Doeke Post

Socio-economic differences in health risk behavior in adolescence : Do they exist?

Socio-economic differences in risk behaviors in adolescence can be seen as a prelude to the re-emergence of socio economic health differences in adulthood. We studied whether or not socio-economic differences in health risk behaviors are present in male and female adolescents in The Netherlands. The relation between socio-economic status (SES) and health risk behaviors was examined, by testing both the main and interaction effects of SES and gender on separate health risk behaviors on one hand, and on the behaviors cumulatively on the other. The data were derived from 1984 adolescents in the four northern provinces of The Netherlands. SES was measured by means of the educational level and the occupational status of both parents. Four health risk behaviors were included in this study: smoking, alcohol consumption, soft drug use, and (no) physical exercise. We found that the relationships between SES and health risk behaviors are not as linear as is often found in adulthood. Our findings can be characterised overall by an absence of relationship between SES and health risk behaviors. The only exception applies to sport, which is linearly related to SES. Adolescents in the lower SES groups engage in sport less than adolescents in the higher SES groups. There was an irregular relationship between the fathers occupational status and the adolescents smoking and drinking. Adolescents in the highest, lowest and middle of the six SES groups have the highest rates of health risk behaviors. All observed relationships are similar for both male and female adolescents. A relationship between gender and the separate health risk behaviors was found only for alcohol consumption and drug use. For both male adolescents showed higher rates of risk behavior. Males also scored higher on the cumulative health risk behaviors than their female counterparts. The findings of this study do not support the hypothesis of latent differences in adolescence.

Influence of Socio-Economic Status, Parents and Peers on Smoking Behaviour of Adolescents

With the aim of analysing the importance of psycho-social factors in predicting adolescents’ smoking behaviour, a model of the interrelations between socio-economic status, parents’, peers’ and adolescents’ own smoking behaviours was tested. The sample consisted of 2,616 adolescents. LISREL analyses were used to support the model; males and females were evaluated separately. Peers’ smoking is the strongest predictor of adolescent smoking. Parents’ smoking behaviour influences adolescents’ smoking directly, but also indirectly through the parents’ influence on peers’ smoking behaviour. Socio-economic status influences adolescent smoking indirectly through its influence on parents’ and peers’ smoking behaviour. Our model is significant in both males and females and explains 42–51% of the variance in adolescent smoking behaviour. Accentuation of peers’ influence on adolescents’ smoking behaviour without considering the interrelations between the influence of socio-economic status, parents and peers may lead us to incorrect conclusions in research as well as in prevention.

The effectiveness of an educational programme for nursing students on developing competence in the provision of spiritual care

AIMnTo determine the effects of a course for nursing students on developing competence in spiritual care and the factors that might influence the effects.nnnBACKGROUNDnStudies suggest that role preparation in nursing for spiritual care is poor. For the assessment of competence, few or no explicit competency framework or assessment tools seemed to be used.nnnDESIGNnQuasi-experimental crossover design (pre-post-test).nnnMETHODnThe subjects were students from Christian nursing schools in the Netherlands (n = 97). The intervention consisted of a course in spiritual care. Competencies were measured with an assessment tool, the Spiritual Care Competence Scale. Data were analysed by t-test procedures (paired-samples t-test). At T(1) vignettes were added to assess the quality of the students own analyses. These data were analysed by a Mann-Whitney test. Regression analyses were performed on the influence of student characteristics on the subscales of the assessment tool.nnnRESULTSnNinety-seven students participated in this study. Analysis showed statistically significant changes in scores on three subscales of the Spiritual Care Competence Scale between groups (T(1)) and over time for the whole cohort of students on all subscales (T(2)). Clinical placement showed as a negative predictor for three subscales of the Spiritual Care Competence Scale. Experience in spiritual care and a holistic vision of nursing both showed as positive predictors on certain competencies. A statistically significant difference was observed between groups in the student analysis of a vignette with explicit spiritual content.nnnCONCLUSIONSnThe outcomes raise questions about the content of education in spiritual care, the measurement of competencies and the factors that influence competency development.nnnRELEVANCE TO CLINICAL PRACTICEnThe results provide nurse educators with insight into the effects of education in spiritual care on students competencies and help them consider a systematic place for spiritual care within the nursing curriculum.

The validity and reliability of an instrument to assess nursing competencies in spiritual care

AIMnThis study contributes to the development of a valid and reliable instrument, the spiritual care competence scale, as an instrument to assess nurses competencies in providing spiritual care.nnnBACKGROUNDnMeasuring these competencies and their development is important and the construction of a reliable and valid instrument is recommended in the literature.nnnDESIGNnSurvey.nnnMETHODnThe participants were students from Bachelor-level nursing schools in the Netherlands (n = 197) participating in a cross-sectional study. The items in the instrument were hypothesised from a competency profile regarding spiritual care. Construct validity was evaluated by factor analysis and internal consistency was estimated with Cronbachs alpha and the average inter-item correlation. In addition, the test-retest reliability of the instrument was determined at a two-week interval between baseline and follow-up (n = 109).nnnRESULTSnThe spiritual care competence scale comprises six spiritual-care-related nursing competencies. These domains were labelled: 1 assessment and implementation of spiritual care (Cronbachs alpha 0.82) 2 professionalisation and improving the quality of spiritual care (Cronbachs alpha 0.82) 3 personal support and patient counseling (Cronbachs alpha 0.81) 4 referral to professionals (Cronbachs alpha 0.79) 5 attitude towards the patients spirituality (Cronbachs alpha 0.56) 6 communication (Cronbachs alpha 0.71). These subscales showed good homogeneity with average inter-item correlations >0.25 and a good test-retest reliability.nnnCONCLUSIONnThis study conducted in a nursing-student population demonstrated valid and reliable scales for measuring spiritual care competencies. The psychometric quality of the instrument proved satisfactory. This study does have some methodological limitations that should be taken into account in any further development of the spiritual care competence scale.nnnRELEVANCE TO CLINICAL PRACTICEnThe spiritual care competence scale can be used to assess the areas in which nurses need to receive training in spiritual care and can be used to assess whether nurses have developed competencies in providing spiritual care.

Socio-economic differences in health risk behaviour and attitudes towards health risk behaviour among Slovak adolescents

SummaryObjectivesSocio-economic differences in the frequency of smoking, alcohol consumption, drug use, physical exercise, and attitudes toward smoking were explored in an sample of Slovak adolescents (1 370 boys, 1 246 girls, mean age 15 years).MethodsIdentification of socio-economic status was based on three indicators: the highest educational level of parents, the highest occupational class of parents, and the type of school the adolescents attended.ResultsHealth risk behaviour was strongly related to socioeconomic status based on all three socio-economic indicators, although there were some exceptions mostly related to education as indicator of socio-economic status and to alcohol consumption experience and drug use experience. The pattern of socio-economic differences was unfavourable for lower socio-economic groups of adolescents, except for differences in frequency of alcohol consumption among females when highest education of parents was used as an indicator of socio-economic status.ConclusionsThere are socio-economic differences in health risk behaviour. Lower socio-economic groups of adolescents behave riskily more frequently than higher socio-economic groups of adolescents.ZusammenfassungZieleSozioökonomische Unterschiede bei den Häufigkeiten von Rauchen, Alkohol- und Drogengebrauch, körperlicher Aktivität und der Einstellung zum Rauchen wurden in einer Stichprobe slowakischer Jugendlichen untersucht (1 370 Knaben, 1 246 Mädchen, Alter im Mittel: 15 Jahre).MethodenDer sozialökonomische Status wurde mit drei Indikatoren gemessen: der höchste Ausbildungsgrad der Eltern, die höchste berufliche Stellung der Eltern und der von den Jugendlichen besuchte Schultyp.ResultateGesundheitsbezogenes Verhalten korrelierte stark mit drei Indikatoren des sozialökonomischen Status, obwohl es auch einige Ausnahmen gab in Bezug auf Ausbildungsgrad und Erfahrungen mit Alkohol und Drogen. Das Muster der sozioökonomischen Unterschiede war ungünstig für die unteren sozioökonomischen Schichten, ausser Unterschiede in Häufigkeit von Alkoholkonsum der Frauen, wenn der höchste Ausbildungsgrad der Eltern als Indikator für den sozialökonomischen Status im Modell aufgenommen war.SchlussfolgerungenEs gibt sozioökonomische Unterschiede beim gesundheitsbezogenen Risikoverhalten. Jugendliche aus den unteren sozioökonomischen Schichten verhalten sich risikoreicher.ResuméObjectifOn a examiné les différences socioéconomiques de la fréquence de fumer, de la consommation dalcool, de lusage de drogues, de lexercice physique et dattitudes par rapport au tabagisme dans un échantillon dadolescents Slovaques (1 370 garçons, 1 246 filles, âge moyen: 15 ans).MéthodesLa position socioéconomique est basée sur trois indicateurs: le plus haut niveau déducation des parents, la plus haute classe professionnelle des parents et le genre décole que les adolescents suivent.RésultatsLe comportement à risque pour la santé est fort associé à la position socioéconomique, basé sur les trois indicateurs socioéconomiques, bien quil y ait quelques exceptions, le plus souvent liées à léducation comme indicateur de la position socioéconomique et à lexpérience de la consommation dalcool et lexpérience de lusage de drogues. Les caractéristiques des différences socioéconomique étaient défavorables pour les adolescents qui appartiennent aux groupes socioéconomiques inférieures, excepté les différences de la fréquence de la consommation dalcool entre filles lorsque léducation des parents était utilisée comme indicateur de la position socioéconomique.ConclusionIl y a des différences socioéconomiques de comportement de risque pour la santé. Les adolescents qui appartiennent aux groupes socioéconomiques bas ont des comportements plus à risque que les autres.

Socio-economic differences in health among Slovak adolescents.

SummaryObjectives: To explore socio-economic health differences among Slovak adolescents.n Methods: Socio-economic differences in health (psychological health: GHQ-12, vitality and mental health scale of RAND, experienced health complaints, chronic illness, use of medicines, self-reported health, self-perceived vulnerability to illness) were explored among Slovak adolescents (n=2 616, 1370 boys, 1246 girls; mean age 15 years).n Results: Adolescents from lower socio-economic groups (parents’ occupation, parents’ education, type of school) experienced more health complaints; less frequently experienced their health as excellent or very good, more frequently reported to fall ill easier and less frequently use non-prescribed drugs in comparison with adolescents from higher socio-economic groups. Moreover, adolescents from lower occupational group of parents and lower type of school score significantly lower in mental health and in vitality and used prescribed drugs more frequently. We did not confirm any socio-economic differences in psychological health or prevalence of chronic illness. Our findings confirmed poorer health of girls in comparison to boys. There are no gender differences with regard to socio-economic differences in health.n Conclusion: There are significant socio-economic health differences among Slovak adolescents.

The clinical spectrum of humidifier disease in synthetic fiber plants

In a synthetic fiber production site with recirculating cold water humidification systems and small-size-particle (> 0.1 mu < 1 mu) oil mist exposure, humidifier disease was diagnosed in several workers. The patients could be divided into three groups illustrating the clinical spectrum of humidifier disease: humidifier fever (toxic inhalation fever) (12 patients): an asthma-like syndrome (8 patients); and allergic alveolitis (4 patients). Natural challenge at the work place, monitored by parameters such as peak-flow, spirometry, blood leucocyte count, and body temperature, provided important diagnostic information. In patients with chronic allergic alveolitis, a gradual recovery during an exposure-free period indicated a work-related causation, more than changes during challenge in normal work. In some patients, the fungus Sporothrix schenckii, hitherto unknown as a sensitizer, may have been at least one of the causative antigens. Measured levels of viable fungi (< or = 100 CFU/m3) and endotoxin (64 pg/m3) in air samples were much lower than those at which health effects usually are reported. Small-size-particle oil mist exposure may have underestimated the exposure to microorganisms, but otherwise an adjuvant role to this type of co-exposure might also be postulated. In contrast to allergic alveolitis, the asthma-like syndrome appeared to be more common in patients with a history of atopy and of smoking.

Learning effects of thematic peer-review: a qualitative analysis of reflective journals on spiritual care.

This study describes the learning effects of thematic peer-review discussion groups (Hendriksen, 2000. Begeleid intervisie model, Collegiale advisering en probleemoplossing, Nelissen, Baarn.) on developing nursing students competence in providing spiritual care. It also discusses the factors that might influence the learning process. The method of peer-review is a form of reflective learning based on the theory of experiential learning (Kolb, 1984. Experiential learning, Experience as the source of learning development. Englewoods Cliffs, New Jersey, Prentice Hill). It was part of an educational programme on spiritual care in nursing for third-year undergraduate nursing students from two nursing schools in the Netherlands. Reflective journals (n=203) kept by students throughout the peer-review process were analysed qualitatively The analysis shows that students reflect on spirituality in the context of personal experiences in nursing practice. In addition, they discuss the nursing process and organizational aspects of spiritual care. The results show that the first two phases in the experiential learning cycle appear prominently; these are inclusion of actual experience and reflecting on this experience. The phases of abstraction of experience and experimenting with new behaviour are less evident. We will discuss possible explanations for these findings according to factors related to education, the students and the tutors and make recommendations for follow-up research.