Volume 26, Issue 3

Mental disorders account for a larger burden of disease among adolescents and young adults than any other class of health conditions, and most of these disorders are untreated. Gatekeeper-trainings represent a potentially powerful mechanism for increasing access to treatment. This article is a comprehensive review of 21 gatekeepertraining studies conducted in schools and other youth settings around the world. Despite the widespread use of these programs, little is known about how they actually affect the abilities and actions of trained gatekeepers and the subsequent help-seeking behaviors of adolescents and young adults. Certain outcomes (knowledge, attitudes, and self-efficacy) have been commonly measured whereas others (behaviors, skills, and population-level outcomes) have rarely been assessed. The studies reviewed here also suggest that positive training effects often diminish over time. The article identifies opportunities for advancing gatekeeper-training research and practice.

Early adolescence (ages 10–14 years) is among the most neglected stages of development, yet there are few stages during the life course where changes are as dramatic. The present conceptual framework proposes four central goals to be achieved by early adolescence: engagement with learning, emotional and physical safety, positive sense of self/self-efficacy, acquisition of life/decision-making skills. The framework proposes an ecological model where the macro level factors (economic forces, historical events, national priorities, laws/policies/norms and values, national events, and political realities) all set the contexts that influence community, family, school and peer factors that all in turn influence the adolescent. Existing indicators for points of development are noted as are future areas of research priority.

Aim: Body image satisfaction significantly influences self-esteem in female adolescents. Increased reports of lowered satisfaction in this population have raised concerns regarding their compromised self-esteem. This research study, therefore, sought to identify a culturally significant moderator of the association between body image satisfaction and self-esteem in Thai female adolescents. Orientation toward self-compassion, found to be particularly high in Thailand, was examined. Materials and methods: A total of 302 Thai female undergraduates from three large public and private universities in the Bangkok metropolitan area responded to a set of questionnaires, which measured demographic information, body image satisfaction, self-compassion, and self-esteem. Data were analyzed using correlation and multiple regression analyses. Self-compassion was tested as a moderator of the relationship between body image satisfaction and self-esteem. Results: Although its effect was relatively small, self-compassion significantly moderated the positive relationship between body image satisfaction and self-esteem. The relationship became less stringent for those with high self-compassion. Discussion: The cultivation of self-compassion was recommended in female adolescents. In addition to moderating the association between body image satisfaction and self-esteem, the benefits to health and well-being of generalizing this cultivation are discussed.

Aim: One proposed strategy to improve youth health is needs assessment, a process for determining and addressing the needs of individual groups. The aim of this study was to explore the attitudes and perceptions of Iranian university students toward reproductive health needs, in order to promote the provision of reproductive health services. Methods: Using an anonymous self-administered questionnaire, a cross-sectional survey was conducted among 548 students who were randomly selected from eight universities in Sari City, Iran. Topics covered the participants’ attitudes towards reproductive health needs as well as their opinion about proper sources of information in this area, as measured using a 5-point Likert scale. Results: The mean age of participants was 21.57 years, and 57.82% were female. The maximum score of perceived reproductive health needs was related to “Be informed about appropriate behavior with my spouse”, and the majority of students (82.82%) supported family-based reproductive health education with emphasis on the mothers’ role. Although 65.14% of the participants agreed that “When a young has been raped, it’s better that she/he counsel with her/his family”, 11.67% of them stated that she/he must hide the problem. Finally, we found that 60.40% of the students preferred someone in a health care center as the one to explain how to use any contraception that may be provided for them. Conclusion: Taken as a whole, these findings support the critical importance of programming for university students as part of a comprehensive strategy to improve the health and development of young adults.

Many adolescents who engage in nonsuicidal self-injury (NSSI) self-identify as religious, but the role of religion in their NSSI is not known. This exploratory study examined the relationship between religious coping and religiousness among adolescents who self-injure and the function of their NSSI. Thirty adolescents aged 12–19 years who had engaged in NSSI participated in an interview and completed questionnaires. Multiple regressions were used to examine the relationship between religious coping and NSSI, and Pearson correlations were used to assess the relationship between religiousness and function of NSSI. Greater use of positive religious coping was associated with lower likelihood of engaging in NSSI to rid oneself of unwanted emotions, whereas greater use of negative religious coping was associated with greater likelihood of engaging in NSSI for this reason as well as to avoid punishment or unwanted responsibility. Higher religiousness was associated with greater use of NSSI to communicate with or gain attention from others, whereas lower religiousness was associated with greater use of NSSI to relieve unwanted emotions. Having a greater understanding of how religious constructs are related to the various functions served by NSSI may inform treatment of this population, particularly among religious youth who self-injure.

Background: Adolescence is the important period in human life. It is an essential prerequisite for playing social roles. Objective: The current study conducted a review on the concept, dimensions, and influential factors on health and risk taking, instruments and measurements of high-risk behaviors, risk factors, and high-risk behavior protective factors through adolescent perspectives. Methods: This literature review was conducted by electronic searching and library study on health and adolescents using Wiley Interscience, ScienceDirect, ProQuest, and Springer (1990–2012). The keywords for searching data collection sources included health, youth, young, adolescents, risk behaviors, risk taking, related factors, protective factors, risk factors, adolescent perspectives, quantitative study, qualitative study, measurement, and instrument. Results: This literature review led to the arrangement of subjects in nine general categories titled definition of health concept and its dimensions, adolescents and health in adolescence, risk taking in adolescence and its measuring tools, gender differences in adolescence health and risk taking, adolescents’ health and relationships, socioeconomic conditions and health, adolescents and psychiatric health, religion, and health, educational facilities and health, non-governmental organizations and their role in adolescents’ health. What has been achieved from a review of these articles is that several personal, social, and family factors are associated with health and risk taking in adolescents. Conclusion: Generally, adolescents cared more about the psychosocial aspects of health than the physical dimensions. They also considered factors such as independence, communication, socioeconomic conditions, mental health, religion, and educational facilities synonymous with the concept of health. Therefore, in formulation and implementation of health promotion programs for adolescents, the concept of health and its various dimensions must be considered from adolescent perspectives.

Background: Suicide attempts and suicides constitute a significant burden on communities and health systems, especially in low income countries. However, many low income countries lack epidemiological information on which to base future preventive strategies. This study reports on gender and age profiles as well as the likely background and means used for suicide attempts and suicides in Bolivia. Method: This study presents 1124 cases from four different sources of information: (i) emergency ward data with suicide attempts by poisoning from the year 2007, (ii) psychiatric ward data including suicide attempts from July 2011 to July 2012, (iii) newspaper articles reporting attempted suicides and suicides from 2009 to 2011, and (iv) the National Statistics on Crime reporting suicides from the years 2010–2011. Data on age was stratified into three age groups: adolescents aged 10–19 years, young adults aged 20–29 years, and older adults aged above 29 years. Data from the hospital wards and Crime Statistics were pooled to compare characteristics of suicide attempts with suicides concerning age and gender. Data on age, gender, methods used, and reasons were analyzed using IBM SPSS version 21. Results: Hospital data showed that more females (403/657, 61%) than males (254/657, 39%) attempted suicide, and females attempted suicide at a younger age than males (p<0.05). In contrast to this, more males (208/293, 70.5%) than females (85/293, 29.5%) committed suicide, and furthermore it was most prevalent among young adults aged 20–29 years of both genders, as observed from the Crime Statistics. The dominant method was pesticide poisoning varying from 400 out of 657 (70.5%) of the hospital poisoning cases to 65 out of 172 (37.8%) of the newspaper cases. Newspaper data showed a higher mortality rate (65/77, 85.1%) among those using violent methods such as hanging and jumping compared to non-violent methods (43/84, 50.9%) such as ingesting chemicals and drugs (p<0.05). The reasons were related to interpersonal problems, economic problems, depression, and unwanted pregnancies. Many cases of suicide seemed to be hidden due to cultural and religious reasons. Conclusion: More females attempted suicide, whereas more males realized suicide. Suicide attempts were most numerous among adolescents in contrast to suicides being most prevalent in the older age groups. Self-poisoning with pesticides was the most popular method used. Access to potential suicide materials should be restricted and psychosocial interventions initiated to prevent suicides.

Background: Internet addictive behaviors are associated with a plethora of psychosocial adversities. The study objectives were to assess the determinants and psychosocial correlates associated with Internet addictive behaviors among adolescents. Materials and methods: A cross-sectional study design was applied among a random sample (n=805) of Cypriot adolescents (mean age: 14.7 years). Self-completed questionnaires, including Internet use characteristics, Young Internet Addiction Test, and Strengths and Difficulties Questionnaire, were utilized. Results: Among the study population, the prevalence rates of borderline addictive Internet use (BIU) and addictive Internet use (AIU) were 18.4% and 2%, respectively. Adolescents with BIU had an increased likelihood of concomitantly presenting with abnormal peer relations (AOR: 5.28; 95% confidence interval, CI: 3.37–23.38), conduct problems (AOR: 4.77; 95% CI: 2.82–8.08), hyperactivity (AOR: 5.58; 95% CI: 2.58–12.10) and emotional symptoms (AOR: 2.85; 95% CI: 1.53–5.32). Adolescent AIU was significantly associated with abnormal conduct (AOR: 22.31; 95% CI: 6.90–72.19), peer problems (AOR: 7.14; 95% CI: 1.36–37.50), emotional symptoms (AOR: 19.06; 95% 6.06–60.61), and hyperactivity (AOR: 9.49, 95% CI: 1.87–48.19). The determinants of BIU and AIU included accessing the Internet for the purposes of retrieving sexual information (AOR: 1.17; 95% CI: 1.17–3.23) and participating in games with monetary awards (AOR: 1.90; 95% CI: 1.15–3.14). Conclusions: Both BIU and AIU were adversely associated with notable behavioral and social maladjustment among adolescents.

Background: Due to an alarming trend of overweight and obesity in children and adolescents, along with the sparse data on dietary habits and lifestyle factors, the present study aims to analyze the current nutritional behavior as well as the lifestyle and mental health of adolescents and young adults living in Austria. Materials and methods: In this cross-sectional study, a total of 500 respondents (aged between 14 and 24 years) completed an anonymous questionnaire on nutrition behavior, mental health, and lifestyle factors by Internet survey. Results: Only 50% of the participants ate breakfast daily and 10% did not eat breakfast at all. About 47% of the respondents consumed milk and milk products daily. Furthermore, only 31% ate fruit and 21% ate vegetables at least once a day, and 46% ate fish seldom or never. Nearly 28% of young people liked to eat fast food twice or thrice a week and more, with males more often replacing a meal with a fast food product (36%) than females (21%). About 46% of the respondents engaged in physical activity only once a week (or more rarely). A fifth of our respondents (23%) spent more than 2 h a day using various social networks, with Facebook being the most popular social network among the respondents. Around 27% claimed to be smokers, with more female (33%) than male (20%) smoker. In terms of sleeping habits, 19% slept <6 h a day. Regarding well-being, 44% were more likely to feel stressed, 35% stated that they were tense, and 43% felt tired and listless. Eating together, physical activity, and sleep patterns showed positive effects on well-being, whereas higher consumption of fast food/snacks/soft drinks and alcoholic drinks/energy drinks was associated with relatively lower well-being. Conclusions: Unhealthy eating habits, suboptimal physical activity, and smoking are still prominent in a sample of Austrian adolescents and young people. In addition, stress and tiredness are also relevant problems in this collective.

Aim: The right to health is a universal human right, and this includes sexual and reproductive health services. The aim of this study is to explore the opinions of Iranian university students toward facilitators and barriers to sexual and reproductive health services. Materials and methods: In 2012, a random sample of 548 university students completed anonymous, self-administered questionnaires. Topics covered the participants’ attitudes towards facilitators and barriers to sexual and reproductive health services in personal, interpersonal, and structural domains. Results: Mean age of participants was 21.57 years and 57.82% were female. The maximum score of facilitators and barriers to sexual and reproductive health services was related to “Young people’s participation in sexual and reproductive health services provision” and “Fear of stigmatization”, respectively. The results showed that among female university students, the mean score of personal and structural facilitators was significantly higher than the mean score of interpersonal ones (F=12.23, p<0.001). This difference was also reported in barrier factors (F=5.51, p=0.004). Conclusion: Results highlight the roles of policy makers and health service providers in improving accessibility to provided services for young people through the enforcement of facilitators and reduction of barriers, particularly in the areas of personal and structural facilitators focusing on female services.

Aims: Alcohol consumption in adolescence has been an important topic in the study of public health policies. This study aimed to analyze and interpret the influence of the family in teenage alcohol consumption. Materials and methods: A qualitative research was undertaken, using interviews, observation, genogram and eco-map, in order to investigate 22 participants at a Family Health Unit in the city of Recife, Pernambuco, Brazil. The family structure, composition, interaction, communication, and religion of the participants were considered. Results: The results were analyzed using inductive thematic analysis and indicated three themes, namely, the internality of the family: fragility and conflicts; among us: limits, responsibilities and hope; and the decision to drink: fun permeated by risks. Conclusion: The family and sociocultural context of adolescents can positively and negatively influence the use and abuse of alcohol and, therefore, can be a target of intervention in nursing.

Background and aims : Condom use at sexual debut is associated with subsequent condom use and with decreased risk of sexually transmitted infections. There is a dearth of data on determinants of condom use at first sexual intercourse. We aimed to determine factors associated with condom use at first sexual intercourse before marriage among Vietnamese adolescents and youths. Methods : The study involved the analysis of data from the Survey Assessment of Vietnamese Youth, 2003, the first nationally representative survey of young people in Vietnam. The survey included 7584 adolescents and youths aged 14–25 years. In this study, data of 605 adolescents and youths who had engaged in premarital sex were analyzed for factors associated with condom use using descriptive analyses, and regression techniques, allowing for sampling weights, clustering and stratification. Results: Of 605 adolescents and youths who had engaged in premarital sex, 28.6% reported condom use at first sexual intercourse. Condom use at sexual debut was less common in females than males [odds ratio (OR)=0.15; 95% confidence interval (95% CI)=0.07–0.30] and less common in those who experienced peer pressure to engage in social higher risk behaviors (OR=0.57; 95% CI=0.32–0.99). Condom use was more common if a friend/acquaintance or a stranger/sex worker was the first sexual partner (OR=2.20; 95% CI=1.16–4.17 and OR=17.90; 95% CI=6.88–46.54) respectively, each compared with fiancé/boyfriend/girlfriend as first sexual partner. Conclusions: These data suggest that approximately one in three unmarried Vietnamese youths used a condom at first sexual intercourse. Gender, peer pressure and the nature of the relationship to the first sexual partner were independently associated with condom use. These results can inform programs directed at preventing HIV and other sexually transmitted infections among young Vietnamese.

The goals of our study were to: 1) describe the incidence of disturbances in sleep quality, sleep hygiene, sleep-related cognitions and nightmares; and 2) investigate the association between these sleep-related disturbances and suicidal ideation (SI), in adolescents admitted to a psychiatric inpatient unit. Our sample consisted of 50 adolescents between the ages of 12 and 17 years (32 females and 18 males; 41 Caucasian and nine African American). Our cross-sectional design involved the administration of the Adolescent Sleep Wake Scale (ASWS), the Adolescent Sleep Hygiene Scale (ASHS), the Dysfunctional Beliefs and Attitudes about Sleep-Short version for use with children (DBAS-C10), the Disturbing Dreams and Nightmare Scale (DDNSI), and the Suicidal Ideation Questionnaire Jr (SIQ-JR). Analyses were conducted using Pearson correlations, as well as univariate and multivariate regression. Results indicated that our sample experienced sleep disturbances and SI to a greater degree than non-clinical samples. Sleep quality was correlated with nightmares, while sleep quality and nightmares were each correlated with SI. Sleep quality, dysfunctional beliefs, and nightmares each independently predicted SI. Our study was the first to use the four sleep measures with an adolescent psychiatric inpatient sample. It is important to develop sleep-related assessment tools in high-risk populations given the link between sleep disturbances and suicidality. Furthermore, a better understanding of the relationships between SI and sleep quality, sleep-related cognitions, and nightmares is needed to develop potential prevention and treatment options for suicidality in adolescents.

Objective: The aim of this study was to highlight body size preferences among university females in five Arab countries. Methods: The sample comprised 1134 females between 17 and 32 years old from universities in five Arab countries: Bahrain, Egypt, Jordan, Oman and Syria. A silhouette figure scale was used to examine body size preferences. Results: There were significant differences between countries regarding female body size preferences (p<0.001) and for preferred body size for men (p<0.001). In general, the university females preferred a thinner body size for themselves than that perceived for men. Conclusion: There was a drastic change in body size preferences for women from plumpness to thinness. Sociocultural factors may play a role in the differences in the body size preferences between countries.

Background: Adolescents have limited knowledge about medicines and their potential adverse effects. In this context, we aimed to investigate the basic knowledge of medicines, any differences in knowledge related to practice of self-medication (SM), attitudes towards SM and sources of information about medicines among expatriate adolescents in the United Arab Emirates (UAE). Methods: A cross-sectional survey was conducted among 324 students from four schools in the UAE using a self-administered questionnaire. Data were analyzed using SPSS version 19. Results: The sample of multi-ethnic students, with ages ranging from 14 to 19 years, was almost equally distributed between the genders. A total of 289 students reported to be self-medicating. More than 60% of adolescents had responded incorrectly to eight questions related to knowledge about medicines. There were no significant differences between mean scores for drug knowledge (maximum score=22) of self-medicating adolescents (12.1±4.32; SMAs) and those not practicing SM (12±4.53; NSMAs). Self-assessment of drug knowledge was perceived as good by 33% and satisfactory by 34% of SMAs. The majority of adolescents (87%) believed that SM was acceptable and reported being aware of its advantages and disadvantages. Parents and pharmacists were common sources of information about medicines. Conclusion: The participants showed a positive inclination towards SM. The SMAs and NSMAs had similar knowledge about medicines. However, gaps in knowledge may lead to drug misuse and toxicity. Healthcare providers, pharmacists, educators and parents should be actively involved in health education strategies for rational use of medicines among adolescents in the UAE.

Germany is one of many nations characterized by an increasing number of children originating from families with a migration background. Medical treatment modalities will be required to adjust for diversity of social and cultural background. Initiated by the Federal Society of Child and Adolescent Psychiatry (BKJPP), representing mainly those psychiatrists working in private practice, and by the Federal Working Commission of Medical Directors employed in Child and Adolescent Psychiatric Clinics (BAG), a questionnaire was constructed to identify mental health professionals’ (psychiatrists’) evaluation of the needs and quality of diagnosis and treatment for migrant families. The current study focused on medical directors and deputy chief physicians in clinics for child and adolescent psychiatry. Preliminary results of this survey – implementing descriptive statistics as well as univariate and multivariate statistical analyses – permitted an assessment of the current state of identification and treatment of migrant offspring attending child and adolescent psychiatric practices in Germany. Recommendations and concrete steps are offered, which aim to promote “cultural opening”, and assist in health and social policy makers’ decisions for improved mental health care.

Rural communities have shown marked increase in metabolic syndrome among young people, with physical inactivity as one of the main contributing factors. This study aimed to determine factors associated with physical inactivity among male and female rural adolescents in a sample of schools in Malaysia. A cross-sectional study was conducted among 145 students aged 13–15 years. Data on socio-demographic, health-related, and psychosocial factors (perceived barriers, self-efficacy, social influences) were collected using a self-administered questionnaire. Anthropometric measurement was taken to generate body mass index (BMI)-for-age, while physical activity (PA) level was assessed using pedometers. The mean steps per day was 6251.37 (SD=3085.31) with males reported as being more active. About 27% of the respondents were either overweight or obese, with more females in this group. There was no significant difference in steps among males and females (p=0.212), and nutritional status (BMI-for-age) (p=0.439). Females consistently scored higher in most items under perceived barriers, but had significantly lower scores in self-efficacy’s items. Males were more influenced by peers in terms of PA (p<0.001) and were more satisfied with their body parts (p=0.047). A significantly higher body size discrepancy score was found among females (p=0.034, CI –0.639, –0.026). PA level was low and almost one-third of the respondents were overweight and obese. Female students faced more barriers and had lower self-efficacy with regards PA. Based on the findings, it is recommended that interventions focus on reducing barriers while increasing support for PA. This is particularly important in improving the health status of the youth, especially among the females.