Françoise Narring

Protective correlates of stages in adolescent substance use: a Swiss National Study

OBJECTIVE To identify factors potentially protective against involvement with additional illicit drugs among adolescent users of marijuana. DESIGN AND METHODS A cross-sectional, secondary analysis of a national data set of Swiss adolescents was performed. The original survey was conducted in 1992-1993 (N= 9268). Stages of substance use were conceptualized as lifetime use of marijuana of three or more times and as use of marijuana and other illicit drugs (opiates, inhalants, cocaine, hallucinogens, or stimulants) more than twice in the past month. Behavioral characteristics associated with level of drug use were examined. Based on the resilience literature, factors potentially protective against progression of drug use were examined in their bivariate relationships and analyzed in a multiple regression model. RESULTS Almost one quarter of the surveyed adolescents were classified as past or current marijuana users. One in 20 of these adolescents also used other illicit drugs. Prevalence of risk-related behaviors (e.g., antisocial behavior, accidents, suicide attempts) was elevated for marijuana users compared to nonusers and even more elevated for users of marijuana with other illicit drugs. In a multivariate logistic regression model, communicating well with a parent was significantly associated with not having progressed to use of illicit drugs other than marijuana [for males, odds ratio (OR) = 0.72, confidence interval (CI) = 0.55, 0.92; for females, OR = 0.60, CI = 0.39, 0.93]. Other significant protective correlates for boys were academic achievement (OR = 0.66, CI = 0.47, 0.92), type of education: school versus apprenticeship (OR = 0.42, CI = 0.21, 0.87), confiding in a family member (OR = 0.49, CI = 0.28, 0.85), and regular participation in a sports club (OR = 0.39, CI = 0.22, 0.77). CONCLUSION Within this national sample of Swiss adolescents, a cross-sectional analysis identified the quality of relationships within the family and factors related to school associated with lack of progression of illicit substance use. However, longitudinal studies will be necessary to confirm these associations and to allow for designing interventions targeting the enhancement of protective factors among young people already at risk for serious substance use.

Emergency contraception among teenagers in Switzerland: a cross-sectional survey on the sexuality of 16- to 20-year-olds

PURPOSE To describe and analyze emergency contraception (EC) awareness and use among sexually active Swiss teenagers. METHODS Anonymous computerized questionnaires were distributed to a national representative sample of 4283 in-school adolescents (aged 16 to 20 years) in high schools and professional centers. Young people who were sexually active (51.5% of the sample: 1058 girls and 1073 boys) responded to questions on EC awareness and use and on sexual perception, attitude, and behaviors. Univariate analyses and multiple regression analyses were used to describe EC awareness and use and their correlates. RESULTS Most of the sexually active girls (89.3%) and boys (75.2%) knew of the existence of EC. Of girls, 20% reported having used EC, and the majority of them used it only once (64.1%) or twice (18.5%). EC awareness was positively associated with the fathers level of education (girls: odd ratio 5.18) and the scholastic curriculum of the respondent. Gender differences in the correlates of EC awareness demonstrate that girls who had a confidant or a group of friends or boys of Swiss nationality and those who have had the opportunity to discuss the issue of contraception declare greater awareness of EC. EC use was higher among girls who lived in urban areas (odds ratio 1.91) and occasionally had unprotected intercourse. We did not find any significant difference in the profile of multiple vs. one-time users. CONCLUSION EC awareness and use should be improved through better information and accessibility, especially among teenagers who place themselves in at-risk situations.

Food and nutrient intakes in a group of 11 to 16 year old Swiss teenagers

Better knowledge of the dietary intake of teenagers is necessary to help health professionals to provide better advice on an individual and data for prevention and health programme. We carried out a dietary survey by 3-day records technique in a group of adolescents living in the Canton of Vaud, Switzerland. Food habits were traditional but rich in refined products and poor in plant food. Mean daily energy intake, which was 8025 kJ for the girls and 9350 kJ for boys, was lower than the recommended dietary allowances, especially for girls. Independently of the gender, breakfast represented 19% of the total daily energy intake, lunch 31% and dinner 29%. Total energy provided by snacks was 23.0% for girls and 20.4% for boys. The percentage of energy supplied by the afternoon snack was 15.8% for the girls and 13.3% for the boys. The source of energy was 14% from protein, 37% from fat and 49% from carbohydrates. A high percentage of adolescents had low micronutrient intakes (vitamins A, E, B1, B6, C, folates and for minerals magnesium, calcium and iron). An increase intake of vegetables and fruit should thus be strongly encouraged; snacking could offer a target vector to improve dietary nutritional quality.

Identifying Adolescent Drug Users: Results of a National Survey on Adolescent Health in Switzerland

OBJECTIVE To explore the proportion and characteristics of adolescents who use illicit drugs and contrast them with adolescents who do not use such drugs in Switzerland. To facilitate the detection of adolescents with drug related difficulties. METHODS We used data from a national survey on adolescent health in Switzerland (N = 9,273) conducted in 1992 and 1993. The survey is based on self-administered questionnaires among a representative sample of adolescents enrolled in schools and apprenticeship programs. We used exploratory analysis for identifying characteristics which set the drug user apart from non-users and performed confirmatory multivariate logistic regression analysis to examine which variables remain independently associated with heroin or cocaine use. RESULTS In Switzerland, 3.1% of adolescents have taken heroin or cocaine at least once in their life, and 27.7% have already used cannabis. Analysis of lifestyles and health of adolescents show that young drug users present difficulties in integrating in society, have health problems and difficulties in relationships, situations which tend to be less common among other adolescents. Yet, they also display marked similarities, most notably in that over 70% had seen a physician in the past year. However, while 40% of the drug users expressed a need for help with drug related problems, only 6% had actually talked about them with a physician. Characteristics that remained independently associated with heroin and cocaine use after controlling for confounding factors were age, sex, nationality, type of education, feelings of suicide, past and present smoking, and use of cannabis. CONCLUSION The level of illicit drug use among Swiss adolescents is high compared to other European countries but lower than the United States. Drug-using adolescents display a constellation of characteristics which should make it possible to identify them and offer help. Yet, even though they may have frequent contact with the health services, their drug problems are generally not recognized by the gatekeepers of the health services and no specific aid is available to them. Drug prevention must be intensified and medical doctors sensitized to the drug problems which adolescents may face.

Brief intervention addressing excessive cannabis use in young people consulting their GP: a pilot study

BACKGROUND When excessive cannabis consumption occurs in adolescence, the adverse consequences extend into adulthood. Interventions by GPs are effective in preventing harm associated with alcohol use. Similar interventions have potential in addressing cannabis use. AIM To develop and pilot test a brief intervention targeting excessive cannabis use (defined as > or = 1x/week) in young people in primary care. DESIGN OF THE STUDY Pilot intervention trial. SETTING Seven family practices in Switzerland. METHOD The team collaborated with GPs and young people to develop the intervention. Seven GPs piloted its use in their consultations. Patients aged 15 to 24 years consulting for any health problem were recruited before the consultation. Cannabis use, other substance use, and their psychosocial correlates were assessed with a short confidential questionnaire administered before the consultation and 1 month later. GPs, staff, and patients were asked to comment on the study and its feasibility. RESULTS Of 81 young people invited to participate, 78 (70% female) agreed (participation rate: 96%). One in seven (13.2%, 95% confidence interval = 7.5% to 18.9%) used cannabis at least once a week. Data at 1 month were available for 42% who had provided email contact details and 91% of those who had provided their mobile phone number (63% overall). In most cases, the intervention lasted no more than 5 minutes. Comments from participants added favourable data towards the feasibility of the study. CONCLUSION This pilot study provides a solid base on which to build a randomised trial of a brief intervention addressing cannabis use in young people consulting in family practice.

YFHS-WHO+ Questionnaire: validation of a measure of youth-friendly primary care services.

PURPOSE To develop and validate a research tool to measure the youth friendliness of primary care services from a clients perspective. METHODS The questionnaire was initially developed in English, but as it was to be used in Bosnia and Herzegovina (BiH), it was validated in the language of this country. Items were adapted from two sources: a reproductive health services quality improvement questionnaire from the World Health Organization, and an Australian survey used to assess youth-friendly primary care services. An English-speaking international panel reviewed the list of items for face validity. After translation-back translation, the questionnaire was pretested with adolescent patients from a family practice in BiH. The stability and construct validation were then conducted with 60 young people from six different health services in BiH. Items for the final questionnaire were selected using item response theory. RESULTS The validation and item response analysis led to a 49-item tool. Test-retest stability at 1 week was excellent (mean κ: .93). Construct validation was supported by the fact that services with the highest and the lowest scores on the questionnaire were also those that had many and few, respectively, youth-friendly characteristics, as assessed by experts, on a predefined evaluation grid. Services seeing a higher proportion of adolescents also had higher scores on the questionnaire. CONCLUSIONS This study supports the validity of the YFHS-WHO+ questionnaire for assessing the level of youth friendliness of family medicine services for research purposes. Further validations in English and French will allow wider use of this tool in the future.

Trends in violent deaths among young people 10-24 years old, in Switzerland, 1969-1997

AbstractPurpose: To assess violent death rates and trends between 1969 and 1997 among young people aged 10–24 years old in Switzerland. Methods: Total causes of death, all external causes of injuries, traffic injuries, suicides and overdoses were retrieved from the databank of the Swiss Federal Statistical Office (SFSO), using the eighth and tenth revisions of the International Classification of Diseases (ICD). Mortality rates per 100,000 individuals were computed by gender and by age (10–14, 15–19, 20–24) using census records as denominators. Results: In 1995–1997, violent deaths represented the primary cause of fatalities among young people. Rates of violent death were much higher among males than among females, with a ratio of 3.5:1 in 1995–1997 and also became increasingly elevated from the age range of 10–14 to 20–24 years (1.9:1–4.4:1). In 1995–1997, violent deaths accounted for 66%(n = 1221) of all fatalities among young people. Among violent deaths, 36% were due to traffic injuries, 13% to other types of injuries, 32% to suicide, 15% to overdoses, 3% to homicides and 1% to undetermined intent. Between 1969 and 1997, rates of traffic injuries decreased in both genders and in the three age groups considered, while rates of suicide remained stable and rates of overdoses stabilised during the nineties after a sharp increase during the eighties. Conclusion: Although violent deaths in Switzerland have become significantly less frequent over the last 30 years, they still represent the single greatest cause of fatalities among young people and, as such, constitute a major public health challenge.

Opportunities for prevention in primary care in a country with universal insurance coverage

Data from studies in the United States suggest that young people engaging in health-compromising behaviors have lower access to health care. Using data from a Swiss national survey we tested the hypothesis that in a country with universal insurance coverage, adolescents engaging in health-compromising behaviors access primary care to the same extent as those who do not engage in these behaviors.

Substance use and suicidal conduct: A study of adolescents hospitalized for suicide attempt and ideation

AIM To study the prevalence of psychoactive substance use disorder (PSUD) among suicidal adolescents, psychoactive substance intoxication at the moment of the attempt, and the association between PSUD at baseline and either occurrence of suicide or repetition of suicide attempt(s). METHODS 186 adolescents aged 16 to 21 y hospitalized for suicide attempt or overwhelming suicidal ideation were included (T0); 148 of them were traced again for evaluations after 6 mo (T1) and/or 18 mo (T2). DSM-IV diagnoses were assessed each time using the Mini International Neuropsychiatric Interview. RESULTS At T0, 39.2% of the subjects were found to have a PSUD. Among them, a significantly higher proportion was intoxicated at the time of the attempt than those without PSUD (44.3% vs 25.4%). Among the 148 adolescents who could be traced at either T1 or T2, two died from suicide and 30 repeated suicide attempts once or more times. A marginally significant association was found between death by suicide/repetition of suicide attempt and alcohol abuse/dependence at baseline (OR=3.3, 95% CI 0.7-15.0; OR=2.6, 95% CI 0.7-9.3). More than one suicide attempt before admission to hospital at T0 (OR=3.2, 95% CI 1.1-10.0) and age over 19 y at T0 (OR=3.2, 95% CI 1.1-9.2) were independently associated with the likelihood of death by suicide or repetition of suicide attempt. CONCLUSION Among adolescents hospitalized for suicide attempt or overwhelming suicidal ideation, the risk of death or repetition of attempt is high and is associated with previous suicide attempts--especially among older adolescents--and also marginally associated with PSUD; these adolescents should be carefully evaluated for such risks and followed up once discharged from the hospital.

Text-messaging to reduce missed appointment in a youth clinic: a randomised controlled trial

Background To assess the effectiveness of text-messages in reducing the proportion of non-attendance in a youth clinic of a University Hospital. Methods Patients who registered for an appointment and provided a mobile phone number were randomly selected to receive or not a text-message reminder before the planned appointment. A 10% reduction in the proportion of missed appointments was considered clinically and economically useful and the study was powered accordingly. Results The proportion of missed appointments was 16.4% (95% CI 13.1% to 19.8%) in the text-message group (N 462) and 20.0% (95% CI 16.6% to 23.4%) in the control group (N 529), showing no significant effect of the intervention (p=0.346). Conclusions In our primary care youth clinic, text-message reminders are not effective in reducing the proportion of missed appointments. This may in part be due to the fact that most patients are referred by a professional or by their parents and do not initiate appointments themselves.