Volume 30, Issue 3

Background: The use of e-cigarettes (ECs) is rising globally. There is concern that e-cigarette may actually lead to smoking, especially amongst adolescents. Objective: To perform a comprehensive review of literature reporting the longitudinal effects of e-cigarette use on onset of smoking among adolescents and young adults. Methods: A search was conducted using PubMed, Google Scholar, Scopus, and Web of Science in February 2016 to identify the studies containing data on EC use among adolescents and young adults (age<30 years). We then narrowed our search to only include longitudinal studies with data on EC and conventional cigarette smoking among this population. Results: Four longitudinal studies were identified that analyzed the use of ECs and smoking at both baseline and follow-ups in the target population. These studies demonstrated that EC use is associated with an increase in combustible cigarette smoking, even amongst the adolescents who were not susceptible to smoking. Conclusion: This review highlights the strong evidence that not only are ECs are not an effective tool for smoking cessation among adolescents, they actually are associated with higher incidence of combustible cigarette smoking. Policy makers need to recognize of the insidious nature of this campaign by the tobacco industry and design policies to regulate it.

Background: Globally, young people account for 15.5% of the total global disability-adjusted life-years burden for all age groups. They face mental health, nutritional problems, accidental and intentional injuries, sexual and reproductive health problems, and substance abuse. These health challenges have effects on their oral health. This paper discusses the oral health problems adolescents face and suggests approaches for providing integrated oral and general health care for adolescents. Discussion: Oral health issues linked with adolescent health concerns include: malocclusion and esthetic concerns linked with mental health status; oral and maxillofacial injuries linked with accidental and intentional injuries; oral manifestations of sexually transmitted infections; oral leukoplakia and oral cancers linked with alcohol, tobacco and psychoactive substance abuse; and oral manifestations of anemia resulting from nutritional problems. Training oral health care providers on adolescent health and care could promote prompt diagnosis, management and prevention of complications associated with major health challenges affecting adolescents. Conclusion: Adolescent oral health care needs focused attention: as a possible route for early diagnosis and management of general health problems and for promoting adolescent oral health care. Oral health care should be integrated into adolescent friendly services and oral health care providers should learn how to handle adolescents’ health needs.

Background: Adolescent pregnancy has been associated with poor pregnancy outcomes including pre-term birth (PTB), low birth weight (LBW) and perinatal death. Objective: To systematically review the effect of adolescent-specific interventions on reducing PTB, LBW, and perinatal death and increasing prenatal care attendance. Search strategy: Possible studies for inclusion were identified by a comprehensive search of OvidSP MEDLINE (limits: humans, 1990–present), EMBASE (limits: humans, 1990–2015), Popline and Global Health Database from the World Health Organisation (WHO) and PubMed International scientific databases, and references of identified articles were searched from 1990 to present. Selection criteria: All types of controlled studies of prenatal interventions were exclusive to adolescents and at least one of the outcomes of interest. Data collection and analysis: Investigators identified relevant studies and entered the data in a pro forma. Data were summarised as forest plots and narrative synthesis. Main results: Twenty-two studies (three randomised controlled trials (RCTs), four prospective cohort studies, nine retrospective cohort studies, five case controls and one natural experiment) were included with all but one study being carried out in higher-income countries. Seven of the 16 studies reporting on PTB found a statistically significant reduction in PTB rates between adolescent-specific prenatal care (intervention) and non-age specific prenatal care odds ratio (OR) and 95% confidence intervals (CIs) ranged from OR: 0.15 (95% CI: 0.03–0.83) to OR: 0.59 (95% CI: 0.45–0.78). Nine of the 12 studies reported statistically significant higher mean prenatal attendance rates among the intervention group compared to controls (ranging from a mean number of visits of 14.3 vs. 10.7 p<0.001 to 10.8 vs. 7.6 visits p<0.001). The type and construct of the interventions, their implementation and local population differed sufficiently that a statistical synthesis was deemed inappropriate. Conclusion: There is some evidence that adolescent-specific programs can increase prenatal attendance and reduce the risk of PTB and low birth rate but their effect on perinatal death is uncertain. There is a distinct lack of evidence of the effectiveness of these interventions for adolescents living in low-middle income countries, despite having the majority of adolescent pregnancies, and associated risk of harm. No high-quality intervention studies were identified. Robust, cluster-based RCTs are an urgent necessity to quantify the impact of these interventions and to identify factors contributing to their success.

Background: International guidelines recommend planned and structured transition programmes for adolescents with chronic illness because inadequate transition may lead to poor disease control and risk of lacking outpatient follow-up. Objective: To investigate the feasibility of a transition intervention aimed at adolescents with chronic illness focusing on declines, drop-outs, no-shows and advantages and disadvantages of participating. Methods: We invited 236 adolescents (12–20 years) with juvenile idiopathic arthritis (JIA) to participate in a randomised controlled trial (RCT) transition intervention. Reasons for decline and drop-outs were calculated. Adolescents’ experiences of advantages and disadvantages of participating and reasons for no-shows were investigated through focus groups and telephone interviews, which were analysed using thematic analysis. Results: One hundred and twenty of the 236 eligible patients declined to participate in the intervention and 20% dropped out during the intervention. Unspecified declines and practical issues were the most common reason to decline, and ‘do not wish to continue’ was the most common reason to drop-out. Reasons for no-shows were forgetting and being too busy. Advantages of participating were stated as ‘participating without parents’, ‘trust and confidentiality’, ‘being able to set the agenda’ and ‘responsiveness’. Disadvantages were ‘unclear aim of the study’, ‘meeting others with JIA’, ‘too few conversations’ and ‘transport issues’. Conclusions: Many adolescents had difficulties understanding the aim of the intervention. However, most participants appreciated the conversations about identity as well as the trust and confidentiality in the communication. In the future, adolescents should be offered more individually organised programmes according to their preferences and needs in cooperation with parents and health care providers.

Background: Menarche age is an indicator of a girl’s puberty besides the clinical assessment of detecting deviations. This study aimed to search the pattern of menarche age (normal, early and late) and its relationship with some demographic characteristics in girls and their parents. Methods: This cross-sectional study was done on girls aged between 9 and 18 years old in Shiraz city. About 2000 students were selected through cluster sampling. Data collection was done by applying a demographic information form. Finally, the data were analyzed using SPSS software. Results: About 1386 students (69.3%) had the history of menarche (at least once). The mean age of menarche was 12.26±1.11 years in Shiraz. The menarche age of the girls ranged from 9 years (as the least) to 15 (as the maximum). The prevalence of late menarche was 1.1%. In addition, no early menarche was reported. There was no relationship between menarche age and economic status, birth order and number of children, but a significant relationship was found between the parents’ education, house status, and the lifestyle of parents. Conclusion: The mean menarche age has been decreasing in cities. Therefore, it seems necessary for the families to be aware about the influence of time, trend and affecting factors on menarche; this helps them to make good decisions when educating their teenagers.

Background: Complex factors influence adolescents’ attitudes. Secondary sexual development and emotional changes are markers of puberty and affect attitudes toward reproductive health (RH). This is especially evident in the society and culture of Indonesia. This study examined the presence of immaturity at puberty and factors associated with negative attitudes toward RH among Indonesian adolescents. Methods: We conducted a cross-sectional study with 1040 students (aged 11–16 years) selected using multistage random cluster sampling. Data were collected using a self-administered questionnaire that included the illustrative questionnaire for interview surveys with young people and the pubertal development scale (PDS), modified in accordance with the Indonesian context. Data analysis used descriptive and comparative statistics and logistic regression analyses. Results: Immature pubertal development was higher in boys [22.7%, 95% confidence interval (CI): 14.7%–30.7%] than girls (18.4%, 95% CI: 11%–25.7%). However, negative attitudes were higher in girls (40.6%, 95% CI: 34.3%–46.8%) than boys (37.1%, 95% CI: 29.9%–44.7%). Factors associated with negative attitudes toward RH in both boys and girls were age, RH communication with parents, and pubertal development. Smoking was an additional factor in boys, whereas living in an urban area was an additional factor in girls. High knowledge about RH was associated with less negative attitudes toward RH in both boys and girls. Conclusion: Immaturity and factors that influence negative attitudes toward RH should be explored during puberty. Improving knowledge about RH may help to prevent negative attitudes toward RH, especially for girls in urban areas and boys with smoking habits.

Background: Suicidal ideation, defined as thoughts, ideas and the desire to commit suicide, is becoming a major public health problem among adolescents. Indeed, suicidal ideation is known as a key predictor of future suicide risk. Objective: This study aims to determine the prevalence and risk factors associated with suicidal ideation among adolescents in Malaysia. Methods: This study used data from the 2013 Malaysian adolescent health risk behavior (MyAHRB) study, a cross-sectional school survey conducted in Peninsular Malaysia among school-going adolescents aged 16–17 years (n=2789). Logistic regression analysis was used to determine the risk factors associated with suicidal ideation among Malaysian adolescents. Results: The overall prevalence of suicidal ideation among the adolescents was 6.2%. The prevalence was significantly higher among females than males (7.6% vs. 4.7%; p=0.002). Multivariate regression analysis revealed that adolescents who were females [odds ratio (OR)=2.02; 95% confidence interval (CI): 1.40–2.92] or of Indian ethnicity (OR=2.32; 95% CI: 1.35–3.98) were more likely to report suicidal ideation. Loneliness (OR=2.54; 95% CI: 1.57–4.11), anxiety or worry (OR=2.70; 95% CI: 1.70–4.31), no close friends (OR=2.71; 95% CI: 1.43–5.14), and lack of supportive peers (OR=1.69; 95% CI: 1.15–2.47) were identified as risk factors for adolescents’ suicidal ideation. Adolescents who ever had sexual intercourse (OR=2.70; 95% CI: 1.48–4.92) and had been in a physical fight (OR=2.45; 95% CI: 1.62–3.70) were also reported to have higher risks of suicidal ideation. Conclusion: This study provides evidence on risk factors associated with suicidal ideation among Malaysian adolescents. Targeted mental health and health risk behavioral interventions for high-risk adolescents are recommended.

Objective: Psychological state may affect the body weight through the hypothalamus and vice versa. The goal of this study is to investigate whether body mass index affect mindfulness awareness (MA) levels and type of coping with stress. Methods: Healthy adolescents were included in the study. The mindfulness attention awareness scale (MAAS), indicating the ways of coping checklist inventory was performed and body mass index (BMI) (kg/m 2 ) of adolescents were calculated. The influence of BMI on MA and ways of coping with stress was tested. According to BMI percentiles the study population was grouped as obese (including overweight), normal-weighted and underweight. Results: A total of 270 adolescents (mean age: 13.63±2.07 years; 165 female/105 male) participated in the study. No significant correlation was found between BMI and MA scores (r=−0.085; p=0.161) and coping strategies were not different between the groups. When MA scores are compared with stress coping methods, it appeares that participants with high awareness levels chose positive coping styles. Conclusion: BMI is not effective on MA levels and choice of stress coping methods. But the higher MA levels are associated with positive coping styles.

Background: Many adolescents are exposed to a significant amount of sexual content in the media. This has far-reaching effects on their sexual practices as this exposure is occurring at a period when most adolescents are often not sure of the choices to make, and the choices they make during adolescence affect their health when they become adults. The aim of this study was to assess the association between exposure of in-school adolescents to sexual content in the electronic media and their sexual intentions. Methods: In this cross-sectional study, information was obtained from 750 senior secondary school students in private and public schools using interviewer-administered questionnaire. Sexual media content in the movies, music video and Internet was assessed using a modified version of the sexual media diet tool. The dependent variable was sexual intention; the main independent variable was exposure to sexually explicit content in the media and confounders that were controlled for selected individual (age, sex, religiosity, self-esteem and attachment to parents), family (parents’ marital status, parents’ type of marriage, hands-on parenting and parent-adolescent communication on sex) and environmental factors (school connectedness and influence from peers) which were previously reported to be associated with sexual intentions of adolescents. Chi-square test was used to determine associations between sexual content of the electronic media and adolescents’ sexual intentions, and confounders were controlled for using logistic regression analysis. Results: Thirty-six percent of respondents were exposed to overtly explicit sexual content from all forms of media in the 3 months prior to this study. Twenty-four percent of the adolescents indicated their intention to have sex within 12 months following the study. Predictors of sexual intention were as follows: moderate [odds ratio, OR=2.21 (95% confidence interval, CI: 1.22–3.99)] and high exposure to sexual content in the media [OR=3.02 (95% CI: 1.69–5.43]; attending a public school [OR=2.19 (95% CI: 1.26–3.83)]; moderate peer pressure [OR=2.36 (95% CI: 1.41–3.95)] and high peer pressure [OR=10.32 (95% CI: 2.94–36.31)]; and previous history of sexual intercourse [OR=3.89 (95% CI: 2.25–6.76)]. Conclusion: Many adolescents were exposed to sexually explicit content in the media and this had a strong association with sexual intention. Interventions to censor sexually explicit content in the media are required to protect adolescents from the consequences of early exposure to sex.

Background: Working adolescents, with less experience and less training than adults, may take more risks and get exposed to a wide variety of toxic substances in the workplace. They may get injured when working in inadequately ventilated areas or entering areas of exposure with improper or no protective equipment. Objective: The purpose of this study was to describe adolescent occupational exposures reported to poison centers. Subjects: Occupational exposures reported to Texas poison centers during 2000–2015 where patients were 13–19 years in age. Methods: The distribution of the cases was determined for various factors. Results: There were 2430 adolescent occupational exposures. The most frequently reported major substance categories were chemicals (18%), household cleaning substances (18%), hydrocarbons (10%), and industrial cleaners (9%). Forty-five percent occurred during May–August. Males accounted for 66% of the patients; 27% were 18 years and 37% were 19 years. The most common exposure routes were inhalation (28%), dermal (27%), ingestion (26%), and ocular (24%). The patients were managed on site in 51% of the exposures. Twenty-three percent of the exposures had serious outcomes. Conclusion: Adolescents involved in occupational exposures tended to be male and older. Adolescent occupational exposures were likely to involve chemicals and household cleaning substances, occur by ingestion and ocular route, and likely to be managed on site. Most were not likely to have serious outcomes.

Purpose: The aim of this cross-sectional study was to describe and analyze accelerometer-measured sedentary time and physical activity (PA) among adolescents in a multicultural area characterized by low socioeconomic status (SES). Method: Seventh-graders (n=114 (girls n=66), mean age: 12.8±0.5 y) were recruited from three schools in a multicultural area of the city of Gothenburg, Sweden. Sedentary time and PA were measured with ActiGraph™ accelerometers. Result: Of total wear-time, 70 (±6)% was sedentary, with girls being more sedentary than boys. Girls had less light PA (LPA) and moderate-to-vigorous PA (MVPA) than boys. Similar patterns were shown during in-school and out-of-school hours. During wear-time, 53% had a mean of ≥60 min of MVPA per day, but only 6% of the girls and 24% of the boys were sufficiently physically active every day. Girls had more sedentary bouts of ≥10 min and fewer MVPA bouts of ≥5 min per day than boys. Those who participated in organized sports spent a mean of 15 more minutes of MVPA per day compared to those who did not. No association was observed between body mass index (BMI) and sedentary time and PA. Conclusion: Only a few adolescents from a Swedish multicultural area characterized by low SES met the PA recommendations every day, and girls were more sedentary and less physically active than boys. Adolescents involved in organized sports had more of MVPA per day than their non-involved peers. Sedentary time and PA were not related to BMI.

Purpose: Approximately one third of adolescents in the United States report experiencing frequent headaches and stomachaches. We examined the association of psychosocial and physical factors with the report of weekly headaches or stomachaches using a representative sample of US teens. Methods: Data for this project are from the survey of Health Behavior in School-Aged Children (HBSC), 2005–2006, a nationally representative sample of students in grades 6–10 in the United States. The total sample includes 12,070 students aged 11–17. Using logistic regression we modeled chronic headache and stomachache separately with the same set of physical predictors (dieting and substance use habits) and psychosocial predictors (attitudes towards self-image, peers, and family) along with demographic controls. Results: Almost 20% of respondents experienced headaches weekly, and 12% experienced abdominal pain. Both physical and psychosocial factors were predictive of chronic symptoms. Increased substance usage and unhealthy eating practices were associated with the likelihood of experiencing both headaches and stomachaches. Negative self-image, family relationships, and school life were also predictive of symptom frequency. Conclusion: Headaches and stomachaches are associated with poor eating and substance use habits, as well as problems with self-image or social relationships among adolescents. For health care professionals, a holistic approach is needed to effectively address symptoms and prevent long-term health problems.

Learning how to cook is an important skill for developing healthy eating behaviors. Moreover, involvement in home cooking may offer young people opportunities for skill building, identity development and social engagement with their families. Recently, there have been concerns that the current generation of young people may not have the opportunities to develop sufficient cooking skills. These concerns have been addressed by the initiation of numerous, localized interventions. Yet, little is known about where the current generation of young people learn cooking skills. The objective of this study was to describe where the current generation of young people report learning to cook, drawing on nationally representative data from New Zealand. Data were collected as part of Youth2012, a nationally representative survey of secondary school students (n=8500) in New Zealand. Almost all students reported learning to cook and from multiple sources. Almost all students reported learning to cook from a family member (mother, father, or other family member), approximately 60% of students reported that they learned to cook from certain media (cookbooks, TV, or the Internet) and half of all students reported learning to cook at school. There were numerous differences in where students learned to cook by socio-demographic characteristics. Findings from the current research highlight the important role that families play in teaching young people to cook and will be useful for those working with young people to develop these skills.

There are many case reports of unusual foreign bodies found in the urinary bladder. Most of these are self-inserted. Mostly these foreign bodies were inserted as a result of sexual curiosity or sexual perversion but there may be other reasons like psychiatric problems. The treatment is individualized and determined by the size, location, shape, nature and mobility of the foreign body. Here we report a peculiar case of a headset in urinary bladder.