Volume 26, Issue 4

Multidisciplinary research has supported a relationship between adolescent future orientation (the ability to set future goals and plans) and positive adolescent health and development outcomes. Many preventive strategies – for example, contracepting, exercising – are based on taking actions in the present to avoid unwanted or negative future consequences. However, research has been hampered by unclear and often divergent conceptualizations of the future orientation construct. The present paper aims to integrate previous conceptual and operational definitions into a conceptual framework that can inform programs and services for youth and efforts to evaluate future orientation as a target for intervention. Recommendations focus on furthering the study of the construct through measurement synthesis as well as studies of the normative development of future orientation. Also suggested is the need to pair environmental intervention strategies with individual level efforts to improve future orientation in order to maximize benefits.

Aortic dilatation and aortic dissection are increasingly recognised in patients with Turner syndrome (TS). Risk factors for aortic dissection include aortic dilatation, bicuspid aortic valves, coarctation of aorta and pregnancy. The risk of death due to aortic dissection in pregnancy in TS is 2%, which is approximately 100 times higher than the general population, as maternal mortality is extremely low. Ongoing cardiovascular monitoring is recommended, although there remain several unanswered questions in relation to cardiovascular imaging especially the choice of modality for detection of vascular, valvular abnormalities and measurements of aortic dimensions. Due to the relative short stature of patients with TS, aortic dimensions need to be defined by aortic measurements adjusted for body surface area, known as aortic sized index (ASI). The relationship of ASI and other risk factors with aortic dissection is only beginning to be clarified. Clinical management and monitoring of such patients should be delivered by a group of clinicians familiar with the issues unique to TS patients in a multidisciplinary fashion. All clinicians including the non-specialists need to have a low threshold of suspecting aortic dissection in these adolescents and young adults. This up to date review, including a summary of all 122 published cases of TS patients with aortic dissection, aims to provide a summary of recent publications on characteristics of aortic dissection and aortic dilatation in TS to highlight gaps in knowledge and propose possible clinical monitoring pathway of cardiovascular health in children and adults with TS. Cardiovascular assessment and risk counselling is especially crucial during the period of transition of adolescents with TS, although life long monitoring by expert cognizant to the issues specific in TS is essential.

Objective: This work aimed to evaluate gender differences among the street-entrenched youth in British Columbia in terms of their demographics, experiences of childhood maltreatment, mental health issues, and substance use behaviors. Materials and methods: Data were derived from the BC Health of the Homeless Study (BCHOHS), carried out in three cities in British Columbia, Canada. Measures included socio-demographic information, the Maudsley Addiction Profile (MAP), the Childhood Trauma Questionnaire (CTQ), the Mini International Neuropsychiatric Interview (MINI) Plus and the National Survey of Homeless Assistance Providers and Clients (NSHAPC)-Health Chapter. Results: Youth constituted 16.5% (n=82) of the homeless population. Females (55%) outnumbered males and engaged in survival sex more frequently (17.8%; p=0.03). Males had greater substance abuse of alcohol (81.1%) and cannabis (89.2%). Depression (p=0.02) and psychosis (p=0.05) were more common among females, while panic disorder was more common among males (p=0.04). Rates of childhood trauma were similar across genders. Conclusion: Our findings reflect trends among youth where illicit drug use may be similar among genders while males may report increased alcohol and cannabis use, possibly as a means to self medicate their panic-related symptoms. In any case, this population of street entrenched-youth frequently experiences several significant problems ranging from childhood abuse to high rates of substance abuse and mental illnesses.

Introduction: Health-promoting behaviors have considerable effects on improving life quality and decreasing healthcare expenses. This study aimed to determine the status of health-promoting behaviors and its subscales, as well as its relationship with self-efficacy and some socio-demographic characteristics in adolescent Iranian girls. Materials and methods: The participants in this study were 750 adolescent girls aged 14–18 years, living in the city of Sanandaj, Iran in 2013. Samples were selected randomly. Questionnaires used in the study were the “Adolescent Healthy Lifestyle” and “Sherer General Self-efficacy” questionnaires. Multivariate linear regresion analysis was used to determine predictors of health-promoting lifestyle. Results: Mean total score of health-promoting lifestyles in adolescent girls was 3.51 (SD 0.55) and its observed scores ranged from 1 to 5. The highest and lowest mean scores were obtained for life appreciation and physical activity subscales, respectively. Self-efficacy had significant positive correlation with the total health-promoting lifestyle scores and all its subscales. The variables of self-efficacy, current disease, mother’s education, mother’s occupation, and sufficiency of income for expenses remained in the multivariate linear regresion model and were able to explain 21% of the observed variance of the total score for health-promoting lifestyle. Conclusion: The findings show that adolescents “sometimes” or “often” show health-promoting behaviors. In addition to self-efficacy as the main predictor, some of the socio-demographic characteristics are also among the predictors of health behaviors. With consideration of adolescence years as a foundation for one’s future life, it is necessary to provide strategies to encourage a health-promoting lifestyle in adolescents.

Background: Adolescents exhibit numerous risky sexual behaviors leading to initiation of sexual intercourse not mindful of the many consequences. Objective: To determine the prevalence and pattern of sexual risky behavior and its association with sexual initiation. Methods: This was a school-based descriptive cross-sectional study among 377 in-school adolescents, who were selected using multistage sampling methods. Research instruments were semistructured self-administered questionnaires. Results: The mean age of respondents was 15.7 (+1.8) years. Most of the respondents claimed to have heard about sex education at one time or another. About 53 (14.1%) had their first sexual experience before or at the age of 15 years. The mean age of the first sexual experience for males was 14 years 3 months and 15 years 3 months for females. Fourteen (3.7%) had no fixed sexual partner; most of the sexually active respondents did not use a condom during their last intercourse. Only 7.7% of the respondents reported to have had a sexually transmitted infection. Most of the 207 female respondents (85.5%) had never been pregnant while 88.9% of those who had been pregnant had an abortion. Females were about 1.5 times more likely to have had first sexual intercourse before the age of 15 years, though the observed likelihood was not statistically significant [odd ratio (OR)=0.7, 95%; confidence interval (CI)=0.3–1.5; p=0.642]. Likewise, males were 1.7 times more likely to have used condoms at the last sexual intercourse, and the observed likelihood was not statistically significant (OR=1.7; 95%CI=0.8–3.4; p=0.079). Conclusion: In this study, adolescents were sexually active with negative consequences on their reproductive health. Stakeholders involved in the care of adolescents should take the consequences into consideration.

Background: A change of medical students’ health behavior over time may be related to a change in their opinion regarding the relationship between physicians’ own health behavior and effective healthy lifestyle counseling in patients. Objective: To investigate Dutch medical students’ (1) change of health behavior over time, (2) change of opinion over time regarding the relationship between a physician’s own health behavior and effective healthy lifestyle counseling in patients, and (3) the relationship between these aspects. Method: All medical students from two Dutch medical schools were invited to fill out an online questionnaire in 2010. Respondents of 2010 were invited for 2011. Health behavior was assessed with five aspects: drinking behavior, smoking, eating habits, sleeping behavior, and sexual behavior. Their opinion regarding the relationship between their own health behavior and effective healthy lifestyle counseling in patients was assessed with one statement. Results: At baseline, 2016 medical students (41%) participated, and at 1 year follow-up 1078 medical students (53%) participated. Fourteen percent adopted healthier behavior over time, and 12% adopted unhealthier behavior. Twelve percent positively changed their opinion, and 13% negatively changed their opinion. Participants who adopted unhealthier behavior were more inclined to also have negatively changed their opinion than participants who adopted healthier behavior (statistically nonsignificant difference, p=0.38). Conclusions: No significant relationship was found between a change in health behavior of Dutch medical students and a change of their opinion regarding the relationship between physicians’ own healthy lifestyle and their ability to effectively influence patients to adhere to a healthy lifestyle.

Aim: Physical conditioning of youth has always been a controversial topic as it raises ethical, physiological, and medical issues. Current recommendations and guidelines suggest that strength training is a relatively safe and worthwhile method in conditioning youth. This, however, requires well-informed coaches who follow age-appropriate strength training recommendations and guidelines, compiles well-designed strength training programs, and provides qualified supervision and instructions. The purpose of this study was to investigate coaches’ awareness of current recommendations and guidelines regarding strength training for youth. Method : A total of 39 football (US: soccer) coaches (34 males and 5 females) training boys in age groups 8–12 years were included in this study. Data were collected using an attitude statement questionnaire, and the assertions were based upon current recommendations and guidelines. Results : The results revealed significant differences among coaches in terms of knowledge of important aspects of strength training for youth. Conclusions : The results suggested that coaches in the present study were not aware of the latest recommendations and guidelines regarding strength training for youth.

Non-medical use of prescription drugs (NMUPD) is increasing among the general population, particularly among teenagers and young adults. Although prescription drugs are considered safer than illicit street drugs, NMUPD can lead to detrimental consequences. The aim of the present study was to investigate the relationship between drug use (NMUPD on the one side, illicit street drugs on the other side) with mental health issues and then compare these associations. A representative sample of 5719 young Swiss men aged around 20 years filled in a questionnaire as part of the ongoing baseline Cohort Study on Substance Use Risk Factors (C-SURF). Drug use (16 illicit street drugs and 5 NMUPDs, including sleeping pills, sedatives, pain killers, antidepressants, stimulants) and mental health issues (depression, SF12) were assessed. Simple and multiple linear regressions were employed. In simple regressions, all illicit and prescription drugs were associated with poorer mental health. In multiple regressions, most of the NMUPDs, except for stimulants, were significantly associated with poorer mental health and with depression. On the contrary, the only associations that remained significant between illicit street drugs and mental health involved cannabis. NMUPD is of growing concern not only because of its increasing occurrence, but also because of its association with depression and mental health problems, which is stronger than the association observed between these problems and illicit street drug use, excepted for cannabis. Therefore, NMUPD must be considered in screening for substance use prevention purposes.

Objective: With advances in knowledge about health promotion, public health professionals are in search for the determinants of personal health behaviors. The purpose of this study was to assess the prevalence of health behaviors and its associated factors in a sample of Indian university students. Materials and methods: Using a cross-sectional survey, we assessed health behavior among a sample of randomly selected university students. The sample included 800 university students from non-health (mainly engineering and sciences) undergraduate courses of Gitam University, Visakhapatnam in India. The students were 541 (67.6%) males and 259 (32.4%) females in the age range of 17–20 years (Median age=18.2 years, SD=1.0). Results: On average, students engaged in 15.8 out of 25 health behavior practices. There was a high rate of overweight and obesity (26.8% and 10.7%, respectively), low rate of brushing teeth at least twice a day (28.6%), annual dental check-up (25.8%), habitual seatbelt use (23%), and poor dietary patterns (79% ate less than the recommended fruit and vegetable consumption of five servings a day, and 68.5% did not avoid eating fat and cholesterol). In multivariate analysis among men, personal constraints (Odds Ratio=OR 1.75, Confidence Interval=CI 1.09–2.82), health benefits (OR=2.01, CI=1.27–3.17), and not suffering from depression (OR=0.60, CI=0.22–0.94) were associated with the health behavior index. Among women, those who were living away from their parents or guardians (OR=1.94, CI=1.06–3.55), economically better off (OR=2.16, CI=1.00–4.63), and had higher social support (OR=3.65, CI=1.75–7.63), were associated with the health behavior index. Discussion: Students had a high proportion of health behavior practices. Several high health risk practices were identified, including overweight, poor dental practices, poor dietary and sleeping habits. It is hoped that the gender-specific predictors identified, including sociodemographics as well as social and mental health variables, can also be utilized in designing health promotion programs.

Purpose: To describe the relation between global Quality of Life (QL) and psychiatric symptoms in adolescents with systemic lupus erythematosus (SLE) and familial Mediterranean fever (FMF), and to analyze the perceptions of parents and adolescents. Methods: This study included 51 adolescents diagnosed with SLE (n=25) and FMF (n=26), and 51 healthy adolescents. The Health Related QL (HRQL) of SLE patients was rated by parents and adolescents using the Simple Measurement of Impact of Lupus Erythematosus in Youngsters © (SMILEY © ). The global QL of FMF patients and healthy adolescents was rated by the response given to the first question of the SMILEY © by each parent and adolescent. All participants completed the Brief Symptom Inventory (BSI), which measures psychiatric symptoms. Results: In total, 92.3% with FMF, 56% with SLE and 76.5% of healthy adolescents reported their global QL as good and very good using the first question of the SMILEY © . The global QL perceptions of adolescents and their parents did not correlate (FMF, p=0.94; SLE, p=0.16). SLE patients had the highest rate of depression (54.2%), whereas hostility was detected among 54.9% of healthy adolescents. Significant relations were detected between BSI and SMILEY © scores. Conclusion: The global QL perceptions of adolescents with FMF were better than those of healthy adolescents, which may be explained by their perceived relief of anguish they suffer during their short-lived attacks. The global QL perceptions of adolescents with SLE were the worst, most probably due to the chronic course resulting in an awareness of limitations and intense treatment. Adolescents with SLE had similar psychopathological symptom scores when compared with FMF patients and healthy adolescents. This could be explained by developing resilience. Differences in the perception of adolescents versus their parents regarding global QL emphasized the importance of adolescent-specific interviews for chronic illnesses and multidisciplinary follow-up with adolescent medicine.

Background: Adolescence is a crucial stage of life. The development and practice of various risk behaviors predisposes the risk of getting injured and consequences in later life. Study methods: This cross-sectional study was conducted among 381 adolescents (15–19 years) studying in different schools and colleges of Udupi. The Youth Risk Behavior Survey (YRBS), Center for Disease Control (CDC) Questionnaire and the Atlanta Questionnaire and Guidelines was adopted for data collection. Behaviors such as poor obeying traffic rules while driving, violence at school premises, and suicidal thoughts of the participants were explored. Univariate analysis followed by multivariate logistic regression was done to estimate the predictors of violence-related behavior using the Statistical Packages for Social Sciences (SPSS) v. 20. Results: In our study, 27.03% of students (total=381) had knowledge of traffic rules in detail, where 65% drove a motorized vehicle. Nearly 75% of students did not use a helmet or seatbelt while driving and 17% used a mobile phone for either talking or texting while driving. Considering all violence risk behaviors, 33.07% of students had at least and 18% had at least two violence-related risk behaviors. Nearly 21.78% thought of hitting somebody, 16.34% of boys and 9.5% of girls carried sharp objects to school, 18.81% of boys and 10.39% of girls damaged or stole other students’ property, 18.37% bullied others in the past month at the school campus, and 11.32% were involved in serious fights. Out of 381 students, 114 (30.32%) were bullied, 10% had been slapped intentionally, and 18% of girls felt unsafe to go out of their home because of threat compared with 15% of boys. In total, 71 (18.93%) students thought of suicide and 22 of them attempted it. Logistic regression showed that boys [odds ratio (OR): 1.72, 95% confidence interval (CI): 1.02–2.93) and students of 16 years of age (OR: 3.02, 95% CI: 1.06–9.02) affected or victimized by violent activities at school (OR: 3.23, 95% CI: 1.76–5.93) and bullied by others (OR: 2.6, 95% CI: 1.55–4.36) were determining factors for violence-related behaviors after adjusting for other variables. Conclusion: There is a need to identify students at risk and for intervention addressing the risk factors. Further qualitative studies could provide more insight.

Objective: Polycystic ovary syndrome (PCOS) is linked with metabolic syndrome, which includes obesity, insulin resistance, dyslipidemia, and endocrine function in patients with PCOS. The aim of this study was to determine the prevalence of adolescent PCOS and characteristics associated with PCOS in adolescents in Babol, Iran. Materials and methods: A cross-sectional study was conducted on 1549 girl high school students aged 16–20 years who were living in Iran. After overnight fasting, blood samples were collected to determine hormones and lipid levels in PCOS patients between the first and fifth days of their menstrual period or withdrawal bleeding. Results: The overall prevalence of adolescent PCOS was 129 (8.3%) (95% CI; 4.0, 12.0). Irregular menstruation was observed in 24.1% of adolescents. A total of 68% of PCOS adolescents had insulin resistance. Compared with non-PCOS adolescents, the OR of adolescent PCOS for family history of hirsutism was 1.53 (95% CI, 1.06–2.20; p=0.024), family history of irregular menstrual cycle was 2.27 (95% CI, 1.56–3.30; p<0.001), menarche age <13 years was 1.95 (95% CI, 1.36–2.81; p<0.001), hirsutism was 1.14 (CI 95%, 1.10–1.17; p<0.001), acne was 5.10 (CI 95%, 3.52–7.40; p<0.001), and wrist circumference was 1.28 (CI 95%, 1.07–1.54; p=0.007). Conclusion: The presenting findings showed the high prevalence of PCOS among Iranian adolescents. Emphasis should be placed on clinical screening in adolescents with high-risk factors, including irregular menstrual, menarche <13 years, hirsutism, acne, high wrist circumference, and paternal obesity to help reduce the risk of developing metabolic disturbance and to find ways to improve long-term health.

This study examined whether relational stressors such as psychosocial stressors, the therapist’s absence and a change of therapist are associated with repeat aggressive or self-harming incidents in child and adolescent psychiatric inpatient care. The study data were derived from critical incident reports and chart reviews of 107 inpatients. In multinomial regression analysis, patients with repeat aggressive or self-harming incidents were compared with patients with single incidents. Results suggested that a higher number of psychosocial stressors and a change of therapist, but not the therapist’s absence are predictors for repeat aggressive and self-harming incidents. There was a high prevalence of therapist’s absence during both, single and repeat, incidents. Repeat aggressive incidents were common in male children and adolescents with disruptive behavior disorders. Repeat self-harming incidents were common in adolescent females with trauma-related disorders. Patients with repeat aggressive or self-harming incidents had a higher number of abnormal intrafamilial relationships and acute life events than patients with single incidents. Interventions to reduce a change of therapist should in particular target children and adolescents with a higher number of psychosocial stressors and/or a known history of traumatic relational experiences. After a first incident, patients should have a psychosocial assessment to evaluate whether additional relational support is needed.

Background: Effect of life skills on physical activity behavior of adolescents is little explored. Objective: To assess impact of life-skills training on the level of physical activity amongst adolescents. Methods: A nonrandomized interventional study with a control group. All students studying in Class IX and XI of two schools in Delhi were included. Data was collected at baseline, 15 days and 3 months after the life-skills training. Two life-skills training sessions were conducted for each standard following collection of baseline data. Results: There were 180 students in the intervention and 183 students in the control group. A significant increase was noted in the level of light-moderate, vigorous physical activity, and stretching and strengthening exercises (p<0.001) in an intervention group over the period of 3 months following the training. The number of students enrolled in physical education classes also increased. Conclusions: A skills-based approach helped to improve the level of physical activity amongst the school adolescents.

Objective: The purpose of this study was to determine the risk of dental caries in relation to oral hygiene habits and food intake among women at university in Saudi Arabia. Methods: A sample of 935 undergraduate university women was selected from the King Abdulaziz University in Jeddah, Saudi Arabia. A previously pretested questionnaire was used to collect the data. Odds ratios were calculated to estimate the risk of dental caries associated with oral hygiene and food intake. Results: The findings revealed that women who cleaned their teeth three times or more per day mostly cleaned their teeth after intake of sweets and chocolates, and had no gingivitis were at less risk of dental caries than other women (p=0.029, p=0.000 and p=0.000, respectively). The intake of milk, fruit and vegetables on 4 days or more per week was found to protect against dental caries (odds ratios=0.34, 0.64 and 0.73, respectively), whereas the intake of chocolate and soft drinks for the same period was found to be a risk factor for dental caries (odds ratios=1.8 and 1.4, respectively). Conclusion: The results of this study are useful for public health intervention programs to combat dental caries in the Saudi community.