In the subgroup of adolescents who were at risk of mental health problems at baseline (and referred for a consultation with the nurse), the E-health4Uth and consultation group showed minor to moderate positive results in mental health status (SDQ: B=-1.79, 95% CI -3.35 to -0.22; YSR: B=-9.11, 95% CI -17.52 to -0.71) and health-related quality of life (B=7.81, 95% CI 2.41-13.21) at follow-up compared to adolescents in the control group who were at risk of mental health problems at baseline. CONCLUSIONS: Findings from this study support the use of the E-health4Uth and consultation intervention in promoting the well-being of adolescents at risk of mental health problems. Future research is needed to further evaluate the effects of the consultation as a standalone intervention, and the dual approach of further tailored eHealth messages and a consultation. TRIAL REGISTRATION: Nederlands Trial Register: NTR 3596; http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=3596 (Archived by WebCite at http://www.webcitation.org/6PmgrPOuv).

An experimental manipulation of maternal perfectionistic anxious rearing behaviors with anxious and non-anxious children.

The anxious rearing model of perfectionism development proposes that children develop perfectionism in response to parental worry about their children being imperfect and parental behaviors such as overprotection from mistakes and focus on the negative consequences of mistakes. In the current study, perfectionistic rearing behaviors were experimentally manipulated during a copy task in clinically anxious children (n = 42) and non-anxious children (n = 35). Children were randomized to receive high or non-perfectionistic rearing behaviors from their parents during the copy task designed to elicit child perfectionistic behaviors. Results showed that self-reported self-oriented perfectionism (SOP) was significantly higher in the anxious group compared with the non-anxious group. All children showed an increase in observed SOP in response to high perfectionistic rearing behaviors. Despite this increase in SOP in the high perfectionistic rearing condition, it was children in the non-perfectionistic rearing condition that improved significantly in task accuracy performance. Non-anxious children declined in task-related striving for perfectionism when they experienced non-perfectionistic rearing behaviors from their parents. Anxious children, however, did not show a decline in task-related striving following non-perfectionistic rearing. Results support the perfectionistic rearing model and parental perfectionistic behaviors' impact on children's observed and self-reported SOP and task performance.

Primary prevention of overweight in preschool children, the BeeBOFT study (breastfeeding, breakfast daily, outside playing, few sweet drinks, less TV viewing): design of a cluster randomized controlled trial.

BACKGROUND: Two overweight prevention interventions were developed to be offered by preventive Youth Health Care (YHC) in addition to the currently applied overweight prevention protocol to parents of 0-3 year old children. The two interventions aim to support parents of preschool children to realize healthy child nutrition and activity behaviors of their young child. The aim of this study is to assess the effects of the two overweight prevention interventions with regard to child health behaviors and child Body Mass Index. METHODS/DESIGN: A cluster randomized controlled trial was conducted among parents and their preschool children who attend one of 51 participating YHC teams. The teams were randomly allocated to one of the two intervention groups, or to the control group (care as usual).The 'BBOFT+' intervention focuses on effective child rearing by parents from birth onwards by enlarging parental skills concerning healthy behavioural life-style habits. Parents who are allocated to the 'E-health4Uth Healthy toddler' intervention group, at the child age of circa 18 and 24 months old, are invited to complete an online E-health module providing tailored health education regarding healthy child nutrition and activity behaviors. The E-health messages are discussed and reinforced during the subsequent regularly scheduled visits by YHC professionals, and were repeated after 4 weeks.The primary outcome measures at child age 3 years are: overweight inducing/reducing behaviors, (for 'BBOFT+' only) healthy sleep, Body Mass Index and prevalence of overweight and obesity. Secondary outcome measures are attitudes and other cognitive characteristics of the parents regarding the overweight-related behaviors of their child, parenting styles and practices, and health-related quality of life of the children. DISCUSSION: We hypothesize that the use of the additional interventions will result in a healthier lifestyle of preschool children and an improved BMI and less development of overweight and obesity compared to usual care. TRIAL REGISTRATION: Nederlands Trial Register NTR1831.

A psychometric evaluation of the behavioral inhibition questionnaire in a non-clinical sample of Dutch children and adolescents.

The Behavioral Inhibition Questionnaire (BIQ) is a parent-rating scale for measuring temperamental characteristics referring to shyness, fearfulness, and withdrawal in young, preschool children. The present study evaluated the psychometric properties of the BIQ in a Dutch community sample of children with a broad age range. For this purpose,the reliability and validity of the BIQ was evaluated in three age groups: 4-7-year-olds,8-11-year-olds, and 12-15-year-olds. The results indicated that the internal consistency of most BIQ scales was satisfactory in all three age groups. Principal component analysis of the BIQ yielded a six-factor model that was largely in keeping with the hypothesized structure consisting of the social and non-social components of behavioral inhibition.Confirmatory factor analysis indicated that this model provided a reasonable fit for the data. Further, support for the validity of the measure was obtained in all age groups. That is, BIQ scores were positively correlated with a wide range of anxiety symptoms, although the most substantial links were found for symptoms of social anxiety. Finally, a self-report version of the BIQ, which was administered to children aged 9 years and above, was found to possess good internal consistency and adequate parent-child agreement. Altogether, the results of this study indicate that suggests that the BIQ might be a reliable and valid measure for assessing behavioral inhibition not only in preschoolers but also in older children and adolescents.

A Controlled Trial in Community Pediatrics to Empower Parents Who Are at Risk for Parenting Stress: The Supportive Parenting Intervention.

The goal of the Supportive Parenting Intervention is to prevent and/or decrease parenting stress and provide a sense of empowerment to parents with a newborn child. We evaluated the effectiveness of the Supportive Parenting Intervention in terms of parenting skills, social support, self-sufficiency, resilience, and child psychosocial health. A controlled trial with pre- and post-intervention testing was conducted in the setting of community pediatrics among parents at risk for developing parenting stress. The 177 parents in the control group received care-as-usual, whereas the 124 parents in the intervention group received six home visits by a trained Youth Health Care nurse during the first 18 months of the child's life. The result with respect to parenting skills, social support (both from family and friends, and the partner), self-sufficiency, and resilience at the 18-month follow-up was either unchanged or (p < 0.05) worse compared to the respective baseline score for both groups. We found no significant difference between intervention and control group with respect to the child's Child Behavior Check List (CBCL). This study shows no positive effect with respect to the indicators of parental empowerment. We recommend research to strengthen the intervention and its application in daily practice, for example by increasing the intervention duration, and to evaluate it in a large randomized controlled trial.

Psychometric evaluation of two new parent-rating scales for measuring anxiety symptoms in young Dutch children.

The current study examined the reliability and validity of the Preschool Anxiety Scale (PAS) and the Children's Moods Fears and Worries Questionnaire (CMFWQ) in a Dutch community sample of 275 preschool children aged 2-6 years. The acceptability of PAS and CMFWQ items was good. Preliminary exploratory factor analyses yielded a meaningful five-factor model for the PAS and a three-factor model for the CMFWQ. PAS scales had moderate to high reliability coefficients (alphas between .59 and .86), whereas CMFWQ scales displayed good internal consistency (alphas between .88 and .95). The validity of both measures was supported by a number of findings. First, PAS and CMFWQ scores were substantially correlated. Particularly high correlations were found between the PAS total scale and CMFWQ fear and anxiety problems. Second, PAS and CMFWQ scores were also correlated with CBCL emotionally reactive, anxious/depressed and withdrawn subscales. Third, girls displayed significantly higher scores on the PAS scales than boys, which is in agreement with previous research. Also some age differences were found on the PAS, with older children scoring higher on the social phobia and generalized anxiety disorder subscales than younger children. Finally, CMFWQ and PAS scores discriminated reasonably between children scoring in the normal, subclinical and clinical range of the CBCL subscales. The utility of the PAS and the CMFWQ as a screening instrument for anxiety problems in preschoolers is briefly discussed.

Concurrent validity, discriminatory power and feasibility of the instrument for Identification of Parents At Risk for child Abuse and Neglect (IPARAN).

OBJECTIVES: To determine the feasibility, concurrent validity and discriminatory power of the instrument for Identification of Parents At Risk for child Abuse and Neglect (IPARAN) among Dutch parents with a newborn child. SETTING: Community paediatrics. PARTICIPANTS: Data from a controlled trial were used. In total, 2659 Dutch parents with a newborn child were invited to participate. Of the 2659 parents, 759 parents filled in the consent form and participated in the study. PRIMARY AND SECONDARY OUTCOME MEASURES: Concurrent validity was determined by calculating correlations-using the Pearson's correlation (r)-between the IPARAN score and related constructs from the following instruments: the Empowerment Questionnaire 2.0, the Family Functioning Questionnaire and the Parenting Stress Questionnaire. Discriminatory power was determined by calculating receiver operating characteristic (ROC) curves between high-risk mothers and low-risk mothers according to their scores on the related constructs. Feasibility was determined by examining the percentage of missing answers. RESULTS: In terms of concurrent validity, we found that 3 out of 12 correlations between the IPARAN score and related constructs were strong (ie, r>0.50) and 4 out of 12 were medium (ie, r=0.30-0.49). In terms of discriminatory power, mothers with a score in the borderline/clinical range or lowest 10 percent (P10) range of the related constructs (high-risk mothers) had a higher IPARAN score than mothers with a score in the normal range or highest 90 percent (P90) range of the related constructs (low-risk mothers). Effect sizes varied from d=0.37 to d=1.93, and the area under the ROC curve varied from 0.62 to 0.93. Regarding feasibility, the part of the IPARAN filled in by the mother had on average 0.7% missing answers, whereas the part of the IPARAN filled in by the father had on average 1.7% missing answers. CONCLUSION: The results of this study support the concurrent validity, discriminatory power and feasibility of the IPARAN among a population of Dutch parents with a newborn child.

Do you think I should be scared? The effect of peer discussion on children's fears.

This study investigated whether close friends affect each other's fear responses (fear beliefs and avoidance) when they discuss fear-related issues together. Children (N = 242) aged 7-10 years were first presented with ambiguous and threatening information about two novel animals respectively, after which their fear responses towards each animal were assessed (T1). Next, dyads of close friends had a discussion about their feelings regarding the animals, and their fear responses were measured again (T2). Results showed that children influenced each other's cognitions following the discussion; from T1 to T2 their fear responses became more similar and close friends' fear responses at T1 significantly predicted children's fear responses at T2. Gender pair type predicted change in children's fear responses over time. Children in boy-boy pairs showed a significant increase in fear responses following the discussion; their fear level became more in line with that of other gender pairs at T2, while those in girl-girl pairs showed a significant decrease in their fear beliefs, at least when threatening information was given. Differences in anxiety level between close friends did not affect change in fear responses over time. Altogether, the results indicate that children may affect each other's fears.

Associations of Truancy, Perceived School Performance, and Mental Health With Alcohol Consumption Among Adolescents.

BACKGROUND: This study examined associations of truancy, perceived school performance, and mental health with adolescents' week, weekend, and binge drinking. METHODS: A cross-sectional study was conducted among 1167 secondary school students of Dutch ethnicity (mean age, 15.9 years, SD = 0.69). Alcohol consumption, truancy, perceived school performance, and mental health status were assessed with self-report questionnaires. Ordinal regression analyses were performed to assess the associations. RESULTS: Truancy (odds ratio [OR] = 2.53; 95% confidence interval [CI], 1.70-3.77) and poorer mental health (OR = 1.04; 95% CI, 1.02-1.07) were associated with binge drinking more often. Truancy (OR = 1.89; 95% CI, 1.14-3.16) and poorer mental health (OR = 1.06; 95% CI, 1.02-1.09) were also associated with drinking (more) alcohol on week days. Furthermore, truancy (OR = 2.60; 95% CI, 1.76-3.83) and having an average (OR = 1.81; 95% CI, 1.19-2.77) or less than average (OR = 3.65; 95% CI, 1.93-6.90) perceived school performance were associated with drinking (more) alcohol on the weekend. CONCLUSIONS: Findings of this study suggest that adolescents who are truant and/or have a poor mental health status are at increased risk of binge and week drinking. Furthermore, adolescents who are truant and/or have an average or less than average perceived school performance are at increased risk of weekend drinking.

Psychometric properties of self-sufficiency assessment tools in adolescents in vocational education.

BACKGROUND: Self-sufficiency is the realisation of an acceptable level of functioning either by the person him/herself or through the adequate organisation of help from informal or formal care providers. Assessment of self-sufficiency for determining an individual's functional strengths and areas for improvement is increasingly being applied among adolescents in vocational education, a group considered vulnerable with high school dropout rates and often characterised by an accumulation of problems. This study examined the psychometric properties of two instruments, i.e. a self-report questionnaire assessing self-sufficiency and the Self-Sufficiency Matrix for professionals (SSM-D) conducted among adolescents in vocational education. METHODS: The self-report questionnaire used to assess self-sufficiency was completed by 581 adolescents. Professionals completed the SSM-D for 224 of the 581 adolescents. Furthermore, constructs related to the domains of self-sufficiency were assessed with self-report questionnaires and information about school absenteeism was monitored via the school registration system. RESULTS: For both self-report and professional-report ratings, the internal consistency was satisfactory (Cronbach'α > 0.70) and various minor to strong correlations were found between the domains of self-sufficiency and related constructs. For most of the domains, there was little or no agreement between professionals and adolescents. CONCLUSIONS: Both the self-report questionnaire assessing self-sufficiency and the SSM-D applied in this study seem to possess adequate psychometric properties. The results indicated that adolescents and professionals provide different views of adolescents' self-sufficiency, which merits further study. In the meantime, we recommend assessment of adolescents' self-sufficiency by using both the self-report questionnaire and the SSM-D to get a comprehensive measure of adolescents' self-sufficiency. TRIAL REGISTRATION: Netherlands Trial Register: NTR3545 ; 30 July 2012.

Maternal expectancy versus objective measures of child skill: evidence for absence of positive bias in mothers' expectations of children with internalizing disorders.

Parents of anxious children are thought to be more attuned to threat, which might translate into less positive bias in parental report of child coping and ability, unlike parents of non-anxious children. Maternal expectancy bias was examined in a sample of 43 clinically anxious (51 % female), 30 clinically anxious/depressed (50 % female), and 44 non-clinical control children (46 % female), 8-14 years of age. When compared to an objective observer's ratings of the children, mothers of non-clinical children demonstrated a positive bias (i.e., over-rated their children's performance) for both ratings of expected speech performance in absolute terms and relative to peers. Mothers in the clinical groups did not exhibit this positive expectancy bias. Moreover, mothers of clinical children reported lower expectations in absolute terms and relative to peers than mothers of non-clinical children. The data suggest that mothers of clinical children held accurate expectations for child performance when compared to the gold standard of an objective observer.

Cyber and traditional bullying victimization as a risk factor for mental health problems and suicidal ideation in adolescents.

PURPOSE: To examine whether traditional and cyber bullying victimization were associated with adolescent's mental health problems and suicidal ideation at two-year follow-up. Gender differences were explored to determine whether bullying affects boys and girls differently. METHODS: A two-year longitudinal study was conducted among first-year secondary school students (N = 3181). Traditional and cyber bullying victimization were assessed at baseline, whereas mental health status and suicidal ideation were assessed at baseline and follow-up by means of self-report questionnaires. Logistic regression analyses were conducted to assess associations between these variables while controlling for baseline problems. Additionally, we tested whether gender differences in mental health and suicidal ideation were present for the two types of bullying. RESULTS: There was a significant interaction between gender and traditional bullying victimization and between gender and cyber bullying victimization on mental health problems. Among boys, traditional and cyber bullying victimization were not related to mental health problems after controlling for baseline mental health. Among girls, both traditional and cyber bullying victimization were associated with mental health problems after controlling for baseline mental health. No significant interaction between gender and traditional or cyber bullying victimization on suicidal ideation was found. Traditional bullying victimization was associated with suicidal ideation, whereas cyber bullying victimization was not associated with suicidal ideation after controlling for baseline suicidal ideation. CONCLUSIONS: Traditional bullying victimization is associated with an increased risk of suicidal ideation, whereas traditional, as well as cyber bullying victimization is associated with an increased risk of mental health problems among girls. These findings stress the importance of programs aimed at reducing bullying behavior, especially because early-onset mental health problems may pose a risk for the development of psychiatric disorders in adulthood.

Correlates of parental misperception of their child's weight status: the 'be active, eat right' study.

OBJECTIVE: This study reported on correlates of parental perception of their child's weight status. Associations between parental misperception (i.e., underestimation of the child's weight) and parental intention to improve their child's overweight-related health behaviors and their child meeting guidelines regarding these behaviors were also investigated. METHODS: Baseline data from the population-based 'Be active, eat right study' were used. The population for analysis consisted of 630 overweight and 153 obese five year-old children and their parents. Questionnaires were used to measure parental perception of the child's weight status, correlates of misperception (i.e., child age, child gender, child BMI, parental age, parental gender, parental country of birth, parental educational level and parental weight status), overweight-related health behaviors (i.e., child playing outside, having breakfast, drinking sweet beverages, and watching TV), and parental intention to improve these behaviors. Height and weight were measured using standardized protocols. Multivariable logistic regression analyses were performed. RESULTS: In total, 44.40% of the parents misperceived their child's weight status. Parental misperception was associated with lower child BMI, the parent being the father, a foreign parental country of birth, and a lower parental education level (p<0.05). Parental misperception was not associated with parental intention to improve child overweight-related health behavior, nor with child meeting the guidelines of these behaviors. DISCUSSION: This study showed that almost half of the parents with an overweight or obese child misperceived their child's weight status. A correct parental perception may be a small stepping-stone in improving the health of overweight and obese children.

Use and Appreciation of a Web-Based, Tailored Intervention (E-health4Uth) Combined With Counseling to Promote Adolescents' Health in Preventive Youth Health Care: Survey and Log-File Analysis.

BACKGROUND: Health promotion for adolescents is important in the prevention of mental health problems and health-risk behaviors. We implemented two interventions in a preventive youth health care setting. Adolescents in the E-health4Uth group received Web-based, tailored messages on their health behavior and well-being. Adolescents in the E-health4Uth and counseling group received the same tailored messages, but were subsequently referred to a school nurse for a consultation if they were at risk of mental health problems. OBJECTIVE: This study evaluated the use and appreciation of these Web-based, tailored messages and additional consultation with a school nurse. Differences in use and appreciation according to demographics (ie, gender, level of education, and ethnicity) of the adolescents were also assessed. METHODS: Two youth health care organizations participated in this study and conducted the interventions in 12 secondary schools. In total, 1702 adolescents participated; 533 in the E-health4Uth group, 554 in the E-health4Uth and counseling group, and 615 in the control group (ie, care as usual). Adolescents completed an evaluation questionnaire assessing the use and appreciation of the tailored messages immediately after receiving these messages and at a 4-month follow-up. After the consultation, adolescents and nurses completed an evaluation questionnaire on the use and appreciation of the consultation. RESULTS: The majority of the adolescents (845/1034, 81.72%) indicated they had read the tailored messages. Most items on the use and appreciation of the tailored messages and the program were scored positive (overall satisfaction on a scale from 1, most-negative, to 10, most-positive: mean 6.70, SD 1.60). In general, adolescents in vocational training, girls, and adolescents of non-Dutch ethnicity, indicated they used the tailored messages more often and appreciated the content of the messages better than adolescents receiving preuniversity education, boys, and adolescents of Dutch ethnicity, respectively (all P<.05). In the E-health4Uth and counseling group, 18.6% (103/553) of the adolescents were referred to a nurse. Adolescents in vocational training and girls were more often referred to a nurse than adolescents receiving preuniversity education (P=.007) and boys (P=.03), respectively. Adolescents and nurses positively evaluated the consultation (overall satisfaction of adolescents: mean 8.07, SD 1.21). Adolescents in vocational training attended the consultation more often (P=.047) and considered the consultation a more valuable addition to the tailored messages than adolescents receiving preuniversity education (P=.034). CONCLUSIONS: The Web-based, tailored messages and additional consultation were used and appreciated positively by adolescents and nurses. The consultation seems a valuable addition to the tailored messages. However, the tailored messages might need further improvement since adolescents did not rate all evaluation items about these messages explicitly positive. As these interventions were already interweaved with the existing practice of the preventive youth health care, they are especially promising for future implementation. TRIAL REGISTRATION: Netherlands Trial Register Number (NTR): NTR3596; http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=3596 (Archived by WebCite at http://www.webcitation.org/6LryL42zH).

Relevance is in the eye of the beholder: attentional bias to relevant stimuli in children.

Attentional biases are most often framed in a threat relevance framework. Alternatively, it could be that not only threat-related stimuli draw attention but also that preferential attention is drawn to all stimuli that have relevance for an individual. We investigated this stimulus relevance theory in primary school-age children by means of a visual search task. As predicted, children displayed attentional biases toward evolutionary and modern threat-related stimuli, such as spiders and guns, but also toward other relevant, positive stimuli (i.e., cakes, gifts, and happy faces). These results suggest that attentional biases are not specific to threat, but seem to apply to all relevant stimuli, both positive and negative in valence, providing first evidence for the stimulus relevance theory of preferential attention in children.