Developing a scale : adolescents' health choices related rights, duties and responsibilities

Background: Adolescents´ health choices have been widely researched, but the ethical basis of these choices, namely their rights, duties and responsibilities, have been disregarded and scale is required to measure these. Objective: To describe the development of a scale that measures adolescents´ rights, duties and responsibilities in relation to health choices and document the preliminary scale testing. Research design: A multi-phase development method was used to construct the Health Rights Duties and Responsibilities (HealthRDR) scale. The concepts and content were defined through document analysis, a systematic literature review and focus groups. The content validity and clarity of the items were evaluated by expert panel of 23 adolescents, school nurses and researchers. We then calculated the content validity index and the content validity ratio at on item and scale levels. Preliminary testing was conducted with 200 adolescents aged 15-16 years. Descriptive statistics, Cronbach´s alpha correlation and statistics for the item-analysis were calculated. Ethical considerations: Ethical approval and permission were obtained according to national legislation and responsible research practice was followed. Informed consent was obtained from the participants and the parents were informed about the study. Findings: The HealthRDR scale comprises of four sub-scales with 148 items: 15 on health choices, 36 on rights, 47 on duties and 50 on responsibilities. The items had a 0.93 content validity index and a 0.85 content validity ratio. The Cronbach alpha correlation coefficient was 0.99 for the total scale and the individual sub-scales scores were: health choices (0.93), rights (0.97), responsibilities (0.99) and duties (0.98). Discussion: The findings are discussed in light of the ethical concepts and validity and reliability of the developed scale. Conclusion: The HealthRDR scale defines and understands adolescents´ rights, duties and responsibilities in relation to health choices and has good content validity. Further testing and refinement of the concepts are needed

Adolescent survey non-response and later risk of death. A prospective cohort study of 78 609 persons with 11-year follow-up

<p>Abstract</p> <p>Background</p> <p>Non-response in survey studies is a growing problem and, being usually selective, it leads to under- or overestimation of health outcomes in the follow-up. We followed both respondents and non-respondents by registry linkage to determine whether there is a risk of death, related to non-response at baseline.</p> <p>Methods</p> <p>Sample data of biennial surveys to 12-18-year-old Finns in 1979–1997 were linked with national death registry up to 2001. The number of respondents was 62 528 (79.6%) and non-respondents 16 081 (20.4%). The average follow-up was 11.1 years, totalling 876 400 person-years. The risk of death between non-respondents and respondents was estimated by hazard ratios (HR).</p> <p>Results</p> <p>The number of deaths per 100 000 person-years were 229 in non-respondents and 447 in respondents (HR 2.0, 95% CI: 1.5–2.6). The hazard ratios of death were for intoxication 3.2 (95% CI: 1.9–5.4), for disease 3.1 (95% CI: 2.2–4.1), for violence-related injury 2.0 (95% CI: 1.5–2.6) and for unintentional injury 1.8 (95% CI: 1.3–2.4) in non-respondents vs. respondents. The association between non-response and death increased with age at baseline, and the increase persisted after the age of 25.</p> <p>Conclusion</p> <p>Our study demonstrated significantly increased rates of death among adolescent non-respondents in a follow-up. The highest hazard ratios were seen in disease- and violence-related deaths. The death rate varied between respondents and non-respondents by death type. Increased rates of death persisted beyond the age of 25.</p

Adolescents' health and health behaviour as predictors of injury death. A prospective cohort follow-up of 652,530 person-years

<p>Abstract</p> <p>Background</p> <p>Injuries represent an important cause of mortality among young adults. Longitudinal studies on risk factors are scarce. We studied associations between adolescents' perceived health and health behaviour and injury death.</p> <p>Methods</p> <p>A prospective cohort of 57,407 Finns aged 14 to 18 years was followed for an average of 11.4 years. The end-point of study was injury death or termination of follow-up in 2001. The relationships of eight health and health behaviour characteristics with injury death were studied with adjusted Cox's proportional hazard model.</p> <p>Results</p> <p>We identified 298 (0.5%) injury deaths, 232 (0.9%) in men and 66 (0.2%) in women. The mean age at death was 23.8 years. In the models adjusted for age, sex and socioeconomic background, the strongest risk factors for injury death were recurring drunkenness (HR 2.1; 95% CI: 1.4–3.1) and daily smoking (HR 1.7; 95% CI: 1.3–2.2). Poor health did not predict injury death. Unintentional and intentional injury deaths had similar health and health behavioural risk factors.</p> <p>Conclusion</p> <p>Health compromising behaviour adopted at adolescence has a clear impact on the risk of injury death in adulthood independent from socioeconomic background. On the other hand, poor health as such is not a significant predictor of injury death. Promotion of healthy lifestyle among adolescents as part of public health programmes would seem an appropriate way to contribute to adolescent injury prevention.</p

Lifestyle behaviours of young adult survivors of childhood cancer

This cross-sectional study collected baseline data on the health behaviours of a large population of survivors of childhood cancer in the UK, aged 18–30 years, compared with those of sex- and age-matched controls. Data from 178 young adult survivors of childhood cancer, diagnosed and treated at Bristol Children's Hospital, 184 peers from the survivors' GP practices and 67 siblings were collected by postal questionnaire. Conditional logistic regression analysis showed that, for matched sets of survivors and controls, survivors of a variety of childhood cancers reported lower levels of alcohol consumption (P=0.005), lower levels of cigarette smoking (P=0.027) and lower levels of recreational drug use (P=0.001) than controls. Analysis of matched sets of survivors and siblings showed similar trends but no significant differences. A health behaviour index for each participant was constructed from the data collected on five key health behaviours which influence future health status. Comparison of the means for each case group showed that survivors of childhood cancer were leading healthier lives than controls or siblings. This finding was expressed most clearly as the difference in the means of the health behaviour index for each case group, derived from five health behaviours (one-way ANOVA, P<0.001)

Response rates and selection problems, with emphasis on mental health variables and DNA sampling, in large population-based, cross-sectional and longitudinal studies of adolescents in Norway

Background Selection bias is a threat to the internal validity of epidemiological studies. In light of a growing number of studies which aim to provide DNA, as well as a considerable number of invitees who declined to participate, we discuss response rates, predictors of lost to follow-up and failure to provide DNA, and the presence of possible selection bias, based on five samples of adolescents. Methods We included nearly 7,000 adolescents from two longitudinal studies of 18/19 year olds with two corresponding cross-sectional baseline studies at age 15/16 (10th graders), and one cross-sectional study of 13th graders (18/19 years old). DNA was sampled from the cheek mucosa of 18/19 year olds. Predictors of lost to follow-up and failure to provide DNA were studied by Poisson regression. Selection bias in the follow-up at age 18/19 was estimated through investigation of prevalence ratios (PRs) between selected exposures (physical activity, smoking) and outcome variables (general health, mental distress, externalizing problems) measured at baseline. Results Out of 5,750 who participated at age 15/16, we lost 42% at follow-up at age 18/19. The percentage of participants who gave their consent to DNA provision was as high as the percentage that consented to a linkage of data with other health registers and surveys, approximately 90%. Significant predictors of lost to follow-up and failure to provide DNA samples in the present genetic epidemiological study were: male gender; non-western ethnicity; postal survey compared with school-based; low educational plans; low education and income of father; low perceived family economy; unmarried parents; poor self-reported health; externalized symptoms and smoking, with some differences in subgroups of ethnicity and gender. The association measures (PRs) were quite similar among participants and all invitees, with some minor discrepancies in subgroups of non-western boys and girls. Conclusions Lost to follow-up had marginal impact on the estimated prevalence ratios. It is not likely that the invitation to provide DNA influenced the response rates of 18/19 year olds. Non-western ethnicity, male gender and characteristics related to a low social class and general and mental health problems measured at baseline are associated with lost to follow-up and failure to provide DNA

Social inequalities in changes in health-related behaviour among Slovak adolescents aged between 15 and 19: A longitudinal study

<p>Abstract</p> <p>Background</p> <p>Lower socioeconomic position is generally associated with higher rates of smoking and alcohol consumption and lower levels of physical activity. Health-related behaviour is usually established during late childhood and adolescence. The aim of this study is to explore changes in health-related behaviour in a cohort of adolescents aged between 15 and 19, overall and by socioeconomic position.</p> <p>Methods</p> <p>The sample consisted of 844 first-year students (42.8% males, baseline in 1998 – mean age 14.9, follow-up in 2002 – mean age 18.8) from 31 secondary schools located in Kosice, Slovakia. This study focuses on changes in adolescents' smoking, alcohol use, experience with marijuana and lack of physical exercise with regard to their socioeconomic position. Four indicators of socioeconomic position were used – adolescents' current education level and employment status, and the highest education level and highest occupational status of their parents. We first made cross tabulations of HRB with these four indicators, using McNemar's test to assess differences. Next, we used logistic regression to assess adjusted associations, using likelihood ratio tests to assess statistical significance.</p> <p>Results</p> <p>Statistically significant increases were found in all health-related behaviours. Among males, the most obvious socioeconomic gradient was found in smoking, both at age 15 and at 19. Variations in socioeconomic differences in health-related behaviour were more apparent among females. Although at age 15, almost no socioeconomic differences in health-related behaviour were found, at age 19 differences were found for almost all socioeconomic indicators. Among males, only traditional socioeconomic gradients were found (the lower the socioeconomic position, the higher the prevalence of potentially harmful health-related behaviour), while among females reverse socioeconomic gradients were also found.</p> <p>Conclusion</p> <p>We confirmed an increase in unhealthy health-related behaviour during adolescence. This increase was related to socioeconomic position, and was more apparent in females.</p

Refined mapping of X-linked reticulate pigmentary disorder and sequencing of candidate genes

The original publication can be found at www.springerlink.comX-linked reticulate pigmentary disorder with systemic manifestations in males (PDR) is very rare. Affected males are characterized by cutaneous and visceral symptoms suggestive of abnormally regulated inflammation. A genetic linkage study of a large Canadian kindred previously mapped the PDR gene to a greater than 40 Mb interval of Xp22–p21. The aim of this study was to identify the causative gene for PDR. The Canadian pedigree was expanded and additional PDR families recruited. Genetic linkage was performed using newer microsatellite markers. Positional and functional candidate genes were screened by PCR and sequencing of coding exons in affected males. The location of the PDR gene was narrowed to a ∼4.9 Mb interval of Xp22.11–p21.3 between markers DXS1052 and DXS1061. All annotated coding exons within this interval were sequenced in one affected male from each of the three multiplex families as well as one singleton, but no causative mutation was identified. Sequencing of other X-linked genes outside of the linked interval also failed to identify the cause of PDR but revealed a novel nonsynonymous cSNP in the GRPR gene in the Maltese population. PDR is most likely due to a mutation within the linked interval not affecting currently annotated coding exons.Lane J. Jaeckle Santos, Chao Xing, Robert B. Barnes, Lesley C. Ades, Andre Megarbane, Christopher Vidal, Angela Xuereb, Patrick S. Tarpey, Raffaella Smith, Mahmoud Khazab, Cheryl Shoubridge, Michael Partington, Andrew Futreal, Michael R. Stratton, Jozef Gecz and Andrew R. Zin