Prevention of alcohol exposed pregnancies in Europe: the FAR SEAS guidelines.

INTRODUCTION: Drinking during pregnancy is the leading cause of birth defects and child developmental disorders in Europe. The adverse effects of drinking during pregnancy may include physical, behavioural and cognitive problems, known collectively as fetal alcohol spectrum disorders (FASD). Evidence-based comprehensive recommendations at the European level on how to implement preventive and treatment policies to reduce alcohol-exposed pregnancies are needed. FAR SEAS, a tendered service contract (number 20,187,106) awarded by the European Commission, aimed at developing guidelines to respond to this knowledge gap. METHODS: FAR SEAS recommendations were built on (1) a two-phase review of interventions, (2) an international expert consultation, and (3) a pilot study on prevention of FASD conducted in the Mazovia region of Poland. The review of interventions included nineteen electronic open access databases, several repositories of grey literature and a key informant consultation covering most European Union (EU) countries and an additional guidelines search. After triangulating sources, 94 records were collected. Experts contributed in the design of the research questions, addressing the gaps in the literature and reviewing the recommendations formulated. The Polish pilot added nuances from real world practice to the formulated recommendations, resulting in the final set of guidelines for dissemination. RESULTS: The FAR SEAS Guidelines comprise 23 recommendations grouped into different topics areas of policies, communication strategies, screening, brief intervention and referral to treatment, treatment and social services. The recommendations highlight the need to respect women's autonomy and avoid discrimination and stigmatization; using universal screening for women of childbearing age, including detection of other psychosocial risks (such as domestic violence); and individualized, comprehensive and multidisciplinary supportive interventions for those who require it, such as those with alcohol use disorders, including women's partners. Policies to prevent FASD should be multicomponent, and public health communication should combine information about the risks together with self-efficacy messages to promote changes. CONCLUSIONS: The FAR SEAS guidelines are a tool to support policy-makers and service managers in implementing effective programmes to reduce prenatal alcohol exposure among general and at-risk population groups. FASD prevention has to involve comprehensive and multi-level evidence-based policies and practice, with services and activities tailored to the needs of women at differing levels of risk, and with due attention to reducing stigma.

Delivery of Brief Interventions for Heavy Drinking in Primary Care: Outcomes of the ODHIN 5-Country Cluster Randomized Trial.

PURPOSE: We aimed to test whether 3 strategies-training and support, financial reimbursement, and an option to direct screen-positive patients to an Internet-based method of giving brief advice-have a longer-term effect on primary care clinicians' delivery of screening and advice to heavy drinkers operationalized with the Alcohol Use Disorders Identification Test-Consumption (AUDIT-C) tool. METHODS: We undertook a cluster randomized factorial trial with a 12-week implementation period in 120 primary health care units throughout Catalonia, England, Netherlands, Poland, and Sweden. Units were randomized to 8 groups: care as usual (control); training and support alone; financial reimbursement alone; electronic brief advice alone; paired combinations of these conditions; and all 3 combined. The primary outcome was the proportion of consulting adult patients (aged 18 years and older) receiving intervention-screening and, if screen-positive, advice-at 9 months. RESULTS: Based on the factorial design, the ratio of the log of the proportion of patients given intervention at the 9-month follow-up was 1.39 (95% CI, 1.03-1.88) in units that received training and support as compared with units that did not. Neither financial reimbursement nor directing screen-positive patients to electronic brief advice led to a higher proportion of patients receiving intervention. CONCLUSIONS: Training and support of primary health care units has a lasting, albeit small, impact on the proportion of adult patients given an alcohol intervention at 9 months.

Effectiveness of the strengthening families programme 10-14 in Poland: cluster randomized controlled trial.

Background: : The Strengthening Families Programme for youth aged 10-14 and parents/carers (SFP10-14) is a family-based prevention intervention with positive results in trials in the United States. We assessed the effectiveness of SFP10-14 for preventing substance misuse in Poland. : Cluster randomized controlled trial with 20 communities (511 families; 614 young people) were allocated to SFP10-14 or a control arms. Primary outcomes were alcohol, smoking and other drug use. Secondary outcomes included parenting practices, parent-child relations, and child problem behaviour. Interview-based questionnaires were administered at baseline and at 12- and 24-months post-baseline, with respective 70.4 and 54.4%, follow-up rates. : In Bayesian regression models with complete case data we found no effects of SFP10-14 for any of the primary or secondary outcomes at either follow-up. For example at 24-months, posterior odds ratios and 95% credible intervals for past year alcohol use, past month binge drinking, past year smoking, and past year other drug use, were 0.83 (0.44-1.56), 0.83 (0.27-2.65), 1.94 (0.76-5.38) and 0.74 (0.15-3.58), respectively. Although moderate to high attrition rates, together with some evidence of systematic attrition bias according to parent education and family disposable income, could have biased the results, the results were supported in further analyses with propensity score matched data and 40 multiple imputed datasets. : We found no evidence for the effectiveness of SFP10-14 on the prevention of alcohol or tobacco use, parenting behaviour, parent-child relations or child problem behaviour at 12- or 24-month follow-up in a large cluster randomized controlled trial in Poland.

FASD Prevalence among Schoolchildren in Poland.

BACKGROUND: Prenatal Alcohol Exposure is a major cause of brain damage and developmental delay, known as Fetal Alcohol Spectrum Disorders (FASD) but in Poland is rarely diagnosed and the scale of problem is not known. METHODS: An active case ascertainment approach was applied to estimate the prevalence of FASD among 7-9 years olds. Pre-screening was conducted in 113 randomly selected regular and special schools. In the screening phase participated 280 children (54% from the risk group, 60% boys). The entire number of eligible students (N = 2500) was taken as a denominator. RESULTS: The prevalence of FASD is not lower than 2%, including 0.4% of Fetal Alcohol Syndrome. CONCLUSIONS: Neurodevelopmental disorders associated with PAE are a serious challenge for the public health system. Development of procedures and services to diagnose and to support individuals affected by PAE and their families is an urgent need in Poland.

Professional's Attitudes Do Not Influence Screening and Brief Interventions Rates for Hazardous and Harmful Drinkers: Results from ODHIN Study.

AIMS: To determine the relation between existing levels of alcohol screening and brief intervention rates in five European jurisdictions and role security and therapeutic commitment by the participating primary healthcare professionals. METHODS: Health care professionals consisting of, 409 GPs, 282 nurses and 55 other staff including psychologists, social workers and nurse aids from 120 primary health care centres participated in a cross-sectional 4-week survey. The participants registered all screening and brief intervention activities as part of their normal routine. The participants also completed the Shortened Alcohol and Alcohol Problems Perception Questionnaire (SAAPPQ), which measure role security and therapeutic commitment. RESULTS: The only significant but small relationship was found between role security and screening rate in a multilevel logistic regression analysis adjusted for occupation of the provider, number of eligible patients and the random effects of jurisdictions and primary health care units (PHCU). No significant relationship was found between role security and brief intervention rate nor between therapeutic commitment and screening rate/brief intervention rate. The proportion of patients screened varied across jurisdictions between 2 and 10%. CONCLUSION: The findings show that the studied factors (role security and therapeutic commitment) are not of great importance for alcohol screening and BI rates. Given the fact that screening and brief intervention implementation rate has not changed much in the last decade in spite of increased policy emphasis, training initiatives and more research being published, this raises a question about what else is needed to enhance implementation.

Personality traits in singers performing various music styles and with different singing status.

OBJECTIVES: Objective was to find personality traits in singers performing various music styles and with different singing status. MATERIAL AND METHODS: The study consisted of 87 singers (66 females, 21 males; age: M±SD 25.5±8.2 years; 40 students, 22 professionals and 25 amateurs; 38 classical singers, 42 contemporary commercial music [CCM] singers; 55 solo singers and 22 choral singers). Participants filled in the NEO Five-Factor Inventory questionnaire and demographic information form. RESULTS: Median values compared to the Polish general population, suggest that solo, CCM, student and professional singers have a high level of conscientiousness. Those who sing in a choir, classical music, amateurs and students have relatively high level of agreeableness. High level of extraversion is observed among CCM singers and students. Students score higher on extraversion then professionals (p < 0.001). Professionals score higher on extraversion then amateurs (p < 0.01). Professionals less frequently than amateurs and students score high on agreeableness (p < 0.001). High scores on conscientiousness are significantly higher among professionals and students compared to amateurs (p < 0.001 in both cases). Solo singers have higher level of conscientiousness (p < 0.001) and openness (p < 0.001) and lower neuroticism (p < 0.01) than choral singers. Classical singers more often than CCM singers score low on openness (p < 0.01) and high on agreeableness (p < 0.01). CONCLUSIONS: Classical singers have lower level of openness and higher level of agreeableness than CCM singers. Neuroticism is higher among choir than solo singers and conscientiousness is higher among solo than choir singers. Amateurs had the highest level of neuroticism and the lowest level of conscientiousness as compared with professional singers and students. Int J Occup Med Environ Health. 2023;36(4):541-50.

Drug policies' sensitivity towards women, pregnancy, and motherhood: a content analysis of national policy and programs from nine countries and their adherence to international guidelines.

BACKGROUND AND OBJECTIVES: Substance use in women is associated with unique psycho-social and physical vulnerabilities and poses complex challenges during pregnancy and motherhood. Gender-sensitive drug policy which considers the needs of women and their children could address these concerns. The objectives of this study were: (1) to systematically explore national-level drug policies' sensitivity and responsiveness to women, pregnant women, and children; and (2) to examine the adherence of drug policies with international guidelines for gender sensitivity in drug policy. METHODS: The research team was diverse professional backgrounds and nine countries. A summative content analysis of national drug policy documents, action plans, and strategies was performed. Specific documents focusing on women, pregnancy, and children were analysed. Specific themes and how frequently they appeared in the documents were identified. This quantification was an attempt to explore usage indicating the relative focus of the policies. A thematic map was developed to understand how national-level drug policies conceive and address specific concerns related to women who use drugs. We adapted the UNODC checklist for gender mainstreaming to assess policies' adherence to international guidelines. RESULTS: Twenty published documents from nine countries were reviewed. The common themes that emerged for women, pregnancy, and children were needs assessment, prevention, treatment, training, supply reduction, and collaboration and coordination. Custody of children was a unique theme for pregnant women. Specific psycho-social concerns and social reintegration were special themes for women, whereas legislation, harm reduction, research, and resource allocation were children-specific additional themes. For women-specific content analysis, special issues/concerns in women with drug misuse, need assessment, and prevention were the three most frequent themes; for the children-specific policies, prevention, training, and treatment comprised the three most occurring themes. For pregnant women/pregnancy, prevention, treatment, and child custody were the highest occurring themes. According to ratings of the countries' policies, there is limited adherence to international guidelines which ensure activities are in sync with the specific needs of women, pregnant women and their children. CONCLUSION: Our analysis should help policymakers revise, update and adapt national policies to ensure they are gender-responsive and address the needs of women, pregnant women and their children.

Reducing the risk of prenatal alcohol exposure and FASD through social services: promising results from the FAR SEAS pilot project.

Introduction: Within FAR SEAS, a multi-component evidence-based community intervention was implemented and evaluated in Mazovia (Poland), with the aim of preventing alcohol-exposed pregnancies, and therefore preventing FASD. Methods: Multi-disciplinary professionals from different services (social, addiction, and psychology), recruited women of child-bearing age (pregnant and not pregnant) in local communities, screened them for alcohol risk, and allocated participants (n = 441) to groups for low- (70%), moderate- (23%), or high-risk (7%) of alcohol exposed pregnancy, to provide interventions tailored to their needs. The non-parametric sign test, testing differences between pairs of observations before and after intervention was used to evaluate the outcomes. Results: Follow-up data (collected from 93% of participants) indicated positive changes in the key outcome variables: risky alcohol consumption dropped by 81%, contraception use increased by 15% and visiting a gynecologist increased by 39%; as well as in associated psychosocial risk factors (decrease in cigarette and drug use, domestic violence and depressive symptoms). No changes were noted in frequency of other service use (medical, psychological, or social). The most prominent changes were observed in the moderate-risk group. Discussion: Changing risky behaviors (alcohol consumption and sex without contraception) to prevent alcohol exposed pregnancies is feasible at the local level, even without engagement of medical professionals. Key challenges, related to engaging professionals and local authorities, must be addressed; and procedures should be adapted to local contexts and needs.

Effectiveness of the Strengthening Families Programme 10-14 in Poland for the prevention of alcohol and drug misuse: protocol for a randomized controlled trial.

BACKGROUND: Alcohol and other drug use and misuse is a significant problem amongst Polish youth. The SFP10-14 is a family-based prevention intervention that has positive results in US trials, but questions remain about the generalizability of these results to other countries and settings. METHODS/DESIGN: A cluster randomized controlled trial in community settings across Poland. Communities will be randomized to a SFP10-14 trial arm or to a control arm. Recruitment and consent of families, and delivery of the SFP10-14, will be undertaken by community workers. The primary outcomes are alcohol and other drug use and misuse. Secondary (or intermediate) outcomes include parenting practices, parent-child relations, and child problem behaviour. Interview-based questionnaires will be administered at baseline, 12 and 24 months. DISCUSSION: The trial will provide information about the effectiveness of the SFP10-14 in Poland. TRIAL REGISTRATION: International Standard Randomised Controlled Trial Number: ISRCTN89673828.

Is Public Health Response to the Phenomenon of Alcohol Use during Pregnancy Adequate to the Polish Women's Needs?

Due to the risks it poses to a child's health, drinking alcohol during pregnancy is a serious problem that the public health sector is struggling to deal with. The reasons why women who do not have alcohol problems do not give up drinking alcohol completely during pregnancy are still poorly understood. And the knowledge available about them does not translate into communication strategies in Poland. The analysis of standards and examples of good practice allows to formulate proposals for improving the quality and effectiveness of social campaigns addressed to the general population and women of childbearing age in order to reduce the risk associated with the prenatal exposure to alcohol.

Diagnosis of Fetal Alcohol Spectrum Disorders (FASDs): Guidelines of Interdisciplinary Group of Polish Professionals.

(1) Background: Considerable prevalence in Poland and serious health consequences of prenatal alcohol exposure indicated the need to develop national guidelines for the diagnosis of fetal alcohol spectrum disorders (FASDs). It was assumed that the guidelines must be in line with international standards but adjusted to the Polish context. (2) Methods: Work on recommendations was carried out by an interdisciplinary team of Polish specialists. Its first stage was to assess the usefulness in our country of the U.S. and Canadian guidelines. In the second stage, after several rounds of discussions, a consensus was achieved. (3) Results: The Polish guidelines for diagnosing FASD cover the following issues: 1. distinguished diagnostic categories; 2. diagnostic procedure; 3. assessment of prenatal exposure to alcohol; 4. assessment of sentinel facial dysmorphias; 5. assessment of body weight, height, and head circumference; 6. neurodevelopmental assessment. An important element of the recommendation is appendices containing practical tools that are useful in the diagnostic procedure. (4) Conclusions: National guidelines may improve the quality and standardization of FASD diagnosis in Poland, but their practical utility has to be monitored.

Warsaw adolescent alcohol use in a period of social change in Poland: cluster analyses of five consecutive surveys, 1988 to 2004.

This study aimed to analyze changes in patterns of alcohol use from 1988 to 2004 amongst Polish (Warsaw) 15-year olds. Data were collected from 5 consecutive surveys, beginning in 1988 and conducted every four years. For each survey a comparable sampling approach, sample size (N >or =1461), procedures and instrument were used to ensure consistency of method across surveys. In 1988 a two-step cluster analysis was used to identify four distinct natural groups of drinkers "light", "heavier", "beer and wine" and "wine" drinkers. Between 1988 and 1992 the percentage of teenage infrequent drinkers decreased and the rate of heavy drinkers increased. A group of students drinking only beer appeared, whilst the group of wine drinkers disappeared. A group of students who drank alcohol to get drunk appeared in 1996. Between 2000 and 2004 drinking of various kinds of alcoholic beverages became more frequent, as did vodka abuse. Increased consumption amongst girls was also observed. The results are interpreted in the context of social change and several hypothetical causes of gender differences are discussed.

Validation of the "problematic use of narcotics" (PUN) screening test for drug using adolescents.

The aim of the study was to examine psychometric properties of the PUN screening test concerning illicit drug problem use by adolescents. The criterion standard for the test's validity was a diagnostic interview conducted by trained specialists. Respondents were reached by snowball sampling in 58 randomly chosen Polish local communities. A total of 1344 adolescent (37% female) aged 13 to 18 years, who used any illicit drug at least once in the past 12 months, participated. The majority (89%) had no contacts with any drug therapy facilities. 41% were diagnosed as occasional drug users and 59% as problematic users or dependents. Logistic regression analysis showed that 10 out of the basic set of 25 test items were most powerful in differentiating occasional and problematic users. A test score of 2 or higher was optimal for identifying problem drug use (sensitivity: 0.88, specificity: 0.79, PPV: 0.86, NPV: 0.81). Validity was not affected by age or sex. These results confirmed the PUN test potential as a brief screening tool.

Attitudes and Learning through Practice Are Key to Delivering Brief Interventions for Heavy Drinking in Primary Health Care: Analyses from the ODHIN Five Country Cluster Randomized Factorial Trial.

In this paper, we test path models that study the interrelations between primary health care provider attitudes towards working with drinkers, their screening and brief advice activity, and their receipt of training and support and financial reimbursement. Study participants were 756 primary health care providers from 120 primary health care units (PHCUs) in different locations throughout Catalonia, England, The Netherlands, Poland, and Sweden. Our interventions were training and support and financial reimbursement to providers. Our design was a randomized factorial trial with baseline measurement period, 12-week implementation period, and 9-month follow-up measurement period. Our outcome measures were: attitudes of individual providers in working with drinkers as measured by the Short Alcohol and Alcohol Problems Perception Questionnaire; and the proportion of consulting adult patients (age 18+ years) who screened positive and were given advice to reduce their alcohol consumption (intervention activity). We found that more positive attitudes were associated with higher intervention activity, and higher intervention activity was then associated with more positive attitudes. Training and support was associated with both positive changes in attitudes and higher intervention activity. Financial reimbursement was associated with more positive attitudes through its impact on higher intervention activity. We conclude that improving primary health care providers' screening and brief advice activity for heavy drinking requires a combination of training and support and on-the-job experience of actually delivering screening and brief advice activity.

Impact of practice, provider and patient characteristics on delivering screening and brief advice for heavy drinking in primary healthcare: Secondary analyses of data from the ODHIN five-country cluster randomized factorial trial.

BACKGROUND: The implementation of primary healthcare-based screening and advice that is effective in reducing heavy drinking can be enhanced with training. OBJECTIVES: Undertaking secondary analysis of the five-country ODHIN study, we test: the extent to which practice, provider and patient characteristics affect the likelihood of patients being screened and advised; the extent to which such characteristics moderate the impact of training in increasing screening and advice; and the extent to which training mitigates any differences due to such characteristics found at baseline. METHODS: A cluster randomized factorial trial involving 120 practices, 746 providers and 46 546 screened patients from Catalonia, England, the Netherlands, Poland, and Sweden. Practices were randomized to receive training or not to receive training. The primary outcome measures were the proportion of adult patients screened, and the proportion of screen-positive patients advised. RESULTS: Nurses tended to screen more patients than doctors (OR = 3.1; 95%CI: 1.9, 4.9). Screen-positive patients were more likely to be advised by doctors than by nurses (OR = 2.3; 95%CI: 1.4, 4.1), and more liable to be advised the higher their risk status (OR = 1.9; 95%CI: 1.3, 2.7). Training increased screening and advice giving, with its impact largely unrelated to practice, provider or patient characteristics. Training diminished the differences between doctors and nurses and between patients with low or high-risk status. CONCLUSIONS: Training primary healthcare providers diminishes the negative impacts that some practice, provider and patient characteristics have on the likelihood of patients being screened and advised. Trial registration ClinicalTrials.gov. Trial identifier: NCT01501552.

Improving the delivery of brief interventions for heavy drinking in primary health care: outcome results of the Optimizing Delivery of Health Care Intervention (ODHIN) five-country cluster randomized factorial trial.

AIM: To test if training and support, financial reimbursement and option of referring screen-positive patients to an internet-based method of giving advice (eBI) can increase primary health-care providers' delivery of Alcohol Use Disorders Identification Test (AUDIT)-C-based screening and advice to heavy drinkers. DESIGN: Cluster randomized factorial trial with 12-week implementation and measurement period. SETTING: Primary health-care units (PHCU) in different locations throughout Catalonia, England, the Netherlands, Poland and Sweden. PARTICIPANTS: A total of 120 PHCU, 24 in each of Catalonia, England, the Netherlands, Poland and Sweden. INTERVENTIONS: PHCUs were randomized to one of eight groups: care as usual, training and support (TS), financial reimbursement (FR) and eBI; paired combinations of TS, FR and eBI, and all of FR, TS and eBI. MEASUREMENTS: The primary outcome measure was the proportion of eligible adult (age 18+ years) patients screened during a 12-week implementation period. Secondary outcome measures were proportion of screen-positive patients advised; and proportion of consulting adult patients given an intervention (screening and advice to screen-positives) during the same 12-week implementation period. FINDINGS: During a 4-week baseline measurement period, the proportion of consulting adult patients who were screened for their alcohol consumption was 0.059 per PHCU (95% CI 0.034 to 0.084). Based on the factorial design, the ratio of the logged proportion screened during the 12-week implementation period was 1.48 (95% CI = 1.13-1.95) in PHCU that received TS versus PHCU that did not receive TS; for FR, the ratio was 2.00 (95% CI = 1.56-2.56). The option of referral to eBI did not lead to a higher proportion of patients screened. The ratio for TS plus FR was 2.34 (95% CI = 1.77-3.10), and the ratio for TS plus FR plus eBI was1.68 (95% CI = 1.11-2.53). CONCLUSIONS: Providing primary health-care units with training, support and financial reimbursement for delivering Alcohol Use Disorders Identification Test-C-based screening and advice to heavy drinkers increases screening for alcohol consumption. Providing primary health-care units with the option of referring screen-positive patients to an internet-based method of giving advice does not appear to increase screening for alcohol consumption.

Impact of primary healthcare providers' initial role security and therapeutic commitment on implementing brief interventions in managing risky alcohol consumption: a cluster randomised factorial trial.

BACKGROUND: Brief interventions in primary healthcare are cost-effective in reducing drinking problems but poorly implemented in routine practice. Although evidence about implementing brief interventions is growing, knowledge is limited with regard to impact of initial role security and therapeutic commitment on brief intervention implementation. METHODS: In a cluster randomised factorial trial, 120 primary healthcare units (PHCUs) were randomised to eight groups: care as usual, training and support, financial reimbursement, and the opportunity to refer patients to an internet-based brief intervention (e-BI); paired combinations of these three strategies, and all three strategies combined. To explore the impact of initial role security and therapeutic commitment on implementing brief interventions, we performed multilevel linear regression analyses adapted to the factorial design. RESULTS: Data from 746 providers from 120 PHCUs were included in the analyses. Baseline role security and therapeutic commitment were found not to influence implementation of brief interventions. Furthermore, there were no significant interactions between these characteristics and allocated implementation groups. CONCLUSIONS: The extent to which providers changed their brief intervention delivery following experience of different implementation strategies was not determined by their initial attitudes towards alcohol problems. In future research, more attention is needed to unravel the causal relation between practitioners' attitudes, their actual behaviour and care improvement strategies to enhance implementation science. TRIAL REGISTRATION: ClinicalTrials.gov: NCT01501552.

School as a risk factor for psychoactive substance use by middle school students.

For the majority of Polish students school is a source of negative experiences and therefore may increase the risk of adolescent problem behaviors. The results of the study conducted in Warsaw middle schools (N=2244, 54% girls) indicated that changes for worse (between 7 and 8 grade) in students' behavior increase the risk of drug use. However, changes for better in students' perception of school value and school achievements are risk factors, too (even when family and peer risk factors are controlled).

[Risk/protective factors, and their indices in research on adolescents problem behaviours.] / Czynniki ryzyka, czynniki chroniace i indeksy tych czynników w badaniach nad zachowaniami problemowymi nastolatków:

Description and explanation of adolescent problem behaviours are in a great part based on risk and protective factor analysis. Research on these factors provides many important data, but due to diversity and complexity of the variables analyzed, it is difficult to summarize their results. One way to deal with this problem is the utilization of risk and protective factor indices, which shows individuals' exposure to the sum of risk and protective factors.In this article eight studies explaining adolescent problem behaviours (mainly: substance use) based on risk/protective factor indices are discussed.The review indicates that study results are strongly influenced by authors' arbitraly decisions on risk/protective factors definitions, the initial list of studied variables, way of determining significant intensity of factors. The most undisputed is the result indicating that after controlling for other variables, both indices (risk and protective) are significant in cross-sectional explanations of problem behaviours. This finding strongly supports the argument for enhancement of protective factors in preventive interventions. However, the main disadvantage of studies based on indices is the "averaging" of importance of various factors, which makes it difficult to assess their specific impact on problem behaviours.

[Diagnosing mental health of adolescents on the basis of their subjective assessments]. / Oszacowanie stanu zdrowia psychicznego nastolatków na podstawie ich subiektywnych ocen zdrowia.

AIM: the aim of the study was to assess the possibility of diagnosing mental health status of adolescents according to their self-reports. METHOD: 13-years old students from randomly chosen Warsaw schools (N=1123, 54% girls), participated in the school survey. The assessment of health status was based on 3 questions from the HRQOL (Health Related Quality of Life) questionnaire. Respondents were asked to assess the number of days in the past month in which (1) their psychological state was not good, (2) they had problems related to their physical health, and (3) their functioning was impaired because of problems with health. Answers were included in the cluster analysis. RESULTS: it permitted to identify a group of adolescents (5% of the sample) who cannot function as their peers because of health (mainly mental health) problems and a group of those who report that they often have psychological problems (9%). This negative subjective validation was consistent with the results of tests commonly used as psychological indicators of mental health: self-esteem (based on scores in Rosenberg's scale), sense of coherence (SOC-13) and psychological distress (GHQ -- General Health Questionnaire). CONCLUSIONS: the study results permit to assess the scale of adolescents' needs for psychological support. Adequate service for groups, mentioned above, is necessary because negative self-perception of health and emotional problems in adolescence are risk factors of mental illness in adulthood.