Volume 30, Issue 6

Background Pride and shame are important emotions known to influence identity development and psychological well-being in adolescence. Research evidence indicates that self-rated health (SRH) is a strong predictor of future health. This cross-sectional study, conducted during 2008–2009, aimed to investigate the associations between pride, shame and SRH among adolescent boys and girls. Methods The study sample comprised 705 adolescents in Sweden aged 17–18 years (318 boys and 387 girls) who completed a questionnaire that included items on SRH, shame and pride (participation rate 67%). Logistic regression analyses (univariable and multivariable) were used to investigate the associations between pride and shame as separate and combined constructs on SRH, adjusting for potential confounders (country of birth, parental educational level, school experience, having enough friends, mood in family and being active in associations). Results Pride and shame separately were significantly associated with SRH in both genders. Logistic regression analysis of the pride-shame model showed that the odds of having lower SRH were highest in boys and girls with lower pride-higher shame. In a multivariable logistic regression analysis of the pride-shame model the odds of having lower SRH remained significant in boys and girls with lower pride-higher shame [boys: odds ratio (OR) 3.51, confidence interval (CI) 1.40–8.81; girls: OR 2.70, CI 1.22–5.96] and in girls with lower pride-lower shame (OR 2.16, CI 1.02–4.56). Conclusion The emotions of shame and pride are associated with SRH in adolescence. Experiencing pride seems to serve as a protective mechanism in SRH in adolescents exposed to shame. We believe that this knowledge should be useful in adolescent health promotion.

Background Illicit substance use among college students represents one of the most complicated social problems. Studying its predictors could help deal with this problem more efficiently. Aims To determine the prevalence of life time illicit substance use and its predictors among Tunisian college students. Methods A cross-sectional study was conducted in five colleges in the region of Sousse, Tunisia in the 2012–2013 school year. A sample of 556 college students responded to an anonymous self-administrated questionnaire. Collected data concerned socio-demographic characteristics and substances use. Results The mean age of students was 21.8 ± 2.2 years. Females represented 51.8% of participants. Among respondents: 31 (5.6%) had used illicit substance at least once. Cannabis was the main substance used by 26 (4.7%) students. The average age of the illicit substance use initiation was 19 (±2.5) years while it was almost 17 (±3) years for both tobacco and alcohol use initiations. Proportions of male students and academic failure were significantly more important among illicit substance users than among non users. While the most influential factors on illicit substance use were: alcohol use, tobacco use and low socioeconomic level. Conclusion This study highlights the strong association between the other risk behaviors and illicit drug use. Future interventions should focus on the whole risk behaviors simultaneously at late adolescence with regard to the environmental context.

Aim This study clarified the characteristics of life habits of obese Japanese male students at the National Colleges of Technology, Japan. Materials and methods Healthy students aged 15–19 years answered a questionnaire containing 21 items on the following five categories of life habits: general exercise, meals, sleeping, leisure activity and illness or injury history. The subjects were divided into three groups based on the criteria of body mass index (BMI) and body fat percentage (%BF): non-obese (%BF < 20%, n = 420), overweight obese (%BF ≥ 20% and BMI ≥ 25, n = 99), and hidden obese (%BF ≥ 20% and BMI < 25, n = 60). The mean differences in waking time, bedtime and amount of time spent walking, sleeping and watching TV per day were examined using one-way analysis of variance (ANOVA) and chi-square tests for each item. Results The overweight obese and hidden obese groups engaged in less exercise time, were more likely to eat until they were full at meals and were less likely to eat between meals or late at night than the non-obese group. In addition, the non-obese group had significantly later waking times and significantly less TV-watching time than the overweight obese group. There were no significant differences with respect to leisure activity and illness or injury history among the three groups. Many students in all groups had regular waking times and were not performing any leisure activities. Conclusion The findings suggest that obese students may need further guidance to help them maintain a healthy life and appropriate weight.

Introduction Until now, the services provided to Iranian youth have been prepared based on authorities’ perspectives and according to the resources and reports from other countries and international agencies. Using youth perspectives to provide health, however, helps in continuing the process of providing health services, and most young people will receive these services. Objective To explain perception of youth and key individuals to improve health programs for safe transition in Iran. Methodology This study is a qualitative research with a grounded theory approach. Data were collected using semi-structured in-depth interviews and group discussions. Participants were first selected by purposive sampling and then by theoretical sampling. Overall, 67 adolescents aged 14–18 years, eight youths aged 19–24 years, 12 parents and important persons involved in providing health services joined the study. Young participants and their parents were selected from different training areas of Tehran and the key individuals were from the Ministry of Health and Medical Education and the Education Department. Collecting samples were continued to saturation. The Strauss and Corbin (2008) method was used for data analysis. Result In this study, the phenomenon of adolescents’ confusion to manage puberty emerged. This process, with appropriate strategies, such as the mobilization of available resources in the community and comprehensive programming to provide health services by policymakers, could have provided youth empowerment as an impact to self-care. Conclusion Current services provided by health centers cannot guarantee the health of adolescents, but it does require proper planning and management in families, schools and societies.

Background Cigarette smoking among adolescents and its consequences are categorized as serious health problems. Cigarette craving is influenced by various psycho-social factors. Objective This study aimed to investigate desire and intention to smoke based on mindfulness and emotional self-regulation in adolescents. Methods In this correlational study conducted based on structural equation modeling, a sample of 350 male students was randomly selected from different schools of education districts in Isfahan. Three questionnaires, including Hooked on Nicotine Checklist, emotional regulation inventory, and Mindful Attention Awareness Scale were employed. Data were analyzed using χ 2 , correlation coefficient and structural modeling tests. In this regard, SPSS and AMOS software were used. Results The results showed that 62% of male students had experienced cigarette smoking at least once. There was a significant inverse correlation between cigarette craving and emotional reappraisal (r = −0.48), expressive suppression (r = −0.58) and mindfulness (r = −0.55), respectively (p < 0.01). In addition to the direct effect, mindfulness through emotional self-regulation had indirect effects on nicotine craving. A total of 58% of the variance in nicotine craving was explained by the study variables. Conclusion The results showed that the high percentage of male students hooked on smoking is an important issue. In this regard, students’ psychological issues such as efficient mechanisms of emotional regulation and their knowledge of the risks of smoking must be addressed by authorities and families.

Purpose This study investigated the prevalence of Internet addiction (IA) and cyberbullying and examined profiles of adolescents with increased risk to develop pathological behaviors. Methods In this cross-sectional, school-based study, 8053 students of 30 middle and 21 high schools (12–18 years old) were invited to participate, based on a multistage stratified random sampling technique. The Internet aiddiction test (IAT) was used along with information on socio-demographics, Internet activities and cyberbullying experience. Results Five thousand five hundred and ninety students participated (response rate 69.4%). Pathological Internet use (IAT ≥50) was found in 526 (10.1%), while 403 (7.3%) experienced cyberbullying as victims and 367 (6.6%) as perpetrators during the last year. In multivariable models, the odds of IA increased with online hours on mobile phones and Internet use during weekends, Internet café visits, chatrooms usage and engagement in cyberbullying. Cyberbullying victims were more likely to be older, female, Facebook and chatrooms users, while perpetrators were more likely to be male, older Internet users and fans of pornographic sites. A perpetrator was significantly more likely to have also been a victim [odds ratio (OR) = 5.51, confidence interval (CI): 3.92–7.74]. Hours of daily Internet use on a mobile phone was independently associated with IA and cyberbullying (OR) 1.41, 95% CI 1.30, 1.53 and OR 1.11, 95% CI 1.01, 1.21, respectively. Conclusions Cyberbullying is associated with IA and the hours spent online on a mobile phone affected both conditions. The increasing Internet access through mobile phones or other devices should be accompanied by the appropriate education of both parents and adolescents on safe Internet use.

Musculoskeletal disorders are common in those employed in the textile industry. The aim of the study is to assess musculoskeletal disorders among adolescent girls who are current employees of textile industries in comparison with the adolescent girls and young women who are past employees of textile industries and adolescent girls who have never been employed in the textile industry. Methodology This is a cross-sectional study. A total of 321 subjects, 107 in each study group were sampled. Standardized nordic questionnaires (SNQ) was used to assess musculoskeletal symptoms. Results More than half of the current employees (67.28%) and past employees (67.28%) reported musculoskeletal pain. Among the never been employed, 18.69% reported musculoskeletal pain. Neck and shoulder were the most common sites of musculoskeletal pain among the current employees (49.5% and 50.5%, respectively) and the past employees (45.8% and 49.5%, respectively). In the regression model, having ever been diagnosed for anemia (AOR 6.57, 95% CI 1.4 to 30.76), working for more than 48 h in a week (AOR 3.37, 95% CI 1.53 to 7.41) and the presence of depression (AOR 6.6, 95% CI 1.48 to 29.36) were significantly associated with the presence of musculoskeletal pain in the study participants. Conclusion Musculoskeletal disorders are a major occupational health problem among the adolescent and young women employees of textile industries. Working hours should be fixed at 48 h per week and anemia and depression should be treated to avert the work related musculoskeletal disorders in the study population.

Introduction Maternal attitudes have been shown to impact adolescent girls’ sexual decision making and attitudes towards contraception. Given the potential for maternal influence on adolescent contraceptive use, we undertook an exploratory study of mothers’ perceptions of the maternal role in adolescent contraceptive decision making, and maternal perceptions of long acting reversible contraceptives (LARC) for adolescent girls. Materials and methods We utilized a mixed methods study design. Acceptability of contraceptive methods and attitudes towards adolescent contraceptive use were assessed using a paper survey of 162 mothers of girls aged 11–19 years in Cleveland, Ohio, USA. Seven survey participants completed subsequent semi-structured interviews, which were analyzed using grounded theory methodology. Results Pills, condoms and injections were most frequently selected as acceptable by 55.4%, 55.4%, and 51.6% of women, respectively. One or more LARC methods were selected by 16.6% of the women. Of those (94.4%) agreed or strongly agreed that, “It is expected of me to make sure that my daughter knows about birth control methods.” Important themes that emerged during interviews were the responsibility mothers felt to help their daughters navigate contraception options, appreciation of the effectiveness of LARC methods and concerns about the use of those methods by teenagers due to the invasiveness. Conclusion Our data suggest that mothers want to be involved and support adolescent decision making about contraceptives. We also found that mothers viewed LARC as less acceptable than other forms of birth control for adolescents and have specific concerns about LARC. These results suggest directions for future work to better characterize the impact of maternal attitudes on adolescent LARC use.

Background While severe obesity in childhood poses the greatest long-term health risks, access to treatment is a common barrier. The present pilot study examined the effect of a 7-week low-dose physical activity (PA) intervention on PA and body mass index (BMI) in severe obese adolescents delivered via telephone and mail. Methods Adolescents (n = 64) receiving care from a pediatric obesity medical clinic were randomized to a control (n = 30) or intervention (n = 34) group. Height and weight were measured and BMI z-scores were calculated. PA was assessed by a pedometer. All measurements were completed pre- and post-intervention. The intervention group received weekly newsletters and telephone calls discussing various PA topics based on motivational interviewing for 7 weeks. The control group received no contact. A series of 2 × 2 (group by time) repeated measures analysis of covariances (ANCOVAs) adjusting for length of time between visits were performed to examine the effect of the intervention on PA and BMI z-scores. Results The majority of adolescents were severely obese (77%, BMI: > 99th percentile). Intention-to-treat analysis revealed intervention effects were not observed for either pedometer steps or BMI z-score (p > 0.05). Among those with complete data, adolescents who successfully changed their BMI z-score had larger BMI z-score changes than those who did not change their BMI z-score (p = 0.0001). This improvement was due to something other than PA as the change in BMI z-score was similar among those who did and did not successfully increase PA levels (p > 0.05). Conclusions More intensive, comprehensive, and longer-term treatment is needed in this high risk population.

Background and objective Sex maturity rating (SMR), defines different levels of sexual maturity, based on the development of secondary sexual characteristics. Periodic assessment of pubertal maturation by physicians is crucial for timely identification of puberty-related disorders. With this pilot study, we aimed to assess the attitudes, knowledge and practices of pubertal assessment by current US pediatric trainees. Methods An anonymous online survey questionnaire was sent to categorical pediatric residents at different levels of training and pediatric chief residents across the US. Results We received responses from 2496 pediatric residents from all over the US. We found that 96% of trainees understand the importance of assessing SMR, 62% feel confident in assessing it and 55% feel comfortable assessing the need for an endocrinology referral. Only 33% of trainees performed external genital exams during all regular clinic visits while 26.9% never performed them during sick visits and 6% never assessed SMR during any of the patient visits. Higher levels of training and having completed an endocrinology rotation were associated with improvement in comfort level, practice and knowledge of trainees regarding pubertal assessment. Conclusion This study revealed that the current clinical practices of performing external genital exams and SMR among pediatric residents need improvement. Stronger reinforcement from continuity clinic preceptors and/or online and clinic based resources for SMR assessment for trainees may improve adherence to the recommended guidelines.

Depression among adolescents is increasing and worrying because of its morbidity and mortality from suicide. It has been found to be associated with negative parental styles. The objective of this study was to determine the relationship between perceived negative parental styles and depressive symptoms among adolescents in Hulu Langat District, Selangor, Malaysia. A cross-sectional study was carried out on 1769 secondary school students by using a multistage cluster sampling method. Data were collected by using a set of validated, pre-tested and standardized questionnaires which included the Measures of Parental styles (MOPS) and modified Depression, Anxiety and Stress Scale 12 (DASS-12) for adolescents. Data were analyzed by using the chi-square test, Pearson’s correlation coefficient and independent t-tests. Out of 1800, 1769 completed the questionnaire giving a response rate of 98.3%. The prevalence of severe depressive symptoms was about 14% while 18.0% and 36.1% of respondents have moderate and mild depressive symptoms, respectively. There were significantly moderate and positive correlations between perceived indifferent parents (Father: r = 0.367; Mother: r = 0.340, p < 0.05), perceived abusive parents (Father: r = 0.338; Mother: r = 0.331, p < 0.05) and depressive symptoms among the respondents. While perceived over control parents shows a significantly positive but weak correlation (Father: r = 0.206; Mother: r = 0.244, p < 0.05) with depressive symptoms among respondents. All types of parental styles in this study were significantly different among respondents with different categories of depressive symptoms (p < 0.008). Perceived negative parental styles have significant influence on adolescents’ depressive symptoms. Intervention on modifying parental style is needed to reduce depressive symptoms.

Objective 1) To assess the incidence of cardiovascular disease (CVD) risk factors in a university population, and 2) to investigate the effects of an 8-week exercise intervention on CVD risk factors. Methods Forty-six students participated in this study. Baseline cardiorespiratory fitness was assessed using maximal oxygen uptake (VO 2 max). Total cholesterol, high-density lipoprotein (HDL)-cholesterol and triglycerides were measured. Body mass index (BMI), waist-to-hip circumference ratio (WHR), blood pressure (BP) and arterial stiffness were also assessed. Participants performed 8weeks of exercise consisting of 60 min of moderate-high intensity exercise three times a week, and all parameters were repeated following the 8-week program. Results Participants were divided into an apparently healthy control group (BMI < 25 kg/m 2 ) and an overweight/obese experimental group (BMI ≥ 25 kg/m 2 ). Both groups had low cardiorespiratory fitness and clear evidence of risk for CVD. Following the 8-week program, participants demonstrated significant improvement in biochemical parameters and in overall fitness (p < 0.05). WHRs decreased whilst peak oxygen volumes increased when comparing baseline and post-exercise values (p < 0.05). BMI decreased in both groups following exercise (p < 0.05). Systolic BP was surprisingly elevated in nearly 30% of participants, but was comparatively lower in the control group (p < 0.05). There was a clear increase in HDL-cholesterol values post-intervention (p < 0.05). Conclusion Early detection of CVD risk factors, particularly in a young population, can lead to earlier prevention of disease through lifestyle changes. Moreover, short-term exercise can have important effects on reducing CVD risk factors, improving body composition and overall cardiorespiratory fitness.