Why are some people in the UK reluctant to seek support for their pets?

Drawing upon data from a study examining experiences of accessing support for pets from the UK animal welfare charity Blue Cross, this paper illuminates reasons why people might not seek support when they need it. This applies to those who are struggling financially and are eligible for, but do not take, free/reduced cost veterinary care, or are having other problems (e.g. the animal's disruptive behaviour or ill health, struggling to care for the pet due to changing circumstances or health problems, or coping with pet loss). Twenty Blue Cross service users (15 female, five male, age 29-67) took part in individual online interviews using a semi-guided narrative approach, where they were encouraged to share their experiences of reaching out. They were also asked to reflect upon why others may not do the same, and if they had any recommendations for organisations to help them reach these people. Findings echo other studies that highlight a fear of being judged, disclosure and stigma. Guilt, shame, lack of awareness, financial concerns, and wanting to manage independently, all play important roles. These factors have implications for the way support services are advertised and delivered to ensure animals receive the care needed. We describe these reflections and recommendations and identify three broader ideological narratives underpinning participants' stories: 'giving back'; 'equity', and 'sacrifice'. These reveal how wider societal attitudes and values shape identities and behaviours. It is vital that support on offer is reframed to explicitly counteract these influences to ensure optimal animal and human welfare.

Women's decision-making power can influence modern contraceptive use: Evidence from Bangladesh.

OBJECTIVES: It is generally believed that gender inequality and women's lack of decision-making power may restrict women's use of modern contraception, leading to high rates of unwanted pregnancies, abortions, and deaths. Evidence shows that empowered women are more likely to use modern contraception methods, but few studies have investigated this across multiple domains of empowerment. STUDY DESIGN: This study examined the associations between women's empowerment and modern contraception use in Bangladesh. Data from a sample of 16,834 married women aged 15-49 years from the Bangladesh Demographic and Health Survey 2017-2018 were analysed. METHODS: Complex survey weight adjusted logistic models were fitted to evaluate the associations after adjusting for clusters, strata, and sampling weights. RESULTS: indicate that just over half of the married women (55.7%) had used modern contraception methods. Women's empowerment was associated with contraceptive use, especially decision-making power. Women who had medium or high autonomy of household decision making were likely to have 20% (AOR = 1.20; 95% CI: 1.04-1.39) and 27% (AOR = 1.27, 95% CI: 1.11-1.45) increased odds of using modern contraceptives compared to those who scored low in the decision-making domain. The findings demonstrated strong evidence of direct influence of women's decision-making power on modern contraception use. The results also found influence of several socio-demographic factors including area of residence, husband's age, wealth index and mobile phone ownership on the use of modern contraceptives. DISCUSSION: Future interventions can focus on integrating women's empowerment into family planning programming, with a particular focus on enhancing women's autonomy in decision making.

Longitudinal relationships between sub-clinical depression, sub-clinical eating disorders and health-related quality of life in early adolescence.

OBJECTIVE: A comprehensive understanding of the relationship between depressive symptoms and eating disorder (ED) symptoms requires consideration of additional variables that may influence this relationship. Health-related quality of life (HRQOL) has been associated with both depression and EDs; however, there is limited evidence to demonstrate how all three variables interact over time. This study sought to explore the bi-directional relationships between depressive symptoms, ED symptoms and HRQOL in a large community sample of young adolescents METHOD: Adolescents (N = 1393) aged between 11 and 14 years (M = 12.50, SD = 0.38) completed an online survey measuring depressive symptoms, ED symptoms and HRQOL. Two-level autoregressive cross-lagged models with three variables (i.e., depressive symptoms, HRQOL and ED) assessed across two time points (T1 and T2) were created to address the study aims. RESULTS: HRQOL was found to predict depressive symptoms and depressive symptoms were found to predict ED symptoms. Components of HRQOL (i.e., social relationships and ability to cope) were found to share a differential relationship with depressive symptoms. Inability to cope predicted depressive symptoms and depressive symptoms predicted negative social relationships. EDs were found to predict reduced HRQOL and negative social relationships. DISCUSSION: Findings suggest prevention and early intervention programs designed to address adolescent depression should focus on improving HRQOL. Future research should assess the relationship between HRQOL and individual ED symptoms (e.g., body-related ED symptoms, restrictive symptoms) as a means of exploring relationships that may have been masked by assessing ED symptoms using a total score. PUBLIC SIGNIFICANCE: This study sought to explore how eating disorders, depressive symptoms, and health-related quality of life (HRQOL) relate over time in a sample of young adolescents. Findings indicate adolescents who self-reported lower levels of HRQOL, including a reduced ability to cope, are at risk of experiencing depressive symptoms. Adolescents should be provided with the tools to develop problem-focused coping strategies as a means of reducing depressive symptoms.

Hypermobility prevalence, measurements, and outcomes in childhood, adolescence, and emerging adulthood: a systematic review.

General Joint Hypermobility (GJH) is a common condition found in 2-57% of the population. Of those with GJH, 10% suffer from accompanying physical and/or psychological symptoms. While the understanding of GJH in the general population is unfolding, its implication in a cohort of children, adolescents and young adults are not yet understood. This systematic review explored GJH's prevalence, tools to measure it, its physical and psychosocial symptoms, with a special interest in aesthetic sports. The CINHAL, MEDLINE, PsycINFO, SPORTDiscus and Scopus databases were searched for relevant studies. Inclusion criteria were (1) Age range of 5-24; (2) Participants had GJH; (3) A measurement for GJH; (4) Studies written in English language. Study screening for title, abstract and full text (when needed) and quality assessment were performed by two independent individuals. 107 studies were included in this review and were thematically grouped into six clusters expressing different foci: (1) GJH's Core Characteristics; (2) Orthopedic; (3) Physical Other; (4) Psychosocial; (5) Treatment and (6) Aesthetic Sports. The review revealed a growing interest in GJH in this cohort in the last decade, especially regarding non-musculoskeletal physical implications and psychosocial aspects. Prevalence varied between different ethnic groups and as a parameter of age, gender and measurement. The most widespread tool to measure GJH was the Beighton scale, with a cut-off varying between 4 and 7. Children show fewer, but similar GJH implication to those in the general population, however, more research on the topic is warranted, especially regarding psychosocial aspects and treatment.

Review: Can digital mental health interventions bridge the 'digital divide' for socioeconomically and digitally marginalised youth? A systematic review.

BACKGROUND: Digital mental health interventions (DMHIs) have the potential to improve the efficiency, accessibility and effectiveness of mental health services for young people, with the potential to reach socioeconomically and digitally marginalised young people with mental health needs who would otherwise not seek help in person. This review aims to investigate the characteristics, acceptability and efficacy of DMHIs specifically developed for socioeconomically and digitally marginalised youth. METHOD: Key databases were searched widely and systematically (EMBASE, MEDLINE, PsycINFO, OpenGrey). Final inclusion in this review required studies to evaluate DMHIs specifically targeting socioeconomically and digitally marginalised children and young people through a broad range of research designs. RESULTS: Ten studies, describing seven DHMIs, were included in this review. Studies varied in terms of methodology, population, intervention, outcome measures, technologies used and methodological quality. Qualitative and quantitative results are synthesised across three key phenomena of interest: effectiveness, acceptability and feasibility. Findings suggest that there is moderate but limited evidence supporting DMHIs for improving mental health outcomes among these populations. CONCLUSIONS: While there is moderate evidence suggesting that digitally delivered interventions can be effective in improving mental health outcomes among socioeconomically and digitally marginalised youth, more high-quality research is needed in order to determine whether DMHIs can fully bridge the so-called 'digital divide'.

What problems associated with ageing are seen in a specialist service for older people living with HIV?

OBJECTIVES: By 2030 the majority of the people living with HIV in the United Kingdom will be over the age of 50. HIV services globally must adapt to manage people living with HIV as they age. Currently these services are often designed based on data from the wider population or from the experiences of HIV clinicians. This article aims to help clinicians designing inclusive HIV services by presenting the most common needs identified during the first year of a specialist clinic for older people living with HIV at the Ian Charleson Day Centre, Royal Free Hospital in London, United Kingdom. METHODS: The records of all thirty-five patients attending the inaugural nine sessions were reviewed. RESULTS: The median age of attendees was 69 (53-93) with 77% being male, 63% being White, 49% being heterosexual and 97% being virally suppressed respectively. The majority (83%) met the criteria for frailty using the Fried frailty phenotype. Eighteen issues linked to ageing were identified with the most common being affective symptoms (51%), memory loss (37%) and falls (29%). CONCLUSIONS: Whilst older people living with HIV are a heterogeneous group frailty is common and appears to present earlier. HIV services either need to adapt to meet these additional needs or must support users in transitioning to existing services. We feel that our multidisciplinary model is successful in identifying problems associated with ageing in people living with HIV and could be successfully replicated elsewhere.

Exploring the economics of public health intervention scale-up: a case study of the Supporting Healthy Image, Nutrition and Exercise (SHINE) cluster randomised controlled trial.

BACKGROUND: The costs and benefits of an intervention within the intervention testing phase may differ from those experienced when that intervention is implemented and delivered at scale. Yet limited empirical work has been undertaken to explore how economic constructs related to implementation and scale-up might have an impact on intervention cost. The aim of this study was to explore the potential economic impacts of implementation and scale-up on a healthy weight and body image intervention tested in a Type II translational research trial. METHODS: The Supporting Healthy Image, Nutrition and Exercise (SHINE) study is a cluster randomised controlled trial, aiming to deliver universal education about healthy nutrition, physical activity and wellbeing behaviours to adolescents in Australian secondary schools. Data on the cost of the intervention were collected alongside the trial using standard micro-costing techniques. Semi-structured interviews were conducted with key intervention stakeholders to explore the potential economic impacts of implementation and scale-up. Thematic content analysis was undertaken by two authors. RESULTS: Fifteen intervention group schools participated in the 8-week online intervention targeting students in 2019 (99 Grade 7 classes; 2,240 students). Booster sessions were delivered during one class session in Grades 8 and 9, in 2020 and 2021 respectively. Time costs of intervention delivery and co-ordination comprised the majority (90%) of intervention cost as per the trial, along with costs associated with travel for intervention training and equipment. Themes related to the benefit of the intervention emerged from interviews with six intervention stakeholders, including the potential for economies of scale afforded by online delivery. Contextual themes that may have an impact on intervention implementation and scale included acceptability across all school sectors, availability and reliability of IT infrastructure for intervention delivery and variations in population characteristics. A number of key alterations to the intervention program emerged as important in supporting and sustaining intervention scale-up. In addition, significant implementation costs were identified if the intervention was to be successfully implemented at scale. CONCLUSIONS: The findings from this study provide important information relevant to decisions on progression to a Type III implementation trial, including budget allocation, and will inform modelled economic evaluation.

A Component Evaluation of a Randomised Control Community Intervention to Reduce Adolescent Alcohol Use in Australia.

Despite a decline in Australian adolescents reporting to have consumed alcohol, a high proportion of the adolescent population still consumes alcohol. Community-led prevention interventions that systematically and strategically implement evidence-based programs have been shown to be effective in producing population-behaviour change related to youth alcohol and drug use. This study evaluated the post-intervention effects of a multi-component community intervention in Australia. It comprised social marketing targeting adolescents and parents, and a community intervention to reduce underage alcohol sales. Structural equation modelling was used to examine direct and indirect effects of community intervention components on intention and consumption. Self-report surveys (N = 3377) and community sales data (27 communities) were analysed to evaluate the effect of the intervention components on intention and consumption before the age of 18. The intervention reduced alcohol sales to minors (OR = .82). Exposure to the social marketing was significantly associated with household no-alcohol rules (OR = 2.24) and parents not supplying alcohol (OR = .72). The intervention predicted intention not to consume alcohol before age 18; intention was associated with not consuming alcohol (OR = 5.70). Total indirect effects from the intervention through to intention were significant. However, parents setting a rule and not supplying alcohol were the only significant direct effects to intention. Parents setting a rule was directly associated with lower consumption. Overall, the intervention logic was supported by the data modelling. The study extends prior knowledge of community-based interventions to prevent adolescent alcohol use by identifying critical intervention components and effect mechanisms. ClinicalTrials.gov Identifier: ACTRN12612000384853.

Evaluation of Communities That Care-Effects on Municipal Youth Crime Rates in Victoria, Australia: 2010-2019.

Internationally, youth crime is a significant social problem. Violent youth crime has been rising over the past decade in the state of Victoria, Australia. Communities That Care (CTC) is a coalition training process designed to prevent youth crime. There has been limited evaluation outside the USA. Using a non-experimental design, this study employed official state crime statistics to evaluate the impact on crime as the five-phase CTC process was implemented between 2010 and 2019 across communities in Victoria. The standard five-phase CTC implementation cycle was supplemented with universal programs to reduce sales and supply of alcohol to underage youth (under 18 years). Growth models evaluated community trends in youth crime (all, person, property and deception and other), comparing communities that implemented CTC at phase 4 or greater with communities that had not implemented CTC. In accord with the hypotheses, the study found significant reductions in crimes associated with CTC over the period between 2010 and 2019. A 2% annual reduction in risk was observed for crimes against persons for all age groups (IRR = 0.98, 95% CI [0.96, 0.998]). A 5% annual reduction was observed for crimes of property and deception for adolescents aged between 10 and 17 years (IRR = 0.95, 95% CI [0.90, 0.99]). These findings support CTC as an intervention for preventing youth crime at a population level. Future studies should evaluate intervention mechanisms and economic benefits.

Depression and eating disorders in early adolescence: A network analysis approach.

OBJECTIVE: Eating disorders (EDs) and depression are among the most debilitating and pervasive mental illnesses. Although they often co-occur, the relationship between EDs and depression remains poorly understood. This study used network analysis to explore the symptom-level relationship between EDs and depression among a sample of Australian adolescents completing their first year of secondary school. METHOD: Adolescents (N = 4,421) aged between 10 and 15 years completed the Centre for Epidemiological Depression Scale and the Eating Disorder Examination-Questionnaire. Network structure was estimated using the Gaussian graphical model and node centrality was assessed using one-step expected influence (EI) and bridge EI. RESULTS: "Depressed," "lonely," and "low energy" were identified as core symptoms of depression. "Shape and weight dissatisfaction," "desire to lose weight," and "preoccupation with shape or weight" were identified as core ED symptoms. "Irritable," "social eating," and "depressed" were identified as the most important nodes connecting (i.e., bridging) symptoms of depression and EDs. DISCUSSION: This study provides an important symptom-level conceptualization of the association between depression and ED symptoms in a community sample of adolescents. This preliminary evidence may guide the development of public health prevention and early intervention programs. Future research should be conducted to address the study limitations (e.g., cross-sectional design).

Barriers and enablers of contraceptive use among adolescent girls and women under 30 years of age in Cambodia: a qualitative study.

OBJECTIVE: Unintended pregnancy and an unmet need for modern contraception remain high among adolescent girls and women in Cambodia. Qualitative descriptive research was conducted to explore the barriers to contraceptive use among young women in urban Cambodia. METHODS: Semi-structured interviews were conducted among 30 adolescent girls and women aged 16-27 years, using purposive and snowball sampling strategies until data saturation was achieved. The audio-recorded interviews were transcribed verbatim and quality-checked. Inductive thematic data analysis was conducted. The results are presented using Bronfenbrenner's theoretical social ecological model. RESULTS: The emerging major and minor themes indicate misconceptions about hormonal contraception as well as women's preference for using oral contraceptive pills for family planning after an unintended pregnancy. Women had low autonomy in choosing a contraceptive method, as their partners or husbands tended to prefer the withdrawal method. Young women faced cultural and supply chain barriers in accessing short- and long-acting reversible modern contraceptive methods at health centres. CONCLUSION: Cambodian women aged 16-27 years are a vulnerable group who have low autonomy and sexual and reproductive health literacy and also face gender inequality.

Children's concepts of childhood and adolescent depression.

BACKGROUND: Research on adolescent Mental Health Literacy (MHL) is rapidly increasing; however, equivalent research in children is lacking. Exploring children's mental health conceptualisations reveals how their knowledge develops and provides the evidence base for the development of mental health education for younger age groups. METHODS: A total of 105 children aged 8-9 and 11-12 years were interviewed using a vignette methodology structured according to the model of illness representations, exploring: recognition, causes, consequences, timeline and curability of depression. Age, gender and experience differences were explored. RESULTS: Children were able to identify the existence of a psychological difficulty in a depressed peer; however, they struggled to categorise depression as a mental illness or to label depression. Children referred to a variety of causal factors, primarily environmental and interpersonal rather than internal biological causes. Children considered depression to be curable within a short period of 1-2 months and anticipated negative outcomes if left untreated. Older children's concepts were more sophisticated than younger children's. Gender and experience were not associated with depression concepts in this age range. CONCLUSIONS: Age trends in children's mental health concepts are evident, in accordance with previous studies. Children from the age of 8-9 years demonstrate detailed concepts of depression. However, mental health educational interventions are needed to target specific gaps and misconceptions in children's understanding.

A qualitative exploration of the sexual and reproductive health knowledge of adolescent mothers from indigenous populations in Ratanak Kiri Province, Cambodia.

INTRODUCTION: Adolescents from indigenous populations in Ratanak Kiri Province in Cambodia experience worse sexual and reproductive health (SRH) outcomes when compared to their urban counterparts. However, few qualitative studies have been conducted to identify factors that may explain the poor SRH outcomes experienced by this population group. METHODS: The socioecological model was used as the analytical lens to explore the SRH knowledge and sources of SRH information of adolescent mothers (aged 15-19 years) from indigenous populations in north-eastern Cambodia. Adolescent mothers from the Tompoun and Jarai indigenous population groups (n=22) were purposively recruited from seven villages in two districts of Ratanak Kiri Province. All adolescent mothers engaged in a combined body mapping exercise and semi-structured interview; this approach was considered the most appropriate qualitative data collection method to use in this context as it reduced language, cultural and social barriers that have previously restricted qualitative exploration of sensitive issues among this population group. The body maps and semi-structured interview transcripts were analysed using thematic analysis. RESULTS: Adolescent mothers demonstrated limited SRH knowledge including that pertaining to the anatomy of the female reproductive body, the physiology of human reproduction, fertility and pregnancy. Adolescents' primary source of SRH information was interaction with female family members and friends within their community. Adolescents' limited SRH knowledge was influenced by factors on individual (eg educational attainment, child marriage), relationship (eg social interaction with female family members and friends), community (eg access to educational and healthcare services) and societal (eg barriers to accessing national SRH programs and initiatives) levels. CONCLUSION: The%u202Ffindings support the need for SRH education in the primary and secondary school curriculum. In 2018 the Cambodia Ministry of Education, Youth and Sports introduced a Comprehensive Sexuality Education (CSE) program into the government primary and secondary school curriculum. The CSE, which is delivered in the Khmer language, provides Cambodian youth with an avenue to access accurate SRH information that will aid their SRH decision-making. However, indigenous girls face numerous social, cultural, economic and language barriers that restrict or prevent their access to formal education. Therefore, additional SRH materials and resources that are culturally and linguistically appropriate need to be developed for indigenous students attending primary and secondary schools in Ratanak Kiri Province and for young people who have ceased formal education. Educating village chiefs to deliver non-formal, community-based education programs is proposed as a means of increasing SRH knowledge and reducing health inequalities faced by this population group while ensuring that accurate information is delivered in a culturally appropriate manner.

Social marketing and community mobilisation to reduce underage alcohol consumption in Australia: A cluster randomised community trial.

BACKGROUND AND AIMS: In many countries adolescent alcohol use is a major health problem. To supplement national policies, it is important to trial community interventions as a potential strategy to prevent adolescent alcohol use. METHODS: This study evaluated a multicomponent community intervention that included community mobilisation, social marketing, and the monitoring of alcohol sales to minors. Evaluation was a clustered randomised trial design with 14 intervention and 14 control communities. Prior to randomisation, communities were matched on socioeconomic status and location. Intervention communities were not blinded. PARTICIPANTS: 3545 Year 8 students (M = 12 years) were surveyed at baseline from 75 schools; 3377 students were surveyed post intervention in 2013 from 54 schools. OUTCOMES: It was hypothesised that the primary outcome, individual alcohol consumption in last 30 days, after the intervention would be 15% lower in intervention communities. Secondary outcomes were consumption in the past year and intention not to drink before age 18. RESULTS: The intervention communities showed larger relative reductions compared to the controls in last 30-day consumption and past year (10%), but not significantly different. A significantly lower proportion of participants in the intervention community (63%), compared to the controls (71%), reported intending to drink before 18 years old. Subgroup analysis identified regional and state differences for some secondary measures. CONCLUSIONS: Intervention assignment was associated with lower adolescent intention to drink before the age of 18. However, more intensive and longer-term intervention may be required to measure significant differences in behaviour change. TRIAL REGISTRATION: ACTRN12612000384853. PROTOCOL: Rowland B, Toumbourou JW, Osborn A, et al. BMJ Open 2013;3:e002423. doi:10.1136/bmjopen-2012-002423.

An Examination of Gender Differences in the Association of Adolescent Substance use with Eating and Weight Loss Attitudes.

OBJECTIVE: To assess gender differences in the relationship between eating and weight loss attitudes (EWAs), and 30-day tobacco and alcohol use among adolescents, while controlling for potential confounds (age, country of birth, psychological distress, pubertal development, peer alcohol and tobacco use, and sexual activity). METHODS: School students aged between 11 and 17 years (N = 10,273) from high schools in the State of Victoria (Australia) completed surveys in class under conditions of anonymity and confidentiality. RESULTS: The interaction between EWAs and gender was significant for tobacco use but not for alcohol use, indicating that the effect of EWAs on tobacco use, but not alcohol use, vary by gender. CONCLUSIONS: Tobacco use was related to EWAs in adolescent females but not males, and this is consistent with the possibility that females use tobacco in an instrumental fashion to control weight. Implications and Contribution: Female adolescents high in eating and weight loss attitudes were more likely to engage in tobacco use. In contrast, eating and weight loss attitudes were not related to male tobacco use. These results point to the potential importance of developing gender-specific approaches towards addressing problematic behaviors in adolescent populations.

Linking eating and weight control attitudes to relationship experiences: A large-scale survey of adolescent females.

OBJECTIVE: To examine the extent to which family conflict, peer bullying and psychological distress account for eating and weight loss attitudes in adolescent females. This study examined the degree to which psychological distress mediated the association between family conflict and eating and weight loss attitudes, and the association of bullying and eating and weight loss attitudes. METHOD: Females aged between 11 and 17 years (N = 5125) were recruited from schools in the State of Victoria (Australia). Key measures included psychological distress, family conflict, and bullying victimisation. RESULTS: A structural model showed good fit, and all predictors were significant. Psychological distress mediated the association between eating and weight loss attitudes, and family problems and bullying. CONCLUSION: Family conflict and peer bullying were associated with eating and weight loss attitudes and this association may occur via psychological distress. Early intervention programs may benefit from a focus on family and peer relationships.

Quality of life and adolescents' communication with their significant others (mother, father, and best friend): the mediating effect of attachment to pets.

The relationship between adolescents' communication with their significant others (mother, father, and best friend) and quality of life (KIDSCREEN) was investigated in 2262 Scottish adolescent pet owners. The variable attachment to pets was also tested and assessed as a mediator of this relationship. A positive relationship between adolescents' communication with their significant other (mother, father, and best friend) and quality of life decreased when controlling for attachment to dogs. In cat owners, a positive relationship between communication with a best friend and quality of life decreased when controlling for attachment to cats. In cat and dog owners, attachment to these pets predicted higher levels of quality of life. Higher attachment to dogs and cats was explained by good best friend (IV) and attachment to pets (DV) and best friends. Mediation effects of attachment to dogs and cats might be explained in terms of the caring activities associated with these types of pets.

The Australian longitudinal study on male health-methods.

BACKGROUND: The Australian Longitudinal Study on Male Health (Ten to Men) was established in 2011 to build the evidence base on male health to inform policy and program development. METHODS: Ten to Men is a national longitudinal study with a stratified multi-stage cluster random sample design and oversampling in rural and regional areas. Household recruitment was conducted from October 2013 to July 2014. Males who were aged 10 to 55 years residing in private dwellings were eligible to participate. Data were collected via self-completion paper questionnaires (participants aged 15 to 55) and by computer-assisted personal interview (boys aged 10 to 14). Household and proxy health data for boys were collected from a parent via a self-completion paper-based questionnaire. Questions covered socio-demographics, health status, mental health and wellbeing, health behaviours, social determinants, and health knowledge and service use. RESULTS: A cohort of 15,988 males aged between 10 and 55 years was recruited representing a response fraction of 35 %. CONCLUSION: Ten to Men is a unique resource for investigating male health and wellbeing. Wave 1 data are available for approved research projects.

Association of different forms of bullying victimisation with adolescents' psychological distress and reduced emotional wellbeing.

OBJECTIVE: The frequency and emotional response to bullying victimisation are known to be associated with adolescent mental ill health. A potentially important under-investigated factor is the form of bullying. Four common forms of bullying behaviours are name-calling, physical threats or harm, rumour spreading and social exclusion. To more comprehensively understand bullying victimisation in adolescence, we examined the association of all three factors (frequency, emotional response, form) to psychological distress and emotional wellbeing. METHOD: A stratified, random sample of adolescents (n = 10, 273; mean age = 14.33 years, standard deviation = 1.68 years) completed validated measures of bullying victimisation (Gatehouse Bullying Questionnaire), psychological distress (K10) and emotional wellbeing (Mental Health Inventory) in classroom time. Associations between the form of bullying victimisation and mental health outcomes were examined. RESULTS: Adolescents reported a high prevalence of all four forms of bullying: teased or called names (30.6%), rumour spreading (17.9%), social exclusion (14.3%) and physical threats or harm (10.7%). Victimisation was independently associated with significantly higher levels of psychological distress and reduced levels of emotional wellbeing for all forms of bullying. In particular, social exclusion had a strong association with mental ill health. Adolescents who experienced frequent bullying that was upsetting reported higher psychological distress and reduced emotional wellbeing. CONCLUSION: Different forms of bullying victimisation were independently associated with psychological distress and reduced emotional wellbeing. In particular, frequent and upsetting social exclusion requires a targeted and measured response by school communities and health practitioners.

Regional versus urban differences in teenage alcohol use: Does parental disapproval account for these differences?

OBJECTIVE: To investigate if parental disapproval of alcohol use accounts for differences in adolescent alcohol use across regional and urban communities. DESIGN: Secondary data analysis of grade-level stratified data from a random sample of schools. SETTING: High schools in Victoria, Australia. PARTICIPANTS: A random sample of 10 273 adolescents from Grade 7 (mean age = 12.51 years), 9 (14.46 years) and 11 (16.42 years). MAIN OUTCOME MEASURES: The key independent variables were parental disapproval of adolescent alcohol use and regionality (regional/ urban), and the dependent variable was past 30 days alcohol use. RESULTS: After adjusting for potential confounders, adolescents in regional areas were more likely to use alcohol in the past 30 days (OR = 1.83, 1.44 and 1.37 for Grades 7, 9 and 11, respectively, P < 0.05), and their parents have a lower level of disapproval of their alcohol use (b = -0.12, -0.15 and -0.19 for Grades 7, 9 and 11, respectively, P < 0.001). Bootstrapping analyses suggested that 8.37%, 23.30% and 39.22% of the effect of regionality on adolescent alcohol use was mediated by parental disapproval of alcohol use for Grades 7, 9 and 11 participants respectively (P < 0.05). CONCLUSIONS: Adolescents in urban areas had a lower risk of alcohol use compared with their regional counterparts, and differences in parental disapproval of alcohol use contributed to this difference.