Alessio Zambon

School-based prevention for illicit drugs use: a systematic review

OBJECTIVE To evaluate the effectiveness of school-based interventions in preventing or reducing drug use. METHODS The search strategy was conducted according to the Cochrane Collaboration method, and applied to MEDLINE, EMBASE, ERIC, PSYCHINFO, Cochrane Library, ACP Journal Club, Cochrane Drugs and Alcohol Group Register. RCTs and CCTs evaluating school-based interventions designed to prevent substance use were reviewed. Data were extracted independently by two reviewers. Quality was assessed. Interventions were classified as skills, affective, and knowledge focused. RESULTS 29 RCTs were included; 28 were conducted in the USA; most were focused on 6th-7th grade students. Compared with usual curricula, skills-based interventions significantly reduce marijuana use (RR=0.82; 95% CI: 0.73, 0.92) and hard drug use (RR=0.45; 95% CI: 0.24, 0.85), and improve decision-making skills, self-esteem, peer pressure resistance (RR=2.05; 95% CI: 1.24, 3.42) and drug knowledge. Compared with usual curricula, affective interventions improve decision-making skills and drug knowledge, and knowledge-focused programs improve drug knowledge. Skills-based interventions are better than affective ones in improved self-efficacy. No differences are evident for skills vs. knowledge-focused programs on drug knowledge. Affective interventions improve decision-making skills and drug knowledge to a higher degree than knowledge-focused programs. CONCLUSION Skills-based programs help to deter drug use. Well designed, long-term randomised trials, and evaluation of intervention components are required.

Socioeconomic effects on meeting physical activity guidelines: comparisons among 32 countries

PURPOSE This study examined the relationship between age and gender with physical activity (PA) and how meeting of PA guidelines (PAGL) is related to socioeconomic status (SES) and sedentary behaviors (SB). METHODS Data were collected from 11-, 13-, and 15-yr-old students in 32 countries participating in the Health Behaviour in School-aged Children (HBSC) survey 2001/2002. A self-completed questionnaire assessed weekly moderate-to-vigorous physical activity (MVPA) and SB for the past 7 d and MVPA for a typical week. SES was assessed using the Family Affluence Scale (FAS). RESULTS None of the countries averaged enough MVPA to meet PAGL. The pattern of MVPA across age and gender was consistent among all countries. In all countries, older children were less active when compared with the youngest children; girls were significantly less active than boys were (mean hours per week of MVPA 3.52 +/- 1.88 vs 4.13 +/- 1.95) and were more likely to not meet the PAGL. SES was significantly associated with the amount of reported MVPA. SES and PAGL were not significantly related in seven countries, and a significant decrease in the influence of age was observed in these countries compared with other countries. CONCLUSIONS Levels of MVPA during adolescence showed consistent patterns across countries in relation to age, gender, and social class. The limited effect of age on PA in countries where the influence of social class was less strong suggests the possibility of a moderating effect of context in the development of habits acquired during childhood.

The role of behavioural factors in explaining socio-economic differences in adolescent health: A multilevel study in 33 countries

Attempts to describe and explain socio-economic differences in health have mainly focused on adults. Little is known about the mechanisms of the relationship between socio-economic status (SES) and health in adolescence including inconsistent findings between SES and health among young people. Data were derived from representative samples of 13 and 15-year-old students in 33 European and North American countries (n=97,721) as part of the Health Behaviour in School-aged Children (HBSC) study 2001/2002. Multilevel logistic regression models were used to investigate socio-economic differences in self-rated health among adolescents and the contribution of health-related behaviours to the explanation of such differences. Odds ratios of self-rated health by family affluence were calculated before and after adjustment for behavioural factors (tobacco smoking, physical activity, television use, breakfast intake, consumption of fruits and vegetables). On average, adolescents from low affluent families had an odds ratio for low self-rated health of 1.84 for boys and 1.80 for girls, compared to those from high affluent families. The majority of behavioural factors were significantly associated with family affluence in all countries and explained part of the relationship between self-rated health and family affluence. Smoking, physical activity and breakfast consumption showed the largest independent effect on health. The present study suggests that behavioural factors in early adolescence partly account for the association between self-rated health and socio-economic status. Prevention programmes should target unhealthy behaviours of adolescents from lower socio-economic groups to help prevent future life-course disadvantages in terms of health and social inequalities.

The contribution of club participation to adolescent health: evidence from six countries

Background: Social networks have been recognised as an important factor for enhancing the health of people and communities. Bridging social capital, characterised by numerous and varied weak ties, exemplifies a particular type of network that can help people reach their goals and improve their health. This study seeks to contribute to the evidence base on the use of positive social networks for young people’s health by exploring the importance of club participation in predicting the health and health-related behaviours of 15-year-old girls and boys across Europe and North America. Methods: Data are derived from a 2005–6 World Health Organization collaborative study, to establish the relationships between different types of club and a range of health outcomes (self-perceived health, wellbeing and symptoms) and health-related behaviours (smoking, drinking). Multi-level logistic regression was used to assess the independent effects of club participation by controlling for gender and socioeconomic position. Data were compared across six countries. Results: All the considered outcomes, both in terms of perceived health and wellbeing and health behaviours were associated with participation in formal associations. The associations are in the expected direction (participation corresponding to better health) except for some particular association types. Conclusions: Participation in formal associations seems supportive for good health and health behaviours in adolescence, and should be promoted in this age group.

Socio-economic position and adolescents' health in Italy: the role of self- esteem and self-efficacy

Background : To underline the importance of self-esteem and self-efficacy as aspects of health promotion, we investigated the hypothesis that self-esteem and self-efficacy mediate the effect of socio-economic position on adolescents’ health. This association has been confirmed by our data. Methods : Data derive from the international Health Behaviours in School-aged Children (HBSC) study, 2001- 02 edition: a representative sample of Italian children (age groups of 11, 13 and 15years, N=4386) was administered a questionnaire at school. We tested with a multivariate model the effect of economic wellbeing on health and behavioural outcomes, first excluding, and then including, self-esteem and self-efficacy among the determinants. Results : Perceiving poorer health, not eating enough fruits and vegetables and doing too little physical activity are conditions affected by economic well-being (O.R. of best-off to worst-off are 0.65, 0.83 and 0.46, all statistically significant), while smoking habit is not affected. Including self-esteem and self-efficacy into the model significantly lowers, or annihilates, the effect of economic conditions on these outcomes. Conclusions : Economic well-being affects adolescents’ health (perceived health and health behaviours) in Italy, but it is reasonable to hypothesize that self-esteem and self-efficacy are among the mediators of this effect. Targeted interventions aimed at enhancing self-esteem and self-efficacy could therefore help in mitigating the effect of health inequalities.

Improving childrens self-esteem and perceived social related abilities: the evaluation of a school-based program

Background and Objective : Health education programmes delivered in school settings are often design to enhance child self–esteem or various social skills in order to improve the way that they interact in every day life. Although these are becoming increasingly frequent, little is known about the real efficacy of many of the available programs that claim to be able to positively develop these psychologica dimensions. This study, which takes a Public Health approach, examines the effect of a school-based educational programme, designed following the WHO recommendations, in order to favour children’s self-esteem and improve perceived socio-relational competences. Method : To test the effectiveness of this intervention, a non randomized, controlled, prospective study was set up. All 291 eligible students, aged between 8-10 years, were enrolled. To assess self-esteem and perceived supportive relationship, a well-known and descriptive scales were utilised (MSCS, SPPC, AIR). Results : No difference was found between the experimental and control groups with respect to the children’s self-esteem and perceived socio-relational competences following the intervention, except in the quality of their relationships with their teachers, which improved in the experimental group and declined in the control group. Discussion : The educational programme used in our study did not seem to be able to enhance self-esteem in the intervention group, but the methodological instruments used to monitor the change in self-esteem domonstrated a different rate of change in the more disadvantaged sub-groups of the observed population.