Volume 31, Issue 2

Aim Adolescence is a developmental period often associated with high-risk behaviors. While some risk-taking behavior is considered normative in adolescents, research has indicated an association between risky behaviors and mental ill-health. The current research aimed to examine the relationship between anxiety and depression with the occurrence of high-risk behaviors in adolescents and also determine the predictive factors of these main variables. Methods A descriptive, cross-sectional, correlational design was used to collect data from 399 adolescents between the ages of 14 and 19 residing in Qazvin, Iran using the Revised Child Anxiety and Depression Scale (RCADS) and the Iranian Adolescents Risk-taking Scale (IARS) between the period of October and November 2015. Data analysis included descriptive and inferential statistics powered by SPSS (v. 23). Results Mean scores for anxiety, depression and risky behaviors were 37.70 ± 21.11 and 80.76 ± 31.30, respectively. Participants’ frequency of suicidal thoughts ( β  = 0.126, p < 0.05) positively predicted anxiety and depression, while age ( β  = −0.126, p < 0.01) and self-confidence ( β  = −0.307, p < 0.001) negatively predicted anxiety and depression. Moreover, having friends that smoke ( β  = 0.366, p < 0.001), suicidal thoughts ( β  = 0.127, p < 0.01), and the strength of suicidal thoughts ( β  = 0.100, p < 0.05) were positive predictors of occurrence of risky behaviors. Furthermore, religious belief ( β  = −0.204, p < 0.001) negatively predicted occurrence of risky behaviors in Iranian adolescents. Male respondents were more likely to have higher level of occurrence of risky behaviors than females ( β  = −0.193, p < 0.001). Conclusion Findings of the present study suggest that anxiety and depression positively and significantly predict the occurrence of risky behaviors in addition to having friends that smoke, suicidal thoughts, and strong suicidal thinking. The implications of these findings have relevance for screening, prevention, and treatment interventions targeting mental health in adolescents.

Background Bullying is a worldwide problem with varying consequences. Victims of school bullying may be targeted for many reasons including their appearance. They may also fear school and have difficulties in concentration. Objective This study aimed to determine the prevalence of bullying amongst adolescents in Kano, Northern Nigeria, the contribution of physical features and the perceived effect of bullying on their academic performance and school attendance. Subjects and methods Eight hundred and thirty-five students aged between 12 years and 17 years from eight randomly selected secondary schools in Kano, Nigeria took part in this study. Data collection was by self-administered questionnaires and analysis was by SPSS version 17. Results The pupils’ mean age and standard deviation was 14.79 + 1.53 years. There were more male and private school pupils with 55.1% and 62%, respectively. About 43% of respondents reported being victims of bullying while about 32% had bullied someone else. There was more bullying in public schools than in private schools (p-value = 0.003). However, there was no significant gender difference (p > 0.05). More bullied pupils hated being in or outside the classroom (p < 0.05). Similarly, significantly higher number of bullied pupils played truant than non-bullied (p < 0.001). One-fifth of the victims of bullying felt it had consequences on their academic performance. Bullies frequently targeted general physical and dento-facial appearance. Conclusion The prevalence of bullying was high among the sampled population especially within public schools. This also had a significant negative effect on the students’ academic performance.

Background The Epworth Sleepiness Scale (ESS) is an 8-item scale to detect excessive daytime sleepiness. Although its psychometric properties are well established on a number of populations the same has not been done for an Indian population, hence this study was designed to cover this knowledge gap. Aims The purpose of this study was to establish the test-retest reliability, validity and internal consistency of the ESS and its correlation with the Pittsburgh Sleep Quality Index (PSQI) in poor sleepers in India. Materials and methods Twenty-five poor sleepers were randomly chosen from a university population. All the subjects were administered the two scales on the test day and the same was repeated after 1 week, which was the retest. Statistical analysis Intraclass coefficient (ICC) and standard error of measurement (SEM) were calculated for the reliability which was further supported by the Bland-Altman graph and a scatterplot. Cronbach’s alpha and Pearson’s coefficient were calculated for internal consistency and correlation, respectively. Results Twenty-five poor sleepers with mean age 25.24 ± 7.04 years were recruited. The test-retest reliability for ESS displayed good reliability (ICC 2,1 : 0.86) which was supported by the Bland-Altman graph and the scatterplot. Cronbach’s alpha was reported as 0.86 and Pearson’s coefficient was r : 0.62, p-value: 0.001. Conclusion The results suggest that the ESS has good internal consistency and test-retest reliability for a university population of poor sleepers in India.

Background Adolescence is the period of accepting self-care responsibility. Many severe diseases that cause early mortality are rooted in adolescence. Hence, adolescence is the definitive time for preventive interventions such as self-care behaviors. In addition to the benefits of self-care behaviors, evidence shows that adolescents face barriers in performing self-care behaviors. Objective The aim of the current study to review the self-care challenges for adolescents. Methods Databases such as Google Scholar, ScienceDirect, PubMed, Web of Science, Scientific Information Database and Scopus were searched to extract papers published from 1994 to 2016 based on the inclusion criterion. The inclusion criterion was English language papers from famous authors on self-care behaviors in adolescents. Results The results of the current study showed that adolescents face cultural (two subcategories, beliefs and convictions, knowledge), socio-economic (five subcategories, family, healthcare providers, peers, social support, economic status) and personal (three subcategories, mental health, gender, ethnicity) challenges. Conclusions Self-care behaviors in adolescents are influenced by biological, psychological, economic and social factors. As this is a multifactorial process, people who deal with adolescents should have enough knowledge regarding adolescent health status and also learn how to perceive the role of culture in self-care behaviors of the adolescents.

Objective To examine the prevalence of and factors associated with sexual behavior and pregnancy involvement among adolescents in foster family homes. Methods A cross-sectional study was conducted among a random sample of children living in foster family homes. Logistic regression with Firth’s correction was used to determine factors associated with sexual risk behavior and pregnancy involvement (i.e. having been pregnant or gotten someone pregnant). Results About half of adolescents (aged 13–18 years) in foster family homes ever had sex, of whom, one third had first sex before the age of 14 and one sixth had two or more sexual partners in the past 3 months. Of adolescents in the study, 9% had ever been pregnant or gotten someone pregnant. Although adolescents in foster family homes had higher rates of sex initiation and pregnancy involvement than those in the general population, the two groups had comparable rates of current sexual risk behavior. Being placed in kin/fictive kin foster homes [odds ratio (OR): 3.04; 95% confidence interval (CI): 1.18–7.80] and number of placement settings (OR: 1.20; 95% CI: 1.02–1.42) were associated with multiple sexual partners, while a history of running away from a foster home (OR: 7.64; 95% CI: 1.87–31.18) was associated with pregnancy involvement. Conclusions Efforts targeting placement stability including prevention of running away may reduce sexual risk behavior and pregnancy involvement among adolescents in foster family homes.

Purpose To further understand the association between body dissatisfaction and sadness/loneliness among adolescent girls, we examine how this association, as reported by pre-teen and adolescent girls, is mediated or moderated by the quality of peer and family relationships. Methods Our data are from the Health Behavior of School-Aged Children 2009–2010, a nationally representative survey of school-aged children in the US. We analyze a sample of 5658 girls in Grades 5 through 10. We utilize ordinary least squares (OLS) regression techniques and adjust for the complex sampling design. We explore how the link between body dissatisfaction and sadness/loneliness is mediated or moderated by family and peer relationships and also include controls for age, race, media exposure, and physical health. Results We find that body dissatisfaction is predictive of sadness/loneliness for girls at all grade levels and that the quality of peer and family relationships mediates 27%–38% of this association, particularly among early adolescent girls. Positive peer relationships also moderate or help mitigate the association between body dissatisfaction and sadness/loneliness among pre-teens. Conclusion Our findings underscore the association between body dissatisfaction and sadness/loneliness among early adolescent girls. In addition, our results highlight the importance of quality peer and family relationships in terms of how girls think about their bodies and respond emotionally to them. To evaluate feelings of sadness and loneliness among early adolescent girls, health care professionals need to consider not only body dissatisfaction but also the context of peer and family relationships.

For the first time in 50 years, traffic fatalities have increased in the United States (US). With the emergence of technology, comes the possibility, that distracted driving has contributed to a decrease in safe driving practices. The purpose of this study was to describe the content on the popular video sharing site, YouTube to ascertain the type of content conveyed in videos that are widely viewed. The 100 most widely viewed English language videos were included in this sample, with a collective number of views of over 35 million. The majority of videos were television-based and Internet-based. Pairwise comparisons indicated that there were statistically significant differences between the number of views of consumer generated videos and television-based videos (p = 0.001) and between television-based videos and Internet-based videos (p < 0.001). Compared with consumer generated videos, television-based videos were 13 times more likely to discuss cell phone use as a distractor while driving, while Internet-based videos were 6.6 times more likely to discuss cell phone use as a distractor while driving. In addition, compared with consumer generated videos, television-based videos were 3.67 times more likely to discuss texting as a distractor while driving, whereas Internet-based videos were 8.5 times more likely to discuss texting as a distractor while driving. The findings of this study indicate that the videos on YouTube related to distracted driving are popular and that this medium could prove to be a successful venue to communicate information about this emergent public health issue.

Background Youth friendly health services (YFHS) are services that attract, respond to the needs of and retain young people for continuing care. This study was conducted to determine the factors affecting utilization of government (GYFF) and non-governmental youth friendly facilities (NGYFF) in Lagos state, Nigeria. Methods A descriptive cross-sectional study was conducted. A total of 543 adolescents aged 15–24 years, between August 1, 2014 and October 31, 2014 were consecutively recruited from 10 (five government and five non-governmental) youth friendly health facilities that had been in operation for at least 6 months prior to the study. Logistic regression was used to determine predictors of utilization of youth friendly health facilities. Results Overall, the mean age of respondents was 17.9 ± 2.8. However, the mean age of respondents at GYFF (18.5 ± 3.0) was significantly higher than those at NGYFF (17.1 ± 2.5) (p < 0.001). Of the 567 youths enrolled, 196 (34.6%) had good utilization of youth friendly facilities (YFF) (34% from the GYFF and 35.2% from the NGYFF). Marital status, school attendance, having a baby, satisfaction with visit, perception that information shared was kept confidential and accessibility of the youth friendly services were associated with utilization of YFF (p < 0.05). Confidentiality and access to facilities were predictors of utilization of YFF. Conclusion There is poor utilization of both government and non-governmental youth friendly services in Lagos, Nigeria. There is a need for both the government and private sector to harmonize resources aimed at encouraging utilization of YFF in Lagos, Nigeria.

Background Given the high prevalence of overweight and obesity in Iran, identification of a healthy diet is essential. Objective This study aimed to assess the association between adherence to a Mediterranean diet and overweight and obesity in female adolescents. Methods Two hundred and eighty female adolescents from high schools in Tehran were recruited. General information, physical activity and food frequency questionnaires were completed. Adherence to the Mediterranean diet was evaluated using the Mediterranean Style Dietary Pattern Score (MSDPS). Results Under and over reporters of energy intake were excluded from the analysis (n = 37). Results indicated that prevalence of overweight and obesity was 13.3% and 12.5%, respectively. The mean of MSDPS was low in this population (15.99 ± 5.64). The MSDPS was positively associated with mother’s education level and energy intake (p < 0.05). No significant relation was observed between MSDPS and overweight and obesity among adolescents. However, there was a negative significant association between MSDPS and WHR just among students who had educated mothers [high: second median v. low: first median, odds ratio (OR) = 0.36, 95% confidence interval (CI) = 0.12–1.03]. Conclusion Adherence to a Mediterranean dietary pattern is low among adolescent females in Tehran, with no association with overweight and obesity.

The aim of this study was to examine the effects of daytime sleepiness on depression and suicidal ideation in adolescent high-school students. A survey of 538 high school students aged 16–17 years attending two academic schools was conducted. The Epworth Sleepiness Scale (ESS), the Beck Depression Inventory and the Scale for Suicide Ideation were used to assess subjects’ daytime sleepiness, depression and suicidal ideation. The mean score for daytime sleepiness was 8.52, which indicates a sleep deficit. Significant positive correlations were found between daytime sleepiness and depression, between daytime sleepiness and suicidal ideation and between depression and suicidal ideation. Gender and depression were significant predictors of suicidal ideation, accounting for 48% of the variance in this measure. Depression acts as a mediator of the relationship between daytime sleepiness and suicidal ideation. High school students in Korea generally have insufficient sleep time and feel sleepy during the day; insufficient sleep during adolescence may be associated with depression and suicidal ideation.

Background In recent years, high-risk sexual behaviors due to their negative consequences both for the individual and society have received more attention than other high-risk behaviors. Objective The aim of this study was to review the influencing factors of high-risk sexual behaviors among young people from an ecological point of view. Methods This review was conducted through searching databases including PubMed, Web of Science, Scopus, Google Scholar and the Cochrane Library with keywords such as sexual risk-taking behavior, high-risk sex, unprotected sex and unsafe sex. The relevant papers published between 1995 and 2016 were extracted. After reviewing the abstract and full text of the articles, 45 papers were used to write this article. Results From an ecological theory approach, factors which influence high-risk sexual behaviors are divided into three categories – the microsystem, the mesosystem and the macrosystem. The microsystem includes factors such as age, gender, race, marital status, place of residence, religion, level of education, personality traits, psychological problems, childhood experiences, body image and coincidence of high-risk behaviors; the mesosystem includes factors such as family structure, peers and sex education; in the macrosystem, the impact of culture and traditions of the society, economic status and the media are presented. Conclusion Given that high-risk sexual behaviors often have multiple causes, it seems that health policymakers must consider multi-dimensional interventions to influence high-risk sexual behaviors based on the ecological approach.

This report describes a decade long initiative to bring a unified approach and improved quality to the process and content of adolescent health care in a large and complex urban primary care network within an academic health system. The moving force was a voluntary multidisciplinary group who comprised the Montefiore Adolescent Primary Care Initiative, known as MAPCI, led by a physician subspecialist in Adolescent Medicine. A series of needs assessments formed the basis for a multipronged effort to create policies and procedures, educational activities and materials, changes in record-keeping and billing practices, and modification of staff attitudes and behavior that would enhance access and ensure confidentiality of services for the adolescent age group. The commitment of medical center leadership contributed to overall progress which was accelerated in the second half of the decade by the addition of a full-time staff member, with the title Adolescent Program Manager. Progress in various arenas was assessed with a series of planned studies, whose positive results provided encouragement for continuing efforts. The example of this initiative and its accomplishments should provide useful and replicable methods that could be adapted for improvement of adolescent health services in some of the other large primary care networks that are an ever-expanding presence in the current health care environment.

Background There is strong evidence that the mean age of menarche has declined over the last few decades in developed and developing countries. This is of a major concern because of its enormous public health implications. This study aimed to estimate the age of menarche in Kuwait and investigate the association between menarcheal age and academic performance among high school girls in Kuwait. Methods A cross-sectional study was conducted on randomly selected female high school students from private and public high schools in all governorates in Kuwait. Data on the age of menarche were collected by self-administered questionnaire from the students, while data on academic performance were extracted from the students’ academic records. Results Of the 907 students we selected, 800 (88.2%) responded. The mean age of menarche was 12.33 [95% confidence interval (CI) 12.18–12.49] years. There was no evidence for significant association between age of menarche and students’ academic performance before or after adjusting for potential confounders. Conclusion The calculated age of menarche among contemporary girls in Kuwait is similar to that of the girls in industrialized countries. Early menarcheal age is unlikely to lead to adverse behavior that may affect academic performance in our setting.

Bicycle crashes are the second most common sports- or recreation-associated cause of serious injury. While the literature suggests that wearing protective helmets can significantly decrease risks associated with bicycle-related injuries, overall helmet use remains sub-optimal. A recent study by Chow et al. suggested that helmet-wearing rates in adolescent boys are negatively correlated with age. The aim of this study was to determine if similar trends are observed in a co-educational high school setting. A questionnaire was circulated at Unionville High School, a co-ed public high school in Markham, Canada. Of the 144 participants, 27 of them were in Grade 9 or 10, and 117 of them were in Grade 11 or 12. While there was no statistical difference between helmet-wearing rates in Grade 9–10 and Grade 11–12 students, overall usage rates were low (41% and 38%, respectively, for recreational cyclists). This trend is interesting, considering that nearly 90% of all students were aware that wearing a helmet while cycling is required under Ontario law. Further studies should be conducted among the young adult population to determine whether the alarming trends discovered by this study and Chow et al. continue.