A single-item measure of childhood relationship quality and association with adult health and health behaviours.

AIMS: Adverse childhood experiences are known to relate positively to various health risks and adverse health behaviour in adult life, although the precise mechanisms are still debated. The aim of this study was to investigate whether a single-item measure of the quality of childhood relationships with family and household members might show a similar association. METHODS: We measured the overall quality of relationships with family and household members during the first 18 years of life. A one-dimensional question scored 0-10 (N=4983) was included in the ongoing SIBS Iceland Patient Association's national 'Life and Health' public health prevention project among adults. Relationship quality was then assessed against measures of health and health behaviour using 21 validated scales. RESULTS: A lower childhood relationships score was associated with a higher risk of all 21 suboptimal health and health behaviour outcomes in adulthood, with adjusted effect sizes measured by standardised betas (magnitude 0.111-0.284), variance explained (1.3-8.5%) and per-point adjusted odds ratios (1.10-1.30). The strongest associations were found with measures of social and mental health, followed by physical health, alcohol and tobacco use, sleeping problems, financial sustenance, physical pain and aerobic fitness. CONCLUSIONS: Odds were found to match well with pooled odds ratios presented in a systematic review of 37 adverse childhood experiences studies. This may indicate that a one-dimensional relationships question is a useful substitute in surveys in which a traditional multi-question adverse childhood experiences scale cannot be accommodated. Further investigations are recommended to investigate the applicability of a single adverse childhood experiences question.

Caffeine consumption and onset of alcohol use among early adolescents.

Preventing or delaying the onset of alcohol use among children and youth is an important public health goal. One possible factor in alcohol use onset among early adolescents is caffeine. The aim of this study was to assess the possible contribution of caffeine to the onset of alcohol use during early adolescence. We used data from the Young Mountaineer Health Study Cohort. Survey data were collected from 1349 (response rate: 80.7%) 6th grade students (mean age at baseline 11.5 years) in 20 middle schools in West Virginia during the fall of 2020, and again approximately 6 months later in spring of 2021. We limited our analyses to students reporting never having used any form of alcohol at baseline. Logistic regression was employed in multivariable analyses and both Odds Ratios and Relative Risks reported. At follow-up, almost 14% of participants reported having consumed alcohol at least once and 57% used caffeine of 100 mg + daily. In multivariable analyses we controlled for social and behavioral variables known to impact tobacco use. Caffeine use was operationalized as a three-level factor: no use, <100 mg per day, and 100 + mg per day, with the latter being the approximate equivalent of the minimum of a typical cup of coffee or can of energy drink. Caffeine use of 100 mg + per day was significantly related to alcohol use at 6-months follow-up (OR: 1.79, RR: 1.56, p = .037). We conclude that caffeine consumption among 11-12-year-old adolescents may be a factor in early onset of alcohol use.

A theoretical model of college students' sleep quality and health-related quality of life.

Poor sleep confers significant morbidities and is highly prevalent among college students in the United States. This research assessed sleep quality and its association with health-related quality of life (HRQOL). Further, because sleep quality research often lacks a theoretical foundation, we applied a theoretical model using selected constructs from the Theory of Planned Behavior (TPB) and Health Belief Model (HBM). A random, stratified sample of undergraduate students participated in an online survey (N = 494). Structural equation modeling assessed the association between theoretical constructs, sleep quality, and HRQOL. The final model fit was acceptable, with ~ 20% of the variance in sleep quality explained by the theoretical constructs and control variables. HBM constructs were indirectly and negatively related to sleep quality, mediated through behavioral intention, and also positively and directly associated with behavioral intention. Behavioral intention was strongly and negatively associated with sleep quality. Approximately 31% of the variance in HRQOL was explained by poor sleep quality, behavioral intention, and gender. Poor sleep was most strongly associated with reduced HRQOL. HBM constructs and behavioral intention from TPB were significantly associated with poor sleep quality, and poor sleep was significantly related to poor HRQOL.

Icelandic Prevention Model for Rural Youth: A Feasibility Study in Central Appalachia.

The purpose of this study was to assess the feasibility of implementing the Icelandic model for Primary Substance Use Prevention (IPM) in rural Central Appalachia. Guided by the IPM's theoretical framework, 26 stakeholders from a single county in West Virginia were purposefully recruited during the spring of 2019 and divided into four focus groups. Interviews were recorded and transcribed verbatim and analyzed into themes based on IPM premises. Focus group material produced seven themes: Drug use overall, Drug treatment and other service needs, Poverty, Parenting/Caregiver practices, Transportation, Downtime/Leisure time activities, and Opportunities for solutions. General support was found for the potential of the IPM in the region. Preferably, the implementation of the model should coincide with attention to the adult population as drug use was reported to be plaguing the whole community. Treatment options were few and mostly far away. General poverty and lack of public transportation further stifled progress and potential for change. Organized leisure time activities and programs for youth were scarce and mostly seasonal. Suggested solutions for the adult community included workforce and skill training, coupled with increased opportunities for organized leisure activities for youth, and access to healthy role models via schools and faith-based organizations. We conclude that implementation of the IPM would be feasible to prevent substance use initiation and progression among youth in the rural Central Appalachia. We present several specific recommendations for policy and practice that address factors unique to this environment to initiate the IPM implementation development and suggest initial model application strategies.

Parental support and monitoring as associated with adolescent alcohol and tobacco use by gender and age.

BACKGROUND: Parental support (PS) and parental monitoring (PM) are known protective factors against adolescent substance use (SU). However, little is known about whether PS and PM may affect SU outcomes differently by gender and age. This study examined the relationship between PS and PM and adolescent SU, specifically alcohol and tobacco use, stratified by gender and age group. METHODS: Middle and high school students (n = 2351, 48.5% Female) completed surveys of self-reported SU, perceived PS and PM, and socioeconomic background. Age group was defined dichotomously as grade 7-8 Middle school and grade 9-10 High school students. PS and PM were each measured using previously validated tools. SU was measured by lifetime and past 30 days cigarette/alcohol use. One-way ANOVA and binary logistic regression models were completed. Odds ratios and means were reported. RESULTS: PS and PM were significantly and negatively related to all outcome variables regardless of gender and age group. Mean differences in PS and PM were insignificant between age groups. Between genders, PM scores were significantly higher for girls (14.05) compared to boys (13.48) (p < 0.01). Odds Ratios of all four SU types (for alcohol and tobacco use) increased with higher age group, with ORs ranging from 1.45-2.61 (p < .05). CONCLUSIONS: PS and PM were protective against SU for all participants, consistent with previous literature. Girls reported greater parental monitoring than boys, irrespective of age-group. While girls experienced higher levels of monitoring, they did not report lower SU than boys. This suggests that monitoring girls more closely than boys appears unnecessary in preventing adolescent SU. Finally, PS was a more significant factor in preventing SU for older adolescents (high school aged group) than for younger adolescents, irrespective of gender suggesting that PS may be more impactful and important as adolescents age. As children mature, particularly from middle school to high school, PS may play a larger role in preventing SU for older adolescents compared to younger ones.

Testing risk and protective factor assumptions in the Icelandic model of adolescent substance use prevention.

Iceland has witnessed a dramatic decline in adolescent substance use that may be partly the result of efforts related to the Icelandic prevention model (IPM). We sought to test risk and protective factor assumptions of the IPM using a prospective cohort study with 12 months separating baseline from follow-up. Participants were students in grades 8 and 9 in the national Icelandic school system enrolled in the spring of 2018 and 2019 (N=2165). Participants self-reported their experiences of cigarette smoking, alcohol consumption, and cannabis use and seven risk and protective factors. Analyses were conducted with generalized linear modeling with extension to general estimating equations with correlated outcomes data. Both individual main-effects models and collective models including all main-effects were tested. Out of 28 individual main-effects models, 23 produced findings consistent with study premises (P<0.05). Multiple main-effects models largely sustained the findings of the individual main-effects models. Findings support the assumption that the risk and protective factors commonly emphasized in the IPM are associated with the four different substance use outcomes in the hypothesized direction. Communities that plan to implement the IPM among adolescents might consider these factors in their work.

Mental Health, Academic Engagement, and Youths' Nonmedical Use of Stimulants: A Latent Profile Analysis.

BACKGROUND:: Nonmedical prescription stimulant (NPS) use is a growing problem in Europe. Poor mental health and lack of academic engagement are potent sources of risk for substance use. Studies suggest that considerable heterogeneity may characterize the risk profiles of NPS users. To understand better the potential profiles of risk that characterize NPS users, we conducted a latent profile analysis (LPA) to document subgroups of users based on their mental health and academic engagement. METHODS:: A nationally representative, cross sectional survey of Icelandic youth was analyzed. The sample included 584 (5% of the sample) older adolescent students participating in a national study in Iceland who reported lifetime NPS use. RESULTS:: Three subgroups of NPS users emerged from our analyses. The largest subgroup (43.1%) we labeled mentally healthy achievers; youth who appear to be academically motivated and have few if any mental health concerns. The second largest group (40.4%), low achievers, resembled a typical profile for drug users in that they reported low or modest academic engagement and moderate levels of mental health concerns. The third group, anxious achievers (16.5%) appears to represent youth who felt academics were very important, had moderate study motivation, and also reported elevated mental health concerns, especially anxiety. CONCLUSIONS:: LPA revealed considerable heterogeneity among these users. Group membership suggests distinct approaches to prevention to address heterogeneity in motivations for NPS use.

Adolescent caffeine consumption and aggressive behavior: A longitudinal assessment.

Background: Adolescent caffeine consumption has been linked to aggressive behaviors, although no longitudinal tests have been reported to date. The purpose of this study was to test the longitudinal relations between daily adolescent caffeine consumption and aggressive behaviors. Methods: Two waves of survey data collected 12 months apart in the spring of 2018 and 2019, from the 2004 birth cohort in the Icelandic LIFECOURSE study, were analyzed using structural equation modeling (N = 2,278). Both direct and mediated models were employed. Results: Caffeine use at time 1 (T1) was associated with aggressive behavior at time 2 (T2) (ß = .12, p < .001) independent of aggressive behavior at T1. A considerable added relation was observed between caffeine at T1 and aggressive behavior at T2 via indirect (i.e., mediated) effects of aggressive behavior at T1 (standardized ß = .20, p < .001). Over 64% of the standardized total effect (ß = .31) observed between caffeine at T1 and aggressive behavior at T2 was due to mediation. Conclusion: Adolescent caffeine consumption forecasts aggressive behaviors. Caffeine use at T1 increased the likelihood of self-reported aggressive behaviors 12 months later irrespective of level of reported aggressive behavior at T1 while controlling for common confounders.

Longitudinal association between social media use and psychological distress among adolescents.

This study aimed to examine in a longitudinal cohort design whether social media use among adolescents is related to symptoms of social anxiety, depressed mood, and physical symptoms of anxiety over time. As part of the LIFECOURSE study of risk and protective factors for healthy adolescent development, three waves of school-based surveys of adolescents born in Iceland in 2004 were analyzed. Of the 3914 eligible adolescents, 2378 gave informed consent. Complete responses for this study were collected from 2211 students at the first wave, with 2052 responding roughly 12 months later, and 2097 responding in year 3. Linear mixed-effects models were used to analyze time spent on social media in relation to psychological distress over time. More time spent on social media was weakly but significantly associated with increased symptoms of depressed mood, social anxiety and symptoms of physical anxiety over time. However, the effect size of these relationships suggest they may not be of clinical relevance. The relationship between time spent on social media and symptoms of depressed mood and physical symptoms of anxiety grew stronger over time, although it is not known if this relationship is causal. The relationship between time spent on social media and all outcomes of psychological distress were stronger for girls than boys and increased social media use had a positive relationship with symptoms of depressed mood over time. The relationships found in this study were relatively small and future studies need to focus on the clinical and public health significance of these effects.

Examining the implementation of the Icelandic model for primary prevention of substance use in a rural Canadian community: a study protocol.

BACKGROUND: The Icelandic Prevention Model (IPM) is a collaborative upstream model that was designed to influence risk and protective factors related to substance use within the community, school, peer and family contexts. By engaging whole communities, the IPM has been found to be effective in reducing youth substance use behaviours across Iceland. As an extension to the IPM's participatory approach, this research will examine how youth involvement can enhance outcomes. In addition, this research will evaluate whether the IPM approach is beneficial for mental health promotion and general youth wellbeing. METHODS: The present research protocol applies the bioecological model within a participatory mixed-method case study design to examine the implementation of the IPM in a rural community in Canada. This study was designed to identify whether the Icelandic substance use prevention model is effective in reducing substance use and promoting mental health and development for Canadian youth. It will also explore how to engage youth within the approach and how this adaptation influences implementation and outcomes. DISCUSSION: The findings from this study will contribute to our understanding of upstream prevention of youth substance use and will be used to support scaling of the IPM across Canada.

Prevention Is Possible: A Brief History of the Origin and Dissemination of the Icelandic Prevention Model.

In two decades, the Icelandic prevention model (IPM) has been employed to dramatically reduce rates of adolescent substance use in Iceland. Briefly, the IPM is a multisectoral, community-based, collaborative system where researchers, policy makers, administrative leaders, and practitioners join forces to reduce the odds of adolescent substance use over time. Comparatively, Iceland now ranks among the lowest in adolescent substance use in all of Europe. Since 2005, the IPM has garnered considerable international attention, and several countries or municipalities within them have adapted, or are presently adapting, the model to their needs. In this commentary, we first briefly review the history and formation of the IPM in Iceland from a school-based survey to a fully integrated prevention system. In the second part, we present a short overview of the national consensus building and institutional collaboration that led to the implementation of the model in Chile in Latin America, as a demonstrative example. In this volume of Health Promotion Practice, we also present a series of two practice-based articles that introduce the IPM. The first article, titled "Development and Guiding Principles of the Icelandic Model for Preventing Adolescent Substance Use," introduces the theoretical origins of the model, five guiding principles, and evidence of effectiveness to date. In the second article, titled "Implementing the Icelandic Model for Preventing Adolescent Substance Use," we outline 10 practice-based steps to guide model implementation in other countries. Both articles are available via open access, and both are also available online in Spanish.

Development and Guiding Principles of the Icelandic Model for Preventing Adolescent Substance Use.

Adolescent substance use-the consumption of alcohol, tobacco, and other harmful drugs-remains a persistent global problem and has presented ongoing challenges for public health authorities and society. In response to the high rates of adolescent substance use during the 1990s, Iceland has pioneered in the development of the Icelandic Model for Primary Prevention of Substance Use-a theory-based approach that has demonstrated effectiveness in reducing substance use in Iceland over the past 20 years. In an effort to document our approach and inform potentially replicable practice-based processes for implementation in other country settings, we outline in a two-part series of articles the background and theory, guiding principles of the approach, and the core steps used in the successful implementation of the model. In this article, we describe the background context, theoretical orientation, and development of the approach and briefly review published evaluation findings. In addition, we present the five guiding principles that underlie the Icelandic Prevention Model's approach to adolescent substance use prevention and discuss the accumulated evidence that supports effectiveness of the model. In a subsequent Part 2 article, we will identify and describe key processes and the 10 core steps of effective practice-based implementation of the model.

Implementing the Icelandic Model for Preventing Adolescent Substance Use.

This is the second in a two-part series of articles about the Icelandic Model for Primary Prevention of Substance Use (IPM) in this volume of Health Promotion Practice. IPM is a community collaborative approach that has demonstrated remarkable effectiveness in reducing substance use initiation among youth in Iceland over the past 20 years. While the first article focused attention on the background context, theoretical orientation, evaluation and evidence of effectiveness, and the five guiding principles of the model, this second article describes the 10 core steps to practical implementation. Steps 1 to 3 focus on building and maintaining community capacity for model implementation. Steps 4 to 6 focus on implementing a rigorous system of data collection, processing, dissemination, and translation of findings. Steps 7 to 9 are designed to focus community attention and to maximize community engagement in creating and sustaining a social environment in which young people become progressively less likely to engage in substance use, including demonstrative examples from Iceland. And Step 10 focuses on the iterative, repetitive, and long-term nature of the IPM and describes a predictable arc of implementation-related opportunities and challenges. The article is concluded with a brief discussion about potential variation in community factors for implementation.

Association Between Nonmedical Use of Prescription Drugs and Sleep Quality in a Large College Student Sample.

Objective/Background: Poor sleep and nonmedical use (NMU) of prescription drugs (NMUPD) are both common among college students. Since lack of sleep adversely influences academic performance, this study examined the association between NMUPD and subjective sleep quality among college students. Participants: Students who completed the American College Health Association-National College Health Assessment data (Fall 2010, Spring 2011; N = 135,874). Methods: Associations were examined between NMUPD in four classes over the past 12 months (antidepressant, painkillers, sedatives, and stimulants), and five aspects of sleep quality (Enough Sleep, Early Awakening, Daytime Sleepiness, Difficulty Falling Asleep, and Problem With Daytime Sleepiness) in the past seven days. Results: Any NMUPD (at least one class), NMU of stimulants specifically, and NMU of painkillers specifically were associated with getting fewer days of Enough Sleep (OR: 0.86, 0.93, and 0.84 respectively), more days of Early Awakening (OR: 1.28, 1.10, and 1.28 respectively), Daytime Sleepiness (OR: 1.23, 1.13, and 1.16 respectively), and Difficulty Falling Asleep (OR:1.32, 1.10, and 1.27 respectively; p < .0001, each). NMU of sedatives was significantly associated with having Problem With Daytime Sleepiness (OR: 1.10), more days of Early Awakening (OR: 1.12), and Difficulty Falling Asleep (OR: 1.17; p < .0001). Conclusions: NMUPD is associated with poor sleep among college students. Therefore, behavioral medicine screening and treatment of this vulnerable population should consider sleep health, NMUPD, and the potential that these problems may be comorbid.

Barriers to using new needles encountered by rural Appalachian people who inject drugs: implications for needle exchange.

BACKGROUND: Using a new needle for every injection can reduce the spread of infectious disease among people who inject drugs (PWID). No previous study has examined new needle use barriers among PWIDs residing in the rural Appalachian part of the United States, an area currently in the midst of a heroin epidemic. OBJECTIVE: Therefore, our primary aim was to explore self-reported barriers to using a new needle by PWID attending a needle exchange program (NEP). METHODS: We conducted a cross-sectional survey of PWID attending two NEPs in rural West Virginia located in the heart of Central Appalachia. A convenience sample of PWID (n = 100) completed the Barriers to Using New Needles Questionnaire. RESULTS: The median number of barriers reported was 5 (range 0-19). Fear of arrest by police (72% of PWID "agreed" or "strongly agreed") and difficulty with purchasing needles from a pharmacy (64% "agreed" or "strongly agreed") were the most frequently cited barriers. CONCLUSIONS/IMPORTANCE: Congruent with previous findings from urban locations, in rural West Virginia, the ability of PWID to use a new needle obtained from a needle exchange for every injection may be compromised by fear of arrest. In addition, pharmacy sales of new needles to PWID may be blunted by an absence of explicit laws mandating nonprescription sales. Future studies should explore interventions that align the public health goals of NEPs with the occupational safety of law enforcement and health outreach goals of pharmacists.

Maternal smoking during pregnancy and academic achievement of offspring over time: A registry data-based cohort study.

Few studies have assessed the cumulative impact of maternal smoking during pregnancy (MSDP) on scholastic outcomes over time. We examined the relations between MSDP and academic achievement in the 4th, 7th and 10th grades using registry data collected at birth, during the neonatal period, and at each grade level from the 2000, LIFECOURSE study birth cohort in Reykjavik, Iceland (N = 1151, girls = 49.3%). Latent growth modeling showed that MSDP influenced Icelandic achievement scores, standardized to a range from 0 to 60, at baseline (ß = -0.04), and over time (ß = -0.05). Likewise, MSDP was negatively associated with standardized mathematics scores at baseline (ß = -0.09) and continued to exert a negative impact on mathematics scores over time (ß = -0.08) after controlling for gender, income, cohabitation, and baseline mathematics and Icelandic achievement scores. Results provide evidence of the persistent negative impact of MSDP on academic achievement in offspring. Findings support the proposition that children whose mothers smoke during the first trimester of pregnancy are, on average, at greater risk for poor scholastic outcomes over time than children whose mothers do not smoke during their first trimester. To our knowledge, this is the first study using a longitudinal cohort design to assess whether the impacts of maternal smoking during pregnancy may persist over time. This study contributes to the current state of knowledge by providing an assessment that focuses on the impact of smoking during pregnancy on academic achievement from childhood into early adolescence.

Social Profile of Middle School-Aged Adolescents Who Use Electronic Cigarettes: Implications for Primary Prevention.

Electronic cigarette (EC) use continues to increase among adolescents. From a primary prevention point of view, an important gap in our knowledge includes determining whether young smokers that use EC maintain a distinct social profile from kids who use combustible cigarettes (CC). Survey data from middle school students in West Virginia, USA were collected between September and November of 2015 (N = 6547, response rate 84.7%) as part of a state wide school-based mental health intervention program. Data was analyzed using multinomial logistic regression for categorical data. The results show that compared to never smokers, EC-only users possessed a weaker social support and parental monitoring profile and performed worse in school. Additionally, EC-only users were more likely to feel alienated from school, to associate with delinquent peers, to spend time outside late at night, and to engage in unsupervised gatherings with their friends. In 11 of 13 statistical models no difference was observed between EC-only users compared with CC-only users. However, dual users (that had used both EC and CC in their lifetime) demonstrated a significantly greater risk profile compared with EC-only users. We conclude that middle school-aged kids that use EC share a similar risk profile as kids of the same age that use CC. Similar to traditional cigarette smoking, EC use in young adolescents is likely to be a social marker of a pathway to further delinquency and should therefore be subject to primary prevention approaches.

Evaluation of an Intimate Partner Violence Training for Home Visitors Using the Theory of Planned Behavior.

INTRODUCTION: Intimate partner violence (IPV) is a public health issue with recent intervention focus by home visiting programs with at-risk families in the United States. Home visitors are typically required to assess IPV but feel unprepared to do so and desire training. Our aim was to evaluate the impact of a daylong IPV training on the intention to enact three key IPV behaviors (screening, making referrals, and safety planning) using the theory of planned behavior. METHOD: Survey of 125 home visitors in West Virginia was conducted before and after a daylong IPV training. RESULTS: The IPV training had a positive impact on intention to perform the three behaviors of interest, with the greatest impact on the intention to conduct IPV screenings. DISCUSSION: Results provide important preliminary evidence supporting the effectiveness of professional development as a means of increasing intentions to conduct activities related to IPV. The impact on IPV screening intention is promising because screening is the first step in addressing IPV. CONCLUSION: The IPV training proved beneficial in increasing intentions and such trainings should be expanded, but further study is needed to link intentions to subsequent behaviors to address IPV with at-risk families.

Cumulative risk over the early life course and its relation to academic achievement in childhood and early adolescence.

Early-life risk factors, such as family disruption, maltreatment, and poverty, can negatively impact children's scholastic abilities; however, most previous studies have relied on cross-sectional designs and retrospective measurement. This study investigated the relation between cumulative risk factors during the early life course and subsequent academic achievement in a cohort of children and adolescents. Data for this study were based on registry-data material from the LIFECOURSE study of 1151 children from the 2000 birth cohort in Reykjavik, Iceland, assembled in 2014-2016. Multiple lifetime risk factors, including maternal smoking during pregnancy, parent's disability status, being born to a young mother, number of children in the household, family income, number of visits to school nurses, and reports of maltreatment, were assessed. Latent class analysis and Analysis of Covariance (ANCOVA) were used to predict academic achievement in the 4th and 7th grades. Individuals with no risk factors reported the highest average academic achievement in the 4th (M=66 points, SD=17) and 7th grades (M=67 points, SD=15). There was a significant main effect for 4th-grade risk factors and academic achievement (F [7, 1146]=12.06, p<0.001) and a similar relationship between the risk factor profile and achievement scores in 7th grade (F [7, 1146]=15.08, p<0.001). Each additional risk factor was associated with a drop in academic achievement at both grade levels. We conclude that academic achievement declines in proportion to the number of risk factors in early life.